Etiquette in the OR?

[trauma_lama, BSN]

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

[NoviceRN10]

I had the same experience with the one surgery I got to observe when I was a nursing student. During the surgery the resident who was performing the lap chole made quite a few rude remarks about the pt's size and her problem with hirsutism. I have never seen anyone be so unprofessional.

[tokmom, BSN, RN]

When I did my surgery rotation a million years ago, I was lucky enough to see professionalism in the week long rotation I did.

The above comments are not appropriate and it's sad the OR crew can be so crude.

[babyNP., APRN]

Add to my list why I won't become a CRNA...I don't think I could deal with kind of bull all the time.

[PureLifeRN]

I am in no way saying what happened was ok, but you will get the same type of attitude no matter WHERE you work in nursing. On the floor, nurses will gossip about patients all day at the nurses station or in the lounge. OR people say stuff in the room. You will probably find yourself blabbing innappropriatly about a patient one stressful day. It's the nature of working with patients all day, every day. No it shouldnt happen, but unfortunately it does. I try to make it a habit to think of my patients always being able to hear me, no matter if they are asleep or not.

[RNOTODAY, BSN, RN]

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....

[MattNurse, MSN, RN]

I heard stuff like that in nursing school too, it was disappointing and still is disappointing when I hear it now. I wouldn't say you are green because you are a student, and you will not necessarily get the same attitude no matter WHERE you work in nursing (you may). For as long as I have been a nurse I just don't forget I am their advocate for their rights and dignity (among other things).

Woman gossip a lot, a sad truth I have found being the only male on my unit, the woman will gossip about the size of the males member, a patient's weight, if the female has facial hair, woman's breast size. I am sure some guys gossip too, I just don't think it is a big issue for us. It may sound sexist, but it is my experience.

Listen everyone reading this who wants to point their finger at me, I am not on a high horse here and I realize some people use gossip for whatever reason, it's human nature etc etc... so don't start typing wildly saying I must gossip because it is human nature.

As a student you can advocate for the patient's rights and tell the staff you think what they are saying is inappropriate, the only person you have to answer too is your nursing instructor at this point, and ask her what she/he would do in that position. You will see some nurses be nasty right to the patient's face. I here nurses all the time getting snippy with drug seekers and alcoholics and frequent flyers, I don't see how it helps anyone to be like that.

[babyNP., APRN]

I don't make fun of people's weight nor would I ever grab a sedated woman's abdomen and shake it around. That is just utterly disgusting and hitting below the belt.

[ORoxyO]

you happened to have a bad experience. don't let that deter you...it's not always like that. as an or nurse it is my job to make sure those things don't happen and sometimes i have to remind people what is inappropriate. but really it doesn't happen all that often. maybe the culture in the or you were in has just gone too far.

sometimes there are comments that have to do with a patient's size that may seem insensitive, but really they just have to do with the fact that there is a large patient. large patients require extra-long safety straps, special heavy duty beds, and sometimes longer instruments to reach far inside them. that's just a fact. it’s all about how you say these things that matters. if you become an or nurse, you can use your disgust of your observation day to influence the behavior of those in your or room. after all, you are your patient’s advocate whether they are awake or anesthetized.

[Anisettes, BSN, RN]

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.

[giveface]

Well, while I disagree with you in some respects (regarding your criticism of colleagues), the experience was yours, you were there in the room to feel the context in the air, and as you said this was a nice lady who didn't deserve that treatment. On the other hand, patients are getting bigger and bigger all the time, wondering why they have DM and are requiring a full bilateral knee arthroplasty at 42, and sometimes it is only human to think to yourself "Why am I breaking my 22BMI ass to move your 45BMI ass around?" Now there is professionalism to consider of course and this should never leave anyone's mouth unless in a sound proofed room away from patients. Basically, if your in an area where your nursing/medical board might catch wind of it do not say it out load is my opinion.

Now this is only MY opinion, no one has to agree with me. I won't take kindly to any self-righteous attacks.

[trauma_lama, BSN]

Thanks for all your replies. I definitely understand the whole "getting frustrated with giant pts" thing... I've even muttered to myself less than kind things when I've pulled muscles helping larger people who seem to have chosen the path to obesity...but never would I say it aloud in their physical presence. Good to hear I'm not offended just because I'm a newb. Keep em comin if you got stories or comments!