burnout in the OR

hi, i just read your note, sorry your feeling so low. i have only just started my odp training. three weeks into it and i can understand your concerns..i have come out of a career in banking to do this, am i mad or what!! if you feel like letting it all out, just e-mail me..i cant give my tel number on this. hope you find your answers soon..stay sane!!lets swop some tales sometimes. it helps to chat to someone who understands and cares..all the best and good luck what ever you decide..tracey

Hi! Been there...done that...find a new job!!! I was in the same boat after 22 yrs at the same job. I thought I was burned out on nursing but took a chance at another facility before I went to Burger King!!! All I needed was a change of scenery...now I look good, feel good, life is good, and I love my job in the OR!

Originally posted by cindybeth:

I've been a nurse for six years, in the OR for five. When I first started, I LOVED it. I actually saw myself staying with it for twenty years. And there are still things that I like. But there is plenty that makes me grind my teeth in my sleep and dread going to work the next day. I am sick of the arrogancy of surgeons, as well as the spinelessness of my peers (including anesthesia MDs). They say NOTHING when surgeons complain about minor things when the biggest screw-ups of the day should really be credited to the surgeon.

I am quite disappointed that things have worked out this way. At a loss for what to do. Have already cut hours to 3 days/week. Considering job changes, even career changes, but not sure what I would WANT to do. (Career changes take a lot of effort, you know?) Would appreciate any encouragement or suggestions. Thanks

i have been a perioperative nurse for 18 years cnor, onc, rnfa, with open heart experience, major ortho and vascular first assistant/circ/scrub experience and love what i do. started out as an ER nurse and went to the OR. Moved back to small town florida and was happy doing gen surgery/endo when a new manager came with her sargeant traveler charge nurse and next thing i know I am terminated because the new mgr did not like my being there - she felt threatened by my experience. I am in a Right to work state which means no laws for the employees. Of course I refuted her claims, but hosp admin stood behind her and kept the rn whom the techs had refused to be on call with, and the one who complained all the time about the work and pretended illness if asked to work. Now Im not burned out on OR nursing, but I am sure burned out on managers who are insecure and unable to manage people and the business. I probably would have had a heart attack or stroke like the other two employees had in this hospital from the daily inuendos and harrassment by this manager. SHE is still there and I am having to leave my home to drive 100 mi round trip or go live elsewhere 13 weeks to get the respect and the job I deserve. it is too late for a career change that I can afford to live on and i am very disappointed that this can happen in the USA. Oh, I forgot to mention the major hospital who brings green card aliens over to work for less than us americans -that is just part of the story.

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Dear burn out, I have been an OR Nurse for ten years and am now on temporary disability because of major burnout!! Everything you said is SOOOO true! I am looking to get out also. Forensic Nursing, Clinical research or Nurse legal consultant but it is hard. I am ready to work anywhere, just not in the OR. My e-mail is [email protected], please respond and maybe we can both figure something out to help each other. Thanks

>I have been an Operating Room Nurse since 1981; I also do

>Legal Nurse Consulting. I have worked in California,

>Washington and Oregon. Whenever I want to earn the pay I

>feel I deserve as an experienced specialty RN, as well as

>get the professional respect I feel I deserve, I work in

>California. The difference in attitudes, as compared to

>Oregon, is like night and day. I believe it is primarily

>due to always having had a strong union (God bless CNA!!!)

>and strong union members--that is, nurses who are radical

>enough and savvy enough to speak up and demand fair pay,

>good working conditions, and proper equipment and staffing

>ratios to do excellent patient care. Also,remember a law was

>recently passed there requiring a certain ratio of nurses to

>patients. When people call in sick, the registry is called,

>and the same number of nurses are contracted to replace

>them. In Oregon, we get a lecture at report about how

>lunches and breaks will be late or non-existent due to our

>colleagues' being sick; people are"counselled" for calling

>in sick, and their names are put up on the board for the

>day so that everyone knows which colleagues "Let us down"

