New OR RN - Surgeon Yells

negatron · Sep 17, 2015

Well, if something goes wrong, there is a ton of liability lying on the table. And it won't be the nurses who get the heat, it's the surgeon. I'm not saying the yelling is appropriate but if you can think of it in their shoes, they are under immense pressure and stress to do what they have to do. Every second matters when a person is cut open and under anesthesia. They are yelling because they want their patient to live and not screw them up in any way..that's how i see it. Best advice i can offer is to not take it personally and develop some form of thick skin for these situations

nursephillyphil, BSN, RN · Sep 17, 2015

i think that with all nursing skill, it will take time and practice until things smoothen out and you get better. The surgeons hold a certain expectation and standard while in the OR, regardless of who is in it, x amount of experience, etc. Once in the OR the surgeon is in his zone and expects it to flow at a certain rate and rhythm. disruptions to that flow cause stress. You will get better with time and practice, so don't worry. I'm sure they took longer than expected on their first surgeries as well :)

HouTx, BSN, MSN, EdD · Sep 17, 2015

This is NOT ACCEPTABLE. There is a lot of literature on the problems associated with disruptive physicians. All of the national quality & patient safety groups/organizations have published articles on it. Joint Commission actually required organizations to have policies to address the issue. Full Disclosure: Years ago - On two occasions, while running an IABP in an OR I have had a clipboard & hemostats thrown at me by ticked-off physicians. At those times (I was young and stupid) I followed my supervisor's advice to "shake it off". Would I do that now???? Heck no.

It is not just the poor stressed-out doc 'blowing off steam'. Acting out like this causes a ripple effect that shuts down critical communication among the entire group. People are afraid to do/say anything for fear of retribution. They tiptoe around the volatile personality - taking great pains to avoid triggering another episode. So - the "stop the line" empowerment that is critical for patient safety in the OR is nonexistent. It's back to the old style Boss & minions model rather than a team effort.

Look up your organizational policy on disruptive physicians to see what process you should follow. Don't let it slide. Our duty is to the patient. If your supervisor does not back you, take it up the chain of command.

PaulBaxter · Sep 17, 2015

No one should make excuses for surgeons, or anyone else in their right mind, behaving inappropriately in the workplace. Poor communication of any type is likely to contribute to worsened patient outcomes.

I haven't (yet) worked in OR, but I'm hoping to. I don't expect "please" and "thank you" or other social niceties, but I do expect people to treat each other respectfully.

Been there,done that, ASN, RN · Sep 17, 2015

Surgeons are volatile creatures. Unless your administration has your back, they will not change.

Some facilities will make the surgeon apologize, and some surgeons learn from it.

Honestly, if your facility is not one.. and you can't tolerate being yelled at, rethink your specialty.

TakeTwoAspirin, MSN, RN, APRN · Sep 17, 2015

If you are a brand new OR nurse in a residency program where was your preceptor when all this was going on?

Clearly, you are not ready to be left alone and that is frustrating for everyone concerned but not your fault. It takes at least 6 months before you can be anywhere near proficient in the OR. As you progress, you might be able to be left a short time in general surgical cases like appendectomy or lab chole cases, but for things like plastics and ortho you will need, and should expect, a different level of support and assistance.

As far as where the graft material was, all of that stuff should have been in the room before the case started, unless the plastics guy changed his mind after the case had started. You should know what is on the surgeon's preference card and make sure everything is in the room before the patient is brought back. If you get stuck, call in the troops and ask for specialty coordinator or charge to come into the room to help you with the bigger cases. At least while you are new, the surgical tech is likely to know a whole lot more about the surgeon's preferences and set up than you are. Make friends with them and work together to make sure everything goes smoothly.

If you are not getting support you need to make noise until you do. It sounds like you were thrown to the wolves a little on this case and set up to fail. Always make sure you get the help that you need. As far as waiting a couple of minutes for warm saline while you find a piece of equipment the surgeons know better than to make a fuss over stuff like that. It will happen even if you have 20 years of experience and they will get over it, this time, and the next time it happens! No OR has the staffing these days to be able to have "runners" waiting in the hallway just in case you need something that isn't in the room. It's a fact of life in modern ORs, you have to leave the room some times. This isn't about you, it's about the system.

pixiestudent2 · Sep 17, 2015

Where's your preceptor?

I've been in the OR for 1.5 months and a surgeon, has only been grumpy towards me once. And my preceptor promptly told him that I'm a new nurse and still learning.

I'm glad she stuck up for me because honestly I probably would have let it continue.

nurseactivist · Sep 18, 2015

Let me preface this by saying, I was never an OR nurse. However, as part of my orientation for ICU (years ago), I had to observe surgery. It was called a CABG. Dr. A. was the nastiest cardiac surgeon (I had observed him in ICU). I am new nurse observing and apparently the scrub nurse is new. He begins yelling, she is rattled and next thing you know, he was cut. He continued after changing gloves (in a professional manner). I never knew what happened to the OR nurse. In those days, nothing happened to the doc.

Hopefully, an unusual occurence. From first hand observation, I would say it could be dangerous to patients and staff, not to have good communication.

ORRN21 · Sep 18, 2015

No excuses for the yelling surgeon. When Im precepting anyone I tell the surgeon at the beginning of the case to extend a little more patience. After all, we all have to start somewhere and they shouldn't forget that.

Some surgeons are "yellers", politely and firmly remind them you are doing your best and that you are still new to the OR.

Good luck!

Anna Flaxis, BSN, RN · Sep 18, 2015

I need some concrete advice on:
#1. Why does this happen?

Because you're dealing with a surgeon.

#2. What can I do to avoid it?

Don't work in the OR.

#3. What to do when/if I do get creamed.

Learn to give as good as you get.

Horseshoe, BSN, RN · Sep 18, 2015

My first week flying solo in the ICU after my critical care internship:

I received a patient from PACU, who came in with blood hanging (had been started probably an hour before in PACU or perhaps even in the OR). PACU nurse didn't relate any problems with the patient's recovery. The first thing I did after getting report was to go in and take the patient's temp. It was 104.

After getting all the other vitals, I called the surgeon and informed him of the patient's status. He yelled into the phone, "So you are calling me to tell me that one hour after the blood is transfusing my patient is SUDDENLY having a blood reaction?!" I calmly replied, "No, I'm informing you that your patient's temperature is 104.9 degrees." He started cursing, told me to DC the blood, etc., etc., blah blah. I hung up and told the charge nurse about it, saying I didn't see why he felt the need to yell at me for that. He said, "He's a surgeon. They're all *&@!. Just get used to it."

Obviously they are not all jerks, but point taken.