burnout in the OR - page 2
I've been a nurse for six years, in the OR for five. When I first started, I LOVED it. I actually saw myself staying with it for twenty years. And there are still things that I like. But there is... Read More
Nov 27, '05[font="book antiqua"]i agree that rns and sts alike need breaks. in ny, there have been laws passed that will not allow a resident to work over a certain amount of hours without an adequate rest period. not only is it dangerous to drive home when you're fall-down tired, but how can you work effectively? thankfully, the place where i work provides breaks regularly and often, and i have given breaks as an "extra." i'm always surprised, though, that other rns will not give an st a break when scrubbed in! sure, there are times when it would be inappropriate, but why not otherwise?
the more i read about other facilities and nm's, the more grateful i am for mine. today i was on-call, and got called in for a major burn and a kidney/pancreas transplant. before i left i made sure that the st scrubbed on the transplant got a full 30+ minute lunch - this is just understood! then the charge nurse made sure i was included in the lunch that was being ordered. i can't imagine working with a nicer bunch. anyone want to come and work in central virginia?:d
Dec 1, '05If you love the OR, but are fed up where you are, try somewhere else before giving up on the OR completely, as there are massive differences in attitudes in both management and surgical between operating suites. There is a worldwide shortage of nurses... that does NOT mean that it is harder to find work, it means it is easier! The hospital needs you more than you need the hospital, if they can't offer you a fair and respectful workplace, then find one that can.
Dec 1, '05Dear Kim,
That is a terrible tale, I'm sorry for you to have suffered so. I've recently suffered a setback in my career that made me feel that things were hard for a while, but your story brought home to me how minor my own hardships were. It sounds like you have weathered the storm and are heading into calmer waters, have faith in yourself and your future. Going for first assistant and changing qualifications is a good idea. If you are a scrub tech, have you considered doing nursing? Something like that might throw your detractors off the scent.
I wish you the best of luck.
Dec 2, '05hi ferret,
not as easy as it seems, believe me i have been trying. if i could not protect patients from harm in the "best hospital in america" what might it be like at lesser institutions? considering the consequences of my actions and the sheer futility of my attempt to reveal the truth i now worry that in future i might remain silent, allowing risky practices to continue without sounding the alarm. what is so very sickening to me is reading all the sanctimonious hype about their creative patient safety initiatives, presented in the media and offered to other us hospitals, when i know the real truth. patient advocates are targeted for removal and their so called compliance line is just a sham. i am told that these "compliance lines" are often set up to weed out the outspoken "troublemakers," who dare to advocate on behalf of patients: be warned.
i am overwhelmed by the need to put things back in balance by demanding the introduction of laws and protocols that will protect medical personnel from retaliation and create genuine transparency in advocating for patient safety. much of this is heavily dependent upon minimizing the negative impact of self-serving management and restoring appropriate control to nurses. in trying to put together my petition for the internet i have been doing quite a bit of research on line. australia actually has some provisions in place for nurses to be provided with breaks; there are no such provisions in the us and hospitals take advantage of the lack of regulation.
the dangerous thing is that all of the hospital staffing cut backs are now leaving nurses stranded without any backup. zero redundancy saves money, but nurses are faced with "patient abandonment" charges if they dare to consider their own basic needs. in the airplane there is a good reason why you are expected to put your own oxygen mask on first before assisting others! nurses must understand that by abandoning their own most vital requirements, like the need for a reasonable rest and food, they will in turn endanger their patients. at arbitration all the management had to say in my case was that "the er was busy," and drivel on about the staffing shortage; a shortage that they had deliberately created with their toxic work environment. they did not even have to elaborate on relevance due to the fact that i didn't work in the er and very few er patients actually come to surgery! there just didn't need to be a reason for abuse: my hospital was simply beyond reproach!