>by having the nerve to be sick. In California, our managers

>ask us at weekly meetings what they can do to make our jobs

>easier, and those things are supplied. All the rooms are

>well equipped and well stocked, to allow us to do the best

>possible patient care we can. In Oregon, we run around

>borrowing such basic items as step stools, extension cords,

>and flash pans from other rooms; specialty equipment such

>as endoscopic staplers are constantly in short supply

>;cautery units, microscopes, video cameras are always out

>for repair or malfunctioning. In California, we are asked

>if we are willing to stay overtime, and are well compensated

>for it, as well as being thanked. In Oregon, "mandatory

>overtime" is frequent and last minute; you are not

>asked--you simply are not relieved on time. If you ask the

>union (if you can call the joke we have for a union, here in

>Oregon) for support on this issue, they vaguely talk about

>patient abandonment and actually support "Management's right

>to ensure safe staffing" by enforcing mandatory overtime. A

>personal example: I was stuck without relief on a case

>once, the day before Thanksgiving. Due, once again, to

>improper planning, the charge nurse claimed she had no one

>to relieve me. My day care provider was furious, when I

>arrived to pick up my son an hour late. Not only did I have

>to pay the standard late fee, (which, in our area, at that

>time, was $1.00 per minute--therefore, $60.00--) I lost my

>day care provider. While the union allowed it was

>"unfortunate, they backed the implementation of "mandatory

>overtime," and I lost the grievance in which I asked for

>reimbursement of the $60 late fee. Our rights--to have a

>life after 8 hours of work, to go home and pick children up

>in a timely fashion from day care, or go to a soccer

>practice or game, to meet our friends or husbands for a

>beer, or just to go home and do nothing--are all disregarded

>in the name of patient care. I had the audacity once to say

>to the nurse manager of an Oregon operating room: "Staffing

>issues are a management dilemma. I am contracted to work

>only 8 hours a day." You would have thought from the

>horrified expression on her face (and on the faces of some

>of the "suck-up" nurses in our department) that I had just

>announced that I was a cannibal! Her response was "How

>would you feel if one of YOUR parents was in surgery, and

>the nurse on the case refused to stay over?" My response

>was: "My parents are dead, and anyway, I would never have

>recommended they have surgery in an operating room whose

>management tyrannized her staff by laying guilt trips on

>them. When a case is expected to run over, it is

>management's JOB to arrange for staffing relief well in

>advance. That usually involves calling registry in the

>morning and asking them to send over nurses for the

>afternoon." Her response: "We don't use registry." This

>was 10 years ago, and it is still this way at this

>particular operating room. The staff don't complain because

>they have been so brainwashed by management into thinking

>there is a "nursing shortage" that they are afraid they

>won't be able to get another job. Indeed, a lot of them

>wouldn't be able to get another job, as some of them have

>very mediocre nursing skills,(some have never learned to

>scrub, and are allowed to continue to refuse to learn; some

>can only be trusted in very minor cases--) and really should

>not be working in an operating room. The attitude among

>management there is that "As long as they can do the

>minimum, that is all we expect." So, the message conveyed

>is "Mediocrity is OK." It does not take the intellect of a

>rocket scientist for one to figure out what follows--people

>start thinking,''Well, if mediocrity is okay, why should I

>strive to do more than the minimum?" Nurses in Oregon do

>not have to take continuing ed--- I have worked with people

>who couldn't even remember how to calculate a simple drug

>dosage, and had to ask anesthesia to do it for them--

>whereas, in California, we are constantly upgrading our

>skills to be able to stay up on top of rapidly changing

>technology and trends in patient care. Standby for call in

>California is paid at half-time, because management, the

>physicians, and the union know that our time is valuable,

>and they respect us as professionals. In Oregon, standby

>pay is around $2 an hour, and the nurses think they are

>making great money, and don't want to ruffle any feathers by

>daring to ask for more. In Oregon, we are expected to clean

>the dirty rooms before going to assess and get our next

>patient--in California, not only would the housekeeping

>union be on our backs for taking their jobs away from

>them--but management would see the bigger picture--not only

>are we contaminating our scrubs with hazardous waste, and

>carrying it to our next patient, but we are taking away

>time that rightfully BELONGS to our next patient. How would

>you like to know that the nurse talking to you and starting

>your IV just came from cleaning a grossly bloody room? As a

>patient, I would expect that a nurse have time to talk to me

>and my family a bit and help prepare us emotionally-- that

>is, after all, our role as O.R. nurses--but that time is too

>often spent cleaning up the room from the previous case, and

>then rushing to get the next patient into the room on time.

