burnout in the OR - page 3

I've been a nurse for six years, in the OR for five. When I first started, I LOVED it. I actually saw myself staying with it for twenty years. And there are still things that I like. But there is... Read More

  1. by   dld
    Thanks Oregon nurse for sharing with us about working in Oregon. I have always worked in California and I am looking to move some where less crowded. I was seriously considering Ore. but now I think I'll stay put! CNA has done alot for RNS in California. I worked at the same hospital for 10 years now and I feel the urge to change something. I wonder is it just me, the hospital or the unit? The paperwork is unbelievable! Anyone for electronic charting?
  2. by   cwazycwissyRN
    Just had to pop in and give this thread credit for staying alive from 8-1-2000 thru today. 5 1/2 years zzzoweee. Guess it goes to show the constant battles of burn out in the OR. High stress/ High egos' / Call back..
    later cwissy
  3. by   Corvette Guy
    Quote from cindybeth
    I've been a nurse for six years, in the OR for five. When I first started, I LOVED it. I actually saw myself staying with it for twenty years. And there are still things that I like. But there is plenty that makes me grind my teeth in my sleep and dread going to work the next day. I am sick of the arrogancy of surgeons, as well as the spinelessness of my peers (including anesthesia MDs). They say NOTHING when surgeons complain about minor things when the biggest screw-ups of the day should really be credited to the surgeon.
    I am quite disappointed that things have worked out this way. At a loss for what to do. Have already cut hours to 3 days/week. Considering job changes, even career changes, but not sure what I would WANT to do. (Career changes take a lot of effort, you know?) Would appreciate any encouragement or suggestions. Thanks
    Yep, I too got burned out w/OR Nursing. However, I'm very excited about getting back to Critical Care Nursing.

    Why don't you leave the OR & try a different area of nursing?
  4. by   shodobe
    I have been in the OR for almost 30 years, YIKES! I have done M/S and ER before but have found my niche in the OR. Surgery is definitely not for everyone and should be looked at very hard when condidering it. I have and do work at several other places and find it to be different every place you go. I have yet to find the surgeon aspect, mean, disrespectful type, anywhere and I know it does exist. Back-biting, "eat your young" type nurses exist everywhere, but I am lucky not to have found any. I feel bad for the nurses who get burned out after a few years because of personalities, it shouldn't happen.Training has alot to do with how a person is molded for the OR. If preceptors are non-engaging types who just go through the motions, then the trainee will not feel part of the team. Training is not just teaching someone the skills they need but also the workings of the OR. It is hard to explain what I am trying to say, but I guess there is some kind of "code" that goes along with the training. Some people feel comfortable after a few years and others take years to feel that they can handle anything. I know it was well over 5 years before I could say to myself, " I can do that"!
  5. by   moliuchick
    Quote from JaneRNBSN
    TO CINDYBETH: I worked in OR as a circulator/recovery RN and I understand how you feel. I burned out after only 6 years. The surgeons were the main reason I quit. As you said, they are arrogant, whining little boys! And to add insult to injury, we were called out for non-emergent procedures simply because it was convenient for the doc to do it on weekends or after hours. Administration was spineless, they would let them abuse us and call us out anytime because "they bring money." The only way to save yourself is to get out! Your experience in the OR is a gem on your resume. Go for something you will really enjoy. Life is too short. I am fortunate in that I have the opportunity and financial resources to stay home with my grandchildren. Godspeed.
    I only worked in the OR for a few months and I already hate it so much that I want to quit my job. Why do you think that our OR experience is a "gem"?
    Do you mind giving me some suggestions as in what specialties I can go into after losing all of my med/surg nursing skills?
  6. by   RNOTODAY
    Quote from shodobe
    I have been in the OR for almost 30 years, YIKES! I have done M/S and ER before but have found my niche in the OR. Surgery is definitely not for everyone and should be looked at very hard when condidering it. I have and do work at several other places and find it to be different every place you go. I have yet to find the surgeon aspect, mean, disrespectful type, anywhere and I know it does exist. Back-biting, "eat your young" type nurses exist everywhere, but I am lucky not to have found any. I feel bad for the nurses who get burned out after a few years because of personalities, it shouldn't happen.Training has alot to do with how a person is molded for the OR. If preceptors are non-engaging types who just go through the motions, then the trainee will not feel part of the team. Training is not just teaching someone the skills they need but also the workings of the OR. It is hard to explain what I am trying to say, but I guess there is some kind of "code" that goes along with the training. Some people feel comfortable after a few years and others take years to feel that they can handle anything. I know it was well over 5 years before I could say to myself, " I can do that"!
    Great point. and I know *exactly* what you are saying........I have had to find out on my own during the last 3 months of my OR training.....it's not only the job you need to learn, its how you deal with the people you work with, that is just as important. For instance, my experience so far has been : the surgeons are fine, but the "problem" lies with the staff... techs and nurses.they have been horrible to the new people...and we really cant understand why yet...but, my point is that I had to learn how to "manage" difficult techs, nurses, even OR assistants who will give me a hard time just because they want to see if you will take it. Once you know how to handle them, they suddenly become more manageable!!!!! Now that I know *how* to do this, I sometimes find myself wondering if I even *want* to be surrounded with these people 5 days a week......OR is a tough place, and I have found that to refer not only to the work and skills you must learn. Its the dynamics of the staff that has been a big hurdle for me at my current job. I do understand that this place in particular might be a little more so than other OR's, so I am told, but it's still hard. I just want to learn!!!!!!! A psych degree wouldnt hurt to have in your background if you want to work in the OR.
  7. by   beachee3
    Currently working in SanDiego and the unions are weak, the salary is low, $30-40's. The call pay is only $6 hr. Northern CA seems to have it going on.
    I've been in the OR 19 years and burned out on bad managers. Seem to be having trouble staying at one place more than 6-8 months. Flying into CA to work as the salary is higher.
    Currently attending University of Phoenix to obtain my degree in nursing to move up as the crap I deal with isn't worth it. Considering working for JCAHO.
    Last edit by beachee3 on May 18, '06
  8. by   staceyp413
    Wow, some of you are working in horrid conditions!! I am a charge person/manager and I for some reason a lunch is missed I feel awful.....unless staff do the "we'll eat after our case" and don't tell me and I put a different case in their run.........I don't as lunch was offered and they should have taken it. Same with breaks, if for some reason we're short, have an emergency case, etc. I don't feel right taking a break or lunch unless my staff do and it really amazes me that others don't feel the same.

