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

[giveface]

Yes POS refers to person of size.

[evolvingrn, BSN, RN]

That is completely inappropriate. I have an aquaintance who is a psychologist and she is treating someone who stayed awake throughout her entire surgery. The anestheiologist didn't believe her until she started telling them what was discussed word for word.....it does happen.

[Do-over, ASN, RN]

I also had a troubling experience with an OR staff person (I really don't know if she was a nurse or not) when I was in nursing school. All I thought was that I would never want to have surgery at that hospital. And, if I did, I would ask for a guarantee that this individual would NOT be present. She was awful, but fortunately was only present for one of the surgeries I attended.

The bright side? The attending surgeon noticed me in the corner observing, came over and introduced himself, asked me what school I was from, and stood with me for much of the procedure and explained everything in detail. It was a great experience.

On another note, I've had plenty of patients that probably could not hear me. BUT, my co-workers can... I try to be conscious of how I present myself to others. Not perfect, of course, who is. I think of it as I do swearing. I really try to control my mouth, even away from work, because these things become habits and will tend to slip out when you don't intend... Or when the patients (or families, or bosses, etc) CAN hear you.

[imintrouble, BSN, RN]

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...

:yelclap:

[sapphire18]

That is disgusting. Not acceptable under any circumstances...always assume the patient can hear you because 1) you can never be sure and 2) it's just plain respectful. This story just makes me so sad for not only the patient but the people doing this to her.

[giveface]

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.

I have to say, she raised a legitimate concern here (i.e., injuring [or from the sounds of it re-injuring] her shoulder), and you chose to write her up instead? Perhaps she said it one too many times, perhaps it was insensitive, but to me that is a valid objection and if my supervisor just overlooked my concern for my own physical safety there would be A LOT of questions to answer afterwards. You cannot just overlook someone's concern for their physical safety. Sorry.

[trauma_lama, BSN]

I have to say, she raised a legitimate concern here (i.e., injuring [or from the sounds of it re-injuring] her shoulder), and you chose to write her up instead? Perhaps she said it one too many times, perhaps it was insensitive, but to me that is a valid objection and if my supervisor just overlooked my concern for my own physical safety there would be A LOT of questions to answer afterwards. You cannot just overlook someone's concern for their physical safety. Sorry.

I totally get what you're saying, but it sounds to me like she had already said she would take care of it and there was no further need to mention the pt's size. Just how I read it maybe...

[aachavez]

I've seen this happen quite a few times and I don't like it either. It's more than gossiping, it's something more, another level entirely and I don't like it. I have a strong personality (re: a *****, if you like) and I call people on their crap. There's no excuse and no reason for it.

I had this patient once - a big, good-looking, strapping fireman who had come in for a scrotal mass. Well, he's out and I uncover him to shave/prep and turns out he's got a micro member. The tech turns around, see this and bursts out laughing, saying how she's going to 'tell everybody'. I was so p*ssed, I said that if I heard word one out of her mouth about it or that if I heard anyone else was talking about it, I would write her ass up so fast and take it as far up as I had to.

It's one thing to vent about the behavior of difficult patients, it's something else entirely to rag on a naked, vulnerable human being's body. Our bodies are so closely tied into our self-esteem and who we are, that it's something so beyond gossip. It's reprehensible. And should never be tolerated by anyone with a conscience. I find it especially disgusting that people were so kind to this patient prior to her being anesthetized. Shame on everyone who participated.

:yeah:

Im shocked at how unproffesionl these guys were... In the OR, when the patient is knocked out, I can understand some off color comments as a coping mechanism, or any other department for that matter. Dealing with death, dying, sickness, it's draining and having a sense of humor about it helps deal with the stresses of the day. BUT patients still deserve dignity even if they are unconscious! Being overweight and having hirsutism myself (PCOS) I'm mortified for myself and I wasnt even there! God I hope I never have surgery I'll be far to worried about what the techs are saying about me! Im self consious enough as it is!!!!

ARGHHH!!! Im just still in shock over reading how insensitive and unproffesional people can be. You can bet your tail that won't fly when I'm around.

[PureLifeRN]

And I hope you act like that to ANY nurse who talks about a patient in such a manner, even if they are in the break room or at the end of a shift. Coming from working on the floor, the OR nurses are a LOT better than some other areas in the hospital. Where I worked before, the nurses were much nastier when talking about the patients. And they had them all day and made comments about patient personalities, family members, personal hygiene habits, you name it. At least in the OR, you dont "know" the patients well enough to gossip about their particular personality traits.

