bully surgeons: should we stand up for nurses in the o.r.

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caligas

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Obviously we must stand up for ourselves and any student or AA or resident under our direction. But what about when he yells at the scrub nurse? Speak up or let them fight their own battle?
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Very interesting question. I think you should speak with them after the fact man to man (or woman to woman whatever) so they know you're watching. No need to cause more tension in the OR. Most surgeons when I was in med school would apologize by the end of the case to the nurse anyways after the heat of the moment was over.
 
These are nurses hired by the hospital mainly to help the surgeon.
They help us occasionally but they are hospital employees and the hospital usually has a process in place to cover disruptive behavior.
So, stay out of it.
 
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I say stand up for them if it is unjustified or cruel. If they are screwing up and putting the patient in harm's way by not doing their job, they probably need and deserve a wake up call. It should not be done in a humiliating way though.

Ideally, if a reprimand is needed, it should be done in private. If praise is given, it should be done in public. Rarely do I see this followed in the OR.
 
If at all, it would best be done at the end of the case, in private with the surgeon. Otherwise it would unnecessarily escalate an already bad situation.

The amount of sh.t that surgical techs and OR nurses often take from a.sshole surgeons is so far above their pay grade that it's almost sad that some put up with it.

Actually, some of the better ones simply DON'T put up with it, but they do it in a very tactful way such as "well, you just asked for the 3.0 vicryl" "that's why I gave you the 3.0 vicryl". Usually they'll shut up after that.

Definitely takes some tact and interpersonal skills to "succeed" in that environment.

For us to tolerate surgeons with personality disorders, well, at least for now we're compensated for it. Others? Not so much.
 
Planktonmd said:
These are nurses hired by the hospital mainly to help the surgeon.
They help us occasionally but they are hospital employees and the hospital usually has a process in place to cover disruptive behavior.
So, stay out of it.
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My thoughts exactly.
 
gasattack3 said:
If at all, it would best be done at the end of the case, in private with the surgeon. Otherwise it would unnecessarily escalate an already bad situation.

The amount of sh.t that surgical techs and OR nurses often take from a.sshole surgeons is so far above their pay grade that it's almost sad that some put up with it.

Actually, some of the better ones simply DON'T put up with it, but they do it in a very tactful way such as "well, you just asked for the 3.0 vicryl" "that's why I gave you the 3.0 vicryl". Usually they'll shut up after that.

Definitely takes some tact and interpersonal skills to "succeed" in that environment.

For us to tolerate surgeons with personality disorders, well, at least for now we're compensated for it. Others? Not so much.
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We, as residents, aren't compensated for it.

Even as an attending, I'll be too busy running around 3-4 rooms to worry about some poor OR nurse taking heat from a surgeon.
 
I say stay out. I'm in NYC where everyone has their union rep within arms length. If they feel uncomfortable by the verbal abuse, they have the backing of the union to address that issue. If there is no union then they should go up the chain of command (with everything in writing, ie email) and see if the situation can be rectified.

Even though I'm against yelling, I'm not gonna get involved unless the yelling is directed in my direction. I just don't feel it's my place to say anything.
 
A long time ago, a colleague of mine reportedly said to a male surgeon who was berating a female nurse, "So, does it make you feel like more of a man to treat a woman that way?" He dialed it down somewhat after that.
 
It is hard to know the full situation if you are supervising the case because you are in and out of the room.
I think a well placed comment such as "In the interest of concentrating on the patient's well-being, maybe we could refocus and discuss this later" might diffuse it a bit and allow everyone to move forward. I have only inserted myself into a situation once before. It was fairly well received and appreciated.
It is about as easy as sticking up for the person who is the underdog in junior high when the cool kids are picking on him. I look back to those years with some regret that I stood by and did nothing on most occasions. I think, if the situation was bad enough, I would step in and ask that cooler heads prevail. It is a huge risk. As I get more years under my belt and I am older than many of the surgeons I work with, I think it would be better received than a few years back when it was the opposite.
 