    As far as relief goes at change of shift. My staff are great. If I ask for volunteers I usually get at least 1 or 2. Many of my staff come to me and want to stay over if they are in a "neat" case or in a case that is within minutes of closing and wrapping up. A lot of staff even call me as it gets close to shift change time to keep me in the know that a case will need to be staffed if they are sure it will run over or if they know their next case will be delayed.

    After writing this, maybe it is because of what the staff do to help me stay sane and on top of things is a small part of why I make sure my staff are well cared for.........without them I am sunk!!
  9. by   TsunamiKim
    Great to read the last post Staceyp413 as this is how it should be, consideration, give and take, but always focusing on what is best for the patients. Keep up the great attitude as we need more like you. Unfortunately, the toxic work environment is driven from the very top and Charge Nurses get lumbered with implementing under-staffing. The “redundancy” of personnel that is so important for safe coverage is being stripped away as an unnecessary expense.
    It was the Hospital policy in the late 90s that started to force Nurses out. The “occurrence” policy and rolling sick bank time into Vacation time as one smaller pool of available time off. The tenure Nurses felt penalized most loosing over a week of vacation time, not exactly a reward for dedication: some quit. There was a domino affect in our ORs because the more Nurses quit the fewer were left behind to cover call. The more Nurses felt trapped by the burden of heavy call commitments the more they considered leaving. We had an exodus of experienced Nurses and plugged the gaps with travelers.
    Then the Hospital offered the traveling Nurses a big fat bonus for committing to a few extra weeks. This was a real smack in the face for our regular staff who did not receive the bonus and were now seriously overburdened with call since travelers did not take any call. If Management had set about designing a plan to make the workplace more intolerable they could not have done a better job, but I think they knew exactly what they were doing. They called their self-created exodus a “nursing crisis” and used it as an excuse to mandate overtime and do more with less staff. They were laughing all the way to the bank. Around this time the above strategy was being implemented in all parts of the Hospital in facilities all over America to maximize profits while making care unsafe.
    Now we come to redundancy of personnel. No spare people, you do without a break. During the regular shifts breaks are accommodated between cases if the unit is short staffed. But what happens when it is the weekend, in the middle of the night? Calling in a call team person to relieve someone in Surgery is an expensive option, so they remain trapped for the duration. I would often try to take my breaks between cases if I could because of providing consistency to my Surgeon. I would go for 6-8 hours without a break no problem and I never complained unless it was beyond 8hours and for no legitimate reason. However, this flexibility gets taken for granted, to the point where no one considers whether you are still functioning safely.
    Not all Charge Nurses were so inconsiderate, but the one that was most inconsiderate to me was the Manager for off-shift personnel. No point reporting a Manager in a Hospital where Managers are never held accountable. I did report and it cost me my job. Leaving someone stranded in Surgery for 10-12 hours presents a risk to patient care and I feel that it should be documented in an “Incident Report” as a potential danger to the patient. In a real emergency no one is going to object if they miss a break, but this should not become part of the regular coverage routine and identifying such incidents might prevent this. It would have documented the repeated abuse of the one Manager at my former Hospital who was always dumping on her staff and perhaps she would have felt compelled to be more considerate in future. Certainly the onus should not be on the person scrubbed to beg for relief and somehow prove that they made this request.
    On the worst occasion, where I was left for 12hours during a Liver Transplant, the call team personnel should have been in the OR on stand by for Trauma. There was a requirement under COMAR that as a Level One Trauma Center we must be able to man a Trauma OR in 15minutes or less. If a Trauma had come to the OR on that particular Saturday night I would have lost the Circulator from my room for well over an hour while the call team person was contacted to come in. My Nurse would not have been just next door either, as the Trauma rooms were down the corridor in another building. This was a very stressful 12hour Transplant case with my patient on bypass; it was not going at all well and the Surgeon was new to our team doing his first Liver at our facility. The Circulator was relieved briefly and told to “run to the bathroom quickly” as if emergency cases were on their way. Under such circumstances you do not tie up the main desk with calls begging for relief.
    When the abusive Manager finally entered the room at 6:00AM I told her I was about to pass out and needed someone to take over the clean up. I did not think this was unreasonable after 12hours in Surgery, but I had to repeat my request three times before she even acknowledged I had spoken. She then gave me another assignment to complete before I was permitted to break scrub. I do not know what part of “I am about to pass out” she did not understand, but disobeying her meant getting written up.. When I discovered that there had been no pending emergencies all night and that this abusive Manager had left me stranded out of pure selfishness I reported her negligent conduct and abuse of power up the chain of command. My complaint was completely ignored.
