If you’re a new intern you are hopefully a little afraid of the new found responsibility in your life. I say “hopefully” because there is nothing more frightening in healthcare than someone who is “unconsciously incompetent.” That is, someone that doesn’t even realizethey have no idea what they are doing.

Before starting medical school I was an emergency nurse. As an RN, I had the opportunity to see many medical students, interns, and residents flit in and out of the department, and I noted some of the the strategies that differed between the ones that shone and the ones that sank. To give some insight into how to be in the former category I’ll pass on some pointers from my former vantage point, to those of you who’ve recently landed feet-first in the hospital.

You are book rich, experience poor.You may know all the cytokines involved in septic shock, but the RN knows what it looks like from 30 ft. Guess which of the two abilities is going to save your patient’s life? You’ll get there too, but in the mean time, pay attention to the patients that the RN’s are concerned about. Which brings me to my next point.

Spidey sense. Cannot be learned, it is developed through experience. Many nurses have been in health care since you were wearing short pants and they’ve got pattern recognition down to a science (or some might say, a freakishly intuitive level). Good nurses know the “sick look,” so when they’re feeling that something ain’t right with a patient … it probably isn’t.

Do yourself a favor and check the patient out. Also, this is a good way to show your nurse colleagues that you respect their opinions.  You hate them because they paged you at 3 am when Ms. Smith wasn’t looking right, but now they’ll love you because you took their concern seriously. And let me tell you newbies: nurse love is the best love when you’re the new kid on the team. Now you won’t get another phone call at 0345h to find out if you wanted to order that “diet as tolerated” by mouth. Not that that has ever happened …

Nurse speak. Nurses learn very quickly how to speak in code to,

• avoid confrontation
• make you think something was your idea
• point out a mistake without being unprofessional
• make a suggestion without appearing to offer advice

Here are some translations for Nurse Speak.

“Are you sure you want to [fill in procedure, medication, etc.] Mrs. Jones?” means “If you do that you’ll probably kill the patient”.

“Did you say you wanted a chest x-ray on Mrs. Jones?” means “Yo! You forgot to order a chest x-ray, I am going to go ahead and order one now to save you time and not make you look like an idiot when you page medicine and then have to tell them you haven’t done a chest x-ray yet.”

“Oh, I haven’t seen it done that way before, I always thought you had to …” means “Dude you are seriously doing that wrong, please let me show you a better / safer / faster way of doing that”.

And finally, “Did you want me to go ahead and dip that urine for pregnancy?” means, “It appears you’ve left out a major differential, I’m going to make sure it has crossed your mind.”

“Albinoblackbear” is a nurse turned medical student who blogs at Asystole is the Most Stable Rhythm.

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