January 27, 2017
This fearless columnist had the confidential and deep conversations you wish you had with your staff, so please open your mind and listen up.
After polling technicians, we share their top 10 suggestions, plus a few bonus ones [see sidebar]. What follows is what I call “How to keep your surgery and anesthesia nurses happy during the new year and beyond.”
Sure, doctors are very important people with multiple things to do: Messages to return, blood work to review, emails to reply to, sandwiches to inhale, facts to check and stories to look up in the last issue of Veterinary Practice News.
Unfortunately, the time to accomplish these critical tasks is not while your patient is under anesthesia and clipped, scrubbed and getting cold.
Stay focused on your surgery patients. Get into the OR. Delaying the beginning of surgery is disrespectful to your tech, costlier for the client and less than ideal for the patient.
Doctors should trust that their techs are capable of monitoring patients. If they are not able to do it, then train them and empower them until you trust them.
Help them to become confident and comfortable with anesthesia, and teach them when to be concerned and when to bring abnormalities to your attention.
Monitoring equipment is both a wonderful help and a terrible nuisance. Sometimes it works great and at other times it doesn’t seem to work at all.
Thankfully, a good nurse doesn’t rely solely on machines. A nurse uses multiple senses to assess the patient’s color, pulse, eye position, jaw tone, breathing and so much more.
When the monitor suddenly shows no heartbeat, it may simply mean that an ECG lead fell off. And when the beeping suddenly stops, it may only be because the probe fell off the tongue or the tongue has dried. Don’t freak out; give your tech a minute to wet the tongue or reposition the lead.
Technicians should be allowed to do tech stuff. This includes placing an IV catheter, starting IV fluids, calculating CRIs, setting up the OR, pre-medicating patients, taking X-rays, inducing, intubating, clipping, etc. Yet we’ve seen doctors do every single one of these tasks.
If you don’t think your nurses can accomplish these everyday duties, train them. In turn, this will free you up to do “doctor stuff”—glamorous things like writing up medical records, reviewing the latest treatment options and talking to clients.
Getting into the OR when you are called is great. But hovering and looking impatient tend to make nurses either nervous or frustrated.
Don’t hang out in the prep room. Don’t breathe down your tech’s neck. Don’t start clipping a patient (unless they ask for your help) as a passive-aggressive way to make them feel inadequate.
Nurses need to do multiple things beyond “knocking down a patient,” such as monitoring vitals, recording everything and logging controlled drugs.
Instead, get your gown and gloves and cap and mask and instruments and sutures ready.
If your faithful technician has already gathered everything for you, you can go do more of the glamorous doctor stuff.
The anesthesia nurse is expected to focus on the patient, and so are you!
Limit the distractions that do not pertain to the surgery hand. Forbid your receptionist and other techs to questions while you’re in the OR.
Anything that is not life-threatening can wait. Staff members should write notes and messages that you can deal with later.
Don’t be distracted by your cell phone.
Chatting about “Dancing With the Stars” during surgery is OK, but only if you are able to keep focusing on surgery.
It is fairly easy for techs to know what one or two doctors prefer. But with multiple doctors, catering to each doctor’s peculiarities quickly becomes unreasonable.
One doctor wants the Mayo stand on the right, while the other likes the trash can on the left. One doctor likes all his patients premedicated with hydromorphone, while the other thinks “hydro” is the devil and demands using morphine.
This leads to at least three issues:
Even though we all would like our bright and unique personality to shine, standardization is a smart way to gain efficiency and reduce mistakes.
Nurses like to be ready for their doctor. Shockingly, most are not mind readers.
If you are about to perform an unusual procedure or you need a specific instrument, letting them know ahead of time would be helpful so that everything can be ready. That elusive instrument may be hidden somewhere, or not even be sterile.
This small courtesy will reduce time wasted and frustration on everybody’s part.
Blood, instruments and fluids occasionally fall on the floor. It’s understandable. But throwing needles, bloody gauze and body parts on the floor intentionally for the tech to pick up is degrading.
Trash belongs in the trash can. Body parts such as testicles, uteruses and tumors can go in a special container placed in the OR ahead of time.
Oh, and collecting and removing your own sharps from your surgery table would be a nice gesture, too—a sign that you truly care.
Use chemical sedation when necessary. Thinking that sedation takes too long is a common mistake. Fighting with an aggressive pet can be much more time-consuming, not to mention stressful and possibly dangerous.
Embrace the Fear Free concept. Don’t hesitate to sedate.
In a busy, intense practice, pressure can rise and a bout of anger or impatience may occasionally happen. Occasionally.
However, being consistently rude, pushy or degrading should never be acceptable. We’ve all heard of doctors throwing instruments around the OR or even at nurses. Patience, respect and appreciation will go much further with your techs!
Again, these are 10 common comments we have heard from technicians working in a variety of hospitals: small and large, low-key and state-of-the-art, day practices and emergency or referral facilities.
We hope you embrace these ideas during this new year.
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Learn about anesthesia tips and tricks, open wounds, Fear Free concepts, rehab, CPR and more.
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Veterinary technicians are the want to heed these ideas:
Dr. Phil Zeltzman’s traveling practice takes him all over eastern Pennsylvania and western New Jersey. You may visit his website at www.DrPhilZeltzman.com and follow him at www.facebook.com/DrZeltz man. Columnists’ opinions do not necessarily reflect those of Veterinary Practice News.
Kelly Serfas, a certified veterinary technician in Bethlehem, Pa., contributed to this article.
Originally published in the January 2017 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today!
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