Opinions on OR nurses

[whatlobster]

First off, let me start by saying that I'm a new BSN RN, so hopefully I'm not intruding your territory here. I really just want to know how OR nurses are generally regarded professionally.

Just a bit of background...I'm currently juggling between two specialties: the ER and the OR. I've been working in the ER as a student nurse since 2nd year, and I love it. Great working relationships between the MDs and the RNs there. Trust me when I say I'm completely unlike the stereotypical 'I do more than doctors' type of nurse, and I generally admire people that practice medicine. I've recently become interested in the OR, but I'd hate to work somewhere where nurses are seen as useless, unimportant, or 'just the handmaiden'. But that seems to be the case around here? From the searches people have nothing but complaints about OR nurses, that they're either trained monkeys or overpaid/overqualified people doing simple, mindless tasks.

Do surgeons/residents/medical students actually feel that way? Or do you guys actually value your OR nurses (the ones that are kind and competent anyway)? Or do you think the tasks in the OR can be done by anybody?

I'm really curious as to what people think. Feel free to move this thread wherever as I don't really know which is the best forum to ask this question.

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[SocialistMD]

I've been working in the ER as a student nurse since 2nd year, and I love it there. Great working relationships between the MDs and the RNs there...
...I've recently become interested in the OR, but I'd hate to work somewhere where nurses are seen as useless, unimportant, or 'just the handmaiden'. But that seems to be the case around here?
Do surgeons/residents/medical students actually feel that way? Or do you guys actually value your OR nurses (the ones that are kind and competent anyway)? Or do you think the tasks in the OR can be done by anybody?

A lot of the answer to your question comes from physician expectations. While I can't really speak as an EM physician, I can say that, based on my observations, they don't have high expectations for their nurses in 90% of instances. They enter a fluid order or a lab order and wait for the result while they are tending to their other patients. If you do it in 5 minutes or you do it in 1 hour, they generally aren't going to notice the difference. When you are an OR nurse, you are treated as part of the team, but the expectations are higher. When we need something, we need it as soon as possible; any delay on the nurses part delays our process. For the most part, the scrub nurses I know are all fantastaic. However, it is not as easy to be lazy and slip through the cracks as an OR nurse when compared to an ER nurse. That is the difference on how they interact with the physicians; highly functional nurses are fine in the OR while marginally functional nurses can still exist in the ER without much notice physician backlash, as it just goes unnoticed most of the time. Since (1) people don't like having other people on their case and (2) physicians aren't getting on the cases of the nurses as much in the ER as a result of expectations, the working relationships appear better in the ER to the casual observer.

 

[maxheadroom]

A good circulator is worth her weight in gold. And a good scrub might be even more important. If you're smart, hard-working, and friendly, you'll be beloved by your surgical staff.

 

[Ronin2258]

A good circulator is worth her weight in gold. And a good scrub might be even more important. If you're smart, hard-working, and friendly, you'll be beloved by your surgical staff.

This.

When the required breaks happen, the difference between a team player OR nurse vs. one less inclined is like night and day. While it may seem like handmaiden work to the outside observer, it is critical to get the case done and the patient of the table safely.

Always appreciate the ones that bust their tail to get the job done.

 

[tkim]

A lot of the answer to your question comes from physician expectations. While I can't really speak as an EM physician, I can say that, based on my observations, they don't have high expectations for their nurses in 90% of instances. They enter a fluid order or a lab order and wait for the result while they are tending to their other patients. If you do it in 5 minutes or you do it in 1 hour, they generally aren't going to notice the difference. When you are an OR nurse, you are treated as part of the team, but the expectations are higher. When we need something, we need it as soon as possible; any delay on the nurses part delays our process. For the most part, the scrub nurses I know are all fantastaic. However, it is not as easy to be lazy and slip through the cracks as an OR nurse when compared to an ER nurse. That is the difference on how they interact with the physicians; highly functional nurses are fine in the OR while marginally functional nurses can still exist in the ER without much notice physician backlash, as it just goes unnoticed most of the time. Since (1) people don't like having other people on their case and (2) physicians aren't getting on the cases of the nurses as much in the ER as a result of expectations, the working relationships appear better in the ER to the casual observer.

