August 24, 2007, 10:31 am

Pearls of Wisdom for Perioperative Purveyors

muppets

This was my favorite skit on the old “Muppet Show”.

Usually the “patient” would sit up and make some wisecrack to the OR team.

Can’t say much for their technique, though!

No one is wearing a mask and Miss Piggy’s hair would easily all into the surgical field.

Oh well, no one is perfect.

******************************

We all expect our surgeons to be perfect.

Perfect in technique, perfect in personality, perfect in demeanor.

Eternally patient, never exhausted, always in a good mood.

Hate to break this to ya, folks but surgeons are human!

*****

It’s no secret that surgeons have a reputation for being egotistical, overbearing and intolerant.

We’ve all heard the horror stories of instrument tossed across the OR in anger.

I once saw a surgeon throw a chest tube full of contaminated blood across a trauma room in an ER.

And let us not forget the infamous Dr. Prissy Pants who intimated that no one in my ER was working because the patient did not have his consent signed by the time the Dr. walked in to see him!

*****

Surgeon stories.

We nurses have a million of them.

But how many of us have ever looked at the situation from the side of the surgeon?

Instead of dreading the idea of having to work with one, what can a nurse do pro actively to make the preoperative experience a smooth one for themselves, the patient and the surgeon?

Having dealt with surgeons as a nurse, a patient and a family member, I have a few ideas born out of my experiences. Your mileage may vary.

  • If you work with inpatients, for pete’s sake make sure the patient is NPO! Nothing will make a surgeon blow up faster than finding out the patient can’t go to OR because they have eaten! I know of one incident that caused a six hour delay in the removal of what turned out to be a gangrenous gall bladder.
  • Make it a priority to have the patient ready for surgery. Paperwork can come later. The surgeon is not operating on the chart.
  • Having said that, the more paperwork you have done, the more efficient the process. Have alert patients fill out their own anesthesia questionnaire if they can.
  • After hours, follow up and make sure the supervisor has called in the OR team and make sure you know the ETA. Hell hath no fury like a surgeon who walks in ready to take the patient to OR only to discover the team wasn’t called in.
  • If pre-op antibiotics/medications are ordered get them in – they are ordered for a reason.
  • Every nurse knows the surgeon must speak to the patient about the risks/benefits of surgery before the consent is signed. Every surgeon knows it too, but that doesn’t stop them from telling you to have the consent done before they get there. Fill it out so it is ready to go after the surgeon is done explaining.
  • Post-op: when you call a surgeon, be concise. Tell them what you want. Is more pain medication needed? Are you seeing signs of infection at the incision site? Is the patient now febrile? Don’t beat around the bush with a long-winded story.

Those are just a few of the ideas that come to mind when working with pre-op patients and their surgeons that contribute to a smooth peri-operative experience for everyone involved.

*****

It helps to remember that surgeons are just like us. They get tired with long hours, they have no control over their workload if they are on-call. Yes, they get paid well and yes, they chose their specialty and yes, being called in is part of the deal they signed up for but that doesn’t mean it is easy. Even though you work a night shift and are chipper at 0400 (raising hand here) the surgeon who is coming in early to fit your appy in before his full day in the OR might not be so upbeat.

There is always room for understanding and for cutting each other a little slack.

That is why I can count the number of think-they-are-God surgeons on less than one hand.

Mutual respect goes a long way.

*****

(Epilogue: to all surgeons reading, please understand that nothing undermines the care of your patient worse than an arrogant, insulting attitude. If you are lucky, the nurse will call you on it. Worst case scenario, the nurse is afraid/unwilling to interact with you and that is never in the best interest of your patients.)

8 Comments

  • […] Clark Pearls of Wisdom for Perioperative Purveyors » This Summary is from an article posted at Emergiblog // The Life & Times of an ER Nurse on Friday, […]



  • Caroline

    August 24, 2007 at 3:22 pm

    A particular thing I love about this blog is your incredible focus on TEAMWORK. We cannot do our jobs without doctors. They cannot do theirs without us. It is a symbiotic relationship…not an authoritarion, heirarchical, antagonistic one! I wish more people knew this…good for you for continue to champion for all-around respect.



  • Terry

    August 26, 2007 at 10:01 am

    I would like to add to this conversation, as someone who works inside the OR and sees it from that angle.

    Teamwork is vital, but it is also important for everyone to do their OWN individual responbilities. Working in an OR, I can’t tell you how many times simple protocols are not followed, from the top down.

    Surgeons are perfectly capable of doing their end of the deal; nurses have more than enough on their plate that needs to be done in order for surgery to happen efficiently and effectively.

    I am thinking of your example of the OR consent. To have the sheet ready and available for the surgeon is not the nurse’s responsibility – that should be the unit clerk’s. Making sure the patient is NPO, that all jewelry and false teeth and clothing are removed, and pre-op medications administered – these are the nurse’s responsibilities. I hate to say it too, but paperwork IS important – things like pre-op vital signs, ordered labs on charts, EKGs, med kardexes – without this vital and necessary paperwork, the surgeon will still have to wait to get the surgery done, because anesthesia cannot be administered without this vital information immediately and readily available.

    An operating room functions like any other unit in the hospital. There are policies and procedures that are followed, and protocols. When emergency or after-hour cases need to be done, the first people notified are the OR personnel, because they need time to get ready. It’s just my opinion, but I don’t think that nurses on other units need to concern themselves with making sure that the OR personnel have been called in – don’t they have enough to do already? Like I said, there are protocols already in place to set those wheels in motion.

    We are all working on the same team, and teamwork therefore is vital. Most surgeons do not think they are God, fortunately. But I believe that if everyone takes care of their own responsibilities, surgery can and will be effectively accomplished. Nurses should never be enablers for anyone – patient advocates and team players, yes.


  • […] How must be your surgeon? How to make the perioperative experience a smooth one for patients, nurses and surgeons? Great tips for all of us. Don’t lose the floor. […]


  • […] How must be your surgeon? How to make the perioperative experience a smooth one for patients, nurses and surgeons? Great tips for all of us. Don’t lose the floor. […]



  • unsinkablemb

    August 26, 2007 at 10:11 pm

    First of all, I love the picture. I must have missed that show.

    Yes, surgeons are human. Nurses are human. Put us in the intense environment of the OR and what do you have? Stress!!! When both sides understand each other and try to work as a team, then the intensity is bearable.



  • SurgeXperiences 1.03 · Articles

    September 5, 2007 at 11:59 pm

    […] How must be your surgeon? How to make the perioperative experience a smooth one for patients, nurses and surgeons? Great tips for all of us. Don’t lose the floor. […]



  • SurgeXperiences 1.03 · New York Articles

    September 13, 2007 at 5:45 pm

    […] How must be your surgeon? How to make the perioperative experience a smooth one for patients, nurses and surgeons? Great tips for all of us. Don’t lose the floor. […]


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My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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