dont worry interns!! it will get better! You wont even notice yourself getting better and better with each day.
A few tips I can offer that worked well for me:
1. Sometimes you just have to babysit every order to make sure it gets done. If things dont get done, saying "but i ordered it" is not the right answer. (Especially if it's a stat order! If so, you have to actually walk over and see if it's getting done, and if not, harass people!).
2. Learn to prioritize well. It's an amazingly valuable skill, for interns as well as residents.
3. People can get easily confused. Write orders as clearly as you can--anticipate misunderstandings and nip them in the bud, even if you have to be redundant and write the same thing in a couple different ways (just like i did right now
). If you think something sounds especially confusing or equivocal, or can be understood a couple different ways, you should actually talk to the nurse and/or secretary (as appropriate) and make sure he or she understands what you have in mind. But to be able to do this, you have to always be thinking about how what you say or write might come across to the person carrying out your order. This is a challenge that not everyone is good at, but if you are able to do this, your life will be that much easier because you wont get paged a million times for clarifications and you wont need to reorder things dozens of times, and less errors will be made on your patients.
4. Document! One of the purposes of documenting is to defend your plan. Write your notes with that in mind. You are building a case for your plan within every note. The other purpose of documenting is to keep track of things. Never copy paste mindlessly. If you do that, look through what you pasted and make sure you know what's in there and that it's updated. whatever you do, NEVER EVER copy paste from other people, it's cheap and shows you didn't bother to learn the story--that's a dangerous thing. You can copy paste from yourself, but just make sure you do what i wrote above. Also, write actual dates (date of admission, date of transfer to the floor or to the ICU, day x of y antibiotic, date of a surgery (POD#n s/p abc surgery) in each note. You will THANK yourself.
5. When you consult a subspecialty service, it is VERY IMPORTANT to have the right question for them. This is not something to be taken lightly because (#1) they might not address the issue in question and (#2) they might question the need for the consult. As such, if you want to consult a service talk to your resident first. Sometimes the resident will need to even talk to the attending before placing the consult. It's that serious of a decision. Also, there is a certain etiquette to placing the consult. If you decide late in the day on placing a consult, if the issue is not urgent (urgent i.e. brisk GI bleeds, impending need for dialysis, acute stroke, acute MI, etc), wait until the next morning to place the consult. Because often the policy on the consult services is, if they hear about the patient, they have to see them that day. So, if you call at 3-4pm, the consultants will grumble. Of course if it's an urgent issue they will yell at you if you DELAY calling! This does require some judgement, so it's good to ask your resident for guidance especially in the beginning until you get the idea or whenever things seem equivocal.
6. Lots of things and ways of doing things are learned through sheer experience. Sometimes you can be ahead of the game by listening to your resident's advice and/or seeing how your resident does things. I was really lucky to have true role models for residents (for the most part), but you can learn even from weaker ones. Even seeing how you DONT want to do things is a learning experience, but all in all, whatever your resident is like, they got through intern year, and thus they usually have more insight into how things are supposed to work on the floors (or in the ICU). That said, the worst residents are the ones who are not interested in doing anything, nor giving advice, so for them this is a moot point.
7. It's better to err on the side of being more thorough than less thorough. However, sometimes you just have to accept that you cant do everything you'd like to. This is where the ability to prioritize is key.
8. If in doubt about ANYTHING no matter how small, ask your resident first. First try to find the answer yourself of course (if you have time to. . .if a patient is crashing, then dont worry about trying to find the answer, just ASK.), but even if you think you know, it doesn't hurt to just consult with your resident to make sure what you want to do is cool. Sometimes you might not have considered some consequence or interaction that your resident has seen happen in the past. You will not be judged for asking.
9. One of the major goals of intern year is learning how to recognize the various degrees of sick.
Seriously though, you guys are doing better than you think! I'm sure my interns feel inadequate often, especially when they realize they ordered something wrong or something didn't get done, and when I try to show them the right way to do it, or when i point out the mistake. But they are doing just fine. I am just trying to help them develop good habits that will serve them well the rest of the month, and year, and residency! I love interns, you are my helpers! So CHEER UP! And take things in stride. . .
. But I must admit, I started in the ICU, the schedule is not so bad (q4) and the nurses have been really good to us in terms of correcting our orders, helping us get it together, get a little sleep, etc. In fact, I am bringing in food for them tomorrow. 