i had relocated to baltimore to take an or job at maryland's most prestigious hospital. after i arrived i bought a house and became absorbed in the renovation in my time outside work. my mortgage took about half of my regular pay check and i ploughed a lot more money into the rehab. it was like a giant doll house, two 1833 row homes rolled into one; i adored it. due to the financial constraints of buying and renovating my historic old home i put off the expense of taking my cst exam, something i now deeply regret. however, i concentrated on learning every aspect of my job very thoroughly and becoming a very proactive technician advocating for many positive changes in the or. because i was not a minimalist, i was chosen for specialized training programs like working with the operative robot on the "living related donor nephrectomy" transplant team. my strongest commitment to surgery was transplant and i was prepared to be called at home any time to come in to assist my transplant team.
everyone who worked in the or was free to attend surgical grand rounds held every saturday morning. this was part of the ongoing training program for medical students, attended by all the residents and surgeons. in the entire time i was there, i was the only member of the nursing staff to ever attend ground rounds, which i went to religiously without fail every weekend for three years. i had earned the respect of my surgeons with this and other demonstrations of commitment to further education, strong dedication and loyalty. that respect was shattered when i was marched out like a common criminal, surrounded by hospital security guards.
my hospital gave very little encouragement to those who tried to perfect higher levels of education, even maintaining basic cpr was not a requirement for technicians. i had taken acls at my previous job and felt that it was unprofessional and inadequate for our techs to not have cpr training. in my statement to miemss i appealed to them to demand cpr training of or techs at our level one trauma centre; they were too busy trying to defend a maryland icon from the most minimal accountability. the hospital was happy to "dumb down" our role in the or and would never even permit the title of "surgical technologist" to be used on documents, as it gave an undesirable impression of professionalism. minimally trained personnel have fewer options and are more compliant with bad policy and dangerous practices. this is never beneficial for patients.
following my wrongful termination that was well timed to defraud me out of half my vacation pay benefits my hospital attempted to block my access to unemployment. however, they couldn't show legitimate cause for firing me, so i was eligible. unfortunately the stress had taken its toll on my health and i frequently had such great difficulty sleeping that i was unfit to start into orientation at a new hospital. i had no concept of the appalling level of corruption in the us. i just knew i was in the right and as a totally naive foreigner i fought tenaciously for reinstatement. when i did apply for a job elsewhere the question of previous employer and why i left kept coming up. i was always truthful, but this was damaging. one call to hr and they got "not eligible for rehire." i delivered yachts offshore as i had done before entering my medical career, but there were persistent regrets.
i had researched returning to the uk to work and found out that the nhs equivalent to my us job was "operating department practitioner" or odp. there were a few important differences with odp encompassing two us job descriptions, surgical technologist and that of the critical care technician. when i had first inquired it was possible to function in just the one role, but things had changed by the time i came to england. the certification was in the process of being turned over from aodp to the health professions council and it was to be an all or nothing qualification. i came to england in mid december shattered by my horrific experiences in america but thinking i would have a job by christmas. i soon discovered i was unemployable in healthcare in the uk and i did not qualify for benefits, assistance or retraining. i have even applied to begin odp training from scratch, but was turned down in favor of new candidates. i had fewer rights in the country of my birth than one of the many refused asylum seekers!
after the tsunami i tried filling out an employment form for the ngo international medical corps, imc. an american organization should have recognized my us experience as valid and judged me accordingly. it asks previous employment and "why did i leave?" all of my years in the or was with that one hospital and the only reason for my leaving was "wrongful termination." i was fired in retaliation for blowing the whistle on negligent practices in the or. it was pointless completing the form unless i was prepared to lie. no one wants to look into this, i am automatically the villain; if they call for a reference the lies further sabotage my job prospects. one very good doctor friend of mine applied to another american ngo; it was a very rigorous hiring process. my fifteen year ambition to work for foreign aid organizations has probably been permanently sabotaged.
the only reason i was able to go out to aceh was that the ngo was indonesian, the situation was one of desperate need and i was willing to fly myself half way round the world at my own expense. unemployment had finally conceded that i had a right to uk support and i recklessly used that money to get on a plane bound for a disaster zone in asia. i know that this was sheer lunacy, but i was determined to take back my soul.
