Be-littling CRNA's

CRNAdreamweaver2b · Dec 29, 2004

Bill,

Try to allow yourself to chalk this one up to human nature. There are nurses and other staff who see the CRNA position as one of "cush" with no true patient care (???). Nevermind the grueling education involved and the time spent with high-acuity patients in ICUs. On top of the perceived lack of work (excuse me, I need a minute to stop laughing) CRNA's are bestowed a "lavish" paycheck for it.

The human nature part...usually jealousy. I am in no way saying that CRNAs are deserving of that...its just the way it is sometimes. People who want more, but don't do more get annoyed with people who have more because they see a lack in themselves. It is then projected onto the "haver" (if you will) in an attempt to belittle the accomplishment and feel better about themselves. It happens in all areas and all parts of the lifespan. I know you know this...just try to remember it when you're dealing with your situation. Also, this type of behavior is very infectious. It should not be surprising to you that if the head nurses are acting this way, the techs will, too. Most of these people have little interactive exposure to CRNAs. (CRNAs are focusing during the case and running around otherwise). The other staff is only going to "know" what they hear from others.

Good luck. Sorry to hear of your situation, it is unfortunate. Try confronting the nurse on her behavior. It can make things a little uncomfortable (is that really different than now?) for a bit, but she will at least know that you won't put up with her and just complain about it to others. Worse-to-worse, perhaps you should look for work elsewhere to be in a more mature environment.

gaspassah · Dec 29, 2004

bill, you have too much respect for yourself to tolerate insolent behavior. i'm not saying you should fly off the handle, but being a professional approach the situation as a professional. pull the nurse aside and explain to her/him that you are a professional and that patient care is the most imp aspect of what you do, however you have other cases to start, ppl to preop, or breaks to give and that a short concise report and completion of charting will allow you to move on to the next patient more quickly.

also mention to the nurse that if she wouldnt treat a md that way she shouldnt treat you that way. i wouldnt start with the incident report, that's probably going a little too far too fast. start with the nurse in question, then the supervisor then incident report. i have found that if you intervene with the person directly that usually works. if not persue the other options. there have been several circulators and scrubs i've encountered as a student who think we just fell off the nurse iv wagon and went to work. i usually smile and make some retort veiled in humor that gets my point across.

lastly dont cower to their insults or assaults as this will only encourage future occurances, stand your ground and present yourself as a professional and that you expect to be treated as such.

my .02

d

CRNAMASTER · Dec 29, 2004

Ok guys, how is this for a scenerio. CRNA and circulator bring pt into PACU. Both start talking at the same time (all the while you are trying to hook up your pt) I don't care if he is stable awake or having a larngospasm as a courtesy you should offer to hook up or do it anyway. Most of you are ICU nurses well so am I but I put 8.5 years into PACU and I have seen most CRNA's do the same thing. They come in start talking before you even get them hooked up never offer to help (on a rare occasion) One even starts giving report when she rolls in the room no matter what is going on. I have learned a lot from working in a PACU and a lot of what I will not do. I had a premier CRNA that I have the most respect for she would help us and wait until we were ready to take report. I know and realize turn over time is essential but if a nurse is by herself accepting a pt help her after all you are still a nurse not an MD. I know there is alot of resentment out there but if you show a little respect so will they after all in the end we are all nurses. I am sorry you had a bad episode with that nurse but for the most part if you show and offer help even when they are asleep you will be surprised at the attitude change. If you guys spent a day as a PACU nurse you would see what I mean. Maybe our hospital is a rarity for this behavior but we need to work as a team after all we are there for our patients.

from a

former PACU nurse , future CRNA

TraumaNurse · Dec 29, 2004

CCRNMaster,

I'm not sure if you are a SRNA yet or not, but when you are standing on the other side of the fence, I think you will see that things are different once you enter into the realm of anesthesia. I hope I am wrong, but you will find that no matter what your background, how helpful you are, or how nice you try to be, you will be looked down upon and treated like crap!(Not by everyone, but a large percentage) We were told from the onset to be extra nice to the PACU nurses and lend an extra hand. It has gotten to the point where the SRNA is EXPECTEd to hook the patient up while the PACU RN stands at the foot of the bed waiting for report. They then find anything and everything that you may have missed or done wrong (in their opinion) so they can rip you apart. Even if things are perfect, you will not see many warm fuzzies as an SRNA. Being an SRNA can be stressful, but working with PACU RNs who purposely treat SRNAs like idiots makes it even worse.

I am still a critical care nurse but it seems as soon as you enter into anesthesia, other nurses look at you differently and feel the need to make your life miserable just because you chose to sacrifice 2.5 years to go back to school to further your career. I'm not sure if it is jealousy or powertripping, but it is real. The one thing we have all learned is to just accept it for what it is and let it roll off our backs. I no longer let them ruffle my feathers, but it still does not make it right.