    The Manager was never disciplined, but by accusing me of “causing a scene in the patient care area” for daring to protest her abuse I was verbally reprimanded. This was a common practice from our Managers; always meet the complaint with a complaint about the informant. That way the most outspoken could be identified and another strike against them might be useful in removing them. When this same Manager was about to change her regular shift duty so that I would have to work virtually alone with her every Saturday night I requested reassignment. I referred to my concern over her past abuse of power by stating that I felt we had reached a ”toxic level of dangerous.” I was told “she probably will not do that again,” but within a few short weeks I was forced to take unpaid leave and then fired.
    In identifying this particular incident I had inadvertently highlighted a serious violation beyond this deplorable act of abandonment. The fact that no call person was bought in to stand by for Trauma was a clear violation of our obligations under COMAR regulations. However not calling in the call team to stand by for Trauma had been a well established cost-cutting strategy for some time. I believe it may have been introduced and was certainly implemented by the abusive Nurse Manager, who also taught Trauma classes. A month after I was fired the OR abruptly changed their policy and started calling in their call team to stand by for Trauma. At my Arbitration Hearing OR Managers admitted that I had been left stranded in Surgery for 12hours, but said the ER was busy and I hadn’t asked for a break. I guess telling your Manager you are about to pass out does not count as asking for a break.
    When I bought this matter to the attention of MIEMSS the Maryland Trauma agency I expressed the concern that this misinterpretation of the regulations might extend to other Baltimore Trauma facilities. I made a sworn statement to their States Attorney, but they never got back to me. When I called a few weeks latter I was told that the situation I had identified “didn’t specifically endanger Trauma patients.” I read this to mean the following: if we were forced to abandon a complex case, even one where the patient was on bypass, for over an hour to open a Trauma OR in an adjacent building it was OK to risk that other patient’s care as long as we met our Trauma obligation. I never received anything in writing from MIEMSS.
    As with so many other Government agencies charged with protecting public safety I was expected to disprove spurious false allegation of disruptive behavior that left my credibility in question. This was almost impossible as I was never allowed to see exactly what the alleged disruptive behavior pertained to. There was no proper documentation of particular event just vague comments about staff feeling threatened. Five years latter I have still seen nothing more than an unsubstantiated one line catch all phrase; that is what my former Hospital calls “transparency.” Due to their success in portraying me as a “disgruntled former employee seeking revenge” the Hospital has never been investigated properly regarding negligent staffing issues.
    If you are always considerate with your team, as it appears you are, in an emergency they will be there for you and back you 100%. Taking a break during Surgery must be determined by what is safe for the patient. In a real emergency, compromises might need to be made. There is a point where concentration begins to flag, blood sugar drops and all you can think of is racing to the toilet ASAP. This is not conducive to anticipating the needs of your Surgeon. It is the duty of a charge Nurse to protect the safety of OR patients my ensuring that their teams are not struggling to function in such a state where they might make a serious mistake. The onus is on that Charge Nurse to order a person to break scrub at the first possible opportunity when they realize someone has remained at the field for too long to function safely. How long is too long? We must bear in mind that, as I stated at my Arbitration Hearing, “no one is more important than the patient unconscious on the OR table.”
    Five years on I am still speaking out about what happened. I feel it is important to document such abuse. I have posted comments on other threads regarding the retaliation and wrongful termination for Whistleblowing I have also started new threads on the toxic work environment, compliance issue and lack of Compliance Line protections. I would really like to hear some consensus of opinion on how long is too long for someone to maintain concentration while scrubbed into Surgery? I want the actions I am currently taking to help in pushing for tighter regulations on the break policy to protect OR patients, but also in other clinical areas. Redundancy of personnel is a vital safety requirement besides making for a better work environment. Documenting abuses and negligent under-staffing is the only way to prevent financial priorities from overburdening Nurses to the point of burnout in all clinical areas
    Staceyp413 I just hope you will keep doing what you are doing as we cannot afford to allow good Nurses to burnout or scare any more experienced Nurses into leaving the profession.
    Stick with it, Tsunami Kim.
  10. by   HRM672
    Wow a lot of thoughts on the downside of OR. In my complete ignorance, I have two questions.
    1. When the scrub is on a 12 hour case without a break, why can't someone else scrub in and take over to give them a break? I don't understand that part.
    2. What about the OR is "sinful"? Do you mean lurid comments, or unethical treatment of patients, or what?

