burnout in the OR

TsunamiKim · Jan 23, 2006

i sooooo understand,

at my former hospital there were those appallingly bad days when the do do really hit the fan. the case doesn't start on time, the circulator is still scrambling for missing equipment; the metz don't cut; the pick ups don't pick up, plus we have just run out of xyz again! the nurse management committee is seriously working on eliminating the only decent, functional skin stapler, because it cost a tad more than the useless piece of garbage that just got hurled at you at the culmination of a very stressful case. yep it was on days like that when my surgeon would glare at me and in a clipped tone that barely stifled his hostility, or his utter contempt for all lower forms of life, he would sarcastically blurt out:

"i wonder what it's like at the second best hospital in america."

sorry to disillusion you folks but the mind numbing frustration and dysfunctional behavior extends to the nation's very best institutions!

hang in there,

fair winds & following seas, tsunami kim

RNroamer · Jan 24, 2006

I worked in an OR for 24 years in a small town. I love OR nursing but I began to hate my job. Over the last 10 years there I had applied for other jobs in the same hospital thinking I would like them. After doing OR for that many years, nothing else really appealed to me. It wasn't so much OR nursing that I didn't like, it was the people I worked with and recurrent situations I found myself in. 1 1/2 years ago I quit my job and began travel nursing. I took a 4 week leave of absence to try it first since I was too big a chicken to just go. :chuckle It was great. We were always told "you won't ever find it as good as you have it here" "The grass isn't always greener on the other side"

Well, I have worked in several other OR's and found that I still love OR nursing and I have had a great time at each one. They are all different and each have their own set of problems but as a traveler, they are not my problems. I feel for those going through them and try to help as I can but it doesn't affect me. I enjoy going to work. There are no political agendas that make any difference for the 13 weeks or more I am there.

I often stay longer than what was originally agreed upon as I make great friends learn new things. I have gone as far away as Hawaii (from PA) and as close to home as 4 hours away. I often work 3 12's in a row and come home for long weekends. I make more money and have more time off and am much more relaxed. The stress level is so much better!

My children are grown and my husband is great about it. He has good health benefits so I don't even have to worry about that, though most agencies provide it. It is not the answer for all but as they say sometimes a "change is gonna do you good".

Best of luck to you.

dld, ASN, RN · Apr 18, 2006

Thanks Oregon nurse for sharing with us about working in Oregon. I have always worked in California and I am looking to move some where less crowded. I was seriously considering Ore. but now I think I'll stay put! CNA has done alot for RNS in California. I worked at the same hospital for 10 years now and I feel the urge to change something. I wonder is it just me, the hospital or the unit? The paperwork is unbelievable! Anyone for electronic charting?

cwazycwissyRN, RN · Apr 18, 2006

Just had to pop in and give this thread credit for staying alive from 8-1-2000 thru today. 5 1/2 years zzzoweee. :idea: Guess it goes to show the constant battles of burn out in the OR. High stress/ High egos' / Call back..

later cwissy

Corvette Guy · May 13, 2006

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

Yep, I too got burned out w/OR Nursing. However, I'm very excited about getting back to Critical Care Nursing.

Why don't you leave the OR & try a different area of nursing?

shodobe · May 14, 2006

I have been in the OR for almost 30 years, YIKES! I have done M/S and ER before but have found my niche in the OR. Surgery is definitely not for everyone and should be looked at very hard when condidering it. I have and do work at several other places and find it to be different every place you go. I have yet to find the surgeon aspect, mean, disrespectful type, anywhere and I know it does exist. Back-biting, "eat your young" type nurses exist everywhere, but I am lucky not to have found any. I feel bad for the nurses who get burned out after a few years because of personalities, it shouldn't happen.Training has alot to do with how a person is molded for the OR. If preceptors are non-engaging types who just go through the motions, then the trainee will not feel part of the team. Training is not just teaching someone the skills they need but also the workings of the OR. It is hard to explain what I am trying to say, but I guess there is some kind of "code" that goes along with the training. Some people feel comfortable after a few years and others take years to feel that they can handle anything. I know it was well over 5 years before I could say to myself, " I can do that"!

moliuchick, RN · May 14, 2006

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.

