Reading, crossword puzzles, etc while administering anesthetics

MaleAPRN · Feb 23, 2005

Reading tabloid magazines, doing crossword puzzles...or ANYTHING that takes away one's attention from the surgical patient is PATHETIC! I have seen it myself as a SRNA (ie, CRNA reading a novel while I manage the patient). What do I think about CRNA's/MDA's who do these things? They should be FIRED. Either they are burnt out or they just don't care. It is difficult to say something as a SRNA, especially when the CRNA that's doing these things has been a CRNA long before I was born. I know of a SRNA who tried to report a CRNA that took a nap during the case to the head of their school, and was SUSPENDED for doing so. The SRNA was told that he/she was disrespecting a senior CRNA and that he/she was telling lies.

This kind of retaliation might be the reason why we don't hear about these things much.

I'm sure that there are others that have experienced anesthesia providers nodding off, balancing their checkbooks, reading, etc during cases. What do non-anesthesia personnel think? Well, they may think that anesthesia is the easiest job in the world and that they're getting paid too darn well for doing too darn little. That's what's happening. And, I've heard it from people in the OR.

I'm sure that this kind of unprofessional/undedicated behavior is not the norm. But, when you do see it happen...it is very unsettling.

sway · Feb 23, 2005

It seems like as practitioners, we are granted the authority and responsibility to decide on a minute by minute what level of monitoring and attention is required. As an RN in the ICU, there are times that I'm standing in my patent's room, transfixed on them and the monitor...and there are other times when I'm at the desk with my feet kicked up, surfing the internet (still in view of the monitor). Perhaps someone walking by would think I am being negligent, but I don't think so. I know what my alarms are set at, and feel comfortable with how I am managing the patient. Of course, people are people and they can sometimes not live up to the responsibility of caring for the patient. Several people have been fired from my unit for sleeping, for example. I would argue that just because someone is reading doesn't NECESSARILY mean that they aren't monitoring the patient. Just like our pulmonologist told me last night, "I don't care what you do, just don't **** up".

On another but similar note, when I worked in the OR, there was constantly music playing in the backround, sometimes pretty loud. The anesthesiologist usually had the responsibility of DJ. How do you all feel about music impacting the care patient's recieve? To me music seems somewhat more risky than reading a magazine or crossword.

jwk · Feb 23, 2005

There's actually some interesting debate about this matter in the last couple of issues of the APSF Newsletter. Several anesthesiologists took issue with those that thought reading implied inattention. Their contention was that on a long case, it actually could be beneficial, in that it breaks the boredom, and actually helps you remain more vigilant overall.

Here's the link to the original article:

http://www.apsf.org/resource_center/newsletter/2004/fall/04reading.htm

Here's the link to the Letters to the Editor in response in the subsequent issue:

http://www.apsf.org/resource_center/newsletter/2004/winter/15_letters.htm

jwk · Feb 23, 2005

On another but similar note, when I worked in the OR, there was constantly music playing in the backround, sometimes pretty loud. The anesthesiologist usually had the responsibility of DJ. How do you all feel about music impacting the care patient's recieve? To me music seems somewhat more risky than reading a magazine or crossword.

We're starting to be hard-asses on this problem in our OR. If I can't hear the alarms or my pulse ox, I will ask that the music be turned down, or I'll turn it down myself if I get no response.

steelcityrn, RN · Feb 23, 2005

Are you saying that this is going on in a operating room? How is it that a crossword puzzle or a book make it into a sterile environment??????

Hello,
I am new to the board and recently passed my board exam and am proud to be amongst your ranks. My post is concerning activities that I have observed from anesthesia providers (both CRNA's and MDA's). I have observed people reading and working crossword puzzles during cases. What are your views on this? I do not think it looks very professional. I am not implying that those that do these activities are not monitoring their patients. I am strictly speaking from am impression viewpoint. What kind of impression does this make on surgeons and operating room staff? What impression does this make on SRNA's? It made an impression on me as a student.

mrdoc2005 · Feb 23, 2005

I am still in BSN school, but the first surgery I got to observe last the gas pass was watching a DVD on a mini DVD player(you know the small $200-300 thing you see at walmart). I was floored when I saw that.