i met many people in aceh who worked for foreign aid organizations and they certainly did not face the hardships that i did. i lost over 1/4 of my body weight while working as a volunteer, not something i regret! i would gladly return to the same minimal living conditions if i just had the mandate to carry out the work that i identified as so necessary. my ngo had precious little resources that they spent very judiciously. i admired the indonesians that i worked alongside tremendously, but they cannot fund my project for creating a decent emergency preparedness plan for meulaboh and i do not have the backing to do it for them. while i remain back here in the uk trying to get back out to continue my work i am haunted by the single biggest blockade that continues to sabotage my credibility and my future: the lies of my former employer.
this morning i received a parcel from the states. someone from my unitarian church, one of the last of my friends to get into my house before the locks were changed salvaged what he could. a survival suite and my wet weather pant from when i was chosen to sail in the whitbread race representing america on the us women's challenge. photographs of my brothers twins right after they were born; my favorite cousin's wedding in the uk and my best friend's wedding in the caribbean, my ex-husband aboard his father's boat; one of my last trans-atlantic yacht deliveries to holland; a roaring fire in the living room of my historic home in baltimore; very old photos of my favorite uncle and a few old pictures of me just before i departed on the whitbread round the world race. how could i have left such precious memories behind; simple i escaped with my life!
i feel gutted one more time contemplating all that i have lost in my efforts to uphold the truth and protect patients from harm. i cannot allow all of this excruciating pain and sacrifice to have been in vain so i cannot just give up and move on. the petition i am working on will be posted soon on thepetitionsite.com. this petition does not ask for anyone to take sides or endorse my cause it only calls for an appropriate investigation into my case. the petition is taking time as i want to set up links to other internet sites to specifically highlight the real motivation driving the "nursing crisis" and the need for whistleblower protections for all healthcare workers. i urge you to encourage as many people as possible, especially nurses, to comment on the petition and to sign,
thank you for reading my posts,
fair winds & following seas, kim.
ps: i sailed into fremantle, australia on leg 2 of the 89/90 whitbread round the world race. after a grueling 39 days at sea crossing the southern ocean at 50 degrees south i was never more glad to see land!
Dec 2, '05Quote from normaraeI hear you Loud and clear Same at my hospital i havent taken another job yet cant find one that pays what i need and is close enough to be there for my kids i feel stuck and put upp with it every day its been so hard really wish i could move and get a better job with my expieriannce but moving now is hard my kids are ready to graduate high school and thier nursing program so im kinda stuck just hoping i dont crack loli have been a perioperative nurse for 18 years cnor, onc, rnfa, with open heart experience, major ortho and vascular first assistant/circ/scrub experience and love what i do. started out as an ER nurse and went to the OR. Moved back to small town florida and was happy doing gen surgery/endo when a new manager came with her sargeant traveler charge nurse and next thing i know I am terminated because the new mgr did not like my being there - she felt threatened by my experience. I am in a Right to work state which means no laws for the employees. Of course I refuted her claims, but hosp admin stood behind her and kept the rn whom the techs had refused to be on call with, and the one who complained all the time about the work and pretended illness if asked to work. Now Im not burned out on OR nursing, but I am sure burned out on managers who are insecure and unable to manage people and the business. I probably would have had a heart attack or stroke like the other two employees had in this hospital from the daily inuendos and harrassment by this manager. SHE is still there and I am having to leave my home to drive 100 mi round trip or go live elsewhere 13 weeks to get the respect and the job I deserve. it is too late for a career change that I can afford to live on and i am very disappointed that this can happen in the USA. Oh, I forgot to mention the major hospital who brings green card aliens over to work for less than us americans -that is just part of the story.
Dec 2, '05Kim, I'm sorry things turned out so bad for you but it sounds like you're having fun in other adventures. You don't have to be quite so honest when applying for new positions. Just say you quit because of unfair working conditions. Fortunately, my hospital has a system where QI reporting can be done anonymously by computer. Since several departments get the report, they cannot be swept under the carpet!
Dec 3, '05Surgeon arrogance is one of the biggest turn-offs about the OR. You know you aren't going to form a lasting relationship w/ your pt, you work more independently than on a nursing unit, and what could be more interesting? It's something new every day.