If the surgeon is a di*k to the nurse odds are he will be to you as well, far better to discuss the issue with them after the case. The surgeon has ALL the leverage all we can have is numbers and consensus that an assh@t is an assh@t.
 
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caligas said:
Obviously we must stand up for ourselves and any student or AA or resident under our direction. But what about when he yells at the scrub nurse? Speak up or let them fight their own battle?
Click to expand...

"Disrespect is a threat to patient safety because it inhibits collegiality and cooperation essential to teamwork, cuts off communication, undermines morale, and inhibits compliance with and implementation of new practices. Nurses and students are particularly at risk, but disrespectful treatment is also devastating for patients."

From: http://journals.lww.com/academicmed...___A_Culture_of_Respect,_Part_1___The.10.aspx

Great article. Check it out. You need your whole institution to get behind the concept of creating a culture of respect. Being a @!#$ is not only unnecessary, it undermines patient safety.
 
I would say stay out of it. Seems like there are plenty of avenues for the scrub nurses to take action whether it be directly, through a supervisor, or through a written process. As others have mentioned it is certainly possible not to know the whole story although there really never is an excuse for behaving poorly in the OR even if the scrub nurse is messing up. From what I have seen the surgeons with good attitudes tend to get what they want, when they want it more often anyway.

Survivor DO
 
what's the point? most likely that type of surgeon is an older guy and a dying breed anyway and he's not gonna change his spots this late in the game. and as for the nurse, it probably wouldn't be the first time she/he has experienced that nor will it be the last - they're used to it and usually shrug it off. and they're adults, if they want to they can handle it themselves by going to administration afterwards if necessary.
 
All that is necessary for the triumph of evil is that good men do nothing.

If minor, I will not insert myself. If egregious, I will.
 
An anesthesiologist has 3 enemies in the OR:
1. The surgeon
2. The Nurse
3. The patient

The more you get involved with either of these people the more likely you are to get rectally penetrated at some point in your career. Keep your mouth shut, take excellent care of the patient, be respectful to everyone you work with and put all that extra energy into a hobby or your family. I've been burned more than once in my career over seriously childish BS and I wont be making the same mistakes again.
 
Gasworks said:
An anesthesiologist has 3 enemies in the OR:
1. The surgeon
2. The Nurse
3. The patient

The more you get involved with either of these people the more likely you are to get rectally penetrated at some point in your career. Keep your mouth shut, take excellent care of the patient, be respectful to everyone you work with and put all that extra energy into a hobby or your family. I've been burned more than once in my career over seriously childish BS and I wont be making the same mistakes again.
Click to expand...

And I thought I was a pessimist...

Beginning with the premise that the patient is your enemy does not seem like a healthy starting point. I am sorry that your work environment is that way. I would imagine that to be very frustrating.
 
[B said:
Gern Blansten;13877282]All that is necessary for the triumph of evil is that good men do nothing. [/B]

If minor, I will not insert myself. If egregious, I will.
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Gern,hats off to you. I think that we don't act enough in our society in general. We just turn the other way. I generally don't do this to the extent that I was eating at a restaurant one day with a buddy. I overheard a dude BERATING his wife, loudly and viciously. This guy went on and on and on..... I finally turned around and said something to the extent that "I'm sick of hearing you abuse your wife. If you continue I will escort you out of here and show you who the real man is". I gambled at not being either 1) shot, or 2) schooled by some dude with deft martial arts skills (guy was a bit older and I didn't sense he was the type)

Seriously, and the guy shut right the f.ck up. This was a few years back, and I might still do that today, only with more pause and different words perhaps. You just don't know. But, as a society we too often do not act.

Probably this guy just went home and abused his wife even more (it was super bad and below the belt verbal abuse, making her feel really small). But, I'm sure he'll hold his tongue a bit more when at a public place the next time...

Now, at work, this is different and requires a very tactful, careful approach, but I think it can be done as an attending to another attending, in a way that would get the point across and allow both parties (you and the surgeon) to save face (critical) and simmer it down.

