Etiquette in the OR?

[trauma_lama]

Hey nurses! I was wondering...I had the opportunity to go down the OR with my pt last week (I'm a NS). This pt was very sweet and easy tempered...in preop, the surgeon, anesthesiologist, CRNA and circulating nurse all came by at one point to introduce their self to the pt. They were all very sweet to her, smiling, taking her hand, etc. Fast forward 15 minutes- she's in the OR but not yet on the operating table and had just "gotten gassed."

It was like a switch had been flipped. This pt was by no means a small person, in the 260 range. As soon as her gown is off, everyone in the room makes at least one comment like "Damn, that's one big girl" and "Man, why do we always get the big ol' ones in here" and "everyone we've had in here is huge today, we can't catch a break!" At one point pre-procedure the surgeon even manipulated her large abdomen and said "wow!" when is rebounded dramatically. And no, the procedure was not abdominal-related in the slightest. Irrelevant side note; at least two of the people in that room were NOT small people their selves, but I guess when you're wearing big baggy surg scrubs it's pretty easy to pick on someone who is so vulnerable and naked and unconscious and spread out in front of you under bright lights...

I've had other experiences with surgery, but only ambulatory stuff- no surgeries as major as this before. So the music and the joking were no shock to me. It was just the cold insensitivity to the pt that really was like a slap in the face.

Aside from the fact that some pts have reported recalling hearing things from the OR and the whole situation being a potential liability, it just seemed overall mean-spirited and nasty. It made me ill to flash back to 20 minutes before to when the surgeon was holding her hand and smiling and telling her how committed they were to doing a great job or 5 minutes before when the CRNA had her hand gently on the pts hair, telling her soothing things in a soft voice. Like how very incredibly two-faced! Sure, I've been nice to a pt who was giving me a really hard time and then gone to the nurses station and ranted briefly, but this lady was nothing but smiles and sweetness to the staff the whole time she was there.

I get that she's a big lady, I get that it probably really is a pain the orifice to have to move such a large person onto the operating table, I get that she is "out" while these things are being said. But it still seemed really nasty and just unnecessary. Yes, she is a big lady but if it's obvious enough that everyone in the room feels the need to comment on it, is there really a need to say anything at all unless it is directly related to safely transferring the pt onto the operating table?

Maybe I'm just naive. Maybe I still have rainbows shooting out of my butt since I'm just a green student. But it seemed crappy and inappropriate to me. Of course I didn't dare say anything since I was below the lowest on the totem pole in there... Have any of you seen things like this? Am I silly to be bothered by it, like do I just need to toughen up? I'm pretty sure OR is the right place for me but I don't know about it if I'm going to have to end up seeing stuff like that happen every dang day. My pt was a person, a lady, and I feel she deserved more respect than that whether she was conscious or not.

Y'all's thoughts? Thanks a lot, hope you're all well :heartbeat

[imintrouble, BSN, RN]

I witnessed the same thing as a nursing student observing a lap chole. I was shocked at the surgeons comments about the woman's size, calling her a "fat *****" I won't ever forget it.

Several years ago I had a breast biopsy. I cringe when I think of what they said about me.

[Guttercat, ASN, RN]

There's a reason many OR peeps choose OR. IME, they're more fascinated with the science of poking around on a slab of meat than they are comfortable with the relational and human-side of the equation.

Once the patient is out, the humanity ceases and they might as well be digging around in a car's engine compartment performing a head gasket replacement.

There are fine, compassionate surgeons out there. IMHO, the surgeon sets the tone, and there are plenty of OR theaters where no one in attendance dare make disparaging and inhumane comments about the unconscious person on the table.

[nerdtonurse?, BSN, RN]

You will see this kind of behavior off and on as long as you are a nurse. We've had people who were 500...600...and even a couple of 700 pounders. Our lifts stop at 400. We do not have the equipment to perform diagnostics on these folks (325 is our CT's limit, and even then, you don't get a good scan). We can't perform surgery on anyone over 375 (table won't hold them). We have to order special beds, and it takes everyone in the unit and people from surrounding floors to leave their patients just to turn the person enough to clean up a BM. Forget wedges, pillows, and turning beyond just a little, because most of these folks if you turn them up on their side, you cause shear injuries on the "up" side folds and compression injuries to the "down" side areas, and then they can't breathe and start turning purple. They usually end up going on a vent --> trach'd --> dying from sepsis/MODS/SIRS. Not to mention I've seen over a dozen nurses get put out of work trying to help these people, nurses going out with everything from a slipped disc (you could actually see the deformation as we were trying to get her on a gurney while she cried in pain, we thought she'd snapped her spine), to a dislocated wrist because the patient threw himself back, popping her wrist like you'd dismember a chicken. Imagine this person being on your floor for weeks and weeks because there's no open bariatric bed in any of the local NHs...every time you come to work, you're going to know you'll go home in pain.