If it was about the doctors being your friend or even being pleasant, it wouldn't matter where you work-you'd just find the best spot for you, and I think what's you have to decide. Where can you be the best you can be?
Dec 3, '05Quote from SRTUh, that was not a friendly read. :uhoh21:>I have been an Operating Room Nurse since 1981; I also do
>Legal Nurse Consulting. I have worked in California,
>Washington and Oregon. Whenever I want to earn the pay I
>feel I deserve as an experienced specialty RN, as well as
>get the professional respect I feel I deserve, I work in
>California. The difference in attitudes, as compared to
>Oregon, is like night and day. I believe it is primarily
>due to always having had a strong union (God bless CNA!!!)
>and strong union members--that is, nurses who are radical
>enough and savvy enough to speak up and demand fair pay,
>good working conditions, and proper equipment and staffing
>ratios to do excellent patient care. Also,remember a law was
>recently passed there requiring a certain ratio of nurses to
>patients. When people call in sick, the registry is called,
>and the same number of nurses are contracted to replace
>them. In Oregon, we get a lecture at report about how
>lunches and breaks will be late or non-existent due to our
>colleagues' being sick; people are"counselled" for calling
>in sick, and their names are put up on the board for the
>day so that everyone knows which colleagues "Let us down"
>by having the nerve to be sick. In California, our managers
>ask us at weekly meetings what they can do to make our jobs
>easier, and those things are supplied. All the rooms are
>well equipped and well stocked, to allow us to do the best
>possible patient care we can. In Oregon, we run around
>borrowing such basic items as step stools, extension cords,
>and flash pans from other rooms; specialty equipment such
>as endoscopic staplers are constantly in short supply
>;cautery units, microscopes, video cameras are always out
>for repair or malfunctioning. In California, we are asked
>if we are willing to stay overtime, and are well compensated
>for it, as well as being thanked. In Oregon, "mandatory
>overtime" is frequent and last minute; you are not
>asked--you simply are not relieved on time. If you ask the
>union (if you can call the joke we have for a union, here in
>Oregon) for support on this issue, they vaguely talk about
>patient abandonment and actually support "Management's right
>to ensure safe staffing" by enforcing mandatory overtime. A
>personal example: I was stuck without relief on a case
>once, the day before Thanksgiving. Due, once again, to
>improper planning, the charge nurse claimed she had no one
>to relieve me. My day care provider was furious, when I
>arrived to pick up my son an hour late. Not only did I have
>to pay the standard late fee, (which, in our area, at that
>time, was $1.00 per minute--therefore, $60.00--) I lost my
>day care provider. While the union allowed it was
>"unfortunate, they backed the implementation of "mandatory
>overtime," and I lost the grievance in which I asked for
>reimbursement of the $60 late fee. Our rights--to have a
>life after 8 hours of work, to go home and pick children up
>in a timely fashion from day care, or go to a soccer
>practice or game, to meet our friends or husbands for a
>beer, or just to go home and do nothing--are all disregarded
>in the name of patient care. I had the audacity once to say
>to the nurse manager of an Oregon operating room: "Staffing
>issues are a management dilemma. I am contracted to work
>only 8 hours a day." You would have thought from the
>horrified expression on her face (and on the faces of some
>of the "suck-up" nurses in our department) that I had just
>announced that I was a cannibal! Her response was "How
>would you feel if one of YOUR parents was in surgery, and
>the nurse on the case refused to stay over?" My response
>was: "My parents are dead, and anyway, I would never have
>recommended they have surgery in an operating room whose
>management tyrannized her staff by laying guilt trips on
>them. When a case is expected to run over, it is
>management's JOB to arrange for staffing relief well in
>advance. That usually involves calling registry in the
>morning and asking them to send over nurses for the
>afternoon." Her response: "We don't use registry." This
>was 10 years ago, and it is still this way at this
>particular operating room. The staff don't complain because
>they have been so brainwashed by management into thinking
>there is a "nursing shortage" that they are afraid they
>won't be able to get another job. Indeed, a lot of them
>wouldn't be able to get another job, as some of them have
>very mediocre nursing skills,(some have never learned to
>scrub, and are allowed to continue to refuse to learn; some
>can only be trusted in very minor cases--) and really should
>not be working in an operating room. The attitude among
>management there is that "As long as they can do the