>Truthfully, very little time is spent actually assessing the

>patient's emotional state, as we are constantly being

>pushed, pushed, pushed to get the next case going. I could

>go on and on. Don't get me wrong--I love living in Oregon.

>I just refuse to work here as a nurse, as I feel that it is

>difficult, if not dangerous, to do excellent patient care

>here. So, when I want to work as an operating room nurse, I

>happily fly off to California for a week or two, where all

>the support is there to do excellent patient care, we are

>respected and appreciated as professionals, and the morale

>is always good. I have the best of both worlds--since I get

>paid more in California, I can work less, and I can spend

>more time at home gardening (my real passion.) My advice

>for nurses who are feeling unhappy about their own job

>situations, and approaching burn-out--take a sabbatical or

>some sort of leave of absence, and try travel nursing.

>Before you do, though, go into a chat room where nurses are

>talking about their travel assignments, and discussing

>travel companies and hospitals by name. Believe me, there

>is a reason why certain hospitals are always advertising for

>travellers--it isn't that they are so busy they need to

>augment their own staff, either. The real reason is that

>they cannot hold on to their own staff, because work

>conditions and/or management are so abysmal that the staff

>nurses just get fed up and quit. I hope I don't get any

>"hate mail" from Oregon nurses. The truth is, though,

>almost every Oregon nurse I have ever known is unhappy in

>her job, but stays for years and years and miserable years,

>just because of the benefits. I have never met a California

>RN who was unhappy in her job. There always seems to be the

>support there to "fix" whatever problem was making people

>unhappy--again, a great union, and supportive management,

>and physicians who respect and treat us as fellow

>professionals. P.S. To be fair, I have NO knowledge of how

>it is for nurses who are not operating room nurses--I would

>like to hear from nurses in other specialties in both Oregon

>and Washington, to see if their working conditions are

>similar. Please feel free to e-mail me at

>[email protected]. My name is

>Stephanie. Thanks again, California Nurses Association!

P.S. No matter where I have worked, the surgeons have NEVER been the problem. (Admittedly, some RESIDENTS tend to get swelled heads and start acting like prima donna at certain points in their residencies, but they respond well to being put in their places by seasoned nurses...) Usually, the problem is management. There are all these management types--some of them are't even operating room nurses, and even the ones that are haven't scrubbed or circulated in so long any patient care delivered by them would be downright dangerous. It seems as if there always battle lines being drawn--with the surgeons and the nurses on one side, united, and management on the other. Again--hate to sound repetitive--this I found to be typical only in Oregon, not California. In California, we all seem to work together for a common goal--excellent patient care.

All is not lost. One of the great things about being a nurse is viarety. One can go in so many directions and still be a nurse. One can go in various directions within the same department. I'm sorry that you are so down. Being an OR nurse, myself I can relate. I hope you find a solution you can be happy with. I found my solution in a travel agency. It doesn't work for everyone, but I must say, I'm having a ball. If I don't like the people I am currently working with, or the environment, the contract isn't so long that I can't weather it out, and then I'm gone. However, most places I have been, have been difficult to leave because of friendships developed, etc. Change is difficult, be it large or small. Hey, I didn't even go into nursing until I was well past my 30th birthday. Now I'm seeing changes every few months. It must be the part of me that likes the OR. That part of me that thrives on stress. I've come home in tears more than a few times. But still... I am an OR nurse.

I wish you the best whatever you decide.

Hello OR nurses: What a dying breed you are! We here in Phoenix are sending an invitation to anyone out there willing to re-locate! I am currently working in a hospital where the management is behind the nurses (especially in the Peri-operative Service Areas). I am hearing a few nurses who love the OR but just aren't in the right place! Ever consider Phoenix? We are coming at the end of our summer right now and with our winter in the 60's--it is a wonderful time to be here. We have had some changes in our hospital with managment and they have all been positive changes. We have been hit with the shortage big time and in the summer with weather at the 120 degree mark--who wants to be in Phoenix? Now is a great time...I am inviting you to contact our nurse recruiter Mary Jean Mazarella at 602-344-5802 (Please call collect and she will accept!) I love working where I am right now and am poised for growth at out facility--I also take my hat off to California Nurses Association!! I wish we all had the courage and initiative to follow their lead and there wouldn't be so many of us unhappy Nurses! Good Luck Sisters!! (You may also contact me at [email protected])

TO CINDYBETH: I worked in OR as a circulator/recovery RN and I understand how you feel. I burned out after only 6 years. The surgeons were the main reason I quit. As you said, they are arrogant, whining little boys! And to add insult to injury, we were called out for non-emergent procedures simply because it was convenient for the doc to do it on weekends or after hours. Administration was spineless, they would let them abuse us and call us out anytime because "they bring money." The only way to save yourself is to get out! Your experience in the OR is a gem on your resume. Go for something you will really enjoy. Life is too short. I am fortunate in that I have the opportunity and financial resources to stay home with my grandchildren. Godspeed.

