E126 Lauren Kirwan on OR Nursing
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Lauren Kirwan 00:00
And it's honestly led to the most burnout I think I've ever seen in a hospital setting before. And then just on top of this, like you're saying, when nurses are burnt out and they're asking for that break to rejuvenate themselves, they're then denied vacation. And I'm starting to see that before people would really try their hardest to get their vacations covered, or just maybe reschedule things because they really didn't want to leave their team short staffed, and honestly now I'm seeing people kind of at their wit's end - like they just don't care and they'll just say, "I'd rather call in sick anyways."
Chad Ball 00:54
Welcome to the Cold Steel podcast hosted by Ameer Farooq and myself Chad Ball. We consider it an absolute privilege to bring you guests from around the world who are truly experts in their craft. Our mission is to offer you a combination of not only masterclasses on clinical surgery topics, but also insights into achieving personal growth, productivity and fulfillment as a surgeon and, perhaps more importantly, as a human.
Ameer Farooq 01:25
Lauren Kirwan is the fantastic Nurse Clinician for General Surgery at the Foothills Medical Center. She's currently finishing up her nurse practitioner degree. We've long wanted to pick Lauren's brain about her thoughts about what it means to be an OR [operating room] nurse and what she wishes surgeons would do to make the OR environment better. We'll also hear from Lauren and about the impact of COVID-19. on our nursing colleagues. We'd love to hear from our nurse listeners. What are some of the things that make your day - or alternatively make you mad - in the operating room? Email us at [email protected] with your thoughts and comments. Laura, it's a real pleasure to have you on the podcast. Dr. Ball and I obviously know you personally from working with you so much in the operating room. And it's really a pleasure and an honor to have you on the show. For those of our listeners who don't know you, can you please tell us a little bit about yourself, where you grew up and where you did your training?
Lauren Kirwan 02:24
Absolutely. Thanks for having me on. This is definitely a new experience, so I'm excited to do this with you guys. I was actually born in New Jersey - I know you can't tell; I have no accent, which is good. I then moved to Florida and Oregon and finally came up to Canada, where I did my high school, in [inaudible]. And then I came to Calgary to pursue nursing at that time. I went to Mount Royal University and I graduated in 2010. From there, I knew that I wanted to get into the operating room right away. It always really excited me [and] I had the opportunity to join the Foothills OR. And honestly, it's been an amazing 11 years there. I can't believe it's actually been that long. So, I have been there for 11 years and during that time I was on the general surgery team, and then shortly thereafter, I decided to take the nurse clinician job for general surgery and transplants. I did that for about five or six years, I believe. Recently, I've taken a bit of a different direction; I've just finished getting my Master's in nursing with the University of Calgary about a month ago and I'm about one week away from finishing my Nurse Practitioner Diploma. But I'm not moving too far away; I'm still going to be doing general surgery here in Calgary. So I'm super excited about that.
Ameer Farooq 04:24
I'll just say for our listeners, like I said at the top of the show, we've been extremely, extremely fortunate and lucky to work with you. Certainly I as a residential and Dr. Ball over the last many years in the operating room with you as a nurse clinician, and I'm looking forward to seeing what you'll do with the general surgery service here are in Calgary. So thank you again for all so, so many years of hard work. Lauren, it's one of these funny things - we work with nurses all the time, but I don't know that surgeons or physicians, in general, necessarily know how nursing works in terms of, do you rotate through every area in the hospital? And is that how got exposed to the operating room? How did you actually get interested, maybe more broadly in nursing, but then more specifically, how did you get interested in being in the OR? How is that structured into your nursing program?