As a new attending in a community ER, I'd have to disagree.

Patient flow in the ER is important - "move the meat, keep the meat happy". A large part of the hospital's revenue flow and reputation hinge on this, as what used to be the back door to the hospital is now the front, and having a reputation as a hospital with a slow ER means more patients go somewhere else. Nurses need to move the meat with me.

This means timely labs, fluids, meds. This means, if someone decompensates, I need to know now versus later. Having a great ER nurse versus a crappy one is very noticeable. They anticipate workup and treatments I will order, and have them ready without asking.

An example - a young male with h/o dislocated shoulder. Nurse had treated the patient before, knew that the shoulder would not go back in without sedation. Had the consent form and sedation packet stickered and clipped to the chart, and had drawn a vial of propofol out of the Pixis before I even saw the patient. Had fluids hanging, an ambu out and the airway cart outside the room. Had a post reduction XR ordered as soon as the shoulder went in. Saved me a bunch of time and made for a very smooth reduction. Easily could have taken much longer to gather everything before the procedure. Dispo under an hour. Meat moved and happy. Bed turned over and another patient roomed.

Another example - middle aged guy with what appears to be septic shock complicated by pulmonary edema. Before I get to the room, there's the central line cart in the room, SiteRite in the room, and the nurse doublechecks with me if I want levo or neo as the pressor hanging, and asks what in addition to vanco I want as abx. Hands me all the extra crap I need to place/secure the line, then orders the post procedure CXR while I'm securing the line. The portable XR machine is being wheeled in as I dispose my last sharp. Calling report to the ICU under two hours.

When they're good, it's really good, and working is a dream.

You get a slow or unobservant ED nurse the place slows down to a crawl and people get sick unnoticed. That gets noticed and dealt with. This ain't the floor and you can't get away with charting vitals every four hours and playing sodoku while surfing Facebook.

 

[maxheadroom]

The facts are:

1. Nursing is a tough job. Staffing with RNs is getting skimpier and skimpier and more and more "techs" and "MAs" are being used for pseudo-RN duties. Consequently, RNs have a lot more pressure as they're spread over lots more patients.

2. A good nurse in ANY hospital unit (OR, ED, L&D, Med-Surg floors, SICU, MICU, Burn Unit, Wound-Ostomy) is tremendously valuable. Almost every unit is chronically under-staffed with quality RNs and they make an impact wherever they are. I used to work at a place where we could send free flaps TO THE FLOOR!! The floor nurses on that unit were awesome. At my current place, all flaps have to go to the SICU if there's to be any hope of appropriate monitoring.

3. The super-smart Orthopods and Cardiologists hire away the best OR nurses/cath lab nurses and train them to be an RNFA or send them to become a CNP.

 

[SocialistMD]

As a new attending in a community ER, I'd have to disagree.

Patient flow in the ER is important - "move the meat, keep the meat happy". A large part of the hospital's revenue flow and reputation hinge on this, as what used to be the back door to the hospital is now the front, and having a reputation as a hospital with a slow ER means more patients go somewhere else. Nurses need to move the meat with me.

This means timely labs, fluids, meds. This means, if someone decompensates, I need to know now versus later. Having a great ER nurse versus a crappy one is very noticeable. They anticipate workup and treatments I will order, and have them ready without asking.

An example - a young male with h/o dislocated shoulder. Nurse had treated the patient before, knew that the shoulder would not go back in without sedation. Had the consent form and sedation packet stickered and clipped to the chart, and had drawn a vial of propofol out of the Pixis before I even saw the patient. Had fluids hanging, an ambu out and the airway cart outside the room. Had a post reduction XR ordered as soon as the shoulder went in. Saved me a bunch of time and made for a very smooth reduction. Easily could have taken much longer to gather everything before the procedure. Dispo under an hour. Meat moved and happy. Bed turned over and another patient roomed.