I burned out after 2 years and took 6 months off. It really helped my attitude. That and being broke for 6 months. Try something else. Nursing has so many choices and you can always come back to the OR.

Don't be in such a hurry to blame the OR. The facility may be to blame. After working in the same OR for 12 years, I finally had enough. I found a better paying position in a busier OR about 10 miles away. Even though we are busier (trauma center), the enviornment is infinitely better. Sometimes the grass IS greener on the other side.............Good Luck

here is my question: how long is too long to remain alert while scrubbed into surgery without a break?

i do not know quite how these posting things work yet, but please let me know. i wanted to put my e-mail so that people could contact me but that is not done, right? my name is kim.

i am trying in vain to find out more information on this particular subject before posting a petition on thepetitionsite.com regarding the issue. it would be all too easy to just have a good old whine on the internet, but this would probably accomplish nothing. i want my petition to function almost as a research document with multiple links to informative web pages. this will give readers a valuable insight into the real cause of such things as the "nursing shortage" and "medical errors." the former has become a catch all excuse and the latter is receiving a rather cosmetic once over that often fails to address the key issue of fatigue. i have found some excellent pieces written by nurses regarding the realities of the staff shortages driven by cost cutting hospital management: a real eye opener. while i have good information on fatigue in general, "breaks," or the complete absence of breaks, is not written about so much.

try to imagine this: a liver transplant, 12hours scrubbed into surgery with no relief break at all. yep that was 12 hours with no water, no food and no chance to pee! while no medical error occurred on this, the worst of several similar occasions, such abuse invites mistakes. the geneva convention requires more humane treatment of pows! a pow must receive a one hour meal break in the middle of their working day, by in the us "breaks are at the discretion on the employer " you can legally be abandoned to the point of passing out on the job while authorities lay that patient needs guilt trip on you to obscure employer greed. how do exhausted, semi-comatose staff best serve the needs of a patient? certainly not with unsafe practices like the level of unconscionable abandonment described above, but a very simplistic explanation like the "nursing shortage" makes an incident like this vanish beyond reason. management is not to be blamed; how could and conscientious nursing staff member be so selfish?

as a surgical technologist i was at the mercy of my charge nurse to send in a relief person so that i could break scrub. as you all know, to just leave is called "patient abandonment," besides my liver transplant patient was on bypass. if the nurse manager who was on duty that saturday night was at all concerned about me or my ability to do my job, passing tiny sutures as fine as a human hair, she might have relieved me briefly herself. however, this or nurse manager had a reputation for being relentlessly abusive to everyone, so she just didn't care.

this evening nurse manager, who actually taught trauma preparedness, should have known better and called in a call team person. however, not doing so saved the department money and the hospital approved of this. she taught by example: newer nurses realized that they were expected to cope with very minimal staff and not call in any back up. past 11:00pm on a saturday night this level one trauma centre maintained an or staff of just one rn, two or techs and an orna to do room turnovers. once a lengthy case came to surgery we should have called in staff to stand by for trauma, but it cost the department less if we did not. with the only rn and one of the techs fully occupied, if a trauma came up to the or that one nurse would be torn between two patients until the call person arrived. when miemms was informed of the potential danger of this patient abandonment situation, that i believed violated comar regulations, they just said: "it doesn't specifically endanger trauma patients."

i used to wonder why the hospital administrators put up with this abusive or manager who had created such a toxic work environment that good or nurses kept leaving our facility. i failed to understand her true value; the upper management really loved her because she was helping them to "downsize" the staff without firing rns: tenure nurses continued to leave us in droves. new nurse graduates were much cheaper, more compliant and they tolerated abuse far better while trying to earn their reputation at the "best hospital in america." i am sure that other iconic institutions use this strategy too; it is not about patient care it's about saving money. if the hospital really wanted to save unnecessary cost they would act responsibly, by taking the advice of those expensive consultancy companies, to eliminate some of their "top heavy" management! downsizing appropriately does not have to impact patient care.

