The nursing staff is the first group you're likely to encounter in your hospital stay, but they're just one group of a confusing array of medical personnel you'll meet.

Note that you may refuse care administered by any staff member with whom you don't feel comfortable, and may ask for a more experienced person to attend to you.

Nurses

Hospital nurses will provide most of your care:

• Nurses' aides and licensed practical nurses (LPNs) will help wash you, help you in and out of bed, make your bed, and perform simple nursing tasks such as checking your pulse and temperature. LPNs, but not nurses' aides, have completed vocational training and may provide medication.
• Registered nurses (RNs) have earned a college degree in nursing and passed a licensing examination. RNs are able to provide more complex and critical medical care than LPNs, such as changing wound dressings, communicating with doctors, starting IVs, and administering IV medications.
• Nurse practitioners or clinical nurse specialists are RNs who have undertaken extensive additional training and are licensed to provide many of the same services that doctors provide. In some states they are able to prescribe drugs under the auspices of a physician. In some hospitals or clinical settings they may perform simple surgeries and procedures, such as lancing abscesses.
• Head nurses and nurse managers are in charge of other nurses, entire floors, or patient centers. Although all nurses now face the additional burden of administrative work that deprives them of time they prefer to spend with their patients, head nurses and nurse managers usually handle administrative issues exclusively, and seldom provide patient care unless staffing is inadequate.
• Enterostomal therapists are nurses specially trained to help those who will be having a stoma surgically created. A stoma is a temporary or permanent opening in the abdominal wall to allow waste to exit the body. Your surgeon will discuss with you whether your surgical procedure will include temporary or permanent ostomy.

Doctors

In teaching hospitals, you'll encounter the full spectrum of doctors in various stages of training. In some community hospitals, you'll encounter just residents and attending physicians. In other community hospitals that have agreements with nearby medical schools, you may find an amalgam of the two systems. Doctors in various stages of training include:

• Medical students who have completed four years of college and are undertaking four additional years of medical school. Medical students do not treat patients, although they may accompany an attending physician on rounds, and the physician may elicit their opinions.
• Interns, also called first-year residents, or postgraduate year-one students, have completed four years of medical school and are in the first year of three to six years of primary specialty training. They will not give you care unless supervised by much more experienced personnel, such as the attending physician or a more experienced resident, but that supervision may be distant. If you prefer not to be treated by an intern, say so.
• House officers (once called residents) may be postgraduate year-two students, postgraduate year-three students, and so on. These physicians are still receiving primary training that can last from three to six years, depending on the field.
• Fellows, or teaching fellows, have completed their six years' primary training, and have undertaken three years of additional training in a subspecialty.
• The attending physician is in charge of all fellows, residents and interns. In university hospitals, she is likely to be a faculty member. In community hospitals, she is hired to oversee patient care in her area of specialty based upon her reputation in the medical community.

I was in the hospital for chemotherapy and a very nervous looking medical type--student? intern?--tried to access my port and couldn't. After several tries the sweat ran down his face and he gave up.

Later that evening another guy in a white coat showed up. With my newfound bravery, I asked him, "Do you know how to access one of these things? Have you ever done it before?"

"Not only have I accessed them," he said, "I've installed hundreds."

He then proceeded to put the needle in with one quick jab--no pain, no anxiety. So much for my insisting on knowing who knows what they are doing!