  11. by   TsunamiKim
    In Answer to HRM672’s Questions:

    Why not send in a relief person? This is a very good question. The strain on the OR’s over-stretched staffing is far greater at night and on weekends as the off-shifts are minimally covered to start with. This is where the dysfunctional system of “zero redundancy of personnel” is breaking down and causing the greatest problems. In many States a Nurse can be mandated to cover a complete second shift for a total of 16hours on the job. However, equally few US States insist upon the staff receiving even a single relief break, which is now becoming dangerous. XXXX

    Documentation of unsafe staffing is the key to forcing Hospitals to address this issue, before more patients are placed in danger. Only through “Incident Report” documentation of the “danger to the patient” on occasions where someone is left stranded in Surgery for 12hours straight can we separate the true emergencies from the negligent abuse of one particularly inconsiderate Manager.

    The obligation is for a Manager to insure that her staff are functioning safely and order them to break scrub when they can no longer be expected to do so. That Charge person should have to justify why no relief was sent into an OR to break someone out after 8, 10 or 12 hours of continuous standing at the field without a break. If there is no legitimate reason for an abandonment incident like this and these incidents happen repeatedly then the person responsible should face discipline.

    On your second point:
    Please don’t get me wrong about the OR, it is a fascinating clinical area in which to work and I still want to return to my job in Surgery. However, frustrations lead to volatile and abusive outbursts when systemic problems are not dealt with and when staff become unnecessarily fatigued through unreasonable work demands. Surgeons can be very intense and demanding people to work alongside. They can also be hedonistic, arrogant and downright rude, but we must remember that we are assisting them while they are engaged in some very challenging procedures. My best advice is to take note of the minor frustrations that tend to precipitate an outburst and try to eliminate them.

    After I had been at my former Hospital for less than a year a Surgeon I had the greatest respect for made me the target of a humiliating outburst. It was not about whether he had the right to criticize my performance; it was doing so in such a rude and demonstrative way, in front of half a dozen coworkers! I wrote him a letter expressing my concerns, but then tormented over handing it to him. One of the Anesthesiologists read the letter and said how it expressed the collective concerns of so many of us in the OR regarding most of our Surgeons. She asked me if she could show it to her boss. I didn’t quite realize that her boss had just been appointed Dean. I agreed as long as all of the names were removed. I did not intend to target this one Surgeon as the worst offender, as he really wasn’t. “The letter” took on a life of its own going from rookie OR Tech to the new Dean in one leap. I hoped that my letter would “shake a few trees;” now it seemed like it might Napalm the forest!