this false "nursing shortage" crisis situation is being repeated all over the us and elsewhere. one good look at the actual number of rn licenses being issued right now reveals the real picture: nurses ready to work, but not ready to compromise patient care by working unsafe hours with too many patients and too few staff. why have i never become a nurse; believe me it's no disrespect to the profession, far from it. i believe nurses are undervalued and misused. assistive personnel should have taken over some of the more mundane routine tasks freeing up nurses to concentrate on more important patient care issues. instead they are assigned another mindless drudgery task filling out excessive paperwork. i also believe that rns are saddled with accountability without appropriate control. i used to be a yacht delivery captain with a uscg license; at sea it was my license, my responsibility. however, a captain can choose who is qualified to sail with them, who is fit and rested enough to stand a night watch and how many people it takes to man the vessel. how many times have you had that control as a charge nurse? however, if a mistake is caused by under staffing, untrained assistive personnel or fatigue will the managers who created this appalling situation be held accountable? i doubt it.

i soon learned that any attempt to complain about a nurse manager's conduct was really futile. my hospital never disciplined their managers for any reason. i was supposed to prove that i had asked for a break! no one supported an employee targeted for removal as they did not care to share my fate. at one point the hospital wanted to "evaluate me for a sugar problem." when i said that under such extreme working conditions, (12 hours without a break), i worried i might cause harm to a patient, i was sent to fasap. i had been working 7am - 7:30pm friday, 3pm - 7:30am saturday night then 3pm -11:30pm sunday evening. it was reasonable to want to normalize my routine to reduce fatigue by eliminating a 16hour shift, but this outrageous demand had prompted my manager to insist on a fasap evaluation as they questioned my sanity! i was forced to take time off work without pay pending this totally unnecessary fasap evaluation which was essential for: "demanding unreasonable accommodation for an undiagnosed medical condition."

the hospital's or managers said that i now "presented a danger to the patients." after five years of flawless service in the or, the last two covering the most demanding and challenging weekend shifts no one else would take, i was victimized, harassed and finally fired! i could clearly see the writing on the wall with forced time off followed by reassignment to a different or suite with no locker, but letters appealing for fair treatment were ignored and i soon realized that the policy of retaliation was endorsed all the way to the top.

it would have been a stretch for them to prove incompetence due to the exceptionally minimally staffed shifts i was covering that required a highly skilled versatile technician who could handle any case. mostly emergency cases, inner city gsws, other trauma and transplant; i had to be able to do everything from pediatric cases, to ortho, neuro, to major maxillofacial reconstruction and even open a cardiac case until their call team arrived. why would any conscientious manager assign a marginally incompetent person to a highly demanding schedule of shifts for two years? instead they opted for the "disruptive" and mentally unstable route, ousting me just three days before i was set to go on a christmas holiday to england. this made them a bit of extra cash by defrauding me out of half my vacation pay and writing off paid national holidays. with an excessive show of force, i was marched out of the or by two security guards, to publicly humiliate me as a warning to my coworkers. this type of intimidation and ever-present threat of job loss is very effective in silencing outspoken patient advocates. but, it continues to severely endanger hospital patients.

my battle for justice and reinstatement was futile. my records were kept from me while the fake charges against me changed and continued to escalate as i refused to give in. there was no real documentation required to support the unrelenting assault on my character; they said that something happened so it was written in stone until they changed their minds to pursue another tactic. i tried hard to prove that i had just asked for a break and reasonable changes to my torturous or schedule to avoid working virtually alone with an abusive or manager. meanwhile they kept things focused on trivialities like how loud was my voice and how a secretary was intimidated by seeing me with my hands on my hips and my arms folded in a so called "aggressive posture." defending my right to call false allegations "a blatant lie" was perverted into defaming my or manager, while saying that she was being "unnecessarily inflexible" with my or schedule reached the level of "verbal abuse."

