5 Tips to My Future Doctor Self, From My Former Nurse Self
Written by Annabelle Chan
My past life as a nurse has taught me many things about what kind of doctor I want to be. And most importantly, what kind of relationship I want to build with my nursing colleagues. Nurses are undoubtedly the backbone of our healthcare system, and the people who you need to have on your side if you want to survive that first 12-hour night shift.
So here are my top 5 tips to future doctors, from my former nurse self.
Nothing screams awkward quite like asking the head of vascular surgery of 30 years who they are, and why they are touching my patient's toe.
Who could be such a fool you might ask?
You guessed it.
I was 23 and the registered nurse in charge of a busy orthopaedic unit one Sunday morning. I turned the corner into my patient's room to find what I assumed to be a surgical registrar— judging by her blue scrubs and sleep deprived eye sockets— alongside a man in a white T-shirt and jeans who was manoeuvring the (almost) severed off big toe of my patient.
"Oh excuse me sir, please don't touch that. My name's Annabelle, I am the nurse in charge this morning and I was told we were meant to leave the dressing on until tomorrow."
He stares at me with a “don’t you know who I am?” look.
"Please remove the remainder of the dressing, apply a thick coat of betadine, gauze and wrap it up for me to review again tomorrow," he commands.
I stare at the unidentified man, who even for a Sunday morning, looks very out of place in his casual attire.
"Sorry, but who are you?"
"Who am I?" He chuffed, making 'are you kidding me' eye contact with the registrar across the room.
"I am the head of vascular surgery and have been so for over 30 years in this hospital."
*cue awkward silence
I pause and take a breath. Not because I’m nervous, but to contain my fury.
Why should I know who he is? Does he know who I am? I’m the one who spends 16-hour double shifts taking care of the patient he sees for 30 seconds.
"Maybe we should start again. My name’s Annabelle and I am the nurse in charge this morning. And what were your names and why were you seeing this patient again?"
*cue awkward silence...
This wasn't an unusual encounter for me. An unidentified doctor standing before me with a list of demands, expecting me to read their minds and know their name, specialty and favourite antibiotic.
It might have been a common encounter, but the arrogance never got old. I hope never to be a doctor that is so arrogant they fail to even introduce themselves.
1. Introduce Yourself
Are you even surprised this is my #1?
I am only 12 weeks into medical school and have already nailed my introductory line.
"Hi, my name is Annabelle Chan, I'm a medical student from..."
Well you know how it goes.
I also know your introductory line probably haunts you to this very day and you're having OSCE flash backs even as you read this. But harness that energy for me, remember that line and start saying it not just to your patients, but to your colleagues. Every. Single. Time.
No one is exempt from the basics of a simple introduction. Not even the head of vascular surgery.
2. If We're Worried, You're Worried.
If a nurse comes to you concerned about a patient, not once, not twice, but three times, well, I would be surprised if the patient is still alive and you really should have listened the first time.
Nurses don't rotate every 10 weeks like you, we spend months, years and even decades in one speciality. We know the ins and outs of our patients and their care, and we know when something is wrong.
I'll never forget the time I was the nurse in charge and called 10 MET calls for a patient in one 8-hour shift. It was safe to say the ICU consultant knew me by name that day. Almost every single doctor dismissed me, every single time. Except for one junior doctor. She sat down next to me in the tea room and I began apologising for causing 'such a fuss'.
She turned to me and said, "If you're worried, I'm worried. I trust you."
Our dinner was interrupted only 2 minutes later by another code. The patient had a GCS of 6, intubated and sent to ICU where they remained for 27 days.
I did tell them I was worried.
3. Include Us in Your Treatment Plans
Doctors LOVE to run tests, take samples and really get to the root cause of a diagnosis. It's what you are trained to do, and it's what we love you for. But sometimes those plans aren't as achievable as you might have hoped.
Those 7 days of IVABs you want on the 97-year-old delirious patient who pulls out his IV every 5 minutes isn't going to work. The TDS sachets of movicol you all love charting for the BNO day-5 patient won't work either. Why? Because she won't even drink a glass of water, let alone one infused with laxatives. Could we use 20mls of lactulose instead?
Nurses know how to problem solve, and we love being involved in our patients' care planning too. So just ask us, and that way there’s a better chance of getting done.
4. Talk to Us
Nurses are flat out reading their own charts, let alone yours too.
So don't be surprised if those five urgent mini bags of K+ you needed 3 days ago still aren't given if you didn't take the time to tell us they existed.
Nurses are busy people and definitely too busy to double check the communication skills we expected you to graduate your MD with.
If you need something done - just talk to us! It's definitely the fastest way.
5. Acknowledge Our Hard Work
Chronic understaffing combined with chronic overworking. That's the truthful summary of my years as a registered nurse. Everyone in the hospital is busy, and doctors are no exception.
However, nurses constantly feel under appreciated by their peers. Maybe it's a hint of imposter syndrome, years of being labelled, 'just a nurse' or the sheer level of burnout we all experience thanks to 16-hour double shifts and back to back nights. Either way there's no denying that nurses need a pat on the back and recognition of their hard work every so often.
Who better to get it from than the people who feed you with the ever changing treatment plans, ECG's, MSU's and prescriptions that we will have to explain to our 85-year-old delirious patient for the third time this week.
Tell us you love us, tell us you appreciate it, and tell us you know we work hard.
Be known as the doctor who appreciates their nurses, because the nurses will appreciate you too. Be humble enough to say thank you when we save you from making those common mistakes all interns do.
There's a lot more I could say, and sometimes I think about writing myself an entire book of reminders of what it was like to be on the other side of health care for a while. But for now, those are the essentials and the ones I dare hope I won't forget. And neither should you too.
Oh and for those of you wondering about the surgeon, he didn't introduce next time he came around. I didn't really expect him to change his 30-year-old habit.
But the next time I saw his registrar, she did, and she has continued to do it every single time since.
So you see, the culture can be changed, it just takes one.
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