JaneRNBSN,

I only worked in the OR for a few months and I already hate it so much that I want to quit my job. Why do you think that our OR experience is a "gem"?

Do you mind giving me some suggestions as in what specialties I can go into after losing all of my med/surg nursing skills?

Thanks.

RNOTODAY, BSN, RN · May 17, 2006

I have been in the OR for almost 30 years, YIKES! I have done M/S and ER before but have found my niche in the OR. Surgery is definitely not for everyone and should be looked at very hard when condidering it. I have and do work at several other places and find it to be different every place you go. I have yet to find the surgeon aspect, mean, disrespectful type, anywhere and I know it does exist. Back-biting, "eat your young" type nurses exist everywhere, but I am lucky not to have found any. I feel bad for the nurses who get burned out after a few years because of personalities, it shouldn't happen.Training has alot to do with how a person is molded for the OR. If preceptors are non-engaging types who just go through the motions, then the trainee will not feel part of the team. Training is not just teaching someone the skills they need but also the workings of the OR. It is hard to explain what I am trying to say, but I guess there is some kind of "code" that goes along with the training. Some people feel comfortable after a few years and others take years to feel that they can handle anything. I know it was well over 5 years before I could say to myself, " I can do that"!

Great point. and I know *exactly* what you are saying........I have had to find out on my own during the last 3 months of my OR training.....it's not only the job you need to learn, its how you deal with the people you work with, that is just as important. For instance, my experience so far has been : the surgeons are fine, but the "problem" lies with the staff... techs and nurses.they have been horrible to the new people...and we really cant understand why yet...but, my point is that I had to learn how to "manage" difficult techs, nurses, even OR assistants who will give me a hard time just because they want to see if you will take it. Once you know how to handle them, they suddenly become more manageable!!!!! Now that I know *how* to do this, I sometimes find myself wondering if I even *want* to be surrounded with these people 5 days a week......OR is a tough place, and I have found that to refer not only to the work and skills you must learn. Its the dynamics of the staff that has been a big hurdle for me at my current job. I do understand that this place in particular might be a little more so than other OR's, so I am told, but it's still hard. I just want to learn!!!!!!! A psych degree wouldnt hurt to have in your background if you want to work in the OR. :uhoh3:

beachee3 · May 19, 2006

Currently working in SanDiego and the unions are weak, the salary is low, $30-40's. The call pay is only $6 hr. Northern CA seems to have it going on.

I've been in the OR 19 years and burned out on bad managers. Seem to be having trouble staying at one place more than 6-8 months. Flying into CA to work as the salary is higher.

Currently attending University of Phoenix to obtain my degree in nursing to move up as the crap I deal with isn't worth it. Considering working for JCAHO.

staceyp413 · May 20, 2006

Wow, some of you are working in horrid conditions!! I am a charge person/manager and I for some reason a lunch is missed I feel awful.....unless staff do the "we'll eat after our case" and don't tell me and I put a different case in their run.........I don't as lunch was offered and they should have taken it. Same with breaks, if for some reason we're short, have an emergency case, etc. I don't feel right taking a break or lunch unless my staff do and it really amazes me that others don't feel the same.

As far as relief goes at change of shift. My staff are great. If I ask for volunteers I usually get at least 1 or 2. Many of my staff come to me and want to stay over if they are in a "neat" case or in a case that is within minutes of closing and wrapping up. A lot of staff even call me as it gets close to shift change time to keep me in the know that a case will need to be staffed if they are sure it will run over or if they know their next case will be delayed.

After writing this, maybe it is because of what the staff do to help me stay sane and on top of things is a small part of why I make sure my staff are well cared for.........without them I am sunk!! :idea:

TsunamiKim · May 20, 2006

Great to read the last post Staceyp413 as this is how it should be, consideration, give and take, but always focusing on what is best for the patients. Keep up the great attitude as we need more like you. Unfortunately, the toxic work environment is driven from the very top and Charge Nurses get lumbered with implementing under-staffing. The “redundancy” of personnel that is so important for safe coverage is being stripped away as an unnecessary expense.