Lauren Kirwan 05:22
So something interesting about the nursing program in general is that you actually get zero exposure to the operating room. I found this surprising because - I know it sounds silly - but when we're watching TV shows, a lot of what we see are actually shows that are based around being in the operating room. So from an outsider, you're like, "Oh, man, that looks really cool. I want to be able to do that." And then, "Okay, I'm going to nursing school, awesome." And then you never get to see the inside of an OR; you might get to do a follow-through case at some point during your nursing training, but otherwise, you don't actually really get any exposure, which I find to be really interesting. And I would say you certainly don't get any exposure to actually how to be an operating room nurse; you have to specifically decide that, "I want to do perioperative care." And then you take a whole other program after. So just to back up a little bit, what interested me [about] nursing is that I come from a family of nurses. My mom's a nurse, so I was, "Maybe I should be a nurse." And then I ended up going to college and I was like, "No, I'm not going to be a nurse. Definitely not." And I started at Mount Royal actually in Applied Justice. And I know ... you guys have worked with me ... that's the most ridiculous career choice I could have made. So, I ended up doing one class on the Criminal Code, and I was like, "Wow, this is definitely not for me." I immediately called my mom after, and I was like, "I think I'm going to go into nursing." And she's like, "Of course you are, and I knew you were going to." What really interested me about a career in nursing was that it really challenged me as a lifelong learner, and then all the different areas that you could work in as a nurse. I think that that really provided a lot of opportunities. So if you ever were to get tired of something, you could certainly switch focus, which I really valued. And also just being able to work with the people I think is really important.
Chad Ball 07:59
That's so true. There's so much variability and variety and heterogeneity in nursing jobs that they're almost like different occupations.
Lauren Kirwan 08:08
Absolutely. Anything from if you want to be in the ICU or if you'd like to go to the operating room, or if you even want to work on an inpatient floor - everything is so different. So that's really exciting. So I think that's what drew me to it initially.
Chad Ball 08:29
Yeah, it makes a lot of sense. I mean, it's sort of synonymous with medicine, right? There's very technical, physical jobs, and then there's very cerebral jobs and everything in between. I think all three of us, for sure, and most of our listeners would probably agree that the operating rooms are a very, very special place for a whole host of different reasons that, in general, are centred around the patient that we're all working on together. But there's also a ton going on and I don't just necessarily mean within the conduct of an operation on the surgical side and the scrub nurse side, but just in terms of all the activity and the setup and the teardown and the interactions and the teamwork, a lot of stuff. I think probably physicians in general are not overly great at situational environmental awareness on average; I don't know if you'd agree or disagree with that on the surgical side but it's sort of my sense when you compare physicians to other occupations outside of medicine. With that in mind, can you tell us what differentiates a really great surgeon-nurse interaction from your point of view - a really great day compared with a poor one? What do you look for and how do you frame it and what do you love?
Lauren Kirwan 09:46
Yeah, definitely. I would certainly agree with you. There are definitely certain surgeons and people in the operating room that have a bit more situational awareness. I won't name any names though. But I would say most importantly, honestly, it starts with just even how you start the day. I really think it's important to take the time when the surgeon comes into the room to greet everyone in the morning, old faces; I think that kind of really sets the tone for the day. Another thing is, honestly, trying to incorporate humour into the day is also very important. I think that our jobs can be just way too serious sometimes and people need to laugh, they need to have fun, they want to be at work. So even just something as simple as that, interacting with the staff in the room can really set the tone for the day. Another thing would be, as a surgeon, thinking ahead, what is needed? or taking the time to find the lead nurse in the room. Telling them what these items are that you're going to need, just trying to plan ahead. I think what makes for a really bad day is when nobody has the right equipment, we're asking for things last minute, it becomes disorganized, people become stressed. That's definitely something important to be able to do.
Chad Ball 11:41
It sounds, based on both of those domains, like common sense, but I would argue that probably it's not to a lot of surgeons, particularly, surgeons who are starting out or particularly trainees like. I back to [when] we had Melinda Davis on. As you and I have talked about on the podcast talking about anesthesia and surgeon interactions. And she told an anecdote about a surgeon she worked with all day who never said anything to her - didn't say hi, nothing. That sort of blows my mind that that's possible. Also, we're doing a technical job with a bunch of requirements and I would imagine that if that communication doesn't happen up front, in terms of, "I'm going to definitely need these three things and potentially these other five things, let's have them in the room, don't open them." That whole communication piece, I'd expect that that's particularly challenging now across the country, when the workforce - my perception is - is really, really a problem on the nursing side. You guys have gone from three nurses to two a lot of days, two and a half, maybe at best. It seems particularly more important in these stressful last couple of years to hit both of those things dead on.
