There is a lot of stress involved in working in the OR. The cost alone for operating room time is around forty-two dollars a minute. With the new Obama health care plan, and the tightening up of federal Medicare and state Medicaid dollars, the nurse is becoming more and more under the gun to “save time”. It doesn’t matter that the doctor in the room may not be really sure of the specifics of the procedure. It doesn’t matter if the doctor has never done this particular procedure in his life… and has to call on a colleague from another department to give guidance (consultation). It doesn’t matter if there is only one set of instruments and there are three cases to do. Or maybe the medical student drops that special item in that one and only instrument tray. It doesn’t matter that the light bulb blows out in the OR lighting, or the only computer for our “computer documentation” is suddenly locked up. It doesn’t matter that the patient has thought up another 37 questions to ask before he is ready to roll back to the OR. It doesn’t matter that the patient forgot to stop his Coumadin prior to coming to the hospital and anesthesia now wants to draw lab work. It doesn’t matter that the patient came to the OR (from the ward, ICU, ER or where ever) with twenty seven pieces of “personal jewelry,” slippers, full clothing, a watch and two wallets full of money and “important papers”. For all problems, no matter who or when they originated, no matter what equipment failure occurs, the circulating nurse is responsible. The division director has told me personally that the nurse is “the gatekeeper.” So as the “captain of the boat” the nurse is the bearer of all responsibility and therefore all blame.
This has been the accepted rule for years and most nurses were perfectly ok with it. Lately, it seems, management is tightening the belt and wanting to shave every minute from the operating room time to cut cost. This morning we had an “all staff” meeting to discuss why we are not getting our first cases in by 0730 and why we can’t get our turnover time less than 20 minutes. Well, I have one question… Does that girl who cleans your room at Holiday Inn Express take less than 20 minutes to clean your room before you sleep in it? And if she does clean your room in a brisk 20 minutes, can you do surgery in that very room and not get an infection?
We are not alone. The surgeons are stereotypically targeted as the top earners in the surgery department. For that reason, they too are starting to get a heat from the administration, in an effort to save money. They are quite unhappy at the idea of a bureaucrat with no medical background telling him how the cow eats the grass, when it comes to doing a surgical procedure. Because of this, they are even more irritated at the “gatekeeper,” or the nurse in the room when things are not going perfectly smooth. When tempers flare no one wants to be “in the room.” Especially the administrators, managers, and the very people who are causing all of the stress. Everyone, even support people are doing the utmost to steer clear of the difficult procedures.
The other day we were doing a laparoscopic procedure. That’s when you have a camera and a little scope looking onto someone’s abdomen This procedure is for removing your gallbladder with only a few very small holes instead of one large incision. Laparoscopic procedures, when everything goes well, is cost effective and allows for a much shorter recovery time. Anyhow, the doctor wanted a second monitor screen on the other side of the bed to power up a second camera. I couldn’t get the screen to work. I switched the switch, changed the camera, changed the light cord, rebooted the computer, and it still wouldn’t work. I called the bio-engineer to take a look at it. After the first ten seconds of not getting a picture, the doctor became furious. The tech guy was also reluctant to help because of the heat radiating from the surgeon in the room. I insisted and forced the issue with the tech guy. Once he arrived, he flipped a few switches behind the monitor and the picture magically appeared within about three seconds. I asked, “hey, how did you do that… I mean, when it happens again, I want to be able to fix it so we may avoid all this drama and harsh language. I mean, why wouldn’t you want to not have people yelling at you if you could avoid it?”
The tech guy said, “well, it’s quite technical, I don’t’ think that you could…”
I interrupted, “Hey, wait… just let me know, I mean, I’m pretty technical… I do my own auto repair,… I did machine work for GM back in the 80’s… I mean really, how hard can it be?”
He looked at me a inquisitively and said, Hmmm, I don’t know… you might mess something up.”
I was feeling a little put out, “you gotta tell me… you just gotta.”
He smiled, “well, if you must know, I’ll tell you how to trouble shoot something like this.”
I was pretty jazzed, “great, tell me how you fixed it.”
He smiled again, and saying in his most condesending voice, “OK, if you must know… it seems that the switch… you know the ‘on and off switch’ well it seems that this particular switch was in the wrong position for proper operation… it would be wise to check this switch first if this problem were to ever happen again.” Then he laughed out loud as I stood there dumbfounded.
Who said tech guys had no sense of humor.