What do surgical nurses know about surgical residents?

What do surgical nurses know about surgical residents? Schlitzkus LL, Agle SC, McNally MM, Schenarts KD, Schenarts PJ. From the Division of Surgical Education, Department of Surgery, East Carolina University, Greenville, North Carolina. Purpose: A fundamental premise of establishing collaborative relationships between residents and nurses is a basic understanding of the attributes of each group. The intent of this study was to determine what surgical nurses know about surgical residents at a university hospital. Methods: After Institutional Review Board approval, a piloted survey tool was administered to a cross section of nurses working in our 3 surgical intensive care units, 1 surgical intermediate unit, and 2 basic surgical floors. The same survey tool was completed by surgical residents. Data were analyzed using univariate measures with statistical significance set at a 2-tailed p-value less than 0.05. Results: The response rate for nurses on the 2 survey days was 94% (n ⫽ 124), or 54% of all surgical nurses employed by our hospital and 96% (n ⫽ 24) for residents. Of the nurses surveyed, 37% worked in the surgery intensive care unit, 26% in the intermediate unit, and 36% on the surgical floor. Ninetynine percent of nurses did not have a surgical resident as a significant other. Fifty-five percent of nurses have more than 5 years experience. Ninety-five percent were licensed registered nurses. Data are presented as the most frequent response by residents and percent of residents and nurses giving this response (Table). Conclusions: Misunderstanding sets the stage for conflict. Based on our findings, nurses have a limited understanding of surgical residents. Educating nurses about the education, roles, and responsibilities of surgical residents might improve collaborative relationships.

Do surgery applicants know what they will want after residency? Potts JR III, Medrano M. From the Department of Surgery, University of Texas, Medical School, Houston, Houston, Texas. Purpose: Applicants for surgery residency frequently state very specific career goals, which include fellowship plans. To our knowledge, no one has previously determined the accuracy of those goals as stated by applicants. The purpose of this study is to do so. Methods: For 17 years, we have formally asked applicants to our program to state in writing their plans for fellowship. A menu of possible fellowships is given as well as the option for “none” and the option for “other,” with which the candidate is to specify a fellowship type not listed in the menu. Applicants can choose up to 3 options and are not asked to rank those choices. By comparing the type(s) of fellowship projected by an applicant with the type of fellowship actually obtained by that individual at the completion of residency, the accuracy of candidates’ projected fellowship choices can be determined. Results: Complete data, which include the resident’s application form, conclusion of residency and professional status following residency is available for 73 individuals. At the time of application, those individuals made a total of 103 projected choices for fellowship (mean 1.3 per applicant). The most popular among them was surgical oncology, which comprised 23 (22%) choices followed by cardiovascular surgery 22 (21%), trauma/critical care 17 (16%), peripheral vascular surgery 10 (10%), pediatric surgery 8 (8%), “none,” plastic surgery and transplantation each with 6 (6%), colorectal surgery 3 (3%), and alimentary surgery 2 (2%). Every individual who ultimately applied for fellowship was selected to enter the desired type of fellowship. Fifty-five of the 73 (75%) individuals performed a fellowship of some type. The most common among them was cardiovascular surgery which 20 individuals (27%) pursued followed by trauma/critical care (8 graduates; 11%), surgical oncology (6 individuals; 8%), peripheral vascular surgery (4 individuals; 5%), pediatric surgery, plastic surgery, transplantation and minimally invasive surgery (each with 3 individuals; 4%), noncardiac thoracic surgery and colorectal (2 individuals; 3%), and hand and endocrine surgery (each with 1 individual; 1%). Eighteen individuals (25%) entered practice without a fellowship. Importantly, only 34 individuals (47%) entered one of the types of fellowship projected on their applications, whereas 39 (53%) did not enter one of the fellowship types projected at application. Conclusions: Even with the option of choosing multiple possible postresidency fellowship types at application, fewer than half of the residents who entered our program correctly predicted their future educational course. The implication for programs is that resident selection should not be heavily influenced by candidates’ projected career paths.

Question Asked

Most Frequent Response

Residents

Nurses

p-Value

Highest degree to start residency Residency duration Residency required to practice % resident time devoted to patient care % resident time devoted to study Mandatory education conferences Know when conferences are held Pass examination to be promoted to next year Are interns legally doctors Are residents legally doctors Do interns hold medical licenses Maximum work h/wk Hours slept while on call Bedside procedures without attending Portions of operations without attending Do residents pay tuition Average resident salary Average resident debt

Medical doctor 5–6 years yes 76% to 90% 15% to 30% yes yes no. yes yes yes 80 hours 1–2 hours yes yes no. $31,000–$45,000 per year $126,000–$150,000

100% 100% 100% 54% 63% 100% 100% 58% 100% 100% 92% 100% 92% 100% 75% 100% 79% 29%

78% 57% 89% 20% 16% 96% 40% 13% 60% 93% 59% 40% 43% 82% 44% 68% 52% 11%

p ⫽ 0.01 p ⫽ 0.02 NS p ⬍ 0.01 p ⬍ 0.01 NS p ⬍ 0.01 p ⬍ 0.01 p ⬍ 0.01 NS p ⬍ 0.01 p ⬍ 0.01 p ⬍ 0.01 p ⫽ 0.03 p ⬍ 0.01 p ⬍ 0.01 p ⫽ 0.01 p ⬍ 0.01

NS ⫽ not significant. 72

Journal of Surgical Education • Volume 66/Number 2 • March/April 2009