Quote from aw6b6
This site, and some discussions/horror stories about verbal abuse to surgical nurses by doctors came up with some Google search I did. This has been a concern of mine for awhile, and I'd like to ask if anyone can provide any advice to someone who will be going into a surgical residency soon about treating nurses and other staff in the operating room like human beings, while still being able to get the job done.
I know for a fact surgeons have a stereotype of being cocky and condescending, especially to nurses, but I REALLY don't want to exhibit that. I can name many RN's who have really made a difference in my life, and I need advice (or just some things to remember) on how I can show the respect I have for nurses when I'm in such a position.
Wow, I can already tell you'd be a great person to work with. You have an awesome attitude.
Here are my thoughts; just a couple----get and open your own gloves (or, alternatively, ask the circulator if she minds if you get and open your own gloves--some very anal circulators (I'm not one, LOL--I'm all about delegating--less for ME to do!) want to control everything in the room or what's added to the field (they also may have to keep track, for billing purposes) OR, often unfairly, they don't trust the first year resident's (intern's) sterile technique. Once they work with you a few times, they'll relax and lighten up.
Don't try to stand up at the head of the table to assist the anesthesiologist with induction. That's the circulator's job. We are all very good at airway support--many of us were doing it before the resident was born. You can, however, ask the circulator if there's anything you can get or do while she's up there. If not, and your attending has nothing he wants you to do (such as assist with positioning) go ahead and scrub.
Generally, circulators have a certain routine. I, personally, usually put my Foley in during my prep on a vaginal case (or any case that requires a vaginal prep.) Sometimes residents want to rush to put the Foley in, and that delays us prepping, and requires unnecessary steps. You can ask the circulator if she minds if you put in the Foley; if she says she prefers to put in her own, respect that. You'll have plenty of other opportunities.
Same goes with TEDS and SCDs. Some residents tend to put them on sort of carelessly, with lots of wrinkles, etc. that could cause problems for the patient--skin tears, pressure. The circulator ends up having to adjust them correctly--redoing what the resident has done. Let the circulator do it, or ASK if she'd like help with the opposite leg. Watch how she puts hers on, and do yours likewise.
Don't put the Bovie pad on. Again, even some 4th and 5th years put it on on the wrong place, or leave gaps that could cause shock or even a burn. Let the circulator do it.
When you get to be a 4th or 5th year, don't get arrogant and act as if you are already a board certified surgeon. To the nurses, you are still a resident, even if, at the med school and to the junior residents you are a pretty important guy already . Treat your interns and second years as you wish YOU had been treated when you were an intern or second year. I dislike nothing more than 4th and 5th years who try to make their junior residents look bad or stupid in front of the attending---the attending, also, can pick up on people who try to make others look bad in the belief that it will make themselves look GOOD. It doesn't.
Before you scrub, delegate care of your patients on the floors to another resident (possibly even a med student) who isn't scrubbed that day. Turn your beeper OFF, or leave it at the desk. Don't come in and expect that the circulator will answer all those calls regarding patients whose care should have been delegated to someone who can actually round on them and make interventions. Understand that, as the patient advocate, your circulator is responsible for the patient ON THE TABLE AT THAT TIME. It would be grossly unfair--and dangerous--for her to compromise that patient's care while constantly taking and relaying messages back and forth for all the residents and med students in the room. If you notice, your attending NEVER has a beeeper going off.
Say to the crew (both scrub and circulator) once in a while, "It was fun (or a pleasure) working with you. Shake their hands. Treat them like fellow professionals. Remember your names, and they will remember yours.
Don't run off to scrub in on another case before your patient is even transported to PACU or ICU. This patient is still your patient---transport them, or at least accompany the people who transport them, to PACU or ICU. Feel free to report anything significant to the RN taking over care of your patient, when the anesthesiologist gives report. You can sit in PACU and write orders, etc. while you are talking, if you'd like, and kill two birds with one stone.
I have worked with some awesome, awesome residents in my day; all of them I recall fondly by name, and many of them, I have since heard, are outstanding and wel-respected surgeons now--but they treat their crew, including their residents, extremely well. I am not surprised--they were a pleasure to work with.
Then again, I've worked with some foreign residents who, in their countries, were royalty---literally--and were used to ordering servants around---many also were taught, in their culture--that women are second class citizens. That won't fly here. Nurses can make your life REALLY hard. Sadly, some of those guys are now attendings, and they still act like jerks--and their residents imitate this behavior, thinking that it's acceptable. It's not, and it's not necessary. Bottom line is, residents are soon gone, and their names forgotten when a new group comes in (until they come back as 4th or 5th years--) but, generally, the attending will support the circulator---not residents with attitudes like this. He has known her much longer, trusts her, and considers her a critical part of his team.
All that said, don't put up with RNs who treat you like scum simply because you are a resident, and they dislike residents, and have "always done it this way--it's tradition." I hate seeing that happen, and it's not true. The nurses who do that have really severe attitude problems and control issues, and it makes them feel important--many of them don't have lives outside that operating room---the operating room IS their life. Take them aside quietly, not publicly, and tell them that you respect that they are in charge of the room, but that you expect to be spoken to like a team member--with respect. You have a right to that.
Makle this your mantra: I resolve NOT to be a prima donna.
Don't wear loupes unnecessarily (say, on a herniorrhaphy) just because you have recently purchased them and you think it makes you look cool or important, (it doesn't) or aspire to be the next Michael DeBakey or Denton Cooley. It looks stupid. Wait until you are actually scrubbed on a vascular case to put them on.
You'll do great. I think it's really cool that you asked our advice. I hope I get to work with you someday!