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

[MaudKennedy]

If it's just humor,why not share it with the patient?

[subee, MSN, CRNA]

Patient awareness should be assumed, especially these days when patients are being kept so light. This kind of talk is usually out of frustration, but the people who are doing it have to be held to higher standards than people on the street. We have no excuse to be so ignorant. Anesthesia should be admonishing staff to cut it out.

[MaudKennedy]

I agree. I woke up during my surgery and I remember perfectly what was said at the time. It happened to be nothing deragotory but I'd have heard exactly the same it had been insulting. I honestly don't understand why people who work in the OR feel so free to talk trash about someone they don't know just because said someone is supposed to not be able to hear them.

[TheMoonisMyLantern, ADN, LPN, RN]

Dignity and humanity aside, no one forced us into nursing. Taking care of those that are ill and sometimes fail to care for themselves os part of the job. A job that we're paid well for. If you can't behave in front of a patient for their dignity at least behave out of the fact that without that big fat person you're lifting on you wouldn't be cashing a paycheck.

[Trauma_Llama]

First of all I would be curious to know how many people in this thread that are so offended actually work in the OR, I am guessing not many. Yes the OR is different, no it is not always nice. Just remember as a student you are a visitor. A patients weight affects everything that we do, from the ability of anesthesia to intubate and ventilate to access to the surgical site and positioning. If someone is fat, we are going to say that, if someone is skin and bones we will say that too. It is just another factor we have to consider in taking care of our patients. Is that PC? Maybe not. Is it reality? Yes.

[MaudKennedy]

Why would the OR be different?? Except from the fact OR teams feel free to make disparaging comments about patients because they're asleep and are not supposed to be able to hear??

That's a thing to say someone's fat/skiny while positionning or intubate and ventilate them because it affetcs what you do. That's another to comment their body like the size of member for men or the breasts for women for instance just for having a laugh at their expense when you would never say anything like that if the patients were awake. Both happen in the OR but that's just "humor" I guess.

[Trauma_Llama]

Why would the OR be different?? Except from the fact OR teams feel free to make disparaging comments about patients because they're asleep and are not supposed to be able to hear??

That's a thing to say someone's fat/skiny while positionning or intubate and ventilate them because it affetcs what you do. That's another to comment their body like the size of member for men or the breasts for women for instance just for having a laugh at their expense when you would never say anything like that if the patients were awake. Both happen in the OR but that's just "humor" I guess.

I have never heard anyone ever make a comment about the size of someones breasts (outside of reduction surgeries) or member, ever. We might be a little emotionally stunted but we aren't animals FFS.

[Rose_Queen, BSN, MSN, RN]

I have never heard anyone ever make a comment about the size of someones breasts (outside of reduction surgeries) or member, ever. We might be a little emotionally stunted but we aren't animals FFS.

I've heard some comments about breast size from my cardiac surgeons. "Her breasts are quite pendulous and are putting tension on the incision. Better use staples instead of absorbable suture for skin. Might need nylon sutures for retention too."

We definitely aren't animals, as you stated. I'm also curious as to how MaudKennedy "knows" what goes on in the OR when all posts indicate that the poster is a patient and not a healthcare professional. One experience does not translate into universal truth.

[MaudKennedy]

How can I know?? I don't know per se but when doctors and medical students admit it themselves,it'd be complicated to not believe it happens https://www.google.fr/url?sa=t&rct=j&q=&esrc=s&source=web&cd=7&ved=0CE8QFjAGahUKEwjln9O0_o3JAhVHWRoKHQ_zAEE&url=http%3A%2F%2Fwww.siumed.edu%2Foec%2Fempathy%2FMaking%2520Fun%2520of%2520Patients.pdf&usg=AFQjCNE4j8jTlelaViPPcGj4_JUGGNwC-w&sig2=h3gllvO9nggtTTtXL-pCkA&cad=rja or when stories like these are told

Читать "The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital" - Robbins Alexandra (EN) - Страница 53 - ЛитМир or Syracuse surgeon slapped sedated patients, called them insulting names, feds say | syracuse.com or http://www.nola.com/health/index.ssf/2015/06/trash-talking_anesthesiologist.html . I don't know how common it is,if you have to expect that kind of behavior every time you're under anesthesia but after reading some comments,it seems to be not as rare one would like to think.

I'm really glad that behavior isn't an universal truth,though!

[WhoDatWhoDare, BSN, RN]

How can I know?? I don't know per se but when doctors and medical students admit it themselves,it'd be complicated to not believe it happens https://www.google.fr/url?sa=t&rct=j&q=&esrc=s&source=web&cd=7&ved=0CE8QFjAGahUKEwjln9O0_o3JAhVHWRoKHQ_zAEE&url=http%3A%2F%2Fwww.siumed.edu%2Foec%2Fempathy%2FMaking%2520Fun%2520of%2520Patients.pdf&usg=AFQjCNE4j8jTlelaViPPcGj4_JUGGNwC-w&sig2=h3gllvO9nggtTTtXL-pCkA&cad=rja or when stories like these are told

Читать "The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital" - Robbins Alexandra (EN) - Страница 53 - ЛитМир or Syracuse surgeon slapped sedated patients, called them insulting names, feds say | syracuse.com or http://www.nola.com/health/index.ssf/2015/06/trash-talking_anesthesiologist.html . I don't know how common it is,if you have to expect that kind of behavior every time you're under anesthesia but after reading some comments,it seems to be not as rare one would like to think.

I'm really glad that behavior isn't an universal truth,though!

I hate to make overly broad generalizations, but in my experience in a couple different hospitals I have not seen a culture of nurses, ACPs, surgical technologists, and surgeons who participate in the behavior you state "to be not as rare as one would like to think." Everyone I work with are professionals. Please consider that there are literally MILLIONS of surgical procedures being performed across this nation yearly. I can't speculate how many times this despicable behavior might occur, but I believe the percentage that it might happen out of those millions of cases is very low.

I get that the behavior of a few can cast a bad light on the larger number of professionals who perform their tasks with care, compassion, and respect. Please consider that those who are part of the larger number of pros still take offense to being painted with such a broad brush.

thanks

[MaudKennedy]

I know and I'm sorry about that. Sadly,like always, courteous,respectful and compassionate professionals suffer from those so called professionals who take adavantage of the fact patients are asleep and not supposed to hear or remember,therefore there's no harm no fool.

Maybe the solution would be to record all surgeries,just audio to keep those despicable behaviors at bay?? Or allow a family member or a friend in the OR,to make sure everyone behaves like they're supposed to?

I don't know but something needs to be done about that. Surgeries are worrisome enough without adding nasty behaviors from fully grown up people who should know better. The fact most patients won't hear or remember those remarks doesn't matter. Those behaviors seem imply OR people who behaves that way have very little,if at all respect for their patients and that's a huge problem. If patients are unsure if they can trust OR doctors and nurses to respect them at all times,how can they trust them enough to seek care when an embarrasing problem arrises?

[sjs1957]

I was being transferred from the OR to the recovery room after a bilateral hydrocelectomy and one the people transporting me, a male (either an orderly, tech, or nurse, I don't know) without saying a single word just lifts up my covers and takes a peek. Can't imagine the need to be "re-checked" so soon since I was only out of the OR less than a minute. Nobody else had to take another peek the remaining hours in recovery. Seemed real pervy to me since they said absolutely nothing.