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Discussion

OR Etiquette

I started in the OR 14 months ago and have been off orientation since July. Since I am not a permanent member of any surgical specialty (I give breaks, then take over a room from someone at the end of the 7-3 shift) I am still trying to find my voice when I am in rooms with people I haven't worked with. Obviously I know all the RN's and surg techs, and I always introduce myself to a surgeon I have never worked with before. BUT, when it comes to surgical residents and PA's (med students too) I am not sure what is proper.

They are supposed to leave their ID badges on the circulator's desk or write their names on the info whiteboard so I can include them in the chart, but they mostly forget or take for granted that since the last nurse knew their name that I do too. Before a case should they come over to me and introduce themselves? I mean, I am usually swamped getting supplies, opening up trays, setting up the room, dealing with the patient, etc and they just waltz in like the surgeon expecting gowns and gloves to be waiting for them too when I have no idea who they are or their size or preference. And then when I am trying to position, they take over from me, grab the foley and put it in, then tell me I can prep and they leave to go scrub! Mind you...I still sometimes at this point have not even gotten their names or titles!

I guess, how can I run the room more without feeling like a slave/gopher to the residents and PA's and gain a little more respect? Seasoned RN's I see have more of a command of the room with the residents and PA's and I'm not sure how to get that. What exactly is the hierarchy in the room? I mean, I know we are supposed to be a "team" but the OR tends to have too many chiefs and not enough Indians. I think the attitude of the residents and PA's is that they believe they are "chief" when then the surgeon is not in the room, yet it is MY license on the line when it comes to patient care!

Would appreciate any advice.

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    So I usually don't ever have a problem with PAs since they seem to be normal human beings as opposed to most physicians (residents/attendings) and they never have a problem answering a question, be it asking their name or what supplies/instruments the doc is going to want for the case etc... One thing I have learned in the past about residents is, if they are a 1st or 2nd year, they are scared to death and they are just trying to look like they know what they are doing, so don't take it personally, and be sure to let them know that a nurse can be their best friend or the greatest enemy! I have had a couple of residents who have acted like they have been an attending for twenty years, and all it takes is quick conversation with a nurse friend on the floor to make their lives miserable for a couple of weeks until they get the idea. Once they get past the first year or two they really lighten up and seem to be some really great people. Personally, I would welcome the fact that they want to position, put in a foley, etc... They are physicians and they are allowed to do these things, let them! You can spend this time helping your scrub, counting, charting, getting the room in order. If you get a new resident or med student ask them if they would be interested in "helping" you prep the PT, maybe they really don't know how if they are "ordering" you to do it. So, if you ask them for help, maybe they will take you up on the offer and make sure you walk them through it if the seem a little lost. The one thing I always say to someone when I don't know who they are is "Name and Rank Soldier?", we have so many med students come through, I only know half the people half the time... NEVER let it get to you when a resident tries to act like the "chief", they will learn their place and usually you guys will end up getting along pretty well.

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    They will treat you they way you allow them to treat you. You need to assert yourself, in a nice way. When they walk in the room there is nothing wrong with asking them to open their gloves or an extra gown if you need them to. We ARE a team in the OR. There is also nothing wrong with asking them to write their names when they enter a room. I work in a large university teaching facility and we have so many people rotating through that there is no way I could know all of their names. No need to worry about what the residents think.

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