    The Dean called a meeting of all his chiefs of Surgery and they were all instructed to read “the letter.” He said this kind of behavior has to stop and it has to stop now. The then Head of Surgical Nursing delivered a copy of the letter to the Surgeon who had lambasted me during an OR case; a meeting took place half an hour latter. He apologized for his behavior and told me of his frustrations. I felt truly committed to eliminating those frustrations if I could. I also met with the Chief of Surgery in the days that followed; at one point he made a startling admission that in hindsight made a lot of sense. He said: “often, when we raise our voice and yell at OR staff it is not because of anything that they have done, but we have reached a particularly crucial point in the case and things might not be going so well so we become angry and loud.” Not his exact words, but you get the drift; we might very rarely be the source of frustration although we are frequently the recipient of a rude outburst.

    In the coming weeks I was pleasantly surprised to see that a new initiative got underway and I was really impressed by such positive action. Fellow staff members warned me that, “nothing ever changes around here,” but I remained optimistic that this time it would be different. Six new separate interdisciplinary OR comities agreed to meet once a week and these meetings lasted for several months. The objective was to create “A Perfect Day in the OR’ and we were asked to address all of those debilitating frustrations that bothered us and try to come up with suggested solutions.

    Between all six committees we produced a one inch thick binder brimming with information, potential problems and positive suggestions. An “OR Retreat” was organized at Baltimore’s Inner Harbor and several hundred OR employees from all disciplines and specialties gave up Saturday afternoon to attend unpaid. I was thrilled to be there, knowing my efforts had provided the catalyst for this positive initiative. It was my birthday and this was the best present I could have received.

    Unfortunately, very shortly after that the Hospital’s reform agenda to create a better work environment was abandoned. The situation deteriorated rapidly as core priorities changed in favor of staff cut-backs to lower costs. The Head of Surgical Nursing left and her replacement was not even seen in the Surgical suites for the first eight months. The drastic policy changes to force the higher paid tenure Nurses to leave were unpopular enough to precipitate a “Nursing Exodus” from our Hospital. My efforts to bring Management’s attention to this issue by suggesting Nurse retention measures were not welcome; I was told: “this happens every once in a while.” All of the identified problems causing such frustration in our historic old OR were conveniently swept under the rug.

    The “Perfect Day in the OR” became an elaborate wall exhibit to delude JACHO on one of their meticulously choreographed scheduled visits. The OR employees paid for that con with their personal time and dedication; quite understandably they felt used. Jaded and disillusioned staff were now far less likely to come forward in the future realizing how futile their input has been. The agenda was corporate profits above patient safety or a tolerable working environment; nothing changed except for the worse. The OR continued to hemorrhage Nursing staff and then rush new Nurse Grads through orientation as swiftly as possible; many were dangerously ill-equipped to take on their responsibilities. The “OR Retreat?” We had received our futile positive action session, been allowed to vent, now we were supposed to return to the same stagnant mindset as before: “don’t rock the boat.”

    The multiple minor frustrations remained as the layout of our vintage OR required creative solutions that Management was not interested in accommodating. Managers are rarely in the OR when the dysfunctional skin stapler gets hurled across the room, so why not purchase the cheaper model? Cost-cutting, especially in the area of negligent under-staffing, only exacerbates the difficult frustrations we face in Surgery. “The letter” earned me a letter of commendation from the Dean. Eventually my outspoken behavior was no longer acceptable to new Management; in the end I was targeted for removal and fired as a tragic consequence of reporting under-staffing in the OR.

    Fatigued staff vent, intolerance reigns and tempers flair: this is the OR at its worst. Surgery can be very stressful even when things seem to be proceeding perfectly; the source of anger might be an unconscious patient, but the recipient of wrath is often the Nursing staff. Not fair, but try not to take it too personally, sometimes the Surgeon will humbly apologize after the case. Pay attention to staffing needs, try to eliminate fatigue and unnecessary minor frustrations and you will work in the most intriguing and rewarding area of the Hospital doing the most incredibly fulfilling job.

    I hope this helps, Tsunami Kim.
    Last edit by sirI on May 27, '06
  12. by   HRM672
    Thank you for your very thoughtful reply. It does help, and I appreciate the time you took to explain everything. I'm sorry that youu had that experience, but I appreciate you sharing it.