I need some serious, honest advice.

[usernamehere]

I have been browsing the threads on doctor's verbally abusing the circulating nurses on this thread, but this is very different and I need help.

I'm a nursing student and I graduate soon. I have been caring for this one very critical patient, it's a very unfortunate, heartbreaking case. I don't want to go into too much detail. I love where I'm at right now in my clinical, and I love caring for this patient, although more often than not I break down as soon as I walk in the door once I am home and feel totally drained for the following couple days.

As you know, as a student, we are encouraged to go with our patient to their procedures, surgeries, whatever, as a learning experience. My patient needs surgery VERY often. Yesterday, he was scheduled for surgery. So I went. This is where I need some advice/counseling, and I figured OR nurses would be the best to ask.

I know surgeons, doctors, anesthesiologists can be very jaded and callous. What happened in the OR yesterday was beyond jaded and callous and there is no excuse for the abuse I heard and witnessed towards my patient. As if my patient's situation wasn't horrific and heartbreaking enough, the surgeon and anesthesiologist were making crude statements about "killing" my patient, making sick, awful, heartless jokes about his situation, current condition, unfortunate procedures he was going through in the OR, and during surgery, took the surgical scissors and knocked them on my patient's bare skull repeatedly, loud enough for me to hear across the room. I was absolutely horrified!!! In the beginning, I was 2 seconds away from politely asking them to please not speak about my patient this way, but then I remembered in orientation that we were told that we will often be asked to leave the OR if things go south or whatever. And this is MY beloved, innocent patient, and I realized I was the ONLY person in the room that was on his side, and if this is what they do when someone from the floor is here, what will they do when nobody's here?? This went on for almost 2 hours.

I burst into tears as soon as my patient was back in his room and helped to recover him with my nurses and our kind, caring unit doctors. They seemed concerned but kind of brushed it off like, "Well, that's surgery, that's how they cope." It killed me to be witness to the abuse towards my patient, and it has been tearing me apart that I didn't/couldn't say or do anything about it. I am a patient advocate, but what do I do?? I feel like I didn't do anything for him. It was horrible. I'm afraid that day will haunt me for the rest of my life. What can I do now? Who can I talk to? First semester, they told us, "If you ever have any issue with a doctor, nurse, anybody at the hospital, don't even try because you won't win." I refuse to take that as an answer after this, it's not about me, it's about my innocent patient and how he is being treated in the OR. What happens when I'm not there?? Next week is my last week. I need some honest advice. I feel like I did a great disservice to my patient for not speaking up, but I felt like I needed to be a witness to the entire surgery and this unethical behavior, for some reason. Like witnessing a crime, I felt like I needed to be very studious and watch exactly what was going on in case it came up later (weird feeling).

Please help, what can I do now? I feel horrible. :crying2::crying2:

[NurseLumpia]

Very disheartening!!! Does your hospital have a patient safety hotline? The hospital that I work with has one of this and takes anonymous calls from everyone. If not, I would suggest go look up their patient service hotline and tell the pencil pushers about what happened since they are scared of bad press this might open their eyes.

[RogueRN]

The behavior of the surgeon is COMPLETELY UNACCEPTABLE!!! You definitely have to step up and report it. There are several options...

1) Many hospitals have what is called a "Business Conduct" hotline where you can report that kind of behavior. You can anonymously report this horrific behavior and that surgeon will be investigated.

2) Write a letter (anonymously, if you want) to the Chief of Surgery at that hospital and send copies to the Hospital President, Medical Staff Director, Director of Nursing, and Director of Nursing in Surgery.

3) If nothing happens after you've done the above, I would tip the local investigative news teams of all the major affiliates in my town and hopefully, they can get somewhere.

Good luck whatever you decide to do. Just make sure you do SOMETHING. Please!

[carluvscats]

Agree with the above posters..... you HAVE to report this. I assume you were with a nurse at the time? What was their reaction ~ did they say anything?

There is a reason such people continue to act the way they do...... it's because they do not get called out on it. It probably has been going on for a long time. Maybe you can help put an end to it.

[usernamehere]

Thank you SO MUCH for your direction. I feel like I was there for a reason, I just didn't know where to turn or who to talk to. We learn a lot in nursing school, but nobody has taught me how to deal with something like this, and I hope I never have to again. It was just wrong, no excuse for that behavior. I did find a patient safety reporting system that can be anonymous, and I will definitely be looking into the other things mentioned like business conduct, and who else in the hospital I can write to. The first thing I did when I came home was document everything. I WILL be reporting the surgeon and anesthesiologist for their behavior. Thank you so much for your support and direction!!!!

