CRNAs working with surgeons

URgettingsleepy · Aug 31, 2004

The better question is why should we really care? Do you respect surgeons that behave that way? NO.

Respect at work is like respect outside the hospital. It is a two way street.

Do what you are trained to do, and do it well. Respect will follow.

I'm curious about the relationship between CRNAs and the surgeons they work with, especially given the bad blood between some CRNAs and some docs. As a new grad I worked general surgery. I didn't think I had a bad relationship with the docs, but I didn't think it was that great either. They could be really rude on occasion. I remember one resident deliberately walking away without answering my question - and this was on Christmas Day!
When I came to MICU I was blown away. We talk to the residents and fellows, we are familiar with each other's personal lives, they respect our input. When I make an inappropriate suggestion they don't make me feel dumb, they explain why they wouldn't choose that option. I've taught the new interns a few things and they are appreciative.There are a few attendings who still think they are God, but even they aren't anything like surgical attendings. I rotated in the SICU as part of my training and did not see this kind of relationship.
I know some of this difference is between the floor and the ICU. MDs respect ICU nurses much more than floor nurses. But I think the bigger difference is medicine and surgery and I'm a little apprehensive about dealing with surgeons again. Do they respect CRNAs? Do they think they are just nurses who got too big for their britches? Do they treat them substantially differently from MDAs? Do they really swear at people and throw things in the OR?

2ndbach · Aug 31, 2004

I know we are not supposed to care what an md/ mda's opinion is of us as srnas/ crnas, but I am trying to educate myself about going into this field as much as possible. This issue is certainly one that greatly affects your daily work environment, and the amount of support vs. stress within it. I worked for social services in England for a few years, and eventually left because of the constant friction between the employees in the sector where I worked who had bachelor's degrees/ relevent qualifications and those that did not. There was a whole VERY negative culture there (within s serv) because of it, and I left partially because the level of care that employees were able to give was being effected by it. Just a side note, it was discriminatory in reverse to this situation because the majority of the s serv. employees where I worked were NOT college educated, and I was one of the few that was. I am from the U.S and live here now and really want to go into crna study with my eyes open as much as possible- so please share your experiences with this even though experiences are likely to vary greatly! No offense intended to any english people- this was very isolated, and I loved it there.

heartICU · Aug 31, 2004

I worked in a CTICU for a year prior to CRNA school, and I have to say that the residents/fellows were incredibly responsive to nurse input. The staff for the most part were very nice, but as you know, the residents/fellows are the ones who do most of the work (because they are still gaining experience) so they spend more time with our patients (and in turn, the nurses taking care of them). I have often made suggestions many times that they said "yeah, that's a good idea, let's try that..." while at the same time, I have suggested things, and they reply why they think something else would be better. I am not sure if our docs just trust us (which they should, because we sit there with the patients all day and are visualizing how they respond to interventions) or if I just got lucky and worked with a laid back bunch.

My old roommate worked in the MICU, and I would occasionally be amazed at some of the stories that she would tell me about the docs there... I know that the residents often go straight to medicine right after med school, and a lot of their patients are in the MICU...it seemed to me that they were the ones who were too big for their britches sometimes....often being disrespectful to the nurses who questioned some of their orders, telling them they were the nurse, not the doctor when they would make a suggestion. However, their director of medical ICU was VERY nice...and the MICU senior fellows were usually very good - it was just the new guys/girls who would be a little inappropriate...but they seemed to calm down after being there a while. But then again, this info about MICU is all second hand...I have never worked there personally so I guess I cannot say for sure. I think it really depends on the culture of the units you work in...any hospital can be different depending on the attitudes of the employees who work there.

ltk007 · Aug 31, 2004

Surgeons have historically been a proponent of nurse anesthesia throughout the struggles of the establishment of the profession.

alansmith52 · Sep 1, 2004

From what I can tell so far they treat us and mda's the same where I am. mostly very respectful and kind. the only issues that really exist is between us and the MDA residents. mostly I think because they are insecure, when they finally finish and get a job they won't feel as threatend hopefully.

EmeraldNYL, BSN, RN · Sep 1, 2004

My old roommate worked in the MICU, and I would occasionally be amazed at some of the stories that she would tell me about the docs there... I know that the residents often go straight to medicine right after med school, and a lot of their patients are in the MICU...it seemed to me that they were the ones who were too big for their britches sometimes....often being disrespectful to the nurses who questioned some of their orders, telling them they were the nurse, not the doctor when they would make a suggestion. However, their director of medical ICU was VERY nice...and the MICU senior fellows were usually very good - it was just the new guys/girls who would be a little inappropriate...but they seemed to calm down after being there a while. But then again, this info about MICU is all second hand...I have never worked there personally so I guess I cannot say for sure. I think it really depends on the culture of the units you work in...any hospital can be different depending on the attitudes of the employees who work there.

