The gown card begins ‘2 word phrases- what is wrong in the OR’.
A 2 word phrase can be useful in establishing urgency in the OR. Think Suction Here. This indicates that suction is needed, right now, in this specific location. It is specific and to the point. No extra words are wasted to get the point across.
A 2 word phrase can be irritating as well. The rest of the gown card is filled with itty bitty writing giving 2 word couplets that can be rage-inducing. I’ll list them as written. And give background when I can.
A) Suction Cannisters. Whose job is it to fill the cannister tree? Everyone’s. Who does it? Hardly a soul. Nothing is more rage inducing than going into a room with an emergency with a single suction cannister in the 4 cannister tree. When I was the evening charge nurse I filled the trees as part of the set-up I did on every room, every night.
B) Warm Blankets. Sometimes the patients can hardly move they under so many blankets. It is an answer to every situation for some people. You’re bleeding uncontrollably? More warm blankets! Yeah, not the answer that will save a patient’s life. Rage inducing when the person giving them all the blankets is the same one who tears them off in a rage because there are too many blankets.
C) Pagers Phones. Prior to scrubbing in the PA or the surgeon will dump their phone or pager on the desk. Not give you the code to get into it, just drop it off and act like you should know the code. After all they gave it to you six months ago.
D) Bat Phone. This is the charge phone and will go off when your hands are dripping, or there is a request from the field. Take care of the field first. And if you answer the phone and it is the next doctor yelling about getting their case started, feel free to tell them that they are slowing down the case ahead with their non-stop calling. You will call them with updates as you have them.
E) Cold Room/Warm Room. No matter the room temperature, someone is always unhappy. AORN has parameters for optimal room temperature and humidity. We are not making this up and sorry if you are hot/cold. This is the temperature that is best for the patient. Got it?
F) Extra Instruments. Some surgeons are unable to work unless every instrument they could conceivably use, but will not, is readily available to the scrub tech, open and counted. Never mind that this practice slows down set-up and breakdown. God forbid the doctor wait a couple of minutes for the instrument that they haven’t used in years but is exactly what they want at this exact time. What? You didn’t look into the future and prepare for every eventuality.
G) Yes, Doctor. This is in reference to the expectation by some surgeons that the OR team is subservient to them and will put up with their nonsense. Instead of a team who is working together for the patient. I’ll use this when I think that the doctor is being irritating. Just imagine the sarcasm dripping. You get it. Sometimes they do not realize that it is an insult.
H. I Need. This is shouted out the door for someone else to get. This is only useful if there is anyone else there.
I) Can Somebody. This is similar to H but not exactly the same. The very first Dispatch I ever wrote was a screed on Somebody that points out that Somebody is sometimes just the person hollering for something. A long winded answer that says sometimes the only one you can depend on is you, because there is no one else.
J) Latex Free. By itself is not rage-inducing. However, when people hoard this knowledge and does not share until it is too late, the room has been set up with latex gloves and therefore must be broken down before the patient enters the room. And re-picked and re-set up. Oh, and the CRNA is coming down the hallway with the patient and the surgeon is pacing, ready to start. Yeah, been there a few times. Thankfully, the incidence of this is down due to the electronic health record flagging of allergies.
K) Sterile Conscience. Really the lack of it and lack of proper sterile technique. There is a reason that all the mothers and babies died in the 19th century when medical students used to go from autopsy to delivery without washing their hands. This was the beginning of the idea that there may be an infectious organism ready to ruin your day. This is a history lesson. Look up Semmelweis and learn why the hospital and especially the OR is so keen on handwashing.
L) It Hurts. Trust me, patient, we are aware that it hurts. This is why you are in the OR. But continually screaming that it hurts will not make us stop what we are doing, which is fixing what hurts. It only serves to distract us. And there is only so much medication that the CRNA can give to you.
M) Hey, nurse. Oh, my favorite. Some doctors don’t even learn our names, preferring to use the word nurse to describe everyone who comes in contact with them. Also what patients call everyone who is not a man involved in their care, even if they are the doctor. It is beyond some people’s awareness that some doctors are women.
N) Work Smarter. There is only one way to work in the operating room, sometimes smart has nothing to do with it. This is a productivity prompt. What they don’t tell you is that sometimes there is no way to increase productivity, not without doing some unsafe practices. Which isn’t smart.
O) Sacred Cows. I’ve written about this before. These are the things that continue to be done in a certain way, not because it is the best way, but that other ways have not been explored because we’ve always done it this way. It is a circular argument. And hard to convince others to explore other ways, because why break what works. But does it though?
The longer I work in nursing, the more the rage inducing 2 word phrases multiply.
Dispatches from the Evening Shift 