>minimum, that is all we expect." So, the message conveyed
>is "Mediocrity is OK." It does not take the intellect of a
>rocket scientist for one to figure out what follows--people
>start thinking,''Well, if mediocrity is okay, why should I
>strive to do more than the minimum?" Nurses in Oregon do
>not have to take continuing ed--- I have worked with people
>who couldn't even remember how to calculate a simple drug
>dosage, and had to ask anesthesia to do it for them--
>whereas, in California, we are constantly upgrading our
>skills to be able to stay up on top of rapidly changing
>technology and trends in patient care. Standby for call in
>California is paid at half-time, because management, the
>physicians, and the union know that our time is valuable,
>and they respect us as professionals. In Oregon, standby
>pay is around $2 an hour, and the nurses think they are
>making great money, and don't want to ruffle any feathers by
>daring to ask for more. In Oregon, we are expected to clean
>the dirty rooms before going to assess and get our next
>patient--in California, not only would the housekeeping
>union be on our backs for taking their jobs away from
>them--but management would see the bigger picture--not only
>are we contaminating our with hazardous waste, and
>carrying it to our next patient, but we are taking away
>time that rightfully BELONGS to our next patient. How would
>you like to know that the nurse talking to you and starting
>your IV just came from cleaning a grossly bloody room? As a
>patient, I would expect that a nurse have time to talk to me
>and my family a bit and help prepare us emotionally-- that
>is, after all, our role as O.R. nurses--but that time is too
>often spent cleaning up the room from the previous case, and
>then rushing to get the next patient into the room on time.
>Truthfully, very little time is spent actually assessing the
>patient's emotional state, as we are constantly being
>pushed, pushed, pushed to get the next case going. I could
>go on and on. Don't get me wrong--I love living in Oregon.
>I just refuse to work here as a nurse, as I feel that it is
>difficult, if not dangerous, to do excellent patient care
>here. So, when I want to work as an operating room nurse, I
>happily fly off to California for a week or two, where all
>the support is there to do excellent patient care, we are
>respected and appreciated as professionals, and the morale
>is always good. I have the best of both worlds--since I get
>paid more in California, I can work less, and I can spend
>more time at home gardening (my real passion.) My advice
>for nurses who are feeling unhappy about their own job
>situations, and approaching burn-out--take a sabbatical or
>some sort of leave of absence, and try travel nursing.
>Before you do, though, go into a chat room where nurses are
>talking about their travel assignments, and discussing
>travel companies and hospitals by name. Believe me, there
>is a reason why certain hospitals are always advertising for
>travellers--it isn't that they are so busy they need to
>augment their own staff, either. The real reason is that
>they cannot hold on to their own staff, because work
>conditions and/or management are so abysmal that the staff
>nurses just get fed up and quit. I hope I don't get any
>"hate mail" from Oregon nurses. The truth is, though,
>almost every Oregon nurse I have ever known is unhappy in
>her job, but stays for years and years and miserable years,
>just because of the benefits. I have never met a California
>RN who was unhappy in her job. There always seems to be the
>support there to "fix" whatever problem was making people
>unhappy--again, a great union, and supportive management,
>and physicians who respect and treat us as fellow
>professionals. P.S. To be fair, I have NO knowledge of how
>it is for nurses who are not operating room nurses--I would
>like to hear from nurses in other specialties in both Oregon
>and Washington, to see if their working conditions are
>similar. Please feel free to e-mail me at
>email@example.com. My name is
>Stephanie. Thanks again, California Nurses Association!
P.S. No matter where I have worked, the surgeons have NEVER been the problem. (Admittedly, some RESIDENTS tend to get swelled heads and start acting like prima donna at certain points in their residencies, but they respond well to being put in their places by seasoned nurses...) Usually, the problem is management. There are all these management types--some of them are't even operating room nurses, and even the ones that are haven't scrubbed or circulated in so long any patient care delivered by them would be downright dangerous. It seems as if there always battle lines being drawn--with the surgeons and the nurses on one side, united, and management on the other. Again--hate to sound repetitive--this I found to be typical only in Oregon, not California. In California, we all seem to work together for a common goal--excellent patient care.
