Match Week: A Letter to PGY1 Residents from an RN

First of all, happy residency match day, and congratulations to all the doctors joining us this year in healthcare!! It truly is the adventure of a lifetime, and as a nurse who will work alongside you, I want to offer you the following words.

I am a nurse at a teaching hospital. That means that each and every year, brand new, shiny yet so green, eager and terrified resident doctors like you join us to dive headfirst into caring for real live patients and join the world of writing real life orders. It seems that a lot of nurses dread this time of year, and while I understand their perspectives in some ways, here are few thoughts that hopefully ease your mind a little bit. 

1. You're learning and we get that. I want to be a nurse who creates a culture of giving you the grace to learn, to help you put in the correct orders in the correct format, and to give you a chance to fix the problem before escalating to your attending. Some nurses will get instantly frustrated and go directly to your attending, which may make you feel undermined, and that's okay. Respond with kindness and inquire on how the situation could be improved. We were all new once, and let's give each other the grace to learn in a way that never compromises patient safety. When your nurse calls to let you know that you entered an order incorrectly, or something isn't timed right, or an unsafe dose is ordered - take that call with grace, understanding, and gratitude. Fix the order, and be thankful that the nurse - who is the last safety check before harm happens to the patient - has your back. 

2. You have a lot of knowledge, but we have a lot of experience. You're coming out of medical school with a brain full to the brim with pharmacology and pathophysiology and you're extremely well studied. But we have experience dealing with families, clustering procedures and care, and doing things in a way most conducive and least invasive to the patient's well being. So when we call you to ask if we can add on that lab you just ordered to blood we drew an hour ago, don't give us attitude about it. Understand that we have time management skills, patient advocacy skills, and general efficiency skills that can greatly add to your toolbox if you'll work with us. And, of course, if you really need that lab drawn an hour later, we will oblige.

3. You may feel more comfortable with the patient's condition than we do, but address our concerns. You're insanely busy seeing all your patients and pulling 24 hour shifts, and we get that it's exhausting. But don't forget that we are your eyes and ears and your gauge of how the patient is truly doing. He may have looked fine ten minutes ago when you rounded, but if I'm calling you to tell you that he suddenly looks sicker - don't discount that and add it as the 43rd thing on your to-do list. Come see the patient, who may have already improved by the time you arrive anyways. The nurse will probably know better than you do how the facility works and if this patient meets criteria for higher levels of care than the current unit offers. Support and trust your nurses' assessment, even if you don't necessarily think your exam agrees with theirs. We see that patient for 12 hours straight and notices small changes. If you build rapport with them, they can be, and will be, the biggest asset to your team. 

4. You will have questions that nurses know the answer to. Ask us. Whether it's a policy question, or a question on how something is done in this particular hospital system, your nurses will know. You rotate through several organizations and units, but we stay in one place most of the time and we know the flow and procedures and protocols followed on our floor. Sure, some nurses will be grumpy and not want to help you, but I want to be apart of the culture that helps you learn, grow, and become the best doctor that you can. And honestly, most nurses are more than willing to help if you'll just politely ask. The world needs more great doctors, and I will be a nurse who supports you in becoming that intuitive and well learned doctor. 

Everywhere we go, there are nurses, residents, and attending physicians alike who have a bad attitude about working with the other discipline. In a culture that relies so heavily on communication for patient safety, I truly believe that there is no space for such division. As a nurse who was a new nurse only a short time ago (like literally this year), I know how scary and overwhelming the healthcare industry can be. I vow to be a nurse who supports you, informs you, and learns alongside you as you journey into an extremely rewarding career.

Good luck, and welcome aboard.