It would have to be way over the line in a place where the nurse did NOT have backing to initiate some sort of nominal recourse.
 
Gern Blansten said:
And I thought I was a pessimist...

Beginning with the premise that the patient is your enemy does not seem like a healthy starting point. I am sorry that your work environment is that way. I would imagine that to be very frustrating.
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I suspect he was talking in a more abstract sense as in; a bad airway or cardiac issue (the patient) is our enemy or a surgical complication (the surgeon) is our enemy.
 
Yes I stand up for the nurses and techs. After distracting the surgeon with idle chatter or crazy music , I'll talk to them in the locker room. My favorite line is , " if you ever spoke to my wife like that I'd tear your f***ing arms off. How would you like your wife's boss to berate her to the point of tears. " There's no excuse for beating on people, especially when the clinical situation is critical. Today the RN/tech ? "someone" forgot to power up the video printer.....surgeon asked for his pics,there were none, the nurse/tech made up a BS excuse about an equiptment error. They forgot to turn it on... I made them go tell him the truth as he left the OR suite.... it goes both ways.
 
Dirtball said:
Yes I stand up for the nurses and techs. After distracting the surgeon with idle chatter or crazy music , I'll talk to them in the locker room. My favorite line is , " if you ever spoke to my wife like that I'd tear your f***ing arms off. How would you like your wife's boss to berate her to the point of tears. " There's no excuse for beating on people, especially when the clinical situation is critical. Today the RN/tech ? "someone" forgot to power up the video printer.....surgeon asked for his pics,there were none, the nurse/tech made up a BS excuse about an equiptment error. They forgot to turn it on... I made them go tell him the truth as he left the OR suite.... it goes both ways.
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I actually know two different guys that have come to the hospital and threatened a couple of surgeons that were nasty to their wives. One literally grabbed the surgeon by his shirt collar, threw him up against the wall, and told him explicitly what he would do if he ever talked to his wife like that again. Problem solved.
 
jwk said:
I actually know two different guys that have come to the hospital and threatened a couple of surgeons that were nasty to their wives. One literally grabbed the surgeon by his shirt collar, threw him up against the wall, and told him explicitly what he would do if he ever talked to his wife like that again. Problem solved.
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One problem solved, new one created: assault charges on the husband.
 
Gasworks said:
An anesthesiologist has 3 enemies in the OR:
1. The surgeon
2. The Nurse
3. The patient

The more you get involved with either of these people the more likely you are to get rectally penetrated at some point in your career. Keep your mouth shut, take excellent care of the patient, be respectful to everyone you work with and put all that extra energy into a hobby or your family. I've been burned more than once in my career over seriously childish BS and I wont be making the same mistakes again.
Click to expand...

Practical, useful advice! :)
 
caligas said:
Obviously we must stand up for ourselves and any student or AA or resident under our direction. But what about when he yells at the scrub nurse? Speak up or let them fight their own battle?
Click to expand...

Ten bucks says the scrub nurse wouldn't stand up for you.
 
fakin' the funk said:
Ten bucks says the scrub nurse wouldn't stand up for you.
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In the medical hierarchy, the scrub nurse is "below" the surgeon and the anesthesiologist. If I saw two guys fighting in the parking lot, I wouldn't run over and save one of them. If I saw a guy assaulting a child, I would certainly intervene. I wouldn't expect the child to try to save me though.
 
TheProwler said:
In the medical hierarchy, the scrub nurse is "below" the surgeon and the anesthesiologist. If I saw two guys fighting in the parking lot, I wouldn't run over and save one of them. If I saw a guy assaulting a child, I would certainly intervene. I wouldn't expect the child to try to save me though.
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The surgeon and the anesthesiologist meet "at the bike rack." Come at me bro!
1237363745_old_people_fighting.gif
 
I personally think an individual should do what he feels is right. If someone is being bullied, I hope I would have the nuts to stand up for what's right. Now, if the scrub tech screws something up and gets yelled at that is one thing. But a repeated battery of verbal abuse without much substance or reasoning is not okay and shouldn't be tolerated by anyone.
 
