Working to change physician's image of OR nurses' role "Where are all the nurses going?" many are asking today. With the National Commission on Nursing public hearings behind us, we are anticipating the summary of findings in Sep- tember. Funded by the American Hospital As- sociation, the hearings were held around the country this spring. One common thread in all the hearings was job dissatisfaction.

Nurse-physician relationships were one of the reasons mentioned for job dissatisfaction. I don't have any pat answers to this problem. I'm just as frustrated as you and have discovered myself joining in when nurses discuss physi- cian "put-downs." We find ourselves criticizing the traditional -handmaiden' attitudes still prevalent in physicians image ot nursing to- day. It's easy to blame physicians for their lack of understanding of what we provide in health care and their lack of respect for us. We need to change the image some physicians have of nurses. And we need to recognize that many physicians have a high regard for nurses and demonstrate it daily.

I'm not certain of the ideal approach to the problem of some physicians' attitudes and be- havior. I've wondered if we should start with a straightforward analysis of why we as nurses project the image we do. We have come a long way from the day when nurses were all things to all people-doing housekeeping and dietary chores and acting as the "go-fer" for all ancil- lary services. especially after hours. But some physicians still view us as servants to fetch whatever they need. Why IS that? Could it be

a President's message

because we haven't made known our need for support services to do those tasks? What can we do to remedy the problem? It's our problem too, you know, not just theirs!

Let's take a hard look at our behavior, at- titude, and professionalism. Do we really be- lieve we're professionals? What image are we projecting? How does it sound to others when we speak in opposition to upgrading educa- tional requirements for entry into nursing prac- tice? Do we take opportunities to inform sur- geons about our perioperative nursing prac- tice, so they won't view us as technical work- ers? A strong self-image is important if we expect others to have a good image of us.

I have discovered that surgeons know what the scrub nurse does, but some of them don't know the depth and breadth of the circulator's responsibilities. They think of it as a "go-fer" role instead of as a patient advocate and coor- dinator of all intraoperative patient care activities. If they don't understand the role, how can they know what knowledge and skills a circulating nurse must possess? How many surgeons know what preoperative as- sessments, nursing care plans, preoperative teaching, evaluations, and nursing audits are all about?

Stop and think about these questions. Sur- geons are totally involved in performing the operative procedure. How can they acquire an understanding of how important perioperative nursing is to the quality and continuity of pa- tient care? Do we expect them to assimilate that information by osmosis? They may de- velop a different attitude about the registered nurse in the operating room if they have some facts about what she does, what knowledge and skills she possesses, and how she uses that knowledge and skill to assess, plan, and

AORN Journal , September 1981. Val 34. No 3 367

implement intraoperative nursing care. They might change their image of nurses as subser- vient assistants to an image of nurses as col- leagues.

With the change of image could come a growing respect. We negd to respect one another. If nurses remain silent or lash out disrespectfully to surgeons instead of asser- tively protesting verbal abuse, surgeons' un- desirable behavior will be reinforced. Their negative image of nurses will be reinforced, and the nurse-physician relationship will not improve. We must learn to speak out with hon- esty, diplomacy, and facts. It's up to each of us to make certain that we are acknowledged with respect.

I've noted that in emergencies, nurses and physicians cooperate and collaborate to save a life. Sometimes that is the only time a nurse's efforts are acknowledged by physicians. Wouldn't it be a good goal to promote daily cooperation and collaboration between nurses and physicians? I believe we will achieve that goal some day if we shed the negative "lt-will- never-happen'' attitude.

Nursing care documentation that is factual, understandable, and meaningful to physicians and nurses will help us gain respect. Also take opportunities to discuss issues not only with individual physicians but also in medical staff committees. Do your homework and bring suggestions for improvement of patient care or bring information regarding patient care proj- ects that your staff is involved in. Include sur- geons in discussions of procedural or product changes before such changes are thrust upon them. Let them hear the rationale for proposed changes. If you're not yet on medical staff committees, keep trying.

I haven't heard of many hospitals establish- ing active physician-nurse committees to re- solve problems between the two groups. But recently I read an article that inspired me, be- cause I've been saying that there should be these kinds of committees ("Meetings can im- prove nurse-physician relationships," Super- visor Nurse, January 1981, 24-26). It was en- couraging to read of one that has been effec- tive.

At the department level, physicians and nurses should serve on joint committees. Staff nurses should be included, not just supervi- sory nurses. Many of us are inundated with

meetings, but many problems can be resolved by allowing every party to discuss problems objectively. Nothing gets solved without two- way communication. Mutual trust must be es- tablished if friction between two groups is to be relieved. This takes time but is worth the effort.

If nurses and physicians are to achieve their individual goals of improving patient care and assisting the patient toward wellness, both groups must learn to communicate, respect each other's knowledge and skills, listen to each other, and work together collaboratively.

Nancy L Mehaffy, RN President

Student nurses back AORN position on regs Delegates at the 29th annual convention of the National Student Nurses' Association (NSNA) adopted a resolution opposing the Health Care Financing Administration's proposed regulation change that would permit personnel other than RNs to circulate in the OR.

The resolution, which was presented by the Student Nurse Association of California, called for NSNA to stand in opposition to the proposed change and to disseminate its position on the issue to major nursing organizations, health care agencies, and federal offices. NSNA has shown its concern for OR nursing in the past by supporting the inclusion of OR experience in nursing curriculum.

The convention, which took place April 29 to May 3 in Cleveland, included NSNA business meetings, elections, clinical focus sessions, and exhibits from more than 360 companies and institutions.

Elected president for 1981 -1 982 was Margaret Ann Chop, a senior at Brackenridge Hospital School of Nursing, Austin, Tex. She will be attending Texas Women's University, Denton, in the fall.

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