originally from england, i, my family and my uk friends were all completely stunned by the total abandonment of any pretence at defending my civil rights, the supposed right to free speech in the us, or any semblance of due process during the sham hearings that dragged on for over a year. additional pieces of "evidence" were inserted into my file months after i was fired, but i had no knowledge of this until well after the fact because i was not allowed access to my employment or my pay files for over 15 months. this tainted "evidence" was shared with public agencies behind my back: the maryland commission on human relations, eeoc and the board of nursing all had access, while i did not. this helped convince agencies that i was a dangerous, disgruntled former employee bent on revenge; therefore there was no point investigating those ridiculous negligence charges because they could trust this prestigious hospital implicitly. probably other iconic institutions enjoy the same level of immunity from genuine scrutiny by public agencies and this is not healthy. in the financially driven us health care industry this diminished accountability is easily taken advantage of with dangerous cost cutting measures instituted that minimize staff and adversely impact patient care.

seeing new forged evidence days before an arbitration hearing that i was told was by the union was not binding arbitration; i did not feel confident. i was told i could not mention forced time off, hidden files, torturous abandonment in the or, just, was the bad thing that i did really so bad? the final insult in the handling of my case was when the head of surgical nursing, one of the top nurse managers in the hospital, lied under oath at my arbitration hearing by presenting a new false allegation made for the very first time15 months after i was fired. it was so incredulous and unsubstantiated that no one really believed her, but no one questioned why she lied under oath to deliberately victimize a subordinate. my own union buckled under pressure, failing to call back witnesses who would refute the or manager's lies while severely restricting what i was allowed to say in my own defense. ignoring my copious written statements of denial a union lawyer put my guilt in writing no less than three times in his summation which i was denied access to for over a year until the arbitrator had made his devastating ruling against me.

by this time i had gone into $60,000 worth of debt trying to hang on to my historic six bedroom baltimore home, but i lost everything i had in the us including that house. i had put my heart and soul into renovating it, but i was forced to abandon it two weeks before christmas. right after the new year the locks were changed and friends could no longer retrieve or store my things. my life was shattered, i felt like a refugee by the time i left america, i was so sick and distraught i was taken off the plane at gatwick in a wheelchair! even now the lies are still negatively impacting my life here in the uk and may sabotage efforts to work as an unpaid overseas medical volunteer for an ngo in tsunami ravaged indonesia. having lost so much myself i could really feel for those people and going out there was a vital part of my healing. despite spending six months in aceh, i know i need a stronger mandate to continue my work there.

even when the crisis was fresh in the news i was not in any position to be taken on by a major ngo. after flying myself out there conditions were frugal as i relied on the things i had bought with me like my own hammock-tent. i was not pampered in air conditioned accommodation with a fancy office, laptop, cell phone, radio, car, driver etc. not that i minded; i was thrilled to be able to help and regain a little of my shattered self respect. i was bought in by "walhi" and worked for "sheep," both indonesian ngos; i volunteered my time in the or at cut nyak dhien hospital in meulaboh, aceh province, on the northwest coast of indonesia. at least i was back in the or again and i knew my services were badly needed by the local population. i have put together a comprehensive proposal for an emergency preparedness plan for meulaboh that is sorely needed, but indonesian ngos do not have the money to fund it and i may never have the chance to implement it. going back out will take a lot more self-funding as major ngo support just isn't possible without getting the false allegation over my dismissal and the damning remark "not eligible for rehire" eliminated.

i am trying to move past the damage by completing a nifa training program to become a first surgical assist. this was something i had set my sights on before loosing my job, but with all the financial troubles it was delayed. now my books are in storage in the us, i cannot work in a uk operating room because the credentials are different and i am subsisting on uk unemployment! at least in areas overseas, where the need is so great, i can go back into the or to complete clinical time while volunteering. i am so disillusioned about my profession, but i want to know that all of the painful personal sacrifices i made to reveal the truth and change negligent practices will someday make a difference. i am not so much "burned out" with my job in the or as i really love what i do; however, my career has been torched!

i have sent "citizen opinion" letters to my us senators and congressman plus i am considering launching a new advocacy group i call "team" rather than targeting any particular medical institution or hospital, i would like to create an advocacy group that really helps level the playing field with regard to all medical facilities, but paying especial attention to "iconic" institutions to insure that they do not receive special immunity from scrutiny as they did in my case

transparency for equal accountability in medicine : t.e.a.m.

not another "support group," but the " t.e.a.m." advocacy group?"

it would take good solid support from nurses to head this up and, being the other side of the atlantic, i might have little input beyond launching an idea, but i think it is very necessary. any ideas or input please let me know. if you have waded through all this, i must apologies for its length, thank you for bearing with me,

fair winds & following seas, kim.

ps: this post inspired me to write. by the way california is one of the only states in the us to try and bring in laws to provide breaks.