Another example - middle aged guy with what appears to be septic shock complicated by pulmonary edema. Before I get to the room, there's the central line cart in the room, SiteRite in the room, and the nurse doublechecks with me if I want levo or neo as the pressor hanging, and asks what in addition to vanco I want as abx. Hands me all the extra crap I need to place/secure the line, then orders the post procedure CXR while I'm securing the line. The portable XR machine is being wheeled in as I dispose my last sharp. Calling report to the ICU under two hours.

When they're good, it's really good, and working is a dream.

You get a slow or unobservant ED nurse the place slows down to a crawl and people get sick unnoticed. That gets noticed and dealt with. This ain't the floor and you can't get away with charting vitals every four hours and playing sodoku while surfing Facebook.

As I said, my comments are based on my observations and experiences. The nurses in our ER are great, but I can think of a few instances off the top of my head where I've asked (and made sure the orders were in) for IV fluids or antibiotics to be started and when I came back by 30 minutes or so later, they weren't done. That lag time would not be acceptable in the OR, but there were no repercussions from the ED physicians in the cases I recall. A lot of it is the two very different operating systems, as the OR nurses have one patient at a time and there is no excuse for waiting more than a couple of minutes for anything. However, it is possible for nurses in the ER, who are not in the constant presence of the physicians by nature of their job, to "take a break," be it scheduled or not, and have most things that were ordered wait until they get off break rather than have a colleague do things in his/her absence. That can't happen in the OR.

 

[tkim]

As I said, my comments are based on my observations and experiences.

In the same post:

While I can't really speak as an EM physician, I can say that, based on my observations, they don't have high expectations for their nurses in 90% of instances. They enter a fluid order or a lab order and wait for the result while they are tending to their other patients. If you do it in 5 minutes or you do it in 1 hour, they generally aren't going to notice the difference.

I do, and I ask about it all the time.

The nurses in our ER are great, but I can think of a few instances off the top of my head where I've asked (and made sure the orders were in) for IV fluids or antibiotics to be started and when I came back by 30 minutes or so later, they weren't done. That lag time would not be acceptable in the OR, but there were no repercussions from the ED physicians in the cases I recall. A lot of it is the two very different operating systems, as the OR nurses have one patient at a time and there is no excuse for waiting more than a couple of minutes for anything. However, it is possible for nurses in the ER, who are not in the constant presence of the physicians by nature of their job, to "take a break," be it scheduled or not, and have most things that were ordered wait until they get off break rather than have a colleague do things in his/her absence. That can't happen in the OR.

Then comparison is pointless, and the real question is whether as a nurse you want to concentrate on one patient at a time, or multiple patients at a time. Attention to detail versus multitasking.

 

[SocialistMD]

I do, and I ask about it all the time.

Then you are the exception to the rule and deserve a sticker.

Then comparison is pointless, and the real question is whether as a nurse you want to concentrate on one patient at a time, or multiple patients at a time. Attention to detail versus multitasking.

Which was kind of my point all along. The reason the outsider might perceive the ER being a fun-loving, everyone-loves-everyone place and the OR being a place where people will hammer you for something is that in the ER you are not under the constant watchful eye of the physician and so any slack off time taken is noticed.

 

[Winged Scapula]

A good circulator is worth her weight in gold. And a good scrub might be even more important. If you're smart, hard-working, and friendly, you'll be beloved by your surgical staff.

I might consider reversing the order:

a good scrub is worth his/her weight in gold

a great circulator may be even more important

The fact is that I can do most of the work myself as long as the instruments are on the Mayo.

But a slow, clueless, lazy or incompetent circulator increases my OR time and adds stress. Frankly some of them are so intent on spending time on the computer or have to leave the room for *every* little thing (Really? You don't have 3/0 Vic in the room?) that I'd swear it adds significant time to the case.

OTOH, its a pleasure to work with people who know what you want, how you want things done and anticipate your next move.

 

[Apollyon]

See, if you're still a resident (to SocialistMD), your perceptions of the ED are of a minority of EDs in the US.