Ignatius J said:
I personally think an individual should do what he feels is right. If someone is being bullied, I hope I would have the nuts to stand up for what's right. Now, if the scrub tech screws something up and gets yelled at that is one thing. But a repeated battery of verbal abuse without much substance or reasoning is not okay and shouldn't be tolerated by anyone.
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Well said. I agree with that sentiment. It is not always black and white. There are some gray areas which can be tough. I am not opposed to a surgeon who is frustrated that they are working with incompetent persons stating there frustration. There does come a point where it crosses the line though. That can be tough to discern sometimes. It is a judgment call for sure.
 
Not making any excuses for bad surgeon behavior, but the nurses and scrub techs certainly do not need anesthesia to be their knight in shining armor. These people by necessity have some thick ass skin. They will report if indicated. Nurses have a lot of bureaucracy to back them up. The surgeon in question probably wonders why his turnovers are so slow and his add-on cases always get bumped, etc. Revenge served cold.

Short of physical abuse, I would keep your mouth shut. Focus on the patient. If it's really out of control put it in writing to the authorities after the case.
 
Keep your head down low and collect da' dough! Stay out of it. Stay out of everything. Trust me you'll end up getting burned. If you tell a surgeon "I'd kick your ass if you talked to wife that way" you'd better be ready for serious retribution at some point down the line - I promise you. It won't be obvious and you may never even know who it came from but he or she will sting you. I don't even interfere when it's CRNA/surgeon issues unless it DIRECTLY or ADVERSLY effects patient care. The more you can stay out of the OR drama the happier you'll be. There are proper channels to deal with difficult or impaired physicians it's not your job.
 
Gern Blansten said:
I say stand up for them if it is unjustified or cruel. If they are screwing up and putting the patient in harm's way by not doing their job, they probably need and deserve a wake up call. It should not be done in a humiliating way though.

Ideally, if a reprimand is needed, it should be done in private. If praise is given, it should be done in public. Rarely do I see this followed in the OR.
Click to expand...

I have no idea why you are on "hold," but props to you for having integrity on this matter.

I agree with you, but I stray a bit. LOL, if they support midlevel expansionism, then, well, I might be tempted to look the other way. . .Only kidding. ;)-
 
Hockeyguy said:
Keep your head down low and collect da' dough! Stay out of it. Stay out of everything. Trust me you'll end up getting burned. If you tell a surgeon "I'd kick your ass if you talked to wife that way" you'd better be ready for serious retribution at some point down the line - I promise you. It won't be obvious and you may never even know who it came from but he or she will sting you. I don't even interfere when it's CRNA/surgeon issues unless it DIRECTLY or ADVERSLY effects patient care. The more you can stay out of the OR drama the happier you'll be. There are proper channels to deal with difficult or impaired physicians it's not your job.
Click to expand...

I see your point, but only to some degree. Doing what's right, it may cost something in the immediate, but it pays off in loads in the long run. Letting your conscience with some wisdom be your guide is a good way to move in life, regardless of what you are doing. And there is a way to say something that is balanced, but makes the point--and a time and place.

ORs can be notoriously harsh environments. Shouldn't be that way necessarily.
 
Listen, in anesthesia the squeaky wheel gets.....

Torn off and replaced with a less squeaky wheel.

Some surgeons are a-holes. You coming up with some clever response, or worse yet, a threat will not fix the personality disorder. And putting your neck on the line for someone who probably knows you as "anesthesia" and would throw you under the bus in a heartbeat makes no sense.

Anesthesia brings the hospital zero patients and zero dollars. Surgeon brings the hospital many patients and many dollars. You will lose nearly every battle if administration gets involved.

But if being the hero is more important than job security to you then let 'er rip. Risk vs benefit.
 
Yo GabbaPentin said:
Listen, in anesthesia the squeaky wheel gets.....

Torn off and replaced with a less squeaky wheel.

Some surgeons are a-holes. You coming up with some clever response, or worse yet, a threat will not fix the personality disorder. And putting your neck on the line for someone who probably knows you as "anesthesia" and would throw you under the bus in a heartbeat makes no sense.