No, it's not right, but my back can understand it.

[trauma_lama, BSN]

I totally get the sentiment, nerdtonurse...it's absolutely frustrating to risk injury to your own body while trying to fix someone else's... it just seems to fly in the face of the "no judgment" principle so central to nursing. I mean, if you're gonna talk about me nasty when I'm not there, please just go ahead and do it in front of me so I can at least defend myself or explain myself, you know? If you think a pt is a lazy sumb*tch, don't smile in their face and hold their hand like you genuinely care about their concerns and fears and health and then trash talk them the second they're out. It just seems crappy. And not that it really makes a difference, but this lady was mid 200s- not all that different from MANY of the pts we see every day in tele and med surg (and I'm sure other units that I don't yet have experience with). Like I can see the frustration, but at the end of the day it just seems unacceptable to trash talk a pt for being big, herniated disk or not.

[giveface]

I just don't think anyone goes into nursing looking forward to doing physical transfers, let alone when it is for a POS. I work with an RN that literally must be around 350-400 Lbs. She has DM and bad knees (besides a bad attitude). She knows she has a weight problem (not in denial about it). Shift after shift she is the one who manages to get organized to order in delivery to the unit when everyone else is still running to feed our patients. Just sayin'.

[trauma_lama, BSN]

I just don't think anyone goes into nursing looking forward to doing physical transfers, let alone when it is for a POS. I work with an RN that literally must be around 350-400 Lbs. She has DM and bad knees (besides a bad attitude). She knows she has a weight problem (not in denial about it). Shift after shift she is the one who manages to get organized to order in delivery to the unit when everyone else is still running to feed our patients. Just sayin'.

Okay don't call me stupid- is POS "person of size"?

[Guttercat, ASN, RN]

Okay don't call me stupid- is POS "person of size"?

Must be. Thanks for clarifying the POS reference with a Q because I was all like what the ****?

:)

(we all know how the acronym POS is usually used...)

[VivaLasViejas, ASN, RN]

Okay don't call me stupid- is POS "person of size"?

Let us hope so.

[azcna]

it is reality. not that it is right, or an excuse... but .... the OR is extremely stressful, we are usually a close knit group.... and the patient is asleep. again, not that its right.... but beleive me, just because you havent heard it anywhere else YET, it happens in every area when the patient is not around. and in the OR... an intubated patient is "not around" so to speak....

I'm glad I don't work where you work :/

[subee, MSN, CRNA]

Shame on anesthesia allowing this kind of banter to happen in the room. You can never be sure that a patient is not experiencing awareness - believe that proposition and you'll do no harm. Yes, I will complain to the staff about my pack pain from lifting the heifers all day, but not with the patient in the room. Gotta vent!

[lockheart678]

I once had a 600 lb patient who was going to the OR for a vac change and the CRNA who was working with me repeatedly told me right in front of this patient that I needed to call the surgeons to come up and help us transfer her to the OR suite because she was not going to hurt her shoulder pushing that bed. Every time she said it, I told her I was calling them, but she just kept going. The patient never said a word, but I know she had to hear every bit of it. I wrote her up for it, but I shouldn't have had to. When someone gets to 600 lbs, I really don't think we need to constantly remind them that they're a huge burden on us and that we risk our own health every single time we have to lift them. They're the ones who have to live with it every single day, and they didn't get like that overnight. There are many times that I hear people comment about our morbidly obese patients, but in this patient's case, I was totally amazed at how professional our surgeons were. The only time this patient's weight was mentioned was when it pertained to us moving her and prepping her for surgery. Their only concern was the safety of the patient and all of the staff involved. They never once made a rude remark about her for being so big, with the exception of that CRNA.

[middleager]

While one understands everyone is human, when one expects a patient to place an incredible amount of trust in someones professionalism and compassion, the betrayal of that trust when they are most vulunerable seems wrong regardless. To make a mistake is human, to be human is expected, to justify it is not. When it comes to trust as in many things, to whom much is given, much is expected...