>i have been an operating room nurse since 1981; i also do

>legal nurse consulting. i have worked in california,

>washington and oregon. whenever i want to earn the pay i

>feel i deserve as an experienced specialty rn, as well as

>get the professional respect i feel i deserve, i work in

>california. the difference in attitudes, as compared to

>oregon, is like night and day. i believe it is primarily

>due to always having had a strong union (god bless cna!!!)

>and strong union members--that is, nurses who are radical

>enough and savvy enough to speak up and demand fair pay,

>good working conditions, and proper equipment and staffing

>ratios to do excellent patient care. also,remember a law was

>recently passed there requiring a certain ratio of nurses to

>patients. when people call in sick, the registry is called,

>and the same number of nurses are contracted to replace

>them. in oregon, we get a lecture at report about how

>lunches and breaks will be late or non-existent due to our

>colleagues' being sick; people are"counselled" for calling

>in sick, and their names are put up on the board for the

>day so that everyone knows which colleagues "let us down"

>by having the nerve to be sick. in california, our managers

>ask us at weekly meetings what they can do to make our jobs

>easier, and those things are supplied. all the rooms are

>well equipped and well stocked, to allow us to do the best

>possible patient care we can. in oregon, we run around

>borrowing such basic items as step stools, extension cords,

>and flash pans from other rooms; specialty equipment such

>as endoscopic staplers are constantly in short supply

>;cautery units, microscopes, video cameras are always out

>for repair or malfunctioning. in california, we are asked

>if we are willing to stay overtime, and are well compensated

>for it, as well as being thanked. in oregon, "mandatory

>overtime" is frequent and last minute; you are not

>asked--you simply are not relieved on time. if you ask the

>union (if you can call the joke we have for a union, here in

>oregon) for support on this issue, they vaguely talk about

>patient abandonment and actually support "management's right

>to ensure safe staffing" by enforcing mandatory overtime. a

>personal example: i was stuck without relief on a case

>once, the day before thanksgiving. due, once again, to

>improper planning, the charge nurse claimed she had no one

>to relieve me. my day care provider was furious, when i

>arrived to pick up my son an hour late. not only did i have

>to pay the standard late fee, (which, in our area, at that

>time, was $1.00 per minute--therefore, $60.00--) i lost my

>day care provider. while the union allowed it was

>"unfortunate, they backed the implementation of "mandatory

>overtime," and i lost the grievance in which i asked for

>reimbursement of the $60 late fee. our rights--to have a

>life after 8 hours of work, to go home and pick children up

>in a timely fashion from day care, or go to a soccer

>practice or game, to meet our friends or husbands for a

>beer, or just to go home and do nothing--are all disregarded

>in the name of patient care. i had the audacity once to say

>to the nurse manager of an oregon operating room: "staffing

>issues are a management dilemma. i am contracted to work

>only 8 hours a day." you would have thought from the

>horrified expression on her face (and on the faces of some

>of the "suck-up" nurses in our department) that i had just

>announced that i was a cannibal! her response was "how

>would you feel if one of your parents was in surgery, and

>the nurse on the case refused to stay over?" my response

>was: "my parents are dead, and anyway, i would never have

>recommended they have surgery in an operating room whose

>management tyrannized her staff by laying guilt trips on

>them. when a case is expected to run over, it is

>management's job to arrange for staffing relief well in

>advance. that usually involves calling registry in the

>morning and asking them to send over nurses for the

>afternoon." her response: "we don't use registry." this

>was 10 years ago, and it is still this way at this

>particular operating room. the staff don't complain because

>they have been so brainwashed by management into thinking

>there is a "nursing shortage" that they are afraid they

>won't be able to get another job. indeed, a lot of them

>wouldn't be able to get another job, as some of them have

>very mediocre nursing skills,(some have never learned to

>scrub, and are allowed to continue to refuse to learn; some

>can only be trusted in very minor cases--) and really should

>not be working in an operating room. the attitude among

>management there is that "as long as they can do the

>minimum, that is all we expect." so, the message conveyed

>is "mediocrity is ok." it does not take the intellect of a

>rocket scientist for one to figure out what follows--people

>start thinking,''well, if mediocrity is okay, why should i

>strive to do more than the minimum?" nurses in oregon do