It was the Hospital policy in the late 90s that started to force Nurses out. The “occurrence” policy and rolling sick bank time into Vacation time as one smaller pool of available time off. The tenure Nurses felt penalized most loosing over a week of vacation time, not exactly a reward for dedication: some quit. There was a domino affect in our ORs because the more Nurses quit the fewer were left behind to cover call. The more Nurses felt trapped by the burden of heavy call commitments the more they considered leaving. We had an exodus of experienced Nurses and plugged the gaps with travelers.

Then the Hospital offered the traveling Nurses a big fat bonus for committing to a few extra weeks. This was a real smack in the face for our regular staff who did not receive the bonus and were now seriously overburdened with call since travelers did not take any call. If Management had set about designing a plan to make the workplace more intolerable they could not have done a better job, but I think they knew exactly what they were doing. They called their self-created exodus a “nursing crisis” and used it as an excuse to mandate overtime and do more with less staff. They were laughing all the way to the bank. Around this time the above strategy was being implemented in all parts of the Hospital in facilities all over America to maximize profits while making care unsafe.

Now we come to redundancy of personnel. No spare people, you do without a break. During the regular shifts breaks are accommodated between cases if the unit is short staffed. But what happens when it is the weekend, in the middle of the night? Calling in a call team person to relieve someone in Surgery is an expensive option, so they remain trapped for the duration. I would often try to take my breaks between cases if I could because of providing consistency to my Surgeon. I would go for 6-8 hours without a break no problem and I never complained unless it was beyond 8hours and for no legitimate reason. However, this flexibility gets taken for granted, to the point where no one considers whether you are still functioning safely.

Not all Charge Nurses were so inconsiderate, but the one that was most inconsiderate to me was the Manager for off-shift personnel. No point reporting a Manager in a Hospital where Managers are never held accountable. I did report and it cost me my job. Leaving someone stranded in Surgery for 10-12 hours presents a risk to patient care and I feel that it should be documented in an “Incident Report” as a potential danger to the patient. In a real emergency no one is going to object if they miss a break, but this should not become part of the regular coverage routine and identifying such incidents might prevent this. It would have documented the repeated abuse of the one Manager at my former Hospital who was always dumping on her staff and perhaps she would have felt compelled to be more considerate in future. Certainly the onus should not be on the person scrubbed to beg for relief and somehow prove that they made this request.

On the worst occasion, where I was left for 12hours during a Liver Transplant, the call team personnel should have been in the OR on stand by for Trauma. There was a requirement under COMAR that as a Level One Trauma Center we must be able to man a Trauma OR in 15minutes or less. If a Trauma had come to the OR on that particular Saturday night I would have lost the Circulator from my room for well over an hour while the call team person was contacted to come in. My Nurse would not have been just next door either, as the Trauma rooms were down the corridor in another building. This was a very stressful 12hour Transplant case with my patient on bypass; it was not going at all well and the Surgeon was new to our team doing his first Liver at our facility. The Circulator was relieved briefly and told to “run to the bathroom quickly” as if emergency cases were on their way. Under such circumstances you do not tie up the main desk with calls begging for relief.

When the abusive Manager finally entered the room at 6:00AM I told her I was about to pass out and needed someone to take over the clean up. I did not think this was unreasonable after 12hours in Surgery, but I had to repeat my request three times before she even acknowledged I had spoken. She then gave me another assignment to complete before I was permitted to break scrub. I do not know what part of “I am about to pass out” she did not understand, but disobeying her meant getting written up.. When I discovered that there had been no pending emergencies all night and that this abusive Manager had left me stranded out of pure selfishness I reported her negligent conduct and abuse of power up the chain of command. My complaint was completely ignored.

The Manager was never disciplined, but by accusing me of “causing a scene in the patient care area” for daring to protest her abuse I was verbally reprimanded. This was a common practice from our Managers; always meet the complaint with a complaint about the informant. That way the most outspoken could be identified and another strike against them might be useful in removing them. When this same Manager was about to change her regular shift duty so that I would have to work virtually alone with her every Saturday night I requested reassignment. I referred to my concern over her past abuse of power by stating that I felt we had reached a ”toxic level of dangerous.” I was told “she probably will not do that again,” but within a few short weeks I was forced to take unpaid leave and then fired.

