Dear Paula,
Is there no hope for polite behavior in surgery? A recent incident in our OR concerning the use of four-letter words (one of them in particular) went beyond the reasonable ways of resolving conflicts and has me wondering where we draw the line on surgeon-staff interactions.

What happened was: The doc was listening to his usual annoying music during a marathon day of cases. Several of the songs on his playlist repeated the four-letter word. The circulating nurse, who was offended by this, counted each time the word was used, then she actually wrote the surgeon up on an incident-and-accident form for discipline!

I'm no fan of the songs or their foul language, but do you think she went too far? The doc has been doing cases in this OR for a number of years, and no one has ever complained about his choice of music before.

— Rocked and Shocked

Dear Rocked,
I agree with the circulator that some music is distasteful. It makes my ears ring and leaves a metallic taste in my mouth, and it hardly seems like creative expression. But then, when I was growing up, my parents didn't see "She loves you, yeah, yeah, yeah," as poetry, either.

This four-letter word is certainly more offensive than others, such as "prep," "stat" or "code," but since it wasn't directed at her, much less uttered by the surgeon, the discipline form doesn't seem warranted. Perhaps asking to choose different music (with a beat the doc can still dance to) would have been a better solution.

My real concern here is, how did the circulator have the time or attention to count the number of four-letter words? When I'm circulating, I'm so busy I can't follow anything that isn't a surgeon's request or a patient's monitor. If it's not patient-care related, iTune it all out.

Dear Paula,
One day a stranger with a clipboard shows up in the OR where I'm circulating. She's there to audit my performance. I asked the young lady how long she'd worked surgery. Never, she said. She'd been an oncology nurse for a year and before that was getting her master's. How can a new graduate with no OR experience audit a field she knows nothing about? It's like when the nurses who write the standards we have to follow haven't worked in an OR since the '90s. It makes me wonder, who's in charge here?

— Watching the Watchers

Dear Watching,
Back when I was an OR educator, another nurse snapped that those who can't handle surgical nursing anymore get a sit-down job or teach. At the time I was insulted, but now I see his point. There's a certain attitude among OR nurses when the clipboards come out and they're not carried by people we're working with in the trenches.

Not to mention the moving target of standards. We complain. We want to change things. We want those who keep making questionably beneficial "improvements" to just leave well enough alone. The things we can't control drive us nuts, no matter where you work. But, to answer your question, you're in charge here. In charge of how you feel about OR nursing (which you're clearly committed to) and in charge of the care you give your patients (which you have to be). Do your job to the best of your ability and don't worry too much about the judges' qualifications. Their standards and changes are in our patients' best interests. And sometimes, if you watch long enough, they even come full circle, changing back when we learn there was nothing wrong with our practices to begin with.