Etiquette in the OR?

anonrn0369 · Feb 13, 2015

I am an OR nurse and let me tell you, it is not for everyone. I have experience being a "real nurse" in ICU and Psych. The stresses endured by an OR nurse are very different from the stresses of an ICU nurse. For example, leaving a shift from ICU, a nurse might think to him or herself, "Is there something I could have done differently that would have prevented my patient from dying tonight?" A nurse leaving the OR after a shift might think, "Is there something I could have done differently that would have prevented that surgeon from calling me a ******* retard in front of the whole room because I had a blue sitting stool for him instead of his favorite green one?"

I'm not complaining about my job. I'm grateful to go home without an aching back, without smelling like poo, and without the mental exhaustion of answering a patient's family's questions like, "If she's having a seizure in her brain, why is her arm twitching? The brain and the arm are in different places!" (Yeah, that happened.) That being said, the psychological pressures of working in the OR are INTENSE.

You get zero satisfaction from direct patient care. You don't get to see people get better. You don't form bonds with patients. Since we don't form any relationship with the patient, we don't get together and quietly giggle about what cutely ridiculous question a patient asked when we were rounding, or what the heck a patient's crazy aunt was wearing when she came to visit. So, that leaves two choices for common topics of discussion: 1. Talk about the personal lives, actions, or rumors of our co-workers (particularly those that are not in the room). 2. Talk about the patient.

Some OR staff members are jerks and say mean things all the time. Some OR staff members are nice and tell a pleasant story about what a patient said in the 30 seconds we are allotted to make small talk on the way to the operating room.

The OR is an odd and dysfunctional family. There are many strong personalities enclosed in a tiny room with no windows for hours on end. I can understand how we look like turds to an outsider at times, but it's mostly a matter or boredom and insecurity on our part. Gossip and snarkiness are everywhere in nursing, but they are magnified in the OR because we don't have to be on our best behavior in front of patients who are interacting with us. A floor nurse might say "Bless your heart," where an OR nurse would say, "You're an idiot." Or, for example, a floor nurse might say that a someone is "NOT a small person," (like you did, remember?) where an OR nurse would say that someone is "fat." It's the same thing.

I guess my point is: The OR is a weird environment with very strange dynamics. We deal with a completely different kind of stress than "real nurses" and it's taken me a long time to understand why we act the way we act. If you don't like it, don't work there. But don't judge us :)

subee, MSN, CRNA · Feb 13, 2015

I am an OR nurse and let me tell you, it is not for everyone. I have experience being a "real nurse" in ICU and Psych. The stresses endured by an OR nurse are very different from the stresses of an ICU nurse. For example, leaving a shift from ICU, a nurse might think to him or herself, "Is there something I could have done differently that would have prevented my patient from dying tonight?" A nurse leaving the OR after a shift might think, "Is there something I could have done differently that would have prevented that surgeon from calling me a f&%*ing retard in front of the whole room because I had a blue sitting stool for him instead of his favorite green one?"
I'm not complaining about my job. I'm grateful to go home without an aching back, without smelling like poo, and without the mental exhaustion of answering a patient's family's questions like, "If she's having a seizure in her brain, why is her arm twitching? The brain and the arm are in different places!" (Yeah, that happened.) That being said, the psychological pressures of working in the OR are INTENSE.
You get zero satisfaction from direct patient care. You don't get to see people get better. You don't form bonds with patients. Since we don't form any relationship with the patient, we don't get together and quietly giggle about what cutely ridiculous question a patient asked when we were rounding, or what the heck a patient's crazy aunt was wearing when she came to visit. So, that leaves two choices for common topics of discussion: 1. Talk about the personal lives, actions, or rumors of our co-workers (particularly those that are not in the room). 2. Talk about the patient.
Some OR staff members are jerks and say mean things all the time. Some OR staff members are nice and tell a pleasant story about what a patient said in the 30 seconds we are allotted to make small talk on the way to the operating room.
The OR is an odd and dysfunctional family. There are many strong personalities enclosed in a tiny room with no windows for hours on end. I can understand how we look like turds to an outsider at times, but it's mostly a matter or boredom and insecurity on our part. Gossip and snarkiness are everywhere in nursing, but they are magnified in the OR because we don't have to be on our best behavior in front of patients who are interacting with us. A floor nurse might say "Bless your heart," where an OR nurse would say, "You're an idiot." Or, for example, a floor nurse might say that a someone is "NOT a small person," (like you did, remember?) where an OR nurse would say that someone is "fat." It's the same thing.
I guess my point is: The OR is a weird environment with very strange dynamics. We deal with a completely different kind of stress than "real nurses" and it's taken me a long time to understand why we act the way we act. If you don't like it, don't work there. But don't judge us :)