Lauren Kirwan 12:59
Absolutely. That brings me to another point: trying your best to really be situationally aware, like, "Is the room short-staffed today? [Are] there a lot of learners in the room?" Just even asking, how you can help alleviate this? Something that has always been really nice is that sometimes we'll even take group breaks together when we are short-staffed, and I think that that's something that we might need to start looking at doing, because it's going to be the reality that we're short-staffed.
Chad Ball 13:35
When you say group breaks, you mean, for example, both nurses in a two-nurse room would take their break at the same time and just take a pause, basically.
Lauren Kirwan 13:45
Yeah, take a break with the whole room. I know that that may not be as efficient, but it would certainly be better for the whole room. And it could be a good option.
Chad Ball 14:01
I'm curious, from a nursing point of view, what are the actual mechanics, the nuts-and-bolts, the cookbook of what you're expecting from a learner and how should that learner interact with the nursing team in particular, as well as the room in general? I wouldn't, of course, say that I did it very well, probably early on either, but it is something, as the faculty surgeon, I try and pay real close attention to. You're maybe a hard person to talk to you about this because you do it so elegantly and Ameer and I have both benefited from your talent in that kind of transitional time, which occurs frequently. But what's your sense of the nursing cohort in general? What should these learners be doing specifically?
Lauren Kirwan 14:53
A lot of this can sound really simple at the time, but just making an effort to do some of these simple things is really important. We encounter a lot of different learners, all the time, entering the rooms every single day. It is really important to obviously introduce yourself to everybody when you are in the room, or when you come in in the morning. Even just writing your first and last name on the board with your credentials as well, this is helpful. Just writing your glove size on the board as well, would be really helpful. This is just a whiteboard that you'd find in the operating room. Another thing ... the learners can pick out their gloves, they can open them for the scrub nurse, but please try to avoid doing this while they're counting. I know they're trying to be so helpful, but the counting process in the mornings is really important, so it's a good idea to not interrupt that as much as you can. Also, just knowing - and this can be hard at first - knowing when to help and when not to help. You can ask the people in the room if you're not sure. For the most part, people are going to be really receptive to the fact that you want to help the team and you want to get the day going. What can you do to help, but also having that awareness, "Okay, maybe the airway is a little bit difficult, maybe I need to just move out of the way right now." Just trying your best ... look at the room, what's going on, take that in. I always tell people, "Just try to think ahead if you can." This can be really hard as a learner and I completely understand that, but even just something simple like, "Do we need to shave this patient before we prep them? Okay, great, so that can be my thing as the trainee; I'm gonna go get those things, get them ready for the nurses; they're busy doing other things." And just don't be afraid to get to know the [sterile core]. I think that's your best friend. It doesn't have to be the nurses that always go and grab stuff. So I think that's a really important skill as well. And then lastly, and I'm sure you guys would certainly agree with this, it's just showing that you're engaged in what is happening. There's nothing worse than a trainee that is on their phone, in the operating room, not really engaged in what's going on. It's a really interesting place to be and you can always find learning in anything. Even if surgery is not necessarily what you want to specialize in, I think it's still important to show that interest when you're in the room. I'm sure you guys would certainly agree with that.
Chad Ball 18:05
The other thing that comes to mind is the noise level within an operating room. That speaks to your comment about situational awareness. We had a podcast by an anesthesiologist. She was amazing. Her entire research program surrounds noise in the operating room. There's nothing more distracting than, you know, the patient's being intubated or you guys are counting the instruments, and someone who's not familiar with the operating room walks in and is talking about a patient they just saw in Emerge at a decibel level of 10 out of 10 - really with no awareness of what they walked into. And so that's the other thing I would add to your list is [that] it's really important to understand noise and not only tone but where we all fit into that.
