Surgeons - ugh!

Is it possible that they are very busy and you are very chatty? What I get from this is that you may have difficulty "reading the room".

While I know that they are busy and I admit that reading the room isn’t my greatest talent, I do know that I am not chatty and I have been told that I need to be more forward and ask more questions. Although now that you mention it, maybe I could have kept my input to myself regarding the patient experience perspective because maybe a surgeon will never see the value of that perspective in the grander scheme of repairing people. But at the same time, I wish my contributions were at the very least tolerated. My coworker, who is on the opposite end of the spectrum (extravert) gets treated similarly. I can’t figure out how to bridge the gap. I hope my personality isn’t the problem, but I’d be willing to work on this if it would help. It’s so hard to figure this out when the surgeons don’t seem to want to interact. Plus there are occasions when I have no choice but to ask a question.

"I work in ambulatory with surgeons"? Do you work in an ambulatory surgery setting where patients come in for minor surgical procedures and go home afterwards? You admit or discharge patients for surgery? Or do you work in a surgery office where patients come to see their surgeon a few days after surgery?

I work in an ambulatory setting in a specialty where patients come in for treatment. Sometimes the patient needs surgery. Sometimes over the course of the years they need repeat surgeries. Sometimes the patient needs to try medications for a while to see if the problem can be solved or at least managed without surgery. Sometimes over the course of months or years their disease progresses to a point where surgery is the only option. Sometimes the patient must decide whether they can live with their symptoms or whether they would choose to have surgery. All of our providers are surgeons. If the patient has surgery I triage them prior to and after surgery.

I hope that made sense. I am a triage nurse who works in an outpatient clinic with providers who provide numerous interventions, including surgeries. I don't work in the operating room.

Maybe I don't understand it either. . . basically, we field all phone calls and messages from patients and if it seems like the patient's complaints warrant a visit or trip to the ED we send them on. But we also provide a lot of advice and anxiety management to patients who don't need to be seen right away, so if for instance a post-op patient writes to ask what, in addition to taking pain medications, they can do for their post-op pain, instead of bothering the doctor with this we might advise the patient to elevate, or limit certain activity levels, or try certain techniques that can help. Basically, we try to take care of as many patient needs that we can in between office visits or else get them in sooner if warranted to help minimize the provider workload whenever possible. But we also room patients, clean rooms, provide instruments, assist with procedures, secure appointments for diagnostic tests, and a lot of other things. So for instance: increasing fluid intake, ambulating, eating more fiber, and trying an OTC medication recommended by their pharmacist for post-op constipation might not be written down in the surgeon's AVS, but a surgeon would be pretty irritated if I asked them to advise the patient on how to manage their constipation - am I influencing the plan of care when I do that? I'm not sure. . .

I sometimes do that if the patient has an upcoming appointment within the next few days, that's for sure! It's a bit of a Catch-22, because the surgeons don't want us to pester them with questions they think we should be able to answer, but they can also be very territorial or particular about what we should or should not advise. I'm hoping that with time I'll figure out what the various providers want, but each one is different and there's so much friction.

56 minutes ago, not.done.yet said:

I see. As a triage nurse its pretty strange for you to try to influence plan of care. It isn't outside of your scope, but it isn't exactly your role either. That probably has something to do with it. It occurs to me, though, that I may not be understanding your role very well.

OP - here we are in the middle of an opioid crisis and you're being told that alternate modalities of pain relief (which are nonaddictive and cheap) are not in your lane to suggest - Yeah. No.

As a school nurse I routinely say that I can't care more about the kids than the parents do. You're in a tetchy place because you plainly care more about patients than your surgeons do....

What is in your P&P/written orders regarding palliative care? If adjuncts like ice packs or moist heat or whatever are there- I would take that as my blessing and not say a darn thing to the doc when I do it.

If these things are not technically in the P&P, and you have energy for it, advocate for that.

As an aside, I had a hysterectomy this year that came with an all-expenses paid one night stay in a hospital. The hysterectomy featured a bolus of slow-releasing lidocaine-type product so I was not in active pain from the sutures most of the time. The nurse offered me a PCA - and remember, I am on track for discharge in 24 hours or less. Why would I need a PCA if ibuprofen/Tylenol/ketorolac would do? Why would they want me not swallowing pills ASAP so I could ambulate to tolerance and leave ? Sorry for the rant. I actually liked my surgeon. I just question how $h!t gets done in hospitals.

Good luck!

9 hours ago, Melanin said:

I have been told that the RNs should not venture so far as to recommend conservative pain relief strategies such as icing or warm compresses because we are practicing "out of our scope."

Told by whom, in what context?

9 hours ago, Melanin said:

I have approached a surgeon to ask his opinion about a new formulation for a very specialized & frequently prescribed medication that the surgeons needed

What kind of opinion? Do they find it efficacious? Do they feel it is better than the old formulation?

9 hours ago, Melanin said:

I've had a surgeon literally turn his back to me and begin speaking to another provider as soon as I started contributing to a discussion about the experiences of a certain population of patients who I triage all day and who provide their own perspective of what they experience in terms of a very specific and subjective condition

I haven't ever really noticed surgeons being the best of experts in the subjective or having much interest in long-term coaching of people regarding their subjective disease experiences (very generally-speaking).

Either you need surgery or you don't, or sometimes it is more a matter of either you want surgery or you don't. At the very end of the day the bottom line is that there are other specialists who work with patients who are struggling with something and either don't need or don't want surgery.

Your patient population sounds at like it could be at least a little bit complicated?

9 hours ago, Melanin said:

No matter what I do or say, they think I am a complete imbecile. They want me to shut up and fax stuff.

It sounds like they are not interested in what you are interested in, or not in the way you are interested in it. And before anyone thinks, "right, they are not interested in the patient" - that isn't (necessarily) true. They are interested if they believe they can help the patient. If they think that what they have to offer is not likely to help or isn't helping or that something someone else can offer would be of more help to a patient, then they do not seem to prefer continued intimate involvement, in my experience/observations.

9 hours ago, Melanin said:

Why should I kill myself for a surgeon?

You shouldn't.

10 hours ago, Melanin said:

I tell myself that it doesn't matter what they think, since I am not doing anything terrible or dangerous.

That is kind of a low bar for measuring your performance.

9 hours ago, Melanin said:

Even if I love what I am learning with all my heart and brain [...]

From their perspective you are not there primarily to learn, although we would all expect knowledge and wisdom to grow while working in a particular area (and hope that it would). But you have to get the job done. Your office's specialty is more surgery, and less medical-psych-social long-term management.

Or, if you are expected to field and pacify and/or turf the day-to-day long-term complicated and partially subjective problems of a large population of patients who are in this middle ground of deciding whether or not surgery is warranted or desired, and if the practice does not involve other disciplines and services that can support this, then yes your job is just frustrating and you should find a different one.