Right,so right, about the OR being so dysfunctional. You're trapped in a room with people you may not like ALL DAY...and there are no windows, poor temperature control and no escape! In another venue, this would be a toxic environment, but it's just what we do day to day. Things are getting better since I have actually experienced surgeons being docked block time for poor behavior. Very different than 40 years ago when I started. A friend (who eventually became a public health nurse) had a surgeon throw a spleen on her brand new Clinics.

FurBabyMom, MSN, RN · Feb 14, 2015

I am an OR nurse and let me tell you, it is not for everyone. I have experience being a "real nurse" in ICU and Psych. The stresses endured by an OR nurse are very different from the stresses of an ICU nurse. For example, leaving a shift from ICU, a nurse might think to him or herself, "Is there something I could have done differently that would have prevented my patient from dying tonight?" A nurse leaving the OR after a shift might think, "Is there something I could have done differently that would have prevented that surgeon from calling me a ******* retard in front of the whole room because I had a blue sitting stool for him instead of his favorite green one?"
I'm not complaining about my job. I'm grateful to go home without an aching back, without smelling like poo, and without the mental exhaustion of answering a patient's family's questions like, "If she's having a seizure in her brain, why is her arm twitching? The brain and the arm are in different places!" (Yeah, that happened.) That being said, the psychological pressures of working in the OR are INTENSE.
You get zero satisfaction from direct patient care. You don't get to see people get better. You don't form bonds with patients. Since we don't form any relationship with the patient, we don't get together and quietly giggle about what cutely ridiculous question a patient asked when we were rounding, or what the heck a patient's crazy aunt was wearing when she came to visit. So, that leaves two choices for common topics of discussion: 1. Talk about the personal lives, actions, or rumors of our co-workers (particularly those that are not in the room). 2. Talk about the patient.
Some OR staff members are jerks and say mean things all the time. Some OR staff members are nice and tell a pleasant story about what a patient said in the 30 seconds we are allotted to make small talk on the way to the operating room.
The OR is an odd and dysfunctional family. There are many strong personalities enclosed in a tiny room with no windows for hours on end. I can understand how we look like turds to an outsider at times, but it's mostly a matter or boredom and insecurity on our part. Gossip and snarkiness are everywhere in nursing, but they are magnified in the OR because we don't have to be on our best behavior in front of patients who are interacting with us. A floor nurse might say "Bless your heart," where an OR nurse would say, "You're an idiot." Or, for example, a floor nurse might say that a someone is "NOT a small person," (like you did, remember?) where an OR nurse would say that someone is "fat." It's the same thing.
I guess my point is: The OR is a weird environment with very strange dynamics. We deal with a completely different kind of stress than "real nurses" and it's taken me a long time to understand why we act the way we act. If you don't like it, don't work there. But don't judge us :)

I am an OR nurse. I like to think I don't make comments about patients and their size (or any other number of positioning challenges) in front of them at all. I like to think it only happens when I'm just with coworkers and venting...but I am human and probably have made some mistake at some point in time.

Most of the conversations I seem to remember about patients and size generally have to do with the safety of the patient and the staff. Some of the ways we position patients we have to be very careful not to hurt them or ourselves in the process. Sometimes we have to think outside the box. We generally don't have those conversations until the patient has been put under anesthesia and intubated. Of course there is a potential for awareness under anesthesia, but the fact is - discussing the next move from a safety perspective is not the same a "picking on" a patient. We have the same types of discussions when we have smaller sized people or even children. If we can't keep our patients safe we are not doing our jobs and if we can't keep ourselves safe we also cannot by definition do our jobs.

I will agree that the OR can be slightly dysfunctional. I think the amount of that behavior that is tolerated is 100% determined by the facility as well as staff in the room (circulating and scrubbing staff, residents/PAs, residents/CRNA and attendings (surgery/anesthesia) - everyone). However, I can only speak for where I am assigned. I work in a pretty forward thinking OR and hospital system really don't tolerate much poor behavior from anyone related to the fact they have a specific credential.

