Should you get your own nurse to assist you in private practice?

Should you get your own nurse to assist you in private practice?

At the beginning

When I started private practice in 1994 I was young and keen on laparoscopic surgery. Laparoscopic Surgery in gynaecology was new at that time. After returning from training in Taiwan I had to implement this new form of surgery to the Gynaecology department of a private hospital. Unfortunately, all the operating theatre nurses working with me did not have any skill in assisting me to perform the surgeries. I not only had to train  myself to do these surgeries but also the nurses to assist me. The process would include preparation of instruments, cleaning and draping the patients , holding the camera during surgery with their left hand while holding an instrument in their right hand to assist me. We struggled during the process of learning. After some time, several nurses who were assigned to me on a regular basis could do these tasks well and performing laparoscopic surgery became more comfortable.

Later

As I pushed my skills to perform more complex laparoscopic surgeries, I became very anxious. My anxiety was not only caused by how I would perform the surgeries but also which nurse would  be assisting me during these difficult surgeries. My success or failure in completing the surgery laparoscopically was not only dependent on my skills, but also dependent on the skills of my assistant.  I was only assigned 2 skilled nurses to assist and if  both were absent,  my surgery would be a nightmare. I had to tell the operation theatre sister several weeks in advance about a forthcoming complex surgery to request for a particular trained nurse  to assist me during the surgery. But alas, sometimes even with such meticulous planning, an emergency would lead to the absence of the nurse and I would have had the stress of either performing the case with the assistance of an untrained nurse or postponing the case. The management was not concerned about my stress. I had to deal with it myself.

Nurses leave for greener pastures

To compound these matters, nurses often  leave for greener pastures. It takes several years to completely train a nurse to assist me but being trained, they  leave for Saudi Arabia or Singapore. Many of them ask me to write a letter of recommendation, which I gladly do for them. Then, I have start the process all over again.  I have to select an interested nurse who is willing to learn from me and then train her to be a good assistant.

I did this from 1994 to 2008 when I finally could not tolerate the pressure anymore.  I decided to employ my own nurse to assist me in all my surgeries. I was fortunate that one of the nurses whom I trained in the late 1990’s  came back to work in my hospital after working in Saudi Arabia. She accepted my offer and joined me as my personal nurse, working in my clinic as well as in the operating theatre. I chose her not only because she is a good assistant but has a very mild temperament as well. I sometimes become flustered during emergencies, performing difficult laparoscopic surgeries and her calm disposition is a great assistance during such times.

The pressure of who would be assisting me at surgery, was lifted. I had  a  good assistant  and  I could operate in peace. She would prepare everything I needed during my laparoscopic surgeries and my surgeries always ran smoothly after that.  Even in very difficult and demanding cases, I can work without added stress.

How the management reacted to this?

The management of the hospital was relieved that I managed a good assistant. They also did not have to pay for my assistant. This was a bonus staff for them. I am unsure as to whether they appreciated this situation.  As for my part, I was still  training other nurses to at least learn to assist me in simple cases but for difficult ones,  my personal nurse assisted me.

Lately, I have become lazy. I have stopped training other nurses. So now I am at a dilemma because when my personal nurse is on leave I cannot operate with other nurses. This is becoming a disadvantage.

I envy the top surgeons in the hospital – the cardiothoracic  and  the neurosurgeons. The hospital always gets a team for them to operate at any time of the day. The also get the biggest and best operating theatres in the hospital. We, pelvic surgeons are lower on the food chain perhaps and do not get such privileges. Laparoscopic surgeons are left to fend for themselves when performing laparoscopic surgery. This is a real bottle neck in most public and private hospitals, where surgeons are struggling to push laparoscopic surgery to greater heights . A dedicated specialist hospital should be the future for the development of such highly skilled procedures.

So what are the advantages and disadvantages of having your own personal nurse.

The advantages are:

1. A personal nurse will know how you do your work and will steer   everyone to ensure that you can do your work effortlessly.

2. You will have less stress when doing your job.

3. She can train and instruct other nurses on how you want them to work.

4. She can plan your operating time and liaise with the operation theatre on the time of surgery, equipment required for the surgery and so on.

5. I have even taught my nurse to do video editing of all my  laparoscopic surgeries. She edits the videos and shows them to the patients,  saving me a lot of time.

6. When travelling to other cities or countries to demonstrate laparoscopic surgeries, she and another operating theatre nurse will travel with me to prepare the operation theatre for surgery.

What are the disadvantages:

1. You have to pay her salary.

2. You can become dependent on her to assist you during surgery. This can be a problem when she is on leave

3. The hospital will abandon you because you have your own nurse so they are not obliged to give you a good nurse to assist you. They become too dependent on your nurse.

4. Some hospitals do consider a personal nurse one of their staff and ask for extra documentation for her credentials.

5. You must have a considerable volume of work to make taking your own nurse an economically viable option.

Conclusion

What advice can I give doctors leaving for private practice

1. Before joining,  make sure that the hospital you are joining is  committed to getting you good assistants to help you perform your job.

2. Continue training your staff so that they continue to improve and are able to assist you.

3. Consider your own personal assistant when you think you have enough volume of work to make the option economically viable for you. You will find that someone who knows how you work will  relieve you of so much stress at work

21/5/22

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Dr. Selva

Dr. Selva

Dr S. Selva (Sevellaraja Supermaniam) is a Consultant Obstetrician and Gynaecologist and a subspecialist in Reproductive Medicine at a private hospital in Melaka, Malaysia. He heads the O&G unit and the IVF Centre at the hospital.

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