[usernamehere]

Do you think I could just send my documentation to the business conduct, director of surgery, etc? As far as HIPAA violations, would it be wrong to put my patient's initials and condition? "My patient, initials, is a x-year-old with this condition." It's a very heartbreaking case, I know much of the hospital knows about my patient already. This behavior wouldn't be okay in any circumstance, but this situations makes it so much worse.

[PetiteOpRN]

I'm wondering if the "surgical scissors and knock[ing] on [the] patient's bare skull repeatedly" might have actually been part of the procedure and not a form of physical abuse. Just a thought. Surgery can look pretty barbaric.

I've seen what it does to residents when a perfectly healthy patient dies on the OR table. They do detach and stop seeing the patient as a person. I'm not saying it's right, but they could not be a good surgeon without this quality. If they were emotionally attached to the person, they could not operate objectively. That is why surgeons don't operate on family members.

You were NOT the patient's only advocate. There was an RN in the room. She is the one with the authority to tell the surgeon to knock it off, and she should have.

Reporting the incident is not a HIPAA violation. There are many reasons to have access to health information, including care delivery, clerical support, chart audits, and quality assurance. Your best option when reporting the incident is to go up the chain of command, starting with your clinical instructor.

[RogueRN]

I don't think you need to send any details of the patient's condition or identity to the hospital leadership. All they need to know are the details of the surgeon and anesthesiologist's bad behavior. For example...

Dear _______,

Because I understand that patient safety and satisfaction are at the top your priority list, I am writing to inform you of very disturbing behaviors that I witnessed during my observation time in surgery as a VISITOR and not part of your staff.

* Dr. Surgeon and Dr. Anesthesiologist made cruel remarks and jokes about a patient's condition and situation. (Insert direct quotes here.) No staff members objected to this behavior.

* Dr. Surgeon took heavy mayo scissors and repeatedly tapped a patient's head with it during the procedure so that I could hear it clearly from the across the room. Again, no staff members objected to this behavior.

While I understand that the patient is sedated, there are instances when people can recall what doctors and staff discuss during a procedure. Not only is it not appropriate for a patient to hear, but as a teaching institution I am concerned that these behaviors are being handed down to the next generation of healthcare providers. Should I assume that professional standards of behavior don't apply to physicians that work at your facility?

What about the physical assault of the patient under anesthesia? There was no one who acted as a patient advocate leading me to believe that this hospital is not one I should choose for my own care or that of my family.

Etc. etc. etc.

**************

Sorry, I got carried away there. Didn't mean to write the letter for you! :)

The only department that might want to know the details is Risk Management. If you're filling out one of those anonymous online forms, then it usually asks for those details anyway.

U, you are doing the right thing. Even though you're still a student, you are thinking like a nurse and, more importantly, like a PATIENT ADVOCATE. Great job!

No matter what position you're in, remember that knowledge is power... In this case, you know that what they did was wrong and now you know who to report it to. Hopefully, the powers that be do their job and advocate for the patient as well.

GOOD LUCK!!!

Keep us posted on what happens...

[usernamehere]

Again, thank you all so much for your help in this situation! I'm so relieved I could find someone to help me out.

As far as surgery being barbaric, I do understand it can be rough and turn one's stomach, but I can 100% ASSURE you that knocking on the patient's bare skull was NOT in any form part of the procedure at hand. Also, despite how detached and jaded the surgeon and anesthesiologists can be, this was downright WRONG. I have been to OR before, in much less serious, critical, much more carefree situations, and they do seem as though they're not even paying attention to the task at hand, talking about golf games, etc. I understand that's how it works, but this was VERY different. It wasn't right. I'll never be able to forgive myself if I don't report their gut-wrenching behavior.

Although the circulating nurse didn't participate in any of this, I felt at the time he was professional. I even thanked him in the end "for being nice to my patient," and proceeded to bawl my eyes out while I helped recover him with the nurses in my unit. But you are right, he should have stepped in and defended my patient as well. Maybe he is jaded to their behavior, it probably happens often. I didn't think about that.

Thank you all again so much.