Saturday, August 16, 2008

Getting things done...not always easy

It's been an interesting couple of weeks. Although I'm actually working the same number of hours this month as I did on trauma, I feel much more relaxed. We have been averaging 3 or 4 patients at any given time, so I have just been rounding on 1 or 2 in the morning, then going home around 3 or 4 unless I'm on call. So far nothing terrible has happened on call.

My attending for the first two weeks is very hyperactive and gets bored very easily. He also has a very direct attitude. I actually really like him, he teaches and makes rounds incredibly entertaining. The anesthesia residents, used to lower-key attendings didn't like him at first but are now coming around. The nurses want to kill him, which has made things somewhat awkward. ICU nurses, at least the ones here, are generally very good. They only take care of one or two patients at a time, so they know their patients well. They are used to taking care of very sick patients, so there isn't much that can phase them. The problem is that their comfort levels are often so high that they think they know how to take care of the patient better than anyone else, and they do all they can to get their way. Whenever one of us (residents) gives an order they disagree with, we have to come by every twenty minutes to make sure that it actually gets done, and that they don't "forget" or get "too busy" to do it. There have been several times I've asked them to do something one way, and a couple hours later I'll come back to find that they've done it the way they jolly well pleased. This makes me very irritated--I really respect ICU nurses, and they often know how things work in the ICU better than I do--if they suggest a plan different than mine, more than likely I'll defer. But doing the opposite of what I say without telling me is unacceptable (and technically illegal). There have been a couple occasions when they didn't like what one of the senior residents said, so the paged the fellow over her head, and lied about not having been able to get a hold of the resident. They are usually better when attendings give orders--the problem is, as previously mentioned, they hate my attending with a passion because he actually insists that things be done the way he orders. So their solution is to call the surgeons with questions rather than the ICU team. This leads to the surgeons' ordering things without our knowledge, which leads to bad patient care from a too many cooks in the kitchen standpoint. It has altogether been very frustrating, and puts me far too often in the position of choosing between being undermined by someone who legally and ethically must follow my order, or making an issue of it and becoming hated by the entire ward and subject to all their passive-aggressive maneuvers. So far I've let things slide. I'm not sure how much longer I'll be able to take it. Many of the older nurses don't bother with the passive-aggressive behavior, they just flat out tell us they won't do something (this is actually why they hate my attending--they've told him that a couple times and he's made them do it). I'm just getting so tired of the squinty-eyed-that's-stupid-I'm-not-going-to-say-anything-but-as-soon-as-he-leaves-I'm-doing-it-my-way facial expressions. I think I find it particularly frustrating because I have always made such an effort to treat nurses like colleagues (and despite how this post sounds, I am actually on very good terms with the nurses in the ICU--which in some ways makes it harder).


Anonymous Anonymous said...

Time for an update!

8:25 AM  

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