MaleAPRN · Dec 29, 2004

Hi,

Sorry to hear about your experiences around PACU staff (particularly this one specific nurse) and OR ancillary staff. Even though I am currently an SRNA, I already am aware and have experienced this kind of attitude by other nurses in PACU and OR. One can only deduce from their attitudes towards anesthesia as either jealousy towards the fact, that they themselves can't be in your shoes, or at least wish they can be in your shoes but can't; or that they are just unhappy individuals and are burnt out at their current positions at your workplace.

Now, as far as the sarcastic RN in PACU is concerned (or for any sarcastic staff), this is how I would handle the situation if I were in your shoes (this is just me): After she or he gives me a sarcastic remark as you had mentioned in your post, I would calmly ask him/her aside and politely tell him/her, "Excuse me, but I did not appreciate that sarcastic remark you just made. Was there anything that I did that may have upset you?" Or, you can be a little more forward and say, "I'm sorry, but are you having a bad shift today? Because I don't think I deserved that sarcastic remark you just made."

I have diffused some situations in the past with the above remarks. It usually works and catches the person off guard. Especially if you say it with such calmness and without appearing to be on the attack. It lets the person see that you are aware that they are being sarcastic and that it offends you.

If they become super defensive and appear to be on the attack, make sure that you try and remember (especially if you know that you didn't provoke anything) what was said to you verbatim, and take it one step higher and write them up for unprofessional behavior in the workplace. This kind of sarcastic behavior from another colleague is unacceptable and can be deemed as a form of harrassment (it sure did me some good spending a few months as a healthcare manager).

Sometimes, you have to initiate action to try and stop this kind of behavior in the workplace, especially if it causes you stress just thinking about it. This kind of unprofessionalism by other nurses towards anesthesia will go on, unless it is brought to their manager's attention. As long as you are professional about it, and you know in your heart that you have done nothing to provoke this person's behavior towards you, then your complaint to him/her manager is warranted.

Now, if you do not wish to go about this approach, then another option would be to either ignore the behavior and put up with it for as long as you can, or one can easily tell you to just quit if you are very unhappy in this environment. It sounds harsh, but it's reality. I have been in the nursing profession for almost 10 years, and I have not worked in a perfect place. Granted, I have always worked well with others, despite whatever differences we may have or opinions we have about things...but it's because I have always remained professional and respectful of others. I have always asked my colleagues to be respectful of me whenever we worked together. This sets the stage early on, letting him/her know that, "hey, you may not like me because of such and such, but all I ask from you is for you to be able to work with me professionally and treat me with respect in front of others and most especially, our patients."

I hope my advice helps. Take from it what you can. Good luck.

skipaway · Dec 29, 2004

I have always tried to live under the "do unto others..." golden rule. That being said, I have noticed a few CRNAs in my dept. feel they deserve to be put up on a pedestal by other professionals ie.. the "high horse" attitude. I have called them on this behavior b/c it's very undignified to our profession. I am not saying that you project this particular behavoir, but some may see it where others do not. I agree with the above poster's good advice on dealing with this particular PACU nurse; however, put yourself in their shoes once in awhile and maybe help if they look like they need some. I make it a habit to help everyone, ie... getting suture for the RN if she's out, tying up surgeons gowns, cleaning up around my area if I've dropped stuff on the floor and especially, thanking everyone for a good job after each and every case. Good relations is two sided. Again, I don't know your situation, and I'm not saying that you don't do these things, but honestly check out your practice and if it needs an adjustment, do it.

Others address the issue of jealousy. It's a must to never, ever discuss salary, educational leave payments, time off etc... This is what generates this behavior.

rn29306 · Dec 29, 2004

TraumaNurse, are we in the same class?? Just joking, but your situation mirrors mine. I was going to write, but your post was much more eloquent. Why this is, I really don't know, but such is life. This particular instance is just another hurdle to jump through during school. Glad to know I am not the only one.....:)

forane2001 · Dec 29, 2004

I dont mind to help out but it really annoys me especially in the OR actions such as tieing everybody up and hanging irrigation and raising the bed or moving this or that. (Hello people, I have a job too. The BP is 60/49 but lets stop and tie up the scrub tech.)

I am sorry but guys CRNA's are not just nurses no matter how hard you want us to be. We are not in the same job. Just a hard fact. Most RNs can fathom the level of responsibility. Thats the way the boards of medicine, nursing and the courts see it. Wait till your sued the first time. See where the buck stops. Ask that PACU RN to come up and answer the deposition!!

Someone made the comment that we are not MD's (true but we deserve no less respect as anyone else.) I have never kissed up to an MD and never will. That is the problem with nursing and it always will be. If the ANA would stick together and not rip everyone Nurses in the US could write their own ticket.