Lauren Kirwan 18:59
I absolutely agree. That's really important. Even some of our learners, some of our scrub nurses ... there's a time to talk about your weekend and then there's a time where, definitely, now's not the time. That goes for honestly anybody in the operating room, for sure.
Ameer Farooq 19:21
Some of what we're talking about Lauren and Dr. Ball is culture and psychological safety. One of my favourite interrogations of this was Atul Gawande, who's a famous surgeon/scientist/writer in the US, obviously, is the person who put together this WHO [World Health Organization] Safe Surgical Checklist. There was some conflicting evidence about whether the checklist actually helped. One of his studies is he went down to South Carolina where they were implementing the checklist and he tried to interrogate what it was about the checklist that was helpful. Was it really so much that the checklist made sure that you didn't operate in the wrong limb, or was there something else going on? So one of his contentions was that in the way that they operationalize the checklist, the nurse was actually the one doing the checklist. And I know that's not actually the case everywhere. In fact, for example, Vancouver, that's not usually the case. But the way they implemented it, they actually would have the nurse being the one to do the checklist. All that I'm trying to get at is that in some way that allowed everyone in the room to be empowered to speak up and to talk about what was going on in the case. And ... one of the suggestions I've heard and that I really like is maybe at the beginning of the day, we should actually be having everyone going around and introducing themselves - from the surgeon, the medical student to obviously all the nurses the anaesthetists. I'm curious about your thoughts. Are there any specific things that we could do, as a team, to really specifically ensure that the nurses feel empowered to participate in the operation and to really provide the best care, and for the rest of the team as well? Are there any specific things that you think would be really helpful and important at the beginning of the day?
Lauren Kirwan 21:28
I know that the surgical checklist can definitely be done quite well in some services and not well in others. When it does work well, how I've seen it is people will have almost a pre-huddle, even before we were to do the briefing, for instance. And that would involve what you were talking about - just introducing everybody in the room - without the patient there, I think, would be a good thing for this pre-huddle, what is everyone's name, is this the learner, is this their first time scrubbing this? That kind of sets the tone for what we need to expect in the room, and patients. I think that the checklist, the formal part of the checklist, the briefing, timeout, and debriefing, I think it's nice if it's a joint effort. A lot of the time I know nursing feels obligated to do this checklist and quite often it's not a true pause, people are talking over nursing staff when they're trying to do the checklist. Taking that pause, listening to the nurse - also I think everybody in the room should be contributing to the checklist. It shouldn't just be the nurse necessarily doing it. It should be more of a conversation, as opposed to this procedural thing that we're supposed to do and that if we don't do this, we get in trouble. It'd be nicer for it to be more of an open communication, because at the end of the day we're all just trying to advocate and provide the best possible patient care for the individual.
Ameer Farooq 23:19
Absolutely. I really like what you're saying about getting out of this, in some ways, rote routine and really actually thinking about what is actually germane to this patient, and making sure that everybody feels empowered to provide their perspective as to how we can best take care of the patient. You know, Lauren, one of the things that has always astounded me, from watching student nurses who are in the OR, is the learning curve involved in actually becoming an OR scrub nurse. I'll post a picture of this - a link to this in the show notes. I took a picture actually of one of the student nurses - the diagram that she had drawn for herself and had actually taped to the wall as to how to set up all her instruments. And I realized it's actually kind of amazing - at least at St. Paul's in Vancouver and I think similar things are happening around the country - it's an amazing process for nurses to learn how to be a scrub nurse; you really kind of get thrown into the deep end and you just got to do it - in the OR with all these potentially frustrated, irritated, grumpy surgeons - and you just gotta go with it. I'm curious, Lauren, what does that process look like - to train to be a scrub nurse? How do you work yourself through that first initial learning phase where you have to learn not only the names of all the instruments, but when it's needed ... how does someone want it loaded? Tell me a little bit about that learning process.