I told an attending surgeon off recentlyt (tactfully). They were scrubbing for their first case, my first patient was not yet under anesthesia and they were loudly (ie yelling) recounting a vile story in the substerile. I walked out into the substerile, and informed them, nicely, that my patient was not under anesthesia yet, and could they please try to keep the noise down. They glared at me, even said something to my boss, but I wasn't wrong.

I work a great group of surgeons. I would let any of the attendings I work with regularly take care of me (some of the residents too). I hope like heck I never need their services, but if it happens, I would let them take care of me. They all pretty much always treat the OR staff well, and all have good interactions with patients when I observe them. Even the most asinine comments or issues from patients, they handle them expertly. The surgeons I work with day in and day out would never call me names (okay they would, but our working relationship is that I'd know they were joking - and they would be).

We spend nearly all of our time in very serious situations. The facility I work in (and specifically my service line) does things no other place does but that is the nature of an academic medical center. More time than I care to imagine, our actions or inactions, our ability to handle 17,501 things at once can literally mean whether a patient lives or dies. There is no such thing as a routine procedure, quite literally anything could happen.

Most of the time, my coworkers and I joke, even about a lot of things. Our lives, my coworkers' kids, the surgeons tell us stories about their kids and/or their lives. We discuss sports, we discuss some current events. We discuss things that happened in the past (generally not patient related - usually it's so and so made thus and such comment). Rarely is the conversation anywhere remotely related to patients. We have sayings, we have inside jokes.

Another poster mentioned we don't get a lot of personal or professional satisfaction from our interactions with patients. We don't. I see most of my patients fro 5 minutes awake before the OR. It's not like when I worked stepdown and saw patients for 5+ days. It's both a good and bad thing. It would be more emotionally draining for me to spend my time taking care of the HORRIBLE things I see in the OR (frequently our patients come to the OR after accidents, abuse and violence, and some come to the OR for answers and leave with a horrible cancer diagnosis) if I had an extensive relationship with my patients/their families. That stuff is easier to leave at work without the connection. But at the same time, you feel as bad or worse when you have a bad outcome in the OR than you did on the floor/stepdown. When I worked stepdown I felt like we tried everything in our power - we did and may still have lost a patient. In the OR - the resources are much greater, and it is that much more defeating when you have a patient with a bad outcome or death. You can do everything right with an emergency case, not lose anything, be 5 minutes from when the OR is notified to in the room, do everything right and that patient might still not make it through the following night. You can be asked to help in another room during a code if your room is out between cases. You can be part of that effort, lose that patient, and have to move RIGHT on to something else.

We also live this adjusted work schedule. We come to work, work our scheduled time, and go home, but that means our cases have to be done or we have to have relief. Sometimes that doesn't happen. It's not like when I worked stepdown/the floor, where we could increase everyone's patient load to send someone from another shift home. You can't be in more than one room at a time. Doesn't work like that. I have been stuck at work late/past my scheduled shift more times in the OR than I ever was on the floor/stepdown. I've been stuck late at work when I'm then on call the same night. I've been called back to work, been stuck at work, all kinds of things.

It's very hard to explain when you don't live it. I know it sounds like we are making excuses, but I'm really only trying to point out I see both sides, having done both kinds of nursing. I think what you experienced was poor behavior, but as it is not my behavior I can't change it nor can I accept accountability for it.

Anxious Patient · Feb 14, 2015

We generally don't have those conversations until the patient has been put under anesthesia and intubated. Of course there is a potential for awareness...

I'm curious. Isn't one of the reasons Versed is used so that the patient can't remember anything later?

FurBabyMom, MSN, RN · Feb 16, 2015

I'm curious. Isn't one of the reasons Versed is used so that the patient can't remember anything later?

Yes. But anesthesia is individual for each person. Not everyone can have the same drugs (allergies, contraindications, family history of/risk factors for MH), some procedures require specific types of anesthetic agents, etc. Agents are administered and titrated differently (inhalation vs IV and even among that different IV agents are given/titrated differently). What it might take to anesthetize you is probably not what it would take for me. And just because you give versed on call to the OR? Some people it doesn't have an effect on, and it may or may not last long enough. If your patient's procedure lasts hours? That pre-op versed isn't going to "cover" the entire OR time (considering versed peaks in 5-7 minutes with a duration of something like 20-30 minutes when given IV). Hopefully the anesthesia team maintains the patient "deep" enough that they have no remembrance of anything. But awareness under anesthesia happens.

