Saturday, October 16, 2010

Why I love working in a teaching hospital

My hospital on the fourth of July; every holiday they bring out these flags and it never ceases to take my breath away.
When I was a student working in the ICU, I remember something that was so exciting about learning in this environment was the fact that we were in a teaching hospital. Most of my clinical experiences… actually probably half of my nursing education was done in the private sector which is completely different from a teaching hospital. In a private hospital you don't deal with residents, fellows and interns… most of the time you deal directly with attending physicians and for nursing, this usually means a lot more of directly following orders and a lot less collaboration and less of a team approach to patient care (at least that was my experience)… so when I came to the VA and started in the ICU it was such an exciting and encouraging place for me because I instantly saw the value of multidisciplinary care and nursing input during rounds was welcomed and even expected!

Now, of course with all good things, there comes a downside. I also quickly discovered that working in a teaching hospital meant that we would be forever working with people who are learning. The direct impact on nursing is that we have to be incredibly diligent about checking and double-checking orders or things that seem strange. One of the best lessons I have learned is to not assume or take anything for granted. If you don't feel right about something… stop and listen... even if it's in the middle of a code because that single minute you stop to double check, could be the one thing that prevents someone from making a huge mistake… but I digress.

This past summer has been a tough one in our ICU because I think a lot of the nurses on our unit are seeing the impact of the teaching aspect of our job. It's strange because there are many, many times when we will be working with physicians who quite literally have no clinical experience or have never worked in an ICU at all. A lot of times this means that the ICU nurses will often have years of critical care experience with knowledge to draw from that the ICU residents/interns just simply don't have. This is one of the downfalls of working night shift also… you have an intern and a resident on call overnight… if you don't agree with their orders or a judgment call they've made… well that means you are paging your fellow and sometimes even your attending at 4:00am, at home. I unfortunately have had to do this multiple times in the past few weeks and it hasn't been fun… at all.

For months…since the new batch of docs started in July, it's been a whirlwind of long nights with unsure interns and lackadaisical residents who are so scared to do anything that I end up having to go up the chain of command to get anything done… and let me just say that for an inexperienced nurse, it's really hard to learn to trust your instincts with this stuff. When I page the fellow I'm basically saying… " Hi, ICU fellow… I know it's 4am and you're trying to sleep but your intern or resident said to do fill-in-the-blank … or they aren't doing anything about fill-in-the-blank… and I think they are wrong, so I've decided to go above them and get a better answer (hopefully) from you." Yikes… scary.

Well… all that to say that finally... finally… there is justice! This week we got a new cardiothoracic surgery fellow. I love cardiac surgery patients, so when we have a crappy CT fellow it can make or break my day. Luckily, this time our CT fellow is completely awesome. Incredibly competent, very personable and works so, so well with all the services and nursing staff. Seriously, this week was one of the best I have had in a long… long… time because I had one of his post-op surgery patients the entire week and working with him was such a joy. It reminded me of why I love working in a teaching hospital so much. It brought me back to that original excitement I had when I first started in the ICU and when I first started working with cardiac surgery patients in particular.

A moment I will remember for a long time coming… it was the second day I was working with the patient that had a 3 vessel CABG with a post-op course that ended up having some major complications. This guy bought himself 3 IV poles worth of drips, continuous cerebral perfusion monitoring and a bunch of other complicated things that I won't go into here. To put it bluntly… this guy was sick.

There were a few things that our ICU team had asked me to do that didn't make sense to me and so I started to discuss it with the CT fellow. We started talking about the plan of care and quickly discovered we were on the same page about everything and all of the stuff I was hoping to do (and not do) he was completely on board with. It was a totally collaborative, peer level dialogue that I haven't had with any of our docs in a while.

"Awesome!" I said, "No fighting to get what I need for my patient. Today is gonna be a good day."

What he said next was one of the best compliments I've ever gotten…

"Andi, seems like you've been doing this for a long time."

"Nope, I've actually only been a nurse for a little over a year… I just love cardiac patients. I think it makes a difference when you love what you do." I said with a smile.

Then he says… "You graduated and went straight into the ICU?! That's crazy! Well, it's gonna be a great couple of months for me if you're gonna be here. If you need anything else just call me directly."

Sweet… my day just got even better. No arguing, no fighting, and I had just been complimented by one of the most competent CT fellows I have ever worked with. This is exactly why I love working in a teaching hospital… the collaboration, growth and encouragement that can happen here… well, my job could not have gotten any better at that moment. :)


  1. More proof that you are a rockstar. Way to go lady (and also, way to stand up for yourself and your patients when you don't agree. That's hard.)

  2. This doctor is definitely an Andi fan! I agree-it seems like you've been at this way longer than you have. You're an "old soul" or better yet, as we said during our internship, an "ass-saver!"

    Humble doctors + collaborative nurses = exceptional care :)