In the community, ED RNs (exclusively - not the "moonlighters") are the make-or-break. One hospital in my system is not academic, and the manager keeps hiring fresh-out-of-school nurses, and the department is horrible. It's mostly ignorance (not knowing) with a smattering of apathy (not caring). Nurses are well-known to "eat their young", and the young in this department are learning from the few, more experienced that being obstructive is the key to success in this department. Then again, the squeaky wheel gets the grease - until it gets replaced.

To the OP, SDN is rife with stories of nurses and techs in the OR that treat lower-level residents with disrespect and outright animus, for the perceived notion of the intern or 2nd year being low on the pole, along with the self-same derision from faculty; this is irrespective of many of these residents being both older and more educated. In any part of the hospital where doctors and nurses work side-by-side, the truism holds: "An efficient nurse is worth their weight in gold". Also, as Slovis and Wrenn wrote in an EM book: "A good nurse will find fault where there is none". Maintain your respect for people, and you'll go far, and be sought out.

edit: WS and I were posting at the same time

 

[albaniandoc]

Whatlobster,

It's always hard to see and appreciate the work a nurse does from the doctor's perspective and the other way around. I have been a nurse for 8 years, finishing medical school and now going into surgery. I can say that over the past four years of medical school I have learned a lot more about the profession of nursing that I did as a nurse when it comes to perspective.

Like others said here, a good nurse is worth his/her weight in gold. This is especially true in high volume situations with fast turn around like ER, OR. I have worked on the floor, unit and OR (never worked in the ER) and can definitely tell you that you work a lot closer with the docs and are appreciated more as an OR nurse. Your work directly impacts the doctor's day and if you are even remotely passive aggressive you can delay their schedule by a couple of hours and make the difference between them having a fantastic day and a miserable one.

I work in a dedicated heart unit with two ORs, two surgeons and 8 team members. We have one PA, and 4 RNFAs. Our nurses are highly trained and very versatile, ready to harvest veins, first assist, close the chest, circulate, scrub, assist with central lines etc. They are very highly respected by the surgeons and the work is so high demand that no lazy person would ever survive that environment. Fortunately, we function like a well oiled machine. We set up the same way, prep the same way and the surgeons do the same surgeries (probably 5-6 procedures over and over again). The majority of the time the doctors do not ask for the next instrument we simply pass it to them. We can handle most extreme emergencies with poise and can anticipate the surgeon's next move. This is simply because we have worked with them for so long.

Now, that is not the case on most operating rooms. We are a dedicated team which means that if there are no surgeries scheduled we stay home and get paid, but there have been days where I have worked 18 hours straight and then came back four or five hours later for another 12. I also would take 20 days of call a month which can be brutal. The pay for us is also better than the average nurse.

Finally, when I applied to medical school both surgeons wrote the nicest letters and so did the anesthesiologists (we have a group of nine of them and they wrote a group letter, which is pretty unique) I still continue to work there (just came back from work actually) as a nurse on holidays, weekend or any days off. Working an going to medical school has certainly given me a new perspective on both professions.

If you are thinking of becoming an OR nurse, it is a very rewarding career and well respected. You would want to do an RNFA program so that you can assist in the OR since most hospitals are eliminating nurses from the scrub position (It's so much cheaper to pay a scrub tech). You would be a huge asset to any hospital. I would strongly recommend that you do shadow or spend a few days in an OR environment to get an idea of what the job is like. some find it abrasive, others love it. One thing is for certain, it is different. For me it was love at first sight and the moment I picked up an instrument I decided to become a surgeon. I have never regretted going into nursing or medicine. If I can answer any questions for you don't hesitate to send me a private message.

First off, let me start by saying that I'm a new BSN RN, so hopefully I'm not intruding your territory here. I really just want to know how OR nurses are generally regarded professionally.