cmj806 · Feb 16, 2015

I work in the OR as a surgical technologist, and I am currently a nursing student. The stress of working in an OR, and because the crew is tight knit does not make it ok to make fun of patients! You as an OR nurse and me as the surgical technologist, it is our job to be an advocate for the patient. I speak up when I hear it happening in the rooms I am assigned to. Anyone that makes fun of a patient while they are laying on an OR table, naked and vulnerable with a tube down their throats is not only unprofessional but overall not a nice human being. My sister is overweight and she was made fun of on while she was walking dow the hall to the OR to get her C section by 4 of the members of her OR team. She heard them, and not only did they ruin was supposed to an amazing day, they made her distrust her surgical team and she became fearful of them. I was with her and she begged me make sure they didn't touch her. You can bet I started yelling for a charge nurse and her team was changed, I got a surgical technologist, a nurse, a CRNA and a resident reprimanded. It is not right to make fun of a patient PERIOD!

sop832 · Feb 19, 2015

Every time I have a heavy/ obese patient, and someone has a snotty comment about the patient's weight, I always ask if they would say the same thing about me. There is no correct answer to that question. If the answer is no, then they can't talk about the patient that way. If the answer is yes, then "Go **** yourselves"

Anxious Patient · Feb 19, 2015

As a patient, I found this article surprising, actually it's an editorial. Has anyone here experienced this kind of conduct in the operating room?

Editor's Page: Sexual Predators in the OR > Outpatient Surgery Magazine > February, 2015

middleager · Feb 19, 2015

I find the comment "If you don't like it don't work here, but don't judge us" to be a bit self serving or perhaps dismissive. People are judged every day. We all judge people and their actions daily. When you sit down at a table for dinner at a nice restaurant, you don't judge just the quality of the food, you judge how the people involved did their job and not just the mechanics of getting it to the table. Did they acknowledge you quickly, did they smile, were they friendly, courteous. You don't bother finding out did they have a bad day, is there stress in the home, did 2 people call off and they are short handed, is their boss a jerk, are they missing their kids birthday party to be there...you judge them on their actions and how they present themselves. That goes from the finest restaurant to the kid making min. wage at McD's. Ever get a kid behind the counter that acted like he didn't care if you were there or not, that talked to his/her friends while waiting on you? Did you ever judge them, their behavior? That goes in nearly every occupation, every job, if you took your car for an oil change and heard the mechanics laughing at some "fat ass woman" pumping gas would you think that was OK as long as she couldn't hear them? No where are people required to put more trust than in health care providers...shouldn't you hold yourself to a higher standard than the teen age kid at McD's...he has stress to.

GadgetRN71, ASN, RN · Mar 20, 2015

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.

I am going to respectlfully say that I think this is a generalization. I have been fortunate to work with nurses, techs and anesthesia providers who truly care about their patients. On the rare occasion where someone made an inappropriate, mean spirited comment, they were disciplined for doing so.

My humanity doesn't cease once that patient is asleep. if anything, it increases, because the patient is helpless. And, I've noticed far more nurses outside of the OR being insensitive to patients. We had a transgender patient a few years ago and the non-OR nurses( pre-op, Pacu, and the floor nurse who gave report) refused to call the patient by their chosen gender, engaged in eye rolling in front of the patient, and made comments about the situation in a snarky tone. Contrast that with the OR, who made it a point to call the patient by their chosen gender identity, even while the patient was asleep. Or, who made it a point to protect the patient's privacy and modesty by covering the windows(pt request).

The example in the original post is the exception, not the rule.

GadgetRN71, ASN, RN · Mar 20, 2015

As a patient, I found this article surprising, actually it's an editorial. Has anyone here experienced this kind of conduct in the operating room?
Editor's Page: Sexual Predators in the OR > Outpatient Surgery Magazine > February, 2015

No, thank God. I suppose the one that may come closest is the one about the surgeon wanting the breasts exposed without need or reason. But, even in that case, the circulator and other staff shut that nonsense down quickly and reported it later.

The surgical tech with the cell phone needs a slap in the head and to be fired immediately.

Chicano nurse · Mar 22, 2015

For thirty years I have been told I would become like many before me...cold, uncaring, negative and callous. I won't lie to you many critical situations and deaths have made me a bit less buoyant in my cup half full outlook. But you were offended and it is appropriate and correct to take your concerns to the OR Manager. Some people talk about anything when the patients are under anesthesia.