In identifying this particular incident I had inadvertently highlighted a serious violation beyond this deplorable act of abandonment. The fact that no call person was bought in to stand by for Trauma was a clear violation of our obligations under COMAR regulations. However not calling in the call team to stand by for Trauma had been a well established cost-cutting strategy for some time. I believe it may have been introduced and was certainly implemented by the abusive Nurse Manager, who also taught Trauma classes. A month after I was fired the OR abruptly changed their policy and started calling in their call team to stand by for Trauma. At my Arbitration Hearing OR Managers admitted that I had been left stranded in Surgery for 12hours, but said the ER was busy and I hadn’t asked for a break. I guess telling your Manager you are about to pass out does not count as asking for a break.

When I bought this matter to the attention of MIEMSS the Maryland Trauma agency I expressed the concern that this misinterpretation of the regulations might extend to other Baltimore Trauma facilities. I made a sworn statement to their States Attorney, but they never got back to me. When I called a few weeks latter I was told that the situation I had identified “didn’t specifically endanger Trauma patients.” I read this to mean the following: if we were forced to abandon a complex case, even one where the patient was on bypass, for over an hour to open a Trauma OR in an adjacent building it was OK to risk that other patient’s care as long as we met our Trauma obligation. I never received anything in writing from MIEMSS.

As with so many other Government agencies charged with protecting public safety I was expected to disprove spurious false allegation of disruptive behavior that left my credibility in question. This was almost impossible as I was never allowed to see exactly what the alleged disruptive behavior pertained to. There was no proper documentation of particular event just vague comments about staff feeling threatened. Five years latter I have still seen nothing more than an unsubstantiated one line catch all phrase; that is what my former Hospital calls “transparency.” Due to their success in portraying me as a “disgruntled former employee seeking revenge” the Hospital has never been investigated properly regarding negligent staffing issues.

If you are always considerate with your team, as it appears you are, in an emergency they will be there for you and back you 100%. Taking a break during Surgery must be determined by what is safe for the patient. In a real emergency, compromises might need to be made. There is a point where concentration begins to flag, blood sugar drops and all you can think of is racing to the toilet ASAP. This is not conducive to anticipating the needs of your Surgeon. It is the duty of a charge Nurse to protect the safety of OR patients my ensuring that their teams are not struggling to function in such a state where they might make a serious mistake. The onus is on that Charge Nurse to order a person to break scrub at the first possible opportunity when they realize someone has remained at the field for too long to function safely. How long is too long? We must bear in mind that, as I stated at my Arbitration Hearing, “no one is more important than the patient unconscious on the OR table.”

Five years on I am still speaking out about what happened. I feel it is important to document such abuse. I have posted comments on other threads regarding the retaliation and wrongful termination for Whistleblowing I have also started new threads on the toxic work environment, compliance issue and lack of Compliance Line protections. I would really like to hear some consensus of opinion on how long is too long for someone to maintain concentration while scrubbed into Surgery? I want the actions I am currently taking to help in pushing for tighter regulations on the break policy to protect OR patients, but also in other clinical areas. Redundancy of personnel is a vital safety requirement besides making for a better work environment. Documenting abuses and negligent under-staffing is the only way to prevent financial priorities from overburdening Nurses to the point of burnout in all clinical areas

Staceyp413 I just hope you will keep doing what you are doing as we cannot afford to allow good Nurses to burnout or scare any more experienced Nurses into leaving the profession.

Stick with it, Tsunami Kim.

HRM672 · May 25, 2006

Wow a lot of thoughts on the downside of OR. In my complete ignorance, I have two questions.

1. When the scrub is on a 12 hour case without a break, why can't someone else scrub in and take over to give them a break? I don't understand that part.

2. What about the OR is "sinful"? Do you mean lurid comments, or unethical treatment of patients, or what?

Thanks!