Just a bit of background...I'm currently juggling between two specialties: the ER and the OR. I've been working in the ER as a student nurse since 2nd year, and I love it. Great working relationships between the MDs and the RNs there. Trust me when I say I'm completely unlike the stereotypical 'I do more than doctors' type of nurse, and I generally admire people that practice medicine. I've recently become interested in the OR, but I'd hate to work somewhere where nurses are seen as useless, unimportant, or 'just the handmaiden'. But that seems to be the case around here? From the searches people have nothing but complaints about OR nurses, that they're either trained monkeys or overpaid/overqualified people doing simple, mindless tasks.

Do surgeons/residents/medical students actually feel that way? Or do you guys actually value your OR nurses (the ones that are kind and competent anyway)? Or do you think the tasks in the OR can be done by anybody?

I'm really curious as to what people think. Feel free to move this thread wherever as I don't really know which is the best forum to ask this question.

 

[tkim]

Then you are the exception to the rule and deserve a sticker.

You know what you can do with the sticker.

 

[whatlobster]

Wow, very encouraging replies you guys! Now I'm more motivated than ever to pursue OR nursing, and looking forward to assist the docs anyway I can.

RNFA definitely sounds interesting, but here in Canada, I don't think they're as prominent as they are in the States. I know there are few practicing in Ontario. Still, one can hope it'll make its way into our health care system more significantly in the near future.

Thanks again for all the grounded and supportive posts. See, surgeons aren't so bad afterall.

 

[albaniandoc]

See, surgeons aren't so bad afterall.

You would be surprised !!

I actually work with two Canadian nurses that came to the US to work through NAFTA. One is from Windsor there by you and the other is a Newfy.

 

[SocialistMD]

See, if you're still a resident (to SocialistMD), your perceptions of the ED are of a minority of EDs in the US.

If I recall correctly, you and I graduated medical school the same year, so I'm not sure how my still being a resident has any bearing on my perception of the entire country's EDs or it being any less vast than your own with the exception of the fact that you are an ED attending, whereby my ER nursing experience will never equal yours (though I highly doubt you have seen a majority of US EDs yourself), so mentioning the fact that I'm still just a resident is only for condescension.

In my short (because I'm still a resident) career, I have worked in 11 ERs spread around 5 cities; 9 associated with academic institutions, 5 Level I trauma, 2 completely private, 2 exclusively pediatric, 2 county and one VA (Interestingly, I've only worked in 7 ORs, so I've actually had a broader ER nursing experience than a [much deeper] OR nursing experience). I can say that in those ERs, there are some trends that hold up across all, one of which is what I've been saying. There is less accountability for timeliness in getting things done in the ER than in the OR. I attribute it to the fact that the nurses can get busy caring for other patients (as can the physicians), something the nurses (and physicians) can't do in the OR. I'm not calling the ER nurses lazy or the EM physicians uncaring, I'm simply stating that there are ways to take advantage of the ER system, should one be inclined, that aren't possible in the OR, and that is probably why there is a difference in perception. Why that warranted the ED brigade coming in here and citing nursing heroics as evidence to the contrary of what I've experienced or calling out my "whipper-snapper" status is still beyond me...

 

[Apollyon]

If I recall correctly, you and I graduated medical school the same year, so I'm not sure how my still being a resident has any bearing on my perception of the entire country's ED or it being any less vast than your own with the exception of the fact that you are an ED attending, whereby mine will never equal yours (though I highly doubt you have seen a majority of US EDs yourself), so mentioning the fact that I'm still just a resident is only mentioned for condescension.

Huh? Over-react much?

I graduated in 2002, so, if you're still a resident (and not a fellow) 9 years later - well, I don't know what to say.

My only point was that academic EDs rarely flow like community EDs. You feel justified in giving a list, although I would state that, if you are being called to these departments, they still have an academic attachment (as your residency program sending you to a place that is not affiliated would render a host of problems). I haven't seen or talked to a resident in almost 2 years (except as a patient - a chief resident in ortho for my shoulder, who was rotating with a guy that does hand also; true to form, they both came to the same diagnosis, but the resident recommended "X", while the attending recommended "Y" - which led to a smirk between the resident and me). The rest of your agitas - well, I have no response. Where you find offense is unknown, but I shall nonetheless offer apologies for any insult; none was intended.

