[spineCNOR]

Just curious...

How commonly do you OR nurses out there experience verbal abuse and/or disruptive behavior from surgeons?

How do you or your facility deal with this issue?

In the facility where I work such behavior from surgeons is common - ranging from demeaning, condescending comments to yelling and screaming. Dealing with this on a daily basis is demoralizing and (I believe) has a detrimental effect on nurse retention.

The surgical department where I work has no policy in place that addresses this issue. Most of my co-workers feel that there is nothing we can do about this issue because we do not have the support of our nursing managers or of hospital administration, as they are so anxious to keep their surgeons (AKA their cash cows) happy.

Do any of your workplaces have policies or procedures in place to deal with disruptive physician behavior???

[nrw350]

I would like to say, what good are the cash cows when the nurses quit and the surgeons start to have care for all the patients themselves?

Nick

[joannep]

In every OR I have worked in for the 15 years I was in this speciality there was no policy. I have seen countless nurses leave the OR, as I did myself when I decided I would no longer tolerate the behaviour. I think it is the number 1 reason there is a shortage of perioperative nurses worldwide.
Joanne

[jude11142]

I have worked in the OR for over 10 yrs as a scrub tech and have just finished LPN school and took the NCLEX last Tuesday(nervous wreck,lol). Anyways, there was always several surgeons who were known to rant and rage during surgery. I have heard and seen so much it's not even funny. The best thing to do is NOT get intiminated by such behavior. When we got a new head nurse, we had several meetings regarding this. We were lucky in that if any of us felt that we were being demeaned/verbally abused etc.........we were able to go to the head nurse and she would take care of it. After several complaints against surgeons..........things changed dramatically. I worked at another hospital and managment felt that surgeons were GOD! We were told to be quiet and ignore these outbursts. Needless to say, I was out of there after only a yr. I have found that I didn't need to "report" any surgeons because if one did act up, I was able to say to him/her(yep, just as bad), "I am offended by how you are talking to me" or something to that effect and usually it would stop. As a scrub, you are really kind of stuck in the moment as you cannot walk off to blow off steam. You are there for the duration of the case, you are basically their right-hand person. Loved scrubbing, but being a tech, I was limited to what I can do. I have always loved nursing, so at the age of 41, I went to school. I may go on for RN, not really sure at this moment. Right now, I am working in a long-term facility and enjoying it.
well, that's my 2 cents worth,lol...............
JUDE

[jevans]

In the UK we complete incident forms even for doctors. This constitutes as aggression, which must not be tolerated. Particularly as this behaviour is often overheard by patients and relatives.

Incident forms are a way of letting senior management know what is happening. And of course they have to address

[mmckinneyrn]

I have worked with plenty of surgeons that become "verbally abusive" and our facility does have a policy that deals with it. We even have a form to fill out called "Disruptive Physician Behavior"
form. I have found that if I give back what I got I get better results. I let the abusive person know that I don't accept their behavior and will not assist them when they act out! WE DON'T HAVE TO TAKE IT! Let them know when their actions are inappropriate. I only see surgeons now act like this when they think they can get away with it. Just like kids on a playground!
I agree, this is a major reason we are experiencing a shortage of perioperative nurses. The surgeons would certainly never admit this!

[ocankhe]

SpineCNOR
Go directly to the head of Human Resources, there are plenty of laws governing this type of behavior so policies aren't needed, and say you have a problem with certain MDs creating a "hostile environment". Even if the MDs are not directly employed by the hospital the hospital is legally responsible for there behavior.
A second approach wouold be to discreetly let the offending MDs know that no nurse is willing to scrub/circulate in their rooms unless their behavior changes.And stick to it.

[stevierae]

I have always been lucky; no matter where I have worked, the RNs, techs, and surgeons were all buddies. We not only had the camaraderie of the operating room, but we had a common enemy--management--who seemed to take great pleasure in making it as difficult as possible to do good patient care, judging by their "bare bones" budget which meant: inadequate staffing, inferior, cheap suture, and instruments CONSTANTLY out for repair (NEVER repalcement; God forbid!)

I may take some flack for this, but--in my experience, the only surgeons who ever "went off" were the ones who CONTINUALLY got people in their rooms who had bad attitudes, and who didn't have a clue as to how to do the case and refused to learn. This usually happens in places where there is "cluster staffing-" peopel get so comfortable in one area (i.e., gyn) that they throw a tantrum and sulk and do a half-a**ed job when they have to step outside their little "niche" and do a thoracotomy or a craniotomy or a spinal instrumentation case. I have always liked to do some of everything. In the '70s and '80s, and even the early '90s we ALL rotated through every area, both scrubbing and circulating, otherwise you could not take call. If you did not know how to do something, you backscrubbed or circulated until you were proficient. Usually, young RNs and techs are eager to learn and get proficient, but management sticks them in one area upon new hire and that becomes their comfort zone. And what's up with the RNs who refuse to scrub? What makes them so self-important?

So, I can say I see the surgeons' side of it, too, when they have had repeated bad experiences--after all, they are dealing with human lives, and so are we. You would go off, too, if you nicked a major vessel, your patient was hemorrhaging, your experienced scrub called out for "a 5-0 Prolene" (which is always in the room, available for just this type of complication) and your circulator wandered out of the room, took her time, came back empty handed, and calmly inquired,"What kind of needle did you want that on?" Trust me, that is a true scenario. You (the scrub) just want to scream at the person, yourself, "Jesus, just get me a damn vascular stitch, ANYTHING, before this patient bleeds to death!" You can see why the surgeon might yell, "Get somebody in here who knows what they're doing!" I think EVERY RN should scrub, so that, when they circulate, they know FIRST HAND what is going on up at the field, and what could go wrong, and REALLY understand the situation, and be prepared for the worst.

If residents act like prima donnas? Put them in their places!! Most are only testing you if they do it. Most residents--attendings, too, for that matter-- I have worked with will do ANYTHING you ask them too, without complaint, if it helps get a case going.

[heartholder]

wow. where I work there is a form for the OR staff to fill out, if a surgeron is abusive. then at the next surgery section meeting the doctor in question is brought before his peers. I recently "wrote a surgeon up" it was the first time I had ever done anything like that] This surgeon is known for his attitude. and I usually overlook his tantrums. This time he wouldn't stop. Just keep it up over and over again. His actions and verbal abuse was undermining the skills of the 2 nurses in the room, we called manager to the room, the manager ran like a scalded dog, then the charge nurse of service was called. did the charge back us up?? NO. no one did. so I took matters into my own hands. did what I thought I had to do. so far I haven't had to work with that surgeon again. I have heard that he is more pleasant to work with. so maybe there is hope.
this is the readers digest version. but bottom line is, where I work there is a policy against abusive behavior from surgeons. even if management doesn't back us up. [color=indigo]

[tmatekwa]

IF YOU ARE PHYSICALLY STRONG, TIME THE SURGEON IN THE CHANGING ROOM IN THE ABSENCE OF WITNESSES,THREATEN HIM/HER ABIT WITH VIOLENCE.