Jan 4, '06[quote=Patricia Smith]Hello OR nurses: What a dying breed you are! We here in Phoenix are sending an invitation to anyone out there willing to re-locate! I am currently working in a hospital where the management is behind the nurses (especially in the Peri-operative Service Areas).
I am currently in Post-partum in one of Phoenix "finest", however I am looking for a change, have even considered leaving nursing totally, but I just can't do it! I have been looking at OR nursing and happened upon this site and quickly registered so that I could get advice and "see" how OR nurses work. I have no experience in OR and have contemplated on taking the 'peri-operative' training course offered at one of the major hospitals here, but am unsure if I am jumping from the frying pan into the fire ! During my LPN years I work resource, everything from step down ICU, ER, Onc, M/S, and PP. I have been an RN for 4 years and have stayed in high-risk PP, but as stated before, am ready for a change...any advice for someone wanting to make such a change?
Jan 22, '06It was 6 years before I left. It was a scary move, as you know O.R. nursing is so different from other Nursing Fields. All my O.R. buddies that have left all feel it is an abusive environment. Not to mention very sinful at times. Anyway I was someone I did not want to be in there.
I have been away from it now for four years, and I do miss the comfort level I had , but do not regret leaving. Life is too short to be yelled at, hit, sexually harrassed, and made to feel like an idiot. Most O.R. Nurses will deny these things I mention but we all know it happens.
Anyway, I'm not saying what is right or wrong for you. Just know if you are going home to your husband saying "I don't want to hear it, I've listened to it all day from the surgeons" then you and your family are suffering the effects of O.R. Nursing.
Jan 22, '06i sooooo understand,
at my former hospital there were those appallingly bad days when the do do really hit the fan. the case doesn't start on time, the circulator is still scrambling for missing equipment; the metz don't cut; the pick ups don't pick up, plus we have just run out of xyz again! the nurse management committee is seriously working on eliminating the only decent, functional skin stapler, because it cost a tad more than the useless piece of garbage that just got hurled at you at the culmination of a very stressful case. yep it was on days like that when my surgeon would glare at me and in a clipped tone that barely stifled his hostility, or his utter contempt for all lower forms of life, he would sarcastically blurt out:
"i wonder what it's like at the second best hospital in america."
sorry to disillusion you folks but the mind numbing frustration and dysfunctional behavior extends to the nation's very best institutions!
hang in there,
fair winds & following seas, tsunami kim
Jan 24, '06I worked in an OR for 24 years in a small town. I love OR nursing but I began to hate my job. Over the last 10 years there I had applied for other jobs in the same hospital thinking I would like them. After doing OR for that many years, nothing else really appealed to me. It wasn't so much OR nursing that I didn't like, it was the people I worked with and recurrent situations I found myself in. 1 1/2 years ago I quit my job and began travel nursing. I took a 4 week leave of absence to try it first since I was too big a chicken to just go. :chuckle It was great. We were always told "you won't ever find it as good as you have it here" "The grass isn't always greener on the other side"
Well, I have worked in several other OR's and found that I still love OR nursing and I have had a great time at each one. They are all different and each have their own set of problems but as a traveler, they are not my problems. I feel for those going through them and try to help as I can but it doesn't affect me. I enjoy going to work. There are no political agendas that make any difference for the 13 weeks or more I am there.
I often stay longer than what was originally agreed upon as I make great friends learn new things. I have gone as far away as Hawaii (from PA) and as close to home as 4 hours away. I often work 3 12's in a row and come home for long weekends. I make more money and have more time off and am much more relaxed. The stress level is so much better!
My children are grown and my husband is great about it. He has good health benefits so I don't even have to worry about that, though most agencies provide it. It is not the answer for all but as they say sometimes a "change is gonna do you good".
Best of luck to you.