 

[tkim]

Why that warranted the ED brigade coming in here and citing nursing heroics as evidence to the contrary of what I've experienced or calling out my "whipper-snapper" status is still beyond me...

Then I suggest you reread your own post. You paint the picture of the OR nurse as superior, the ER as a place where nursing mediocrity can flourish under the nose of ER docs who either don't know or don't care what's not getting done, and with no sense of teamwork.

God forbid that in your 11 ER whirlwind tour, that if I offer a example counter to that experience - I mean, it's only where I work *all the time*, that you would condescend by patting me on the head and giving me a sticker and calling my behaviour special. Same tactic used for the oppressed races when one of the tribe does something unexpected or beyond the belief of the smugly superior.

Are you getting it, Neidermeyer? Your bias is so obvious yet deeply ingrained that you don't even recognize it for what it is.

 

[SocialistMD]

Your bias is so obvious yet deeply ingrained that you don't even recognize it for what it is.

My bias, or your being the victim of the evil surgeons for too long?

Then I suggest you reread your own post.

Yes, let's.

...they don't have high expectations for their nurses in 90% of instances. They enter a fluid order or a lab order and wait for the result while they are tending to their other patients. If you do it in 5 minutes or you do it in 1 hour, they generally aren't going to notice the difference.

Perhaps I forgot an "as," and it should have read "...they don't have as high of expectations..." Is this what bothers you so much? For every patient in the OR, we expect a response within seconds to minutes. For every patient in the ER, you don't. Is it unrealistic to expect an ED nurse to have an IV started and labs drawn in 5 minutes? In most cases, but it doesn't make your expectations equal to ours, and just because I didn't phrase things in a surgical forum that conforms to the EM view of the world, it doesn't mean I'm anti-EM. Let's continue...

However, it is not as easy to be lazy and slip through the cracks as an OR nurse when compared to an ER nurse. That is the difference on how they interact with the physicians; highly functional nurses are fine in the OR while marginally functional nurses can still exist in the ER without much notice physician backlash, as it just goes unnoticed most of the time.

Again, the ED system without constant physician hawking allows for "mini-breaks," should one want one. Did I say most ER nurses do that? No, I said the opportunity to do so is more available when you aren't trapped in the same room as the physician with whom you are working. How that can be misconstrued to suggest OR superiority over the ER's "flourishing mediocrity" is more a testament to your imagination and personal feelings of inferiority than my subconscious loathing for the ED.

You paint the picture of the OR nurse as superior, the ER as a place where nursing mediocrity can flourish under the nose of ER docs who either don't know or don't care what's not getting done, and with no sense of teamwork.

That's your inference, not what I implied. I never said you didn't care or didn't know, mostly because it isn't even your job to know where the nurses are and what they are doing on a minute to minute basis and I do think you care (though clever phrases such as "move the meat, keep the meat happy" don't help your cause). I know it is a team down there, and I know that it is probably more "equal" in terms of a lack of the hierarchy that is seen in the OR team. However, that doesn't mean that our standards are not higher (yes, I consider the time frame in which you expect something done a standard).

God forbid that in your 11 ER whirlwind tour, that if I offer a example counter to that experience - I mean, it's only where I work *all the time*, that you would condescend by patting me on the head and giving me a sticker and calling my behaviour special. Same tactic used for the oppressed races when one of the tribe does something unexpected or beyond the belief of the smugly superior.

I wasn't condescending you for offering a counter example (which is why I reitereated that my statement was based on my experience), I was condescending because the normal condition (again, in my experience) is if I ask the ED physician where we stand with labs/images/fluids/antibiotics/etc... they have absolutely no idea, again because it isn't a top priority. If you are that special physician down there who is so on top of your patients that you know if the labs have been sent, antibiotics started, etc... vs just knowing if they have been ordered, then you are a rare person. It hasn't been my experience with any of the ED physicians (interns to attendings) on patients I've been consulted to see.

If you want to see how I really feel about EM folk, PM me.