Lauren Kirwan 25:03
Definitely. So just to preface that, I'll talk about the learning process in the operating room. I know this specifically for where I work, but I know a lot of other places are similar. In order to get into the operating room, you first have to complete a perioperative course. The perioperative course is a 10-week course and then it is four weeks of didactic learning, where you're learning about the theory of everything that happens in the OR, because as I had said, we don't really get that training in nursing school at all. So this is all extremely new information for us. After that four weeks, you get to actually go into the operating room. And what happens is you're buddied with a person for the last four weeks. So during that time, the first part of it ... they teach you to be a scrub nurse for the first two weeks, so that's kind of your focus. So you'll be buddy-scrubbed with another experienced nurse, just in case you're ever out of your depth somewhere, you at least have a backup person. And I always remember how I would prepare for that would be, "Okay, well, first off, what even is this surgery?" That includes going home, actually reading about the surgery. And then I would say like, clearly anatomy is a super important part of this job, just being familiar with the anatomy and what's actually going to be happening. And then also, we have these pick lists that are printed off and it basically holds the instruction manual for how the whole procedure is going to go. It will talk about surgeon preferences and certain parts of the procedure and how you can have yourself set up and ready to go. So it would include also taking those notes home and actually studying those notes. So that is a way to prepare for that role. And then once you start to become a better scrub nurse, then you transition into the circulating role and then you start to learn that [inaudible] bit. But definitely I would say all the learners, they start with the scrub role. And then the more experienced you are, you'll actually do a lot more circulating, I would say, which is actually quite the opposite of what people would think.
Chad Ball 28:05
I'm curious, can you take us into a room or a day where the differences in what's going on, what's needed and really maybe how the room can better support the scrub and the circulator nurse when they're counting when you have an instrument-heavy case - I don't know, I'm just throwing it out there - but like a spine case or a big-joint case versus maybe a lighter one, which maybe is an inguinal hernia setup? What are the things that we can all do to make those heavier days, the Whipple days for example, easier?
Lauren Kirwan 28:44
... A more instrument-heavy case compared to a lighter case, generally, the heavier case means you're going to have probably more experienced staff in the room. And something to recognize is if we don't have this available, it can be very stressful and tricky for the nursing staff in the room to be able to coordinate that. So just being patient with that process. A lot of the time, these larger cases, they require a lot more planning concerning the staffing experience, like who's going to be scrubbing, circulating, when are breaks going to happen. And a lot more thought goes into preparing for complications. Like I had said before, just really having that outline of, "Okay, these are the things I'm going to require." Or, even a lot of surgeons will actually put the stages of what they're going to be doing on the board. If it's a combined multiservice case that you're going to be doing, let's say Plastics is going to come in after and do a reconstruction of something, even just putting up the stages and what your plan is for when that's happening, even on the whiteboard, is a really great way to make sure that there's really clear communication, and to give people a bit of an idea of what the day is going to look like. It's super important. It's also important to remember these cases are a lot more complicated; they require a lot more time to set up for, so maybe an 8:15 [am] start is not going to be realistic. So like I said, just being patient about that process and not rushing the room is going to be really important. But that's not to say that ... I think the more complex the case is, the more fun it is honestly. That's kind of where I really thrive as the more experienced nurse, but it's still fun to be able to do both types.
Chad Ball 31:02
Exactly. Let's be clear to all of our listeners, you thrive no matter what the requirements of the case are. We know that for sure and we appreciate you for it. I want to go maybe to a little bit of a darker place here, just for a couple of minutes. I think we all have to work with colleagues and, in your case surgeons, who maybe have sort of poor behaviour in the operating room that challenges everyone around us. I'm curious ... I'm sure it's the same across all different areas in the operating room, whether that's anesthesia, surgery or nursing ... When you come in in the morning and you look and you see that name, and you're like, "Boy, this is gonna be a long day," how do you deal with some of that maybe negativity or intensity or sort of poor behaviour - as a nurse - that can come from a surgeon who may be like that, naturally, may be stressed in a given case, may have had a bad day, like everybody does? How do you how do you frame that?