Sorry for rambling.

I have always tried to live under the "do unto others..." golden rule. That being said, I have noticed a few CRNAs in my dept. feel they deserve to be put up on a pedestal by other professionals ie.. the "high horse" attitude. I have called them on this behavior b/c it's very undignified to our profession. I am not saying that you project this particular behavoir, but some may see it where others do not. I agree with the above poster's good advice on dealing with this particular PACU nurse; however, put yourself in their shoes once in awhile and maybe help if they look like they need some. I make it a habit to help everyone, ie... getting suture for the RN if she's out, tying up surgeons gowns, cleaning up around my area if I've dropped stuff on the floor and especially, thanking everyone for a good job after each and every case. Good relations is two sided. Again, I don't know your situation, and I'm not saying that you don't do these things, but honestly check out your practice and if it needs an adjustment, do it.
Others address the issue of jealousy. It's a must to never, ever discuss salary, educational leave payments, time off etc... This is what generates this behavior.

stevierae · Dec 30, 2004

Those circulators really think they run the OR and anesthesia.

OK, I have worked with both CRNAs and anesthesiologists for nearly 30 years. Before I was an OR nurse, I was a Vietnam era corpsman. Ive worked with awesome CRNAs and anesthesiologists and bad ones--just as you've worked with awesome OR nurses (and bad ones) awesome OR techs (and bad ones) and awesome PACU and ICU and L&D nurses (and bad ones.) Oh, and let's not forget the awesome (as well as bad) surgeons, RTs, pulmonologists, intensivists, ER docs, hospitalists, etc.

We're a TEAM in the OR, remember? I can work with anybody, and do, and I am pretty laid back---I know my job very well, and the one thing I get impatient with (although I do not show it) is people who are too intense and stressed out. These people do not belong in an OR--everything I have done, I've done 1000 times before, and will do 1000 times again---the majority of situations do not require all the intensity with which some people approach them--they need to relax and let some of the drama go by the wayside .

I DO my job, whether scrubbing or circulating, very well. I keep up with continuing education; I am ACLS certified, and have been for many years. I also teach IV nursing. I do not treat ANYONE with condescension, sarcasm or disrespect, and I expect the same, in return.

Remember that some of us have been doing this a while; that we've seen and helped handle airway emergencies that possibly you haven't encountered yet; have possibly done LOTS of trauma and weird on call cases in our day and might just possibly be a big asset to you if you encounter a drug, situation or emergency that possibly you have not encountered before--we may just be that extra pair of hands (and SHOULD be) when you need an IV or two started (pediatric or adult) whether it be a difficult peripheral or, if need be, an EJ; when you need us to ventilate the pediatric patient while YOU start the IV, if you prefer to do your own.

We MAY just be able to offer a suggestion that just might work when what you are doing ISN'T working--imagine that!--because we are EXPERIENCED, and we've BEEN there before. Some of us have worked all over the country with a variety of very skilled and very experienced anesthesia providers and surgeons--while some of you are just starting out. Why not benefit from our experience?

When I am the circulator, anesthesia knows they do not have to ask for anything--I am damned good at anticipating and at critical thinking, as well as LISTENING for any problems that may be occuring up at the head of the table, and there in a heartbeat to offer my assistance. Pretty much every CA OR nurse I have ever worked with is equally skilled. (I can't say the same for Oregon---Oregon operating room nurses--not all, but many-- seem to have trained differently, and have different views of how to set priorities--more than once I've seen circulators running aorund or out of the room or charting during induction--but that's another issue, and one of the reasons I won't work there anymore. The CRNAs I have worked with in Oregon were pretty much ALL phenomenal CRNAs--in fact, I have chosen CRNAs always when my family or I needed anesthesia in Oregon.)

We are pretty damned skilled at giving cricoid pressure (Selleck's maneuver) and there is really no need to call in an exta anesthesia provider to do this, or to set up and titrate drips, CVP lines, PA lines or art lines, or set up, pressurize, and hang and pump blood. Do you see where I'm coming from? Frankly, I find it somewhat insulting when an anesthesia provider feels a need to have an anesthesia tech or another anesthesia provider (or, worse, the surgeon or a surgical resident) come in to assist him with induction or any of these things--what does he think the circulator is there for?!

