The Difficult Surgeon: What Scrub Scout Nurses Tell Us in Reference Calls

Oct 25

3 min read

Scrub scout and anaesthetic nurses in theatres across Australia and New Zealand: almost every one of you has a story about a difficult surgeon.

Kate and Paul at Carejobz have never scrubbed. What we have done is sit through several hundred reference conversations and candidate interviews, and this comes up in almost all of them.

So this is not clinical advice. It is a pattern we have noticed in how nurses describe handling it, and in what Nurse Unit Managers say about the ones who handle it well.

What the nurses who manage it well tend to describe

Almost none of them talk about confrontation. They talk about pre-empting it.

The recurring theme is that a difficult surgeon is usually reacting to a break in flow rather than to a person, and that staying ahead of the case removes most of the friction before it becomes anything. Knowing the individual surgeon's pace comes up constantly, more often than any technical skill.

When it does escalate, the consistent description is of doing less rather than more. Staying still. Answering briefly. Not explaining or defending mid-case. Several have said some version of the same thing: the calmer you stay, the faster they come down.

What NUMs tell us they are actually screening for

Two failure modes, and they are opposite ones.

The nurse who folds, who agrees to something they should not agree to because a surgeon pushed. And the nurse who escalates, who meets aggression with aggression and breaks the working relationship for everyone else in the room.

What they want is the one who holds the clinical line without making it personal. That is a narrow target, and it is why this question gets asked in almost every senior interview.

When it happens to you

Everything above is technique. This part is about afterwards, and it is the part we hear most often.

If you have ever been on the receiving end of it, you will recognise the silence that follows. Nobody says anything. The anaesthetist does not, the scout does not, and the list simply keeps moving. That silence is usually what stays with you, more than whatever was actually said.

It is not agreement. It is relief that it was not them. Most people in that room have had their turn.

Two things are worth knowing. It happening to you says nothing about your competence, and almost every nurse who has spent long enough in theatre has a version of this story. And experienced nurses do not absorb it better than you do. They handle it differently.

That means writing down what happened while it is fresh, telling someone you trust rather than driving home with it, and using the incident process where the behaviour warrants it. Not because you are making a complaint, but because a pattern that is never recorded is a pattern the hospital never has to address.

The nurses who last in theatre are not the ones who learned to take it. They are the ones who stopped carrying it home.

One thing worth checking before you accept a role

Ask what the surgeon relationships are actually like on that list. Not whether they are good, because nobody says no.

Ask how long the current scrub team has been working with them, and what the turnover has been.

The answer to that second question tells you more than anything in the job ad.

Over to you

Coffee Break with Kate is where theatre nurses tell us how it really is. How does your team handle the hard moments on a list, in the room and afterwards? Tell us on LinkedIn, and we will keep the conversation going.

You can also browse current theatre nursing jobs in Australia to see what hospitals are asking for right now.