burnout in the OR

[cindybeth]

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 plenty that makes me grind my teeth in my sleep and dread going to work the next day. I am sick of the arrogancy of surgeons, as well as the spinelessness of my peers (including anesthesia MDs). They say NOTHING when surgeons complain about minor things when the biggest screw-ups of the day should really be credited to the surgeon.

I am quite disappointed that things have worked out this way. At a loss for what to do. Have already cut hours to 3 days/week. Considering job changes, even career changes, but not sure what I would WANT to do. (Career changes take a lot of effort, you know?) Would appreciate any encouragement or suggestions. Thanks

[TsunamiKim]

In Answer to HRM672’s Questions:

Why not send in a relief person? This is a very good question. The strain on the OR’s over-stretched staffing is far greater at night and on weekends as the off-shifts are minimally covered to start with. This is where the dysfunctional system of “zero redundancy of personnel” is breaking down and causing the greatest problems. In many States a Nurse can be mandated to cover a complete second shift for a total of 16hours on the job. However, equally few US States insist upon the staff receiving even a single relief break, which is now becoming dangerous. XXXX

Documentation of unsafe staffing is the key to forcing Hospitals to address this issue, before more patients are placed in danger. Only through “Incident Report” documentation of the “danger to the patient” on occasions where someone is left stranded in Surgery for 12hours straight can we separate the true emergencies from the negligent abuse of one particularly inconsiderate Manager.

The obligation is for a Manager to insure that her staff are functioning safely and order them to break scrub when they can no longer be expected to do so. That Charge person should have to justify why no relief was sent into an OR to break someone out after 8, 10 or 12 hours of continuous standing at the field without a break. If there is no legitimate reason for an abandonment incident like this and these incidents happen repeatedly then the person responsible should face discipline.

On your second point:

Please don’t get me wrong about the OR, it is a fascinating clinical area in which to work and I still want to return to my job in Surgery. However, frustrations lead to volatile and abusive outbursts when systemic problems are not dealt with and when staff become unnecessarily fatigued through unreasonable work demands. Surgeons can be very intense and demanding people to work alongside. They can also be hedonistic, arrogant and downright rude, but we must remember that we are assisting them while they are engaged in some very challenging procedures. My best advice is to take note of the minor frustrations that tend to precipitate an outburst and try to eliminate them.

After I had been at my former Hospital for less than a year a Surgeon I had the greatest respect for made me the target of a humiliating outburst. It was not about whether he had the right to criticize my performance; it was doing so in such a rude and demonstrative way, in front of half a dozen coworkers! I wrote him a letter expressing my concerns, but then tormented over handing it to him. One of the Anesthesiologists read the letter and said how it expressed the collective concerns of so many of us in the OR regarding most of our Surgeons. She asked me if she could show it to her boss. I didn’t quite realize that her boss had just been appointed Dean. I agreed as long as all of the names were removed. I did not intend to target this one Surgeon as the worst offender, as he really wasn’t. “The letter” took on a life of its own going from rookie OR Tech to the new Dean in one leap. I hoped that my letter would “shake a few trees;” now it seemed like it might Napalm the forest!

The Dean called a meeting of all his chiefs of Surgery and they were all instructed to read “the letter.” He said this kind of behavior has to stop and it has to stop now. The then Head of Surgical Nursing delivered a copy of the letter to the Surgeon who had lambasted me during an OR case; a meeting took place half an hour latter. He apologized for his behavior and told me of his frustrations. I felt truly committed to eliminating those frustrations if I could. I also met with the Chief of Surgery in the days that followed; at one point he made a startling admission that in hindsight made a lot of sense. He said: “often, when we raise our voice and yell at OR staff it is not because of anything that they have done, but we have reached a particularly crucial point in the case and things might not be going so well so we become angry and loud.” Not his exact words, but you get the drift; we might very rarely be the source of frustration although we are frequently the recipient of a rude outburst.

In the coming weeks I was pleasantly surprised to see that a new initiative got underway and I was really impressed by such positive action. Fellow staff members warned me that, “nothing ever changes around here,” but I remained optimistic that this time it would be different. Six new separate interdisciplinary OR comities agreed to meet once a week and these meetings lasted for several months. The objective was to create “A Perfect Day in the OR’ and we were asked to address all of those debilitating frustrations that bothered us and try to come up with suggested solutions.

Between all six committees we produced a one inch thick binder brimming with information, potential problems and positive suggestions. An “OR Retreat” was organized at Baltimore’s Inner Harbor and several hundred OR employees from all disciplines and specialties gave up Saturday afternoon to attend unpaid. I was thrilled to be there, knowing my efforts had provided the catalyst for this positive initiative. It was my birthday and this was the best present I could have received.

Unfortunately, very shortly after that the Hospital’s reform agenda to create a better work environment was abandoned. The situation deteriorated rapidly as core priorities changed in favor of staff cut-backs to lower costs. The Head of Surgical Nursing left and her replacement was not even seen in the Surgical suites for the first eight months. The drastic policy changes to force the higher paid tenure Nurses to leave were unpopular enough to precipitate a “Nursing Exodus” from our Hospital. My efforts to bring Management’s attention to this issue by suggesting Nurse retention measures were not welcome; I was told: “this happens every once in a while.” All of the identified problems causing such frustration in our historic old OR were conveniently swept under the rug.

The “Perfect Day in the OR” became an elaborate wall exhibit to delude JACHO on one of their meticulously choreographed scheduled visits. The OR employees paid for that con with their personal time and dedication; quite understandably they felt used. Jaded and disillusioned staff were now far less likely to come forward in the future realizing how futile their input has been. The agenda was corporate profits above patient safety or a tolerable working environment; nothing changed except for the worse. The OR continued to hemorrhage Nursing staff and then rush new Nurse Grads through orientation as swiftly as possible; many were dangerously ill-equipped to take on their responsibilities. The “OR Retreat?” We had received our futile positive action session, been allowed to vent, now we were supposed to return to the same stagnant mindset as before: “don’t rock the boat.”

The multiple minor frustrations remained as the layout of our vintage OR required creative solutions that Management was not interested in accommodating. Managers are rarely in the OR when the dysfunctional skin stapler gets hurled across the room, so why not purchase the cheaper model? Cost-cutting, especially in the area of negligent under-staffing, only exacerbates the difficult frustrations we face in Surgery. “The letter” earned me a letter of commendation from the Dean. Eventually my outspoken behavior was no longer acceptable to new Management; in the end I was targeted for removal and fired as a tragic consequence of reporting under-staffing in the OR.

Fatigued staff vent, intolerance reigns and tempers flair: this is the OR at its worst. Surgery can be very stressful even when things seem to be proceeding perfectly; the source of anger might be an unconscious patient, but the recipient of wrath is often the Nursing staff. Not fair, but try not to take it too personally, sometimes the Surgeon will humbly apologize after the case. Pay attention to staffing needs, try to eliminate fatigue and unnecessary minor frustrations and you will work in the most intriguing and rewarding area of the Hospital doing the most incredibly fulfilling job.

I hope this helps, Tsunami Kim.

[HRM672]

TsunamiKim,

Thank you for your very thoughtful reply. It does help, and I appreciate the time you took to explain everything. I'm sorry that youu had that experience, but I appreciate you sharing it.