>not have to take continuing ed--- i have worked with people

>who couldn't even remember how to calculate a simple drug

>dosage, and had to ask anesthesia to do it for them--

>whereas, in california, we are constantly upgrading our

>skills to be able to stay up on top of rapidly changing

>technology and trends in patient care. standby for call in

>california is paid at half-time, because management, the

>physicians, and the union know that our time is valuable,

>and they respect us as professionals. in oregon, standby

>pay is around $2 an hour, and the nurses think they are

>making great money, and don't want to ruffle any feathers by

>daring to ask for more. in oregon, we are expected to clean

>the dirty rooms before going to assess and get our next

>patient--in california, not only would the housekeeping

>union be on our backs for taking their jobs away from

>them--but management would see the bigger picture--not only

>are we contaminating our scrubs with hazardous waste, and

>carrying it to our next patient, but we are taking away

>time that rightfully belongs to our next patient. how would

>you like to know that the nurse talking to you and starting

>your iv just came from cleaning a grossly bloody room? as a

>patient, i would expect that a nurse have time to talk to me

>and my family a bit and help prepare us emotionally-- that

>is, after all, our role as o.r. nurses--but that time is too

>often spent cleaning up the room from the previous case, and

>then rushing to get the next patient into the room on time.

>truthfully, very little time is spent actually assessing the

>patient's emotional state, as we are constantly being

>pushed, pushed, pushed to get the next case going. i could

>go on and on. don't get me wrong--i love living in oregon.

>i just refuse to work here as a nurse, as i feel that it is

>difficult, if not dangerous, to do excellent patient care

>here. so, when i want to work as an operating room nurse, i

>happily fly off to california for a week or two, where all

>the support is there to do excellent patient care, we are

>respected and appreciated as professionals, and the morale

>is always good. i have the best of both worlds--since i get

>paid more in california, i can work less, and i can spend

>more time at home gardening (my real passion.) my advice

>for nurses who are feeling unhappy about their own job

>situations, and approaching burn-out--take a sabbatical or

>some sort of leave of absence, and try travel nursing.

>before you do, though, go into a chat room where nurses are

>talking about their travel assignments, and discussing

>travel companies and hospitals by name. believe me, there

>is a reason why certain hospitals are always advertising for

>travellers--it isn't that they are so busy they need to

>augment their own staff, either. the real reason is that

>they cannot hold on to their own staff, because work

>conditions and/or management are so abysmal that the staff

>nurses just get fed up and quit. i hope i don't get any

>"hate mail" from oregon nurses. the truth is, though,

>almost every oregon nurse i have ever known is unhappy in

>her job, but stays for years and years and miserable years,

>just because of the benefits. i have never met a california

>rn who was unhappy in her job. there always seems to be the

>support there to "fix" whatever problem was making people

>unhappy--again, a great union, and supportive management,

>and physicians who respect and treat us as fellow

>professionals. p.s. to be fair, i have no knowledge of how

>it is for nurses who are not operating room nurses--i would

>like to hear from nurses in other specialties in both oregon

>and washington, to see if their working conditions are

>similar. please feel free to e-mail me at

>[email protected]. my name is

>stephanie. thanks again, california nurses association!

p.s. no matter where i have worked, the surgeons have never been the problem. (admittedly, some residents tend to get swelled heads and start acting like prima donna at certain points in their residencies, but they respond well to being put in their places by seasoned nurses...) usually, the problem is management. there are all these management types--some of them are't even operating room nurses, and even the ones that are haven't scrubbed or circulated in so long any patient care delivered by them would be downright dangerous. it seems as if there always battle lines being drawn--with the surgeons and the nurses on one side, united, and management on the other. again--hate to sound repetitive--this i found to be typical only in oregon, not california. in california, we all seem to work together for a common goal--excellent patient care.

When an RN burns out in the OR they have other options open to them. When a tech burns out, there is nowhere else to go. Continue your education if you still want to work in the medical field. What happened to you sounds horrible but you have to put it behind you and move on. Good luck.