Lauren Kirwan 32:15
I have a point of view that's like a nurse-clinician point of view, because I would often have to complete all the staffing for a lot of these rooms, and everyone knows the difficult people that are out there that we have to work with. Honestly, these rooms, because of the bad behaviour, will often have consistent sick calls, so people calling in to not come to work in these rooms. Something really important that we have to do is rotate staff through these rooms, because the intensity is quite high, or the behaviour is just ... It's okay; it shouldn't necessarily be okay, but it is something that has to happen. Essentially, we will rotate staff through that room or that surgeon particularly. It's important to potentially not staff the same people with people that behave like that, and that's just to address burnout. I know that may not be the best; it's kind of a Bandaid to a larger problem. Any of the staff that is a bit more higher needs that I've worked with, most of the time you can boil it down to it might be a stressful case. And something that I think is important is for everyone to be able to debrief after that case. That should ideally include the surgeon if they're open to that, or even just debriefing with the team after is a super important way to be able to handle some of these behaviours so that we can reflect on what's happened, "we shouldn't take this personally, this is not anything directed at us," and maybe have a couple laughs because, like I said before, sometimes humour is just the best way to deal with some of that. But like I said, it's definitely a bandage.
Chad Ball 34:40
Totally. It makes complete sense. It's interesting to take a step back and look at how high-intensity cases or subspecialties within surgery are staffed and treated a little bit differently in Canada than the US and, so if for example, you looked at transplantation service in the US, if you looked at an HPB service in the US, looked at a vascular service in the US, you as a staff surgeon have the exact same group of folks every single day. You have the same small group of anesthesiology; you have the same scrub nurse, you have the same circulator. It was interesting to train in that environment. It's always interesting to think about it, because it certainly would relieve a lot of the, I think, uncomfortable moments in some of these harder cases. Of course, what you're referring to is this Canadian system that we all work in and sort of spreading that pain out over more people. And I think that's the way that probably has to happen here, but it is interesting to think of those different models of operating room staffing across the board and surgical care delivery.
Lauren Kirwan 36:07
It'd be definitely a different approach to have the same team every day. But that might actually alleviate some of the issues, because a lot of people that are potentially more difficult to work with, it's like they have high standards, as everyone should, obviously, but a lot of the times it might be just frustration from continual learners and I understand [that] it's hard to repeat yourself over and over and over again when something's done wrong. But if you've got a consistent team, you know how to communicate together and everyone knows their role maybe a bit better.
Chad Ball 36:54
Yeah, I'm not sure if one is better than the other, it's just interesting to think about. In my personal training experience in the US, we actually had a number of very well-known surgeons whose scrub team / nursing team would follow them as they moved from city to city, job to job - like it was part of that recruitment. It was like, "I gotta bring a team." And it was all fascinating to watch. Really, those groups were like families, they were so close and they knew everything about each other's lives. It was a remarkable thing to be involved with for a short period of time and to watch from the outside. Another question that I want to ask you, and transitioning from that, really surrounding the idea of stress is, and maybe I'm wrong, but I think we all know, health care morale across the country and really across the world right now is probably at an all-time low, at least in our lifetimes and our working times. And I'm really worried about the OR nurses - that you and I know so well and that we work with every day - given COVID and family stresses and nursing shortages, and I realize that's been manifest across the country, honestly, in talking to colleagues, as I'm sure you have, in denials of vacation requests and cutting of part-time lines and all this mechanical stuff that I imagine only adds tremendously to the stress felt by our nursing colleagues, like yourself and your friends and other folks. I'm curious if you could let us know how nurses are doing these days and what's stressing them, and again, maybe to close the loop a little bit and ask how we can try and be helpful in any way that we can?
