Those without much experience with hospitalizations are often confused by the hierarchy of power at Club Med. The strange (to the layperson) job titles don’t help.
Attending – The Attending Physician is the full-fledged doctor who authorizes your admission to the Club. The Attending has ultimate power over what happens to you during your visit (well, no — YOU have ultimate power because you can refuse anything — but the Attending can order things to happen, and some other folks can too, on a more limited basis); the Attending can write “order” prescribing meds and treatments. The Attending is typically your doctor from the CF Clinic (or the CF Clinic doctor serving as On-Service or On-Call doctor that month, in those clinics where this duty is rotated among the docs). This exalted being leads “round”, which is that (usually) daily visit when the Attending sweeps into your room followed by a gaggle of docs in training, and uses you as a training aid while pretending that the visit is to make sure everything is going well for you. They are likely to want to listen to you with a stethoscope (stethoscope must be cleaned with an alcohol pad, and hands must be washed, in front of you!). Changing Attendings is very difficult; it may require that you be discharged from the Club, and be readmitted another day — this seldom happens. BTW – “round” is your best chance of actually contacting your Attending; plan accordingly (e.g., you may want the Attending to put on the chart that the patient is not to be disturbed from 10 pm to 6 am EXCEPT for meds — if he does, post on your door also).
Fellow – A doctor who has completed his residency (last phase of required doctor training) and is attached to the CF Clinic (or other organization, e.g., the Surgical Fellow) for specialized training in that area. This person may actually appear if a very serious situation requires a change to your meds other than during “round”; Fellows can write orders. Second only to the Attending in power.
Primary – The nurse on the unit who is nominally charged with developing your nursing care plan. Often the Primary is the nurse who cares for you on Day Shift (on the other shifts they just try to follow the care plan without messing up). Watch the hand-washing!
Charge Nurse – The administrative boss nurse on each shift. You don’t usually see the Charge Nurse.
Resident – A doctor enduring the punishing last 3-5 years of required doctor training during which inhumanly long (e.g., 36 hours, maybe more) tours of duty on-call in the hospital are required to “gain experience”. This is who you are likely to see after evaluation in the ER should you go there, or at night in the Club if an order needs to be written. Residents crave sleep (after they have taken care of your child or yourself; they will not go to sleep if there is a problem). Residents know at lot (especially after being in residency for a while), and therefore command respect. BTW – New Residents, First Years, Second Years, and Third Years are created in July; schedule hospitalizations after the New Year when possible (and ideally in May or June).
Intern – The first year of residency is often referred to as internship, although the true internships don’t exist anymore, the term has stuck to refer to a first year resident.
First Year, Second Year, Third Year – Unless qualified by the term “medical student”, these terms indicate which year of residency the person is in. Watch the hand-washing!
Medical Student – After a bachelor’s degree, a prospective doctor goes to medical school. This is 4 years in length. The first two years are basically classroom time. Third year begins clinical experience. The fourth year is more of the same clinical experience. After medical school, residency begins. They may learn from you; do NOT learn from them. They have no power. Remind them stethoscope must be cleaned with an alcohol pad, and hands must be washed, in front of you!
Nurse Practitioner – Nurse practitioners are nurses with an advanced level of knowledge and education in both nursing care and human physiology. They practice in a variety of settings and may provide primary care to defined subgroups of people. This includes advanced management of disease states and pharmacology. Some states permit prescription writing. Credentialling varies from practice area and state to state but in general, most have at a minimum a bachelor s degree plus some post-baccalaureate schooling. Many have master’s degrees and some doctorates.
Registered Nurse (RN) – A rank, not a job title. Nearly all RN programs give a college degree (either an A.A.S. or BSN). A major difference between RN an LPN training is that in RN programs more time is spent on theory and rational. In LPN programs the concentration is on learning specific skills. In most hospitals they can do pretty much the same things, but RN’s should have more understanding as to why they are doing things. They are senior to Practical Nurses, Nursing Aids, and other nursing staff. In the 80’s they were talking about eliminating LPN’s and requiring all nurses to have a college degree. Now many hospital are increasing the use of LPN’s because their salaries are lower (some say RN refers to a Rich Nurse; PN refers to a Poor Nurse). Watch the hand-washing!
Licensed Practical Nurse (LPN) – Practical Nurses attend schools for 9-12 months and are required to pass a state licensing exam. May give oral meds, and may also give IV, SQ and IM medications, monitor IVs, run and read EKG’s, help intubate patients, suction them and fix the ventilator when it acted up, and may also be assigned to the hospital code team.
Nursing Aide – A nursing helper who handles non-hazardous chores (taking vitals, bringing meals, changing linens) as opposed to delivering meds, monitoring IVS, etc. Trains for 40 hours in many programs. Stethoscope must be cleaned with an alcohol pad, and hands must be washed, in front of you!
Respiratory Therapist (RT) – Delivers your inhalation treatments. Watch the hand-washing! May also do CPT in some hospitals, or on some shifts. Ask for a clean nebulizer at least every 24 hours.
Physical Therapist – Gives CPT (poundings), may try to get you to exercise more (and they’re right, you should). Watch the hand- washing! May also deliver inhalation treatments in some hospitals, or on some shifts.
Lab Tech – The person who must come around and take your blood for tests ordered by the docs. Even more stressful a job than parking meter attendant because the best they can do is only hurt you a little. Try to understand (but it’s ok to secretly hate them). When they are drawing blood, ask for a butterfly needle, they hurt MUCH less. Hospitals won’t use them unless requested because they cost more. You may even have to have your Attending write an order saying only butterfly “sticks”.
Nutritionist – May try to get you to gain weight (and they’re right, you should). May be helpful in getting the kitchen to send up the double and triple orders of food that you request (if the kitchen balks). Easy to spot because of the rank peanut butter smell attached to them (nutritionists try to force peanut butter on all unsuspecting souls they come into contact with!).
Social Worker – Can make referrals to lots of services in the community that a PWCF may need (e.g., low income housing, income support, interpersonal relationship problems). Each CF Clinic is supposed to have one assigned to work with their patients when needed.
Patient Advocate – The hospital’s Complaint Department. Their job is to calm you down by listening to your complaints, and asserting that they are going to look into the situation.
Play Lady – Children’s hospitals often have Child Life Specialists who try to make visits to Club Med a bit less horrible by fighting boredom. They may supply books, art supplies, toys and games, introductions to other patients, VCRs and video tapes, and supervised play in a dayroom.