To the OP, my statement still stands. Surgeons love their nurses (sometimes inappropriately) as much as EM physicians. However, we have different expectations and are better able to witness shortcomings because you can't escape us.

 

[Buzz Me]

Let's get back on topic, please.

I'd agree that a great circulating nurse or scrub nurse is worth his/her weight in gold. The entire flow of the operation depends so much on how well the OR staff can predict each other's moves - you'll see that the scrub nurses who are familiar with any given procedure (e.g. lap chole) will know exactly which instrument is needed for which portion of the procedure, and can plan accordingly. Same goes for an astute circulating nurse, who will have all the necessary equipment in the room or readily available and can even troubleshoot when necessary (e.g. when the laparoscopic tower fails).

 

[ESU_MD]

nothing better than a good ole er bashing. most people attracted to this type of work are not really interested in anything much more than starting the bare minimum of treatment and then turning over the care to someone else. that is the role of the system, so we cant complain too much. much like or nurses are not particulary adept with dealing with awake patients or things you do to awake patients.

we can go on forever, but the true facts are that the vast majority of medical professionals just dont like er's, and dont like people who think er is cool. its not really personal....

 

[SLUser11]

Huh? Over-react much?

Are you getting it, Neidermeyer? Your bias is so obvious yet deeply ingrained that you don't even recognize it for what it is.

nothing better than a good ole er bashing. most people attracted to this type of work are not really interested in anything much more than starting the bare minimum of treatment and then turning over the care to someone else.....

.....In before the lock.


Anyway, I think Socialist's response was emotional but not really an over-reaction. Apollyon, your post was sort-of condescending, and it did assume that his knowledge was limited to 1-2 ERs.

Either way, things are getting too emotionally charged. We all should just cool down and remember we're on the same side.

As surgery residents, we will see some of the worst ER nursing and physician behavior, and possibly don't experience some of the best, since we're popping in and out of the ER for consults....there's a natural selection bias.

On the other hand, my brother is an ER doc, and he samples some of the worst surgeon and resident behavior when they come down to his ER....once again, sample bias.

I think we can all agree that there are horrible nurses out there in the OR and in the ER, and there are plenty of horrible ER docs and surgeons as well.

 

[igap]

As a new attending in a community ER, I'd have to disagree.

Patient flow in the ER is important - "move the meat, keep the meat happy".

...Meat moved and happy.

This seems like a pretty depressing, and offensive way to view patients, but... ah... ok. I have a hard time believing that this is the typical viewpoint of an ED attending but maybe I am just naive? It would be profoundly disheartening if this is the way attending ED physicians think.

This ain't the floor and you can't get away with charting vitals every four hours and playing sodoku while surfing Facebook.

Could you possibly be more dismissively offensive to a group of people that we depend on to help take care of our patients? I understand, and respect, your advocacy for ED nursing staff, but do you have to do it at the expense of floor nurses? Wow.

 

[tkim]

My bias, or your being the victim of the evil surgeons for too long?

Yes, let's.

Perhaps I forgot an "as," and it should have read "...they don't have as high of expectations..." Is this what bothers you so much? For every patient in the OR, we expect a response within seconds to minutes. For every patient in the ER, you don't. Is it unrealistic to expect an ED nurse to have an IV started and labs drawn in 5 minutes? In most cases, but it doesn't make your expectations equal to ours, and just because I didn't phrase things in a surgical forum that conforms to the EM view of the world, it doesn't mean I'm anti-EM. Let's continue...


Again, the ED system without constant physician hawking allows for "mini-breaks," should one want one. Did I say most ER nurses do that? No, I said the opportunity to do so is more available when you aren't trapped in the same room as the physician with whom you are working. How that can be misconstrued to suggest OR superiority over the ER's "flourishing mediocrity" is more a testament to your imagination and personal feelings of inferiority than my subconscious loathing for the ED.