Lauren Kirwan 38:45
Yeah, that's definitely a hard question. At the start of the pandemic, I think the nurses were honestly all really bound together by this one common cause. And I think that that was really great to see. And it was probably almost the most support we, as a profession, have ever had was kind of during those early days. But like with any situation that comes with stress, you certainly can't sustain that forever. And it's honestly led to the most burnout I think I've ever seen in a hospital setting before. And then just on top of this, like you're saying, when nurses are burnt out and they're asking for that break to rejuvenate themselves, they're then denied vacation. And I'm starting to see that before people would really try their hardest to get their vacations covered, or just maybe reschedule things because they really didn't want to leave their team short staffed, and honestly now I'm seeing people kind of at their wit's end - like they just don't care and they'll just say, "I'd rather call in sick anyways." And part of me, I can't blame them for needing that break. I would say definitely this has been one of the lower points in my nursing career for sure ... now, how do you solve that problem? I mean, it's such a huge issue. But I think even just some simple things of obviously being aware that this is happening, we're short staffed, just asking the team how can you help in the morning, even if it's just something simple like maybe you can prep or maybe you can open - things that you haven't done prior can just really go a long way. Offering those little things to alleviate some of the stress in the OR is something that can be really helpful.
Chad Ball 41:10
That's probably dead on. To go back to what you said about situational awareness, it's the little things and you know [inaudible] together with me for a long time, one of the things that sort of drives me nuts in my head is when you have a room full of residents, learners, whatever descriptor you want, and you have a 300-pound patient. And they're all standing there watching two tiny nurses, like yourself, trying to move these patients. There's one example I think of how we should always be more helpful.
Ameer Farooq 41:43
Lauren is pretty strong, Dr. Ball. I wouldn't put it past her. [Everyone laughs]. But yeah, your point is so right.
Chad Ball 41:55
And the honest truth is, you can use that time to do more important things, like you were saying, count out, switch over the room, all the things that we are less helpful at.
Lauren Kirwan 42:07
Yeah, just those little things. And it also doesn't hurt to buy coffee every so often for people. It's such a nice gesture. And nobody will say no.
Ameer Farooq 42:25
You're so right, Lauren. And sort of along those lines, one of the things that's been on my mind, as I am about to start my practice, is the delicate and intimate relationship between surgeons and nurses and [inaudible] in that room it's a different little microcosm, as I think we've all been talking about throughout our conversation today. And it is not an easy thing necessarily to build up that trust and that relationship between surgeons and nurses. I think, especially as you're starting out, and I'm curious to hear your thoughts, my impression is that people are looking to see, how is this person? what are they like to work with? are they good? are they bad? are they easy to work with? are they hard to work with? What are some things that you think new surgeons, who are starting their practice, should be aware of, or are there any things that surgeons should do, maybe even before starting? I have thought maybe it would be good for me to actually sit down with the nurses beforehand and talk about the way that things go. What are some of your thoughts for new surgeons or advice to new surgeons?
Lauren Kirwan 43:47
I think that for new surgeons starting it's extremely important to seek out the nurse-clinician of the service. That might be a bias thing to say, but quite honestly, just even setting aside meeting time with the nurse-clinician, people that are controlling all the staffing and your pick list - even just starting there is a really good thing to do. And that's just so that, "Okay, well, what are your expectations? These procedures I'm going to be doing. Okay, great." Then we can make the lists, which are the recipe cards essentially, for everything you're going to need. Taking that time to really create that is a really great way to [inaudible] with the OR. The worst thing is, is when you're a new surgeon, you're trying to find your own way and then to not have the right equipment, [inaudibe] nothing that you want to be around, and then that creates stress, and it's just like a bit of a trickle effect. So I think that that's a place to start. Like I've said before, it's just building rapport with the nursing staff, being respectful, being patient. And then also just being really open to teaching people in the OR, teaching our learners, I think is so important, too. In order to create a really good team and a good scrub nurse and circulating nurse, if you're willing to teach and share knowledge, I think that that's also going to go a long way.
Ameer Farooq 45:48
It's such an astute point that we don't sometimes take the time. Someone has been operating with us and doing all these cases with us for hours and hours and we never stop or even pause and say, "Hey, by the way, this is what this cancer feels like, or this is this is the ureter this like this thing that we've been obsessing about for last 30 minutes, this is what it is, this is what it looks like." So again, I'm pretty close to my residency years and training years, and we've talked about this a little bit, what are some things that you think are easy things that residents and medical students can do to help the day go along? I think we've talked about what to do in Dr. Ball's room: help transport the patient, for sure. But are there any simple, easy things that residents and medical students can do to help the day go along and to help the nurses and to get the cases ready to go?
