PARAphrase Fall 2012

Resident Physicians May Come and Go
on the ICU, but Nurses Remain
PARAphrase/a different perspective on the ICU
Matthew Wenger, Nurse on the
Royal Alexandra Hospital ICU
In its recommendation for creating
positive and supportive learning
and work environments, the Future
of Medical Education in Canada –
Postgraduate Project highlighted
the need to “provide residents with
adequate opportunities to learn and
work in environments that foster
respect among professions and are
reflective of an interprofessional
and intraprofessional, collaborative
patient-centred approach to
care.” In the quest to do our part
to foster some interprofessional
understanding on a unit where collaboration is key – intensive care
– PARA sought out an intensive care nurse for his thoughts on what
goes on in his unit and where resident physicians fit on the ICU.
Mathew Wenger graduated from the Faculty of Nursing at the
University of Alberta two years ago. During his after-degree program
in nursing, his experience in the ICU at the University of Alberta
Hospital confirmed that intensive care was where he wanted to work.
Since September of 2011, he has been working in the intensive care
unit at the Royal Alexandra Hospital.
What is it you like about intensive care?
The Royal Alexandra General Systems ICU is an adult population
where care is focused on everything from neurology to respiratory.
I enjoy the workload that comes with the acuity of the patients. I
specifically enjoy working with people and explaining how things
function: what the monitor is doing; what the breathing machine
is doing. For families, that’s huge, because patients are quite often
intubated or mechanically ventilated – they are either in a coma; an
induced coma; they are drowsy or delirious – so it is beneficial for
the family to know what is going on and to encourage them to ask
many questions. I tell them if you have a question in the middle of
the night, write it down and bring it to us and, if I can’t answer it,
I’ll pose the question to the doctor. It creates an open atmosphere;
when the family walks into that room, the shock of all of the lines and
tubes, the fact that the loved one doesn’t look like the same person –
it helps if they can understand what’s going on and why we have the
ventilation tube in their mouth and multiple intravenous lines, and
they know they can come to us with questions.
How would you describe the role of resident physicians and nurses
on the ICU?
As the ICU nurse, our focus is more bedside patient care and
ensuring that the hourly care is seen to. We’re all striving towards
the common goal of getting the patient healthier or weaned off the
ventilator or weaned off medications. I think that, in the RN role at
the bedside, it’s more minute-on-minute care, but if anything changes
over the longer period, we let the resident know. Sometimes the
residents are right there with us at the same time doing their own
tasks like putting in a central line or an arterial line, or intubating
the patient or performing a bronchoscopy. Sometimes our duties can
be completely separate or sometimes they can be parallel, but the
common goal of patient care is always there.
In my experience, residents and nurses have to be on the same page
to ensure that what we all do is all about the patient in the bed.
I’ve experienced a good rapport between nurses and residents. A
good relationship is beneficial for all sides. Nurses understand that
residents have lots of patients and patient histories on their mind
and they are writing quite quickly and nurses can provide that quick
confirmation. For example, the other day I had a Tylenol order that
was irregular so I just clarified with the resident and he switched
the order from 600mg to the more common 650 mg. Residents
can teach us too; they bring their own experiences whether it is
from emergency or other placements to the bedside, which is really
valuable and we definitely notice that. At the bedside during rounds,
we get to learn from residents and doctors, just like the residents
themselves do. Small moments of teaching happen all the time.
What do you think are the greatest challenges that resident
physicians have coming onto the ICU?
Having just come through the education system, I am also building
the same relationships that residents have to; it gives me a unique
perspective now that I am eight months down the road in an acute
critical care setting and I’m seeing the new residents come in. I can
appreciate that as a new resident, not only do you have to focus
on where you are – brand new unit, brand new staff, brand new
preceptors – you also have a lot of brand new patients. I think it must
be quite overwhelming especially for such a short period of time;
I couldn’t imagine switching nursing units every six to eight weeks
like residents do with their different placements and, then, trying to
absorb all you can.
What advice do you have for resident physicians for succeeding on
the ICU?
The senior nurses have been there awhile and when residents are doing
things outside their scope, the nurses know. We can tell when residents
need help; we’re happy to help, but the resident needs to be open to it;
in any situation, don’t assume that you already know what’s going on.
You always need to ask questions. No question is a dumb question.
Communication is key. We have about 150 or so full-time, parttime,
casual staff members and we have RNs, nurse practitioners,
respiratory therapists, multiple residents, a handful of doctors,
dieticians, a mobility team usually made up of student nurses – so it’s
a huge multidisciplinary team of people with new faces almost every
day. All members of a care team need to be able to address differences
of opinion or interpersonal issues upfront in a mature, professional
way with the end goal always being patient care. For residents in
particular, I think it’s valuable for them to introduce themselves – at
least keep their name badge in plain sight (and write their name
clearly at the bottom of orders). I particularly appreciate residents
who are approachable no matter how small the issue is. I’ve found
that the residents who’ve impressed me most are the ones who will
come by even if it is post-doctors’ rounds to ask me if I have any other
questions or concerns.
www.para-ab.ca | volume 29 fall 2012 12