Anesthesia brings the hospital zero patients and zero dollars. Surgeon brings the hospital many patients and many dollars. You will lose nearly every battle if administration gets involved.

But if being the hero is more important than job security to you then let 'er rip. Risk vs benefit.
Click to expand...

Bingo. Money talks and you'll walk. Especially if your group takes a stipend. You are living on borrowed time if you are mixing it up surgeons. You don't have to friends with the surgeons but be friendly and laugh all the way to bank. Do you want to right or do you want to be rich? With a real problem surgeon or any colleague report them ANONYMOUSLY to the impaired physician committee or the CMO. Let them deal with it, it's what they do.
 
Gern Blansten said:
"Account on hold" is my chosen status. Did it a long time ago as a joke and have enjoyed it. It makes me feel more like a rebel.:)
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Haha! Got to read more carefully when I zip through here.

:thumbup:

Can I write, "banned," under my moniker?:laugh:
 
Yo GabbaPentin said:
Listen, in anesthesia the squeaky wheel gets.....

Torn off and replaced with a less squeaky wheel.

Some surgeons are a-holes. You coming up with some clever response, or worse yet, a threat will not fix the personality disorder. And putting your neck on the line for someone who probably knows you as "anesthesia" and would throw you under the bus in a heartbeat makes no sense.

Anesthesia brings the hospital zero patients and zero dollars. Surgeon brings the hospital many patients and many dollars. You will lose nearly every battle if administration gets involved.

But if being the hero is more important than job security to you then let 'er rip. Risk vs benefit.
Click to expand...


I'm just saying, if there is way to do speak up that maybe saves some face but makes the point, well. . .

then again, it depends. . .


BTW, as a nurse, I have stood up for docs when they were being unfairly trashed by nurses or other residents, etc. I have stood up to a couple of cardiac surgeons--not disrespectfully, but made my point as strongly yet politely as possible, while others on rounds had shaky knees. But then again, as a nurse, I had less to lose compared to the residents, fellows, and med students. Most of the surgeons I've worked with like me and we work fine together. But yes. There are are those few that you just ignore their antics, because it's either that or get nauseated or ticked off. Not gonna change them. Sometimes you might (very rarely) influence them. And in time, only a bad outcome might temporarily knock the hubris out of them--sadly.

No way I could make a call as to the situation, unless I had been there and sized it up for myself. But I'd like to think I'd be like Glen B.
 
Surgeon called med equipment rep a
fu€ker in the OR today. He had a monitor in the wrong orientation. I was slack-jawed. To me that's inexcusable, completely unprofessional and in retrospect I wish I said something. The reality is that this guy brings in a ton of patients for out-patient surgery and could probably do whatever he wanted without retribution by the hospital powers-that-be.
 
IveGotTwins said:
Surgeon called med equipment rep a
fu€ker in the OR today. He had a monitor in the wrong orientation. I was slack-jawed. To me that's inexcusable, completely unprofessional and in retrospect I wish I said something. The reality is that this guy brings in a ton of patients for out-patient surgery and could probably do whatever he wanted without retribution by the hospital powers-that-be.
Click to expand...

Well, at least you learned something today.
 
Prof Moriarty said:
"Disrespect is a threat to patient safety because it inhibits collegiality and cooperation essential to teamwork, cuts off communication, undermines morale, and inhibits compliance with and implementation of new practices. Nurses and students are particularly at risk, but disrespectful treatment is also devastating for patients."

From: http://journals.lww.com/academicmed...___A_Culture_of_Respect,_Part_1___The.10.aspx

Great article. Check it out. You need your whole institution to get behind the concept of creating a culture of respect. Being a @!#$ is not only unnecessary, it undermines patient safety.
Click to expand...

:thumbup:
 
Another question...

What do you do with a surgeon who, on more than one occasion, has hit an anesthesia resident in the head with an instrument when our resident is under the drapes checking the arms or the airway?
 
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