That's your inference, not what I implied. I never said you didn't care or didn't know, mostly because it isn't even your job to know where the nurses are and what they are doing on a minute to minute basis and I do think you care (though clever phrases such as "move the meat, keep the meat happy" don't help your cause). I know it is a team down there, and I know that it is probably more "equal" in terms of a lack of the hierarchy that is seen in the OR team. However, that doesn't mean that our standards are not higher (yes, I consider the time frame in which you expect something done a standard).

I wasn't condescending you for offering a counter example (which is why I reitereated that my statement was based on my experience), I was condescending because the normal condition (again, in my experience) is if I ask the ED physician where we stand with labs/images/fluids/antibiotics/etc... they have absolutely no idea, again because it isn't a top priority. If you are that special physician down there who is so on top of your patients that you know if the labs have been sent, antibiotics started, etc... vs just knowing if they have been ordered, then you are a rare person. It hasn't been my experience with any of the ED physicians (interns to attendings) on patients I've been consulted to see.

If you want to see how I really feel about EM folk, PM me.

To the OP, my statement still stands. Surgeons love their nurses (sometimes inappropriately) as much as EM physicians. However, we have different expectations and are better able to witness shortcomings because you can't escape us.

I'm going to stop because the point-by-point response is fairly ridiculous.

OP - do what interests you most.

 

[tkim]

This seems like a pretty depressing, and offensive way to view patients, but... ah... ok. I have a hard time believing that this is the typical viewpoint of an ED attending but maybe I am just naive? It would be profoundly disheartening if this is the way attending ED physicians think.

No, I'm not typical ER attending. I'm special and have a sticker to prove it.

Could you possibly be more dismissively offensive to a group of people that we depend on to help take care of our patients? I understand, and respect, your advocacy for ED nursing staff, but do you have to do it at the expense of floor nurses? Wow.

I could ... I could be a surgical resident talking about ER nurses.

 

[SLUser11]

No, I'm not typical ER attending. I'm special and have a sticker to prove it.



I could ... I could be a surgical resident talking about ER nurses.

That was actually pretty good.

 

[tkim]

That was actually pretty good.

Thanks. Now get down here and press on the belly of a patient I've never laid hands on and consulted you for as a surgical abdomen, which will turn out to be constipation. Stat.

 

[Winged Scapula]

Thanks. Now get down here and press on the belly of a patient I've never laid hands on and consulted you for as a surgical abdomen, which will turn out to be constipation. Stat.

Alright...give your sticker for being special back if that's how you're gonna be.

 

[Buzz Me]

Thanks. Now get down here and press on the belly of a patient I've never laid hands on and consulted you for as a surgical abdomen, which will turn out to be constipation. Stat.

How come we get consulted for a symptom (abdominal pain)? Can you imagine calling Cardiology for "chest pain," or Pulmonary for "shortness of breath"? They'd laugh and hang up the phone.

 

[Apollyon]

How come we get consulted for a symptom (abdominal pain)? Can you imagine calling Cardiology for "chest pain," or Pulmonary for "shortness of breath"? They'd laugh and hang up the phone.

Cardiology for chest pain? Good story with the right history - I've sent patients to the cath lab, without STEMI and negative cardiac markers - with restrictive lesions found on cath. Unstable angina is a sound diagnosis, and that is acceptable with no EKG or serum chemical changes.

Also, the abdomen is heterogenous, whereas the heart is compact, and the lungs are homogenous diffusely. On the medical side, there's GI (with the subset of hepatology), endocrinology, nephrology, OB/GYN from the other side of the aisle, and heme/onc for the spleen. A book by Slovis and Wrenn from Vanderbilt stated that "your surgeons are like a very specific and very sensitive test. Use them like a rifle, and not a shotgun".

Here in the community, I honestly can't remember the last time I actually saw a surgeon (general, CT, neuro, or ortho) in the ED, unless it was about 7 months ago, when one of the transplant surgeons admitted one of her kidney txplt pts with an unrelated SBO. ENT, those guys I actually get pretty quickly. Otherwise, I'm calling on the phone and setting up for f/u the next day, or for the surgeon to consult the next day. I guess that's why I haven't burned my bridges - because they're not having to come out.