Lack of Professionalism in PACU

[MamaJean, RN]

As a nurse of over 30 years and an educator for 20 years, I'm very concerned about the lack of professionalism that I have observed in the PACU. A few years ago I was the pt undergoing a bilateral orbital decompression in a large metropolitan eye institute. The patients were in a circular curtained area, facing the wall, with the nurses station in the middle. As my nurse was getting me ready for discharge her supervisor called out from the desk, "When you're finished with that one you can go to lunch." I immediately called out in a loud voice, "Did she just call me "THAT ONE"? Well, apologies flew around very quickly and we all had a good discussion about appropriate communication and lack of civility, etc.

Today my husband was in the PACU post umbilical hernia repair. The hospital was different, the set up was the same except the patients were facing the nurses station this time and were less than 5 feet away. The nurses directly in front of us were all gathered around the computer watching a You-Tube video and laughing loudly, bantering back and forth about the content. I was appalled. Don't we save that stuff for break time anymore? I'm all about having fun with coworkers, but not in front of patients, and not while you should be monitoring your patients who are just minutes out of the OR!

Maybe I'm just too old fashioned, or the instructor in me is really expecting better behavior. Thoughts?

[CrunchRN, ADN, RN]

Just the way it is now. Don't let it get to you.

[imintrouble, BSN, RN]

Our docs make rounds in blue jeans, sneakers, and polo shirts. The definition of professionalism in healthcare has changed.

"Just the way it is now" about sums it up.

Everything about how we act and look as nurses has relaxed.

[MunoRN, RN]

I think you overreacted in the first example, "that one" refers to the task of post-op recovery, which is correctly referred to as "that one".

If the nurses spent your entire recover period watching you tube videos I would certainly see your point, but research actually shows pretty clearly that occasional diversions, outside of breaks, actually greatly decreases the risk of errors and increases productivity, so really you should be thanking them for taking a minute to watch a youtube video.

[AJJKRN]

I think it's just the change in how we have become more technologically dependent which in turn blurs the lines of what used to be thought of a social mores and boundaries. It's the new age Yo!

[Serhilda, ADN, RN]

I think you overreacted in the first example, "that one" refers to the task of post-op recovery, which is correctly referred to as "that one".

If the nurses spent your entire recover period watching you tube videos I would certainly see your point, but research actually shows pretty clearly that occasional diversions, outside of breaks, actually greatly decreases the risk of errors and increases productivity, so really you should be thanking them for taking a minute to watch a youtube video.

As uncomfortable as this makes us, it's absolutely true. Studies have shown that the occasional break or "slacking off" really does improve work productivity and quality. Perhaps being more quiet about it would have been more appropriate, but watching a quick video before getting back to work is harmless.

[Penelope_Pitstop, BSN, RN]

I worked in PACU, and it's a very unique place because the patients aren't in "rooms," it's always (in my experience) ward-style.

Therefore, the nurses don't have a true "nurses' station" like in most hospital areas. Everything they do is in view of numerous patients.

Where I work, if I want a minute, I am able to shut my office door; however, if your work station is in the middle of all of the patients, well, that can't be done.

[evolvingrn, BSN, RN]

I think you are hyper analyzing...... "That one " is really not that big of a deal. And the you-tube video? Maybe not ideal.... But I want nurses who know their stuff but enjoy their job.

[nrfitchett4]

There is a local hospital that even just a few years ago had a no cellphone while on the clock policy. Sorry, if my children need to reach me, they will be able to reach me. Times do change and you should as well. As long as they are not ignoring their patients, I don't see the harm in it. I know an ER doc that carries and iPad just to play clash of clans when not seeing patients.

[Lad345]

I don't know, I think allowing staff to treat the station as a reprieve as well as a central area to chart and monitor is something that depends on the floor. There's a culture of hyper-connectedness in healthcare now. That's great for patient outcomes, as turn around time on issues lessens; but at the same time, nurses may be in a constant state of keeping track of care plans that update constantly.

We sometimes have shifts where we might not get to eat, revolving doors of admits/discharges because of clinical pathway adherence, not getting to listen to our body and rest a few minutes after settling medically heavy, total care patients , and we have ever-updating electronic charts and always ringing portable phones.

Things are evolving, patients that used to be treated in ICU are on the floor now.

I personally think it's okay to have some comic relief for the sake of staff camaraderie. Burnout can creep up on one quickly, sometimes you really need to stop and do something else for a few minutes.

[vanilla bean]

As my nurse was getting me ready for discharge her supervisor called out from the desk, "When you're finished with that one you can go to lunch." I immediately called out in a loud voice, "Did she just call me "THAT ONE"? Well, apologies flew around very quickly and we all had a good discussion about appropriate communication and lack of civility, etc.

And if she had referred to you as "bed 21" would that have been better? They certainly can't refer to you as "Ms. MamaJean" (or your actual name) because of HIPAA. You were in an area where other patients would have been able to overhear your name if they had referred to you as such, which would have been a HIPAA violation. I sometimes feel that we nurses have been put in a no-win situation in terms of how to refer to patients. Referring to someone as "Bed 1" or "Room 26" is deemed too impersonal, but we can't use patient names in areas where other patients, visitors, or staff not directly involved in care can overhear (read: just about everywhere in the hospital). I mean this in all sincerity: how would you like to be referred to by staff in a way which doesn't violate HIPAA? I will gladly consider your suggestion(s) going forward.

[MamaJean, RN]

And if she had referred to you as "bed 21" would that have been better? They certainly can't refer to you as "Ms. MamaJean" (or your actual name) because of HIPAA. You were in an area where other patients would have been able to overhear your name if they had referred to you as such, which would have been a HIPAA violation. I sometimes feel that we nurses have been put in a no-win situation in terms of how to refer to patients. Referring to someone as "Bed 1" or "Room 26" is deemed too impersonal, but we can't use patient names in areas where other patients, visitors, or staff not directly involved in care can overhear (read: just about everywhere in the hospital). I mean this in all sincerity: how would you like to be referred to by staff in a way which doesn't violate HIPAA? I will gladly consider your suggestion(s) going forward.

How about, "When you are finished with your current patient"? Or what about waiting until the nurse returned to the desk area? Shouting things out across the pt area is never appropriate, in any setting, unless it is an emergency.