Yep, I totally agree with your roomate here. I work MICU and usually if I have a problem with one of the docs it is almost always an intern. Most of the pulmonary fellows are very knowledgeable and open to suggestions, and most of the attendings are as well. The medical director of our unit gave the new July interns a lecture about listening to the nurses! Some of our new interns are wonderful, but many just seem lazy to me or have little knowledge and understanding of what a nurse's level of education is (one intern tried to explain to me how lactulose worked-- gee, I only give the stuff almost every single day!!) These are just my perceptions, this is the only unit I have ever worked on so I'm not sure how it is elsewhere.

apaisRN, RN, CRNA · Sep 1, 2004

My old roommate worked in the MICU, and I would occasionally be amazed at some of the stories that she would tell me about the docs there... I know that the residents often go straight to medicine right after med school, and a lot of their patients are in the MICU...it seemed to me that they were the ones who were too big for their britches sometimes....often being disrespectful to the nurses who questioned some of their orders, telling them they were the nurse, not the doctor when they would make a suggestion. However, their director of medical ICU was VERY nice...and the MICU senior fellows were usually very good - it was just the new guys/girls who would be a little inappropriate...but they seemed to calm down after being there a while. But then again, this info about MICU is all second hand...I have never worked there personally so I guess I cannot say for sure. I think it really depends on the culture of the units you work in...any hospital can be different depending on the attitudes of the employees who work there.

We do get new interns and they can be clueless, but you can always go to the fellows to straighten things out. You learn pretty fast which docs are on the ball and which ones have their heads up their asses. The interns rotate monthly, too, so if you can't stand one you know he/she'll be banished to the nursing home, I mean, general medicine floor pretty soon. For me the MICU's been great. Our SICU takes everything we don't, which means neurosurg, CABG, trauma, vascular, peds etc. It's a hard ICU to work in, you might get a crani one day and an RSV baby the next. Maybe this stress is why the docs and nurses are so grumpy? I hear their nurses eat new staff alive, whether or not they are experienced.

apaisRN, RN, CRNA · Sep 1, 2004

The medical director of our unit gave the new July interns a lecture about listening to the nurses! Some of our new interns are wonderful, but many just seem lazy to me or have little knowledge and understanding of what a nurse's level of education is (one intern tried to explain to me how lactulose worked-- gee, I only give the stuff almost every single day!!)

I have to tell this story . . .there is an intern, now in her 2nd year, who we actually think has psychological problems. But she also gets the weirdest ideas - we had a 500+ pound pt who got an enormous pressure ulcer from his weight and us not having enough staff to turn him more than q4-6. It got debrided and basically he lost his buttocks. The wound must have been four inches deep. Obviously keeping stool out of the wound was a challenge, and he had no shortage of bowel movements. The pt was a stubborn *^%# who refused to stay off his butt, too. I mentioned to this intern that I was holding his bowel meds, and she said that I should give them, she was always worried about obstruction, and even patients with obstructions could pass stool. I hadn't heard a word in report or rounds about obstruction, so I asked her resident. He said no, no one thought the pt was obstructed, and no, the patient did NOT need to be stooling more than he already was with this huge wound. He further said that it was very hard being her resident because she said and did so many inappropriate things, and that he had to read over the notes she wrote because she put things that were way out of line.

The patient eventually went to the floor and got a colostomy but is still expected to die of sepsis as the wound will never heal. He's 28 and originally came in with resp failure secondary to his weight. Sad.

EmeraldNYL, BSN, RN · Sep 1, 2004

Hehe, I think that it's a requirement written somewhere that to get admitted to the MICU, you have to weigh AT LEAST 300 lbs. :rolleyes:

yoga crna · Sep 1, 2004

I have have been blessed to work with excellent and internationally respected surgeons throughout my long career and one thing I am clear on is--the best surgeons are the nicest and easiest to work with. We show mutual (earned) respect. But, you have to do your part, understand the politics of the operating room, when to keep quiet, when to compliment, when to ask questions, when to offer your opinion, how to stand your ground, how to negotiate and to always put patient care first. They will test you, push you, make you angry, but remember you are a critical part of the surgical team and modern surgery would not have been possible without modern anesthesia and anesthetists.

In my private practice, anesthesiologists are always trying to take over, but the surgeons are comfortable with me, the patients are complimentary of the care and the price is right.

keep up with anesthesia and surgery techniques and above all, act like a professional. There is no place to work like an operating room.

Yoga

are-in · Sep 4, 2004

Thanks for the insight Yoga! It helps.

Also, I am starting CRNA school in January at USC Columbia. I currently work in the MICU and am having some trouble getting through these last few months of work before starting school. Even though I have only been an RN for 2 years (all of which has been in this unit), I find myself getting burned out. I am very much looking forward to moving on to a more challenging and more personally rewarding career (not that I haven't gained a tremendous amount here). Now that I have been accepted, I find myself worrying that when I do finish school, I may get to this same point as a CRNA. I have had CRNA school as a goal for @5 years. Am I just letting end-timers get to me? Thanks for the advice

Are-in

I have have been blessed to work with excellent and internationally respected surgeons throughout my long career and one thing I am clear on is--the best surgeons are the nicest and easiest to work with. We show mutual (earned) respect. But, you have to do your part, understand the politics of the operating room, when to keep quiet, when to compliment, when to ask questions, when to offer your opinion, how to stand your ground, how to negotiate and to always put patient care first. They will test you, push you, make you angry, but remember you are a critical part of the surgical team and modern surgery would not have been possible without modern anesthesia and anesthetists.
In my private practice, anesthesiologists are always trying to take over, but the surgeons are comfortable with me, the patients are complimentary of the care and the price is right.
keep up with anesthesia and surgery techniques and above all, act like a professional. There is no place to work like an operating room.
Yoga