Surgeons - ugh!

[Melanin]

I work in ambulatory with surgeons, and 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." I have approached a surgeon to ask his opinion about a new formulation for a very specialized & frequently prescribed medication that the surgeons needed and in the middle of my first sentence he cut me off by yelling "I don't care." 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.

No matter what I do or say, they think I am a complete imbecile. They want me to shut up and fax stuff. I try not to care about this every single minute of every day. I tell myself that it doesn't matter what they think, since I am not doing anything terrible or dangerous. But every single day I also consider whether I can go on like this. I wonder if this is even healthy - maybe the stress of all this is shortening my life span. Why should I kill myself for a surgeon? Even if I love what I am learning with all my heart and brain, I wonder if I should just go back to being poor and yet treated with decency and respect. I don't know what to do.

I have worked in this clinic for about 10 months now. Will it ever get better?

[Sour Lemon]

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".

[Melanin]

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.

[brownbook]

"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?

[Melanin]

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.

[Nurse SMS, MSN, RN]

It has been my experience that surgeons of a certain age or personality mindset are extremely butthurt sensitive at the idea that a mere nurse may have something valuable to contribute. Not all of them, certainly. But enough that it isn't uncommon.

I am sorry this is happening to you. Advocating for your patients is the right thing to do. Advocating for yourself is too.

[Melanin]

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.

[Nurse SMS, MSN, RN]

5 minutes ago, Melanin said:

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.

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.

[Melanin]

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. . .

[Nurse SMS, MSN, RN]

The surgeons would be wise to be collaborative. Since they aren't that wise, perhaps advise the patients instead to ask their doctor about XYZ?

[Melanin]

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.

[ruby_jane, BSN, RN]

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!