I can understand what you are saying about a book or mag helps give you a break and may be benificial. But, the DVD I think is a bit much. I also went in on a case where the sergean had a plasma screen in the OR and had it on sportscenter.

Kiwi, BSN, RN · Feb 23, 2005

While in school I've seen both CRNAs and MDAs working crossword puzzles during CABG on-pump procedures. At first I was kind of shocked, but then I thought that maybe they were doing it to promote mental alertness while the heart was stopped and no interventions were needed.

jdpete · Feb 23, 2005

we just talked about that debate today and read the rebuttals that were there in the mags that jwk spoke of---I agree with the theory that this doesn't take away, but makes you sharper---in the sense that when I am not reading or looking at an article of some type, you are in a dream type state at times---some cases are 3 hours long or greater---there is no way you dont have passing thoughts---anesthesia sometimes is like watching paint dry----before you flame, make sure you have been there---you are completely in tune with your monitors, being esoph steth, pulse ox, BP warnings, etc. Our pulse ox controls the tone of our heart rate, and many know you pick up on desaturation quicker than anyone in the room regardless of how loud the room is, how long the case is, or what I might be reading,,PERIOD! Nobody picks it up quicker----People outside of the OR do not understand, as the above remark about a magazine being sterile, so discount these remarks. Does it look professional? I think that it doesn't. I know people will start saying how much I make and I can go without reading while I am working, but dont judge us quickly. I know some CRNA's who don't read, and that is certainly their right, and I dont at all disagree with them. I do believe that it looks more professional---but I have never thought I was slow to respond, or felt anymore distant from my pt. just because I was reading. Also, this doesn't mean that I read all of the time--I think that we are professionals, and are capable of distinguishing when is a good time to look at a magazine and when one isnt----Lumbar Lami---good time if BP stable----total hip with spinal block--great time----Colon resection---bad time---this is a tough debate because I can see both sides of the coin---but I repeat that I truly believe it keeps my mind sharper, as said in the article, when I am reading in a long case that has a stable patient---watching DVD's??? tough to justify----and a last thought, It does not look pathetic either vinny

jwk · Feb 23, 2005

How is it that a crossword puzzle or a book make it into a sterile environment??????

It's not a sterile environment. It's clean. People aren't sterile - scrub clothes aren't sterile. Shoes aren't sterile, yada,yada,yada. Heck, there's some good studies that say that wearing masks makes no difference in infection rates.

air · Feb 23, 2005

It's not a sterile environment. It's clean. People aren't sterile - scrub clothes aren't sterile. Shoes aren't sterile, yada,yada,yada. Heck, there's some good studies that say that wearing masks makes no difference in infection rates.

Believe I have never worked in a theater until now that I am in school. What beats me is that, when the circulator screams at me to mask on, the patient is not masked and having a pleasant conversation. The surgeon may drop in unmask to do positioning and skin prep before retreating to scrub in. The sales rep. mask after being in the room for more than a couple of minutes. I have seen Ortho Docs walk around with their scrubs on surgi-center to main hospital theater without changing sometimes stopping for a snack, yet everybody behaves like that 30 second that I failed to mask I just about killed somebody. I try not to make those mistakes anymore. I even mask when podiatry is doing toes, or when Gyn is doing LEEP. under IV sedation.

yoga crna · Feb 23, 2005

When I administer anesthesia I am always attentive to the patient, the monitors, the surgery and the OR. I get up and move around the OR, eat my lunch by the door and clean up/set up for the next case. I can do all of that and still be attentive to the patient. The one thing I do control--often to the consternation of the OR staff and surgeons--I do NOT permit loud music or radio in the OR. I can't hear the subtle changes in the audio monitors and find loud noises distracting to my concentration. They often don't like it, but I don't care. Since I own the surgery center, I can get away with a few more things than I did as an independent contractor.

By the way, today, I picked up two disconnects and one CO2 line blockage, just by listening to the machine and monitor. It is hard to do that if there is a lot of ambient noice in the operating room.

YogaCRNA