SRNAs/CRNAs - how do you deal with difficult surgeons?

jwk · May 28, 2004

Okay,
There are moments when I really wonder what the heck I am doing this for, and then there are days like today when I want to get in my car and drive back to my old hospital and get my bedside nursing job back!
I would appreciate any advice on how best to work effectively with surgeons, especially those that have a clear preference for an MDA at the head of the table and/or intolerance for having students. I had a situation today in which I became the "whipping boy" for the surgeons and their intra-op difficulties. Patient was doing fine, hemodynamically stable. Absolutely no patient detriment. But preceptor was at lunch and surgeons felt I was in over my head and were very angry about it. I have already been told that, "it's always anesthesia's fault", but any insight from more experienced folks would be gladly accepted. What do you do? Apologize later? Let it go? Hide behind the drape and hope they forget about it?
The surgeon-anesthesia relationship can be an odd one. And one I didn't even consider before I went to school...

Unfortunately, students have always gotten abused to a certain extent, and anesthesia gets blamed for everything all the time. If you haven't worked in the OR prior to starting anesthesia training, it's surprising the level of verbal abuse (and sexual innuendo) that gets tossed around. Make sure you differentiate between legitimate complaining (possible, right?) and truly abusive actions by the surgeon (still far too common in the OR).

If it's something I've done and know it, I usually apologize immediately. I probably wouldn't seek them out later since half the time they don't remember an hour later what irritated them in the first place. My favorite response to surgeons, often used when they consider muscle relaxation to be inadequate, is "Anesthesia makes surgery possible, not easy". Sometimes they laugh, sometimes they don't. That's their problem.

If you experience what you consider to be truly abusive behavior (verbal or physical), make sure you file an incident report with the appropriate department of the hospital, and keep a copy for yourself. In our facility, such complaints get referred to our medical staff office, which takes it very seriously. If you have a risk management department, that's a good place for those complaints to go as well. Buzzwords such as "hostile work environment" and "sexual harassment" carry some weight. Hospitals that ignore repeated instances of bad physician behavior run the risk of lawsuits filed under federal law, directed at the hospital for ignoring or tolerating the abuse. They don't want to go down that road. I know of surgeons who have had to undergo mandatory anger management therapy and sensitivity training. If they don't comply, they lose their privileges, plain and simple. And by all means - physical abuse should never be tolerated. Criminal complaints for assault and battery have also been used against abusive surgeons.

athomas91 · May 28, 2004

most of the ones i work with are great to be honest.....

but when i have real a&&hole&....i like to flick em of behind the ether screen....hehehehehehehe....makes me feel better...LOL :rotfl: :rotfl: :rotfl:

Brenna's Dad · May 29, 2004

ketamine dart

yoga crna · May 29, 2004

I hate to tell you this, but it is a problem that doesn't go away. How you handle it depends on where you are in your professional life. As a student, simply call your supervisor. Let them handle it--it is part of their job description.

As a very experienced CRNA, I deal with this type of situation on occasion. It usually has to do with a difference in opinion on anesthesia related issues, although just yesterday I got into a heated discussion with a senior surgeon on whether ice or frozen peas are better to place on a face after eyelid surgery. He wanted frozen peas, I voted for ice, because it doesn't smell when it melts. He roared. "I'm the surgeon" to which I responded, "and what does that have to do with nursing care?" We went with the ice.

Learn to deal with the situation early in your career. My advise--don't be argumentative regarding little things--save it for the big stuff. But don't let them intimidate you regarding patient care, if you know what is best regarding anesthesia. I let them know early that I have worked for some of the best surgeons in the world and have found them to be the easiest to work with in the OR. I think it has something to do with self-confidence.

There are some situations that never get better, so you have several choices, get a new job, live with the situation or try to prove yourself that you are capable of being respected.

It goes with the territory, but on the positive side, I have met many outstanding surgeons throughout my career and am a better person for having known them.

Yoga

susswood · May 29, 2004

Jerks are everywhere. I think the problem about jerks in the OR is that you can't just get up and walk away! Well, I suppose you could, but it probably wouldn't be the best idea. :)

TeenyBabyRN · May 29, 2004

I'm going to have to go along with Brenna's Dad on this one

a ketamine dart is the way to go

:devil:

zenman · May 29, 2004

Just go pull their pants down and go back to your chair! :chuckle

ROBDANURSE · May 29, 2004

JWK and YOGA offer some very good advice. I was fortunate enough to work in the OR for three years prior to begining my SICU experience. They are both correct. It is your supervisor job to handle this type pf behavior! Let them do it! Do not hesitate to use the hospitals incident reporting system and the risk management department. Definitely keep a copy of the IR for yourself and make a list of other people in the room, memories of friends fade fast!

other unfortunate observations I have made in the OR

1. In many cases this is still a " GOod OLD BOYS" place of business. A Woman has no business in the OR.

2. Much of the verbal abuse given to SRNAs is spared if that student is female, athletic, flirty, and cute (see #1).

3. 99% of all abusive comments to anesthesia personel are an attempt by some surgeons and MDAs to "mark their territory" similar to wolves and lions.

Their bark is usually worse than their bite.

4. The circulator (OR nurse) can be oyur best friend.

5. The abuse is often worse when the MDs are residents

God help us all!

Brenna's Dad · May 29, 2004

I thought number 5 was interesting. This goes against what I have experience. In general, I find residents extremely aware of the pecking order and have never really had a problem.

Athlein1 · May 31, 2004

Ketamine dart? :chuckle Should have thought of that one! A few surgeons have given me that same dissociative stare in the morning anyway!

I'll admit that I was unprepared for the culture of the OR. Loud metal music from ortho, nasty rap from general surgery residents. All sorts of sexually provocative banter and plays-on-words from staff and surgeons. I am not a prude by any means, but I really am surprised by how much of this is allowed in the OR.

Addendum for newbies and wannabes: Please note that the above comment is much more the exception than the rule. The majority of the time, I work with delightful and skilled docs and nurses. (Though days stuck behind the drape forced to listen to FIFTY-CENT or acid metal really do occur :eek: ).

JWK and Yoga, thanks for the advice. I know it will be an issue in my career (hopefully rare!), but you are right that for now, it's best to let my preceptor handle it with my help. Not tattletelling, just informing. It's sound advice to learn to let the little things go and choose battles carefully.