Lauren Kirwan 46:52
So I've said a bit of this before, but maybe I'll go into just a few of the things that scrub nurses or OR nurses really dislike [laughs]. Something that could really benefit trainees or medical students or residents is don't be afraid to have a conversation with the OR nurses. Get to know them. Tell them your name, etc. And also I think it's really important, and I don't see this as often anymore, but it does still exist, is don't disrespect the knowledge that the nursing staff might have. Ask us tips, like, "I'm working with this surgeon today, are there any things ... do they just hate this? what do they like?" A lot of the OR nurses are very happy to be able to share that sort of information with you. And quite honestly, that's going to make you look a lot better in front of your attending. If you're prepping right or if they're using this specific scissors to cut something ... just really lean on your OR staff to help make you better, quite honestly. And then, as you said, don't leave as soon as the incision is closed, there are still a lot of things that you can do, just help cleaning up the patient, transferring them and then just waiting to make sure that patient is extubated safely is also a really important thing. I understand a lot of the time, the attendings and some of the senior residents may need to go and do rounding, but at least just having somebody around as an extra hand in case something like that goes wrong. Most of all, just asking how you can help, I think it's really important. And we've kind of talked about that already, but just offering a helping hand I think is probably the most important thing that you try to do. Be open to teaching you how to do things like prep, etc. So, just reaching out asking, "Oh, can I help prep, but do you mind just watching me this first time just to make sure I'm doing it okay?" "Okay, great."
Ameer Farooq 49:28
That's fantastic, Lauren. I really wish I had your advice when I started; it would have been awesome to be able to go to someone like you and say, "Hey, how does so-and-so do their anastomosis or how does so-and-so do XYZ? are there any things that I should watch out for like that?" That is some golden advice right there that you've just given our listeners. So thank you for that. Are there any other things that we haven't talked about that nurses are keenly aware of when they're in the OR, but that you think that most surgeons just aren't aware of or don't pay attention to? For example, the comment you made about the fact that you actually rotate out people with bad surgeons or people that are hard to work with - something I definitely wasn't aware of. Are there other things that you wish surgeons knew that all nurses know?
Lauren Kirwan 50:34
Yeah. I've got a couple points, I think. Something that's really important that maybe, as a surgeon, you may not think about all the time, it's just that the case booking is actually so important. When a case is booked incorrectly, we don't get the right instruments and that can cause a lot of headaches. So really keeping that in mind ... even if it's a clinical clerk going to book a case, really make sure that you're very clear about what is being booked exactly, will really help alleviate a lot of issues in the OR. Also, I think something really interesting is, as a surgeon, getting to know what is in your instrument sets. Because a lot of the time you guys will ask for a specific instrument, and you're, "Oh, I'd like this Scanlan." "Okay, great." But it would be really good to be more familiar with - like learning - okay well, what is the actual set that the Scanlan is in - because a lot of the times, the set is not even called that. So just really starting to familiarize yourself with that, and that's going to definitely benefit the whole team, especially when you've got learners because it takes years to learn about the hundreds of OR sets that we have. So if you can even get to know the sets that you use very regularly, that's a great a great starting point, for sure.
Chad Ball 52:16
You know, we usually ask a last closing question to all of our guests and we'd love to ask you as well and that's really quite simple on the surface, but if you were to go back and chat with your younger self, maybe when you were just starting your nursing career or at some point early on, what advice would you give yourself in retrospect?
Lauren Kirwan 52:38
Definitely be patient with yourself. Mastery, it takes time and experience and learning is going to feel uncomfortable, but that's certainly okay. And then lastly, just always ask why and stay curious. I think that that's the best way to continue learning and continue growing as a nurse or whatever profession that you're in.
Ameer Farooq 53:17
You've been listening to Cold Steel, the official podcast of the Canadian Journal of Surgery. If you like what you've heard, please leave us a review on iTunes. We'd love to hear your thoughts, comments and feedback. So send us an email at [email protected] or tweet at us @CanJSurg. Thanks.