All I'm trying to say is that if you are this upset about the situation in the OR, you better be just as upset if a floor/ICU/tele/home health/SNF nurse complains about her patients being overweight or annoying or anything. just sayin....

[aachavez]

And I hope you act like that to ANY nurse who talks about a patient in such a manner, even if they are in the break room or at the end of a shift. Coming from working on the floor, the OR nurses are a LOT better than some other areas in the hospital. Where I worked before, the nurses were much nastier when talking about the patients. And they had them all day and made comments about patient personalities, family members, personal hygiene habits, you name it. At least in the OR, you dont "know" the patients well enough to gossip about their particular personality traits.

All I'm trying to say is that if you are this upset about the situation in the OR, you better be just as upset if a floor/ICU/tele/home health/SNF nurse complains about her patients being overweight or annoying or anything. just sayin....

You said it! I know it can be incredibly frustrating, but patients are people, and deserve respect and dignity.

[ChristineAdrianaRN, BSN, RN]

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

WORD. Ick. :/

OP, I am right there with you. I am disgusted by what you encountered. It's one thing to be frustrated by a patient's weight - and yes, I've been there, as we all have - and I understand the need for special equipment and all that, but that does not sound at all like that's what this was. This was malice, plain and simple. Going up and shaking their belly?! Really?! Could not be more unprofessional.

I would have had no qualms about saying something if I witnessed something like that, but I can definitely see your hesitation being a student. I think you should go to the manager, though. That is something they want to hear. If nothing else, they don't want to hear that a potential future employee, or even a future patient or loved one of a future patient, would be turned off of the place because of their rude and unprofessional staff. It shouldn't happen ever, but its particularly sad that they should be good representations of their facility to someone visiting their department, such as yourself.

The only similar thing I've seen happen is that one of our anesthesiologists always used the acronym "FLK" or would talk about how ugly some of our kids are. Someone ended up reporting her for that. Management was not okay with it. So, I think you should say something. Chances are they will be shocked and embarassed by it.

Dignity is important. Maybe it's my floor nurse training, but in the OR I still cover up the patient when we're not working. Someone gave me a funny look for doing that one time, and all I said is, "Respect patient dignity." They were taken aback. But I've seen other OR nurses do the same thing. This sounds like a particularly bad place - take comfort in that we're not all like that.

"Treat others the way you want to be treated." We learned that one in kindergarten, people. Sad that some "professionals" are more immature than 6 year olds.

[trauma_lama, BSN]

WORD. Ick. :/OP, I am right there with you. I am disgusted by what you encountered. It's one thing to be frustrated by a patient's weight - and yes, I've been there, as we all have - and I understand the need for special equipment and all that, but that does not sound at all like that's what this was. This was malice, plain and simple. Going up and shaking their belly?! Really?! Could not be more unprofessional.I would have had no qualms about saying something if I witnessed something like that, but I can definitely see your hesitation being a student. I think you should go to the manager, though. That is something they want to hear. If nothing else, they don't want to hear that a potential future employee, or even a future patient or loved one of a future patient, would be turned off of the place because of their rude and unprofessional staff. It shouldn't happen ever, but its particularly sad that they should be good representations of their facility to someone visiting their department, such as yourself.The only similar thing I've seen happen is that one of our anesthesiologists always used the acronym "FLK" or would talk about how ugly some of our kids are. Someone ended up reporting her for that. Management was not okay with it. So, I think you should say something. Chances are they will be shocked and embarassed by it.Dignity is important. Maybe it's my floor nurse training, but in the OR I still cover up the patient when we're not working. Someone gave me a funny look for doing that one time, and all I said is, "Respect patient dignity." They were taken aback. But I've seen other OR nurses do the same thing. This sounds like a particularly bad place - take comfort in that we're not all like that."Treat others the way you want to be treated." We learned that one in kindergarten, people. Sad that some "professionals" are more immature than 6 year olds.

Hah! It never occurred to me that I could say something to a manager... Hmmm... Thanks for the idea!!

And ps your response is excellent. Patient dignity. So simple and so right on. No need for further words or explanation and can't be argued. Patient dignity. Yeah!