Etiquette in the OR?

[trauma_lama]

Hey nurses! I was wondering...I had the opportunity to go down the OR with my pt last week (I'm a NS). This pt was very sweet and easy tempered...in preop, the surgeon, anesthesiologist, CRNA and circulating nurse all came by at one point to introduce their self to the pt. They were all very sweet to her, smiling, taking her hand, etc. Fast forward 15 minutes- she's in the OR but not yet on the operating table and had just "gotten gassed."

It was like a switch had been flipped. This pt was by no means a small person, in the 260 range. As soon as her gown is off, everyone in the room makes at least one comment like "Damn, that's one big girl" and "Man, why do we always get the big ol' ones in here" and "everyone we've had in here is huge today, we can't catch a break!" At one point pre-procedure the surgeon even manipulated her large abdomen and said "wow!" when is rebounded dramatically. And no, the procedure was not abdominal-related in the slightest. Irrelevant side note; at least two of the people in that room were NOT small people their selves, but I guess when you're wearing big baggy surg scrubs it's pretty easy to pick on someone who is so vulnerable and naked and unconscious and spread out in front of you under bright lights...

I've had other experiences with surgery, but only ambulatory stuff- no surgeries as major as this before. So the music and the joking were no shock to me. It was just the cold insensitivity to the pt that really was like a slap in the face.

Aside from the fact that some pts have reported recalling hearing things from the OR and the whole situation being a potential liability, it just seemed overall mean-spirited and nasty. It made me ill to flash back to 20 minutes before to when the surgeon was holding her hand and smiling and telling her how committed they were to doing a great job or 5 minutes before when the CRNA had her hand gently on the pts hair, telling her soothing things in a soft voice. Like how very incredibly two-faced! Sure, I've been nice to a pt who was giving me a really hard time and then gone to the nurses station and ranted briefly, but this lady was nothing but smiles and sweetness to the staff the whole time she was there.

I get that she's a big lady, I get that it probably really is a pain the orifice to have to move such a large person onto the operating table, I get that she is "out" while these things are being said. But it still seemed really nasty and just unnecessary. Yes, she is a big lady but if it's obvious enough that everyone in the room feels the need to comment on it, is there really a need to say anything at all unless it is directly related to safely transferring the pt onto the operating table?

Maybe I'm just naive. Maybe I still have rainbows shooting out of my butt since I'm just a green student. But it seemed crappy and inappropriate to me. Of course I didn't dare say anything since I was below the lowest on the totem pole in there... Have any of you seen things like this? Am I silly to be bothered by it, like do I just need to toughen up? I'm pretty sure OR is the right place for me but I don't know about it if I'm going to have to end up seeing stuff like that happen every dang day. My pt was a person, a lady, and I feel she deserved more respect than that whether she was conscious or not.

Y'all's thoughts? Thanks a lot, hope you're all well :heartbeat

[WhoDatWhoDare, BSN, RN]

I'm sorry you feel that your modesty was compromised in such an impersonal manner, without warning and not saying anything... I will say that you were most likely being transported to the recovery area by the RN and the anesthesia provider... In my experience, there are often times that moving the patient from the OR table to the bed/stretcher things shift or come undone... things like dressings, bandages, and staples if we aren't careful. It is likely the nurse was making sure you were still as the surgeons intended you to be (called assessment) and not having any uncontrolled bleeding, a post operative complication we are always looking for, and didn't think to say much before because many of our patients are still in a state of wake where you are still "waking up"... They probably didn't realize you were as awake and aware as you were. Once again, even though I wasn't there, as a nurse I am sorry you left feeling that way. That is never our intention.

[Green Tea, RN]

First of all, there is a fact that approximately 70% of adult population in this country are either overweight or obese (according to CDC.)

I work as a circulator RN (BMI 22), and majority of patients I see are larger than me. I often times have to ask for help because there is no way I can position my patient alone and it's not safe to both the patient and me. When I ask for help, do you feel it inappropriate if I say "I need some help because my patient is overweight/obese?" Or you mean I should say "I need some help" and no more and let my coworker notice why I am asking for help once she/he sees the patient because saying anything related to body size is touchy to you?

Besides, OR staff are put under stress of time. Even if there is a few minutes of delay, I am asked why by management. Also, some patients complain to OR staff if there is delay in schedule even the it is caused by ensuring safe practice in the OR.

You may need consider that some staff cannot lift patient at all because of various reasons (back issue, pregnancy, etc) and other staff are repetitively asked for lifting help. Often times, enough staff are not available because resouce is limited.

It may make you feel morally superior by writing the thread. But the fact is you don't work in the OR... You don't face this hardship or frustration everyday.

[BarbaraNM, ASN, RN]

Edited

[BarbaraNM, ASN, RN]

First of all, there is a fact that approximately 70% of adult population in this country are either overweight or obese (according to CDC.)

I work as a circulator RN (BMI 22), and majority of patients I see are larger than me. I often times have to ask for help because there is no way I can position my patient alone and it's not safe to both the patient and me. When I ask for help, do you feel it inappropriate if I say "I need some help because my patient is overweight/obese?" Or you mean I should say "I need some help" and no more and let my coworker notice why I am asking for help once she/he sees the patient because saying anything related to body size is touchy to you?

Besides, OR staff are put under stress of time. Even if there is a few minutes of delay, I am asked why by management. Also, some patients complain to OR staff if there is delay in schedule even the it is caused by ensuring safe practice in the OR.

You may need consider that some staff cannot lift patient at all because of various reasons (back issue, pregnancy, etc) and other staff are repetitively asked for lifting help. Often times, enough staff are not available because resouce is limited.

It may make you feel morally superior by writing the thread. But the fact is you don't work in the OR... You don't face this hardship or frustration everyday.

In my OR, we move nearly every patient with 4 people....the Anesthesia provider at the head, one person on each side, and one at the feet. Of course, if it is a child or a very small patient we will sometimes move with only 2 or 3. Add an additional person on each side for an especially large patient. We will broadcast 'Moving help needed in room 7'...no explanation required. And we truly don't have anyone working that can't lift at all....fortunately, those with temporary limitations are taken care of by all coworkers.

I feel that safety for all employees in the OR and safety for the patient far outweighs any desire to move more quickly. I understand about turnover times...our target is 30 minutes....which doesn't start until we are out of the room.

[guest655229]

Our regular OR tables hold 675 pounds, excluding Jackson and fracture tables, of course. The bariatric certified table holds 1000. I can't believe they make on OR table that only holds 375...The noise level can get quite loud but the critical commentary is almost nonexistent. Sometimes we have unprofessional banter between the staff but not about the patient.