Just FYI--argue with this all you want, but it happens to be the truth--THE CIRCULATOR IS IN CHARGE OF THE ROOM. Don't believe me? Ask your OR supervisor, or an older anesthesia provider--better yet, ask AORN. We do not "run" anesthesia--they have their own departmental managers, and they are (except for Kaiser CRNAS in Oregon!) independent practitioners---we do expect them to know their jobs, just as we do. The majority of us don't have attitudes. Please do not lump us all together ("those circulators") because you have encountered a few bad apples who DO have attitudes.

forane2001 · Dec 30, 2004

Have any jobs open stevie ???

lol

OK, I have worked with both CRNAs and anesthesiologists for nearly 30 years. Before I was an OR nurse, I was a Vietnam era corpsman. Ive worked with awesome CRNAs and anesthesiologists and bad ones--just as you've worked with awesome OR nurses (and bad ones) awesome OR techs (and bad ones) and awesome PACU and ICU and L&D nurses (and bad ones.) Oh, and let's not forget the awesome (as well as bad) surgeons, RTs, pulmonologists, intensivists, ER docs, hospitalists, etc.
We're a TEAM in the OR, remember? I can work with anybody, and do, and I am pretty laid back---I know my job very well, and the one thing I get impatient with (although I do not show it) is people who are too intense and stressed out. These people do not belong in an OR--everything I have done, I've done 1000 times before, and will do 1000 times again---the majority of situations do not require all the intensity with which some people approach them--they need to relax and let some of the drama go by the wayside .
I DO my job, whether scrubbing or circulating, very well. I keep up with continuing education; I am ACLS certified, and have been for many years. I also teach IV nursing. I do not treat ANYONE with condescension, sarcasm or disrespect, and I expect the same, in return.
Remember that some of us have been doing this a while; that we've seen and helped handle airway emergencies that possibly you haven't encountered yet; have possibly done LOTS of trauma and weird on call cases in our day and might just possibly be a big asset to you if you encounter a drug, situation or emergency that possibly you have not encountered before--we may just be that extra pair of hands (and SHOULD be) when you need an IV or two started (pediatric or adult) whether it be a difficult peripheral or, if need be, an EJ; when you need us to ventilate the pediatric patient while YOU start the IV, if you prefer to do your own.
We MAY just be able to offer a suggestion that just might work when what you are doing ISN'T working--imagine that!--because we are EXPERIENCED, and we've BEEN there before. Some of us have worked all over the country with a variety of very skilled and very experienced anesthesia providers and surgeons--while some of you are just starting out. Why not benefit from our experience?
When I am the circulator, anesthesia knows they do not have to ask for anything--I am damned good at anticipating and at critical thinking, as well as LISTENING for any problems that may be occuring up at the head of the table, and there in a heartbeat to offer my assistance. Pretty much every CA OR nurse I have ever worked with is equally skilled. (I can't say the same for Oregon---Oregon operating room nurses--not all, but many-- seem to have trained differently, and have different views of how to set priorities--more than once I've seen circulators running aorund or out of the room or charting during induction--but that's another issue, and one of the reasons I won't work there anymore. The CRNAs I have worked with in Oregon were pretty much ALL phenomenal CRNAs--in fact, I have chosen CRNAs always when my family or I needed anesthesia in Oregon.)
We are pretty damned skilled at giving cricoid pressure (Selleck's maneuver) and there is really no need to call in an exta anesthesia provider to do this, or to set up and titrate drips, CVP lines, PA lines or art lines, or set up, pressurize, and hang and pump blood. Do you see where I'm coming from? Frankly, I find it somewhat insulting when an anesthesia provider feels a need to have an anesthesia tech or another anesthesia provider (or, worse, the surgeon or a surgical resident) come in to assist him with induction or any of these things--what does he think the circulator is there for?!
Just FYI--argue with this all you want, but it happens to be the truth--THE CIRCULATOR IS IN CHARGE OF THE ROOM. Don't believe me? Ask your OR supervisor, or an older anesthesia provider--better yet, ask AORN. We do not "run" anesthesia--they have their own departmental managers, and they are (except for Kaiser CRNAS in Oregon!) independent practitioners---we do expect them to know their jobs, just as we do. The majority of us don't have attitudes. Please do not lump us all together ("those circulators") because you have encountered a few bad apples who DO have attitudes.

jewelcutt · Dec 30, 2004

I think this is just another situation where one side doesn't see the other, both the PACU RN and SRNA/CRNA are busy and have certain responsibilities. Whenever there is overlap in care some people have more expectations. The way I look at it is when the patient gets into the OR we hook them up to the monitors, no one else and this is the way we prefer it. When we bring a patient to PACU, it's the nurse's territory and usually they have a routine or things they like done first. When I was an ICU nurse and admitted open hearts this was absolutely the truth, the CRNA was busy finishing paperwork and that was fine with me because I liked to get things set up and organized before report. I think maybe people underestimate the paperwork that needs to be completed, often while waking a patient to extubate you don't get to chart fora full 15-20 minutes, and being the anal organized people we are it's like a burning itch until the CHARTING is complete and right, HA!! :rotfl:. I have always also followed the do unto others rule, I'm pleasant to everyone. It really does bug me though when I'm nice to someone and they're mean back, it's uncalled for. Why can't everybody just get along??