When I started my case study research in the hospital, somewhere in the back of my mind there was this thought: I have been working in hospitals for over 10 years, so what more will I learn from this? Of course I did not really believe the answer to be ‘little’ – otherwise I would not have even started the research – but in hindsight I must admit it was a bit confronting when I realized that some things, I discovered in my research I had not known or seen before.
One of those things was the role of both the Anesthesiologist and the Nurse Anesthesist. First of all, about the name. When my paper – currently under review – was proofread, I had a discussion about the word Anesthetist and Anesthesiologist. In Dutch we say ‘Anesthesist’ or ‘Anesthesiologist’ for the medical specialist who is responsible for the administering of anesthesia to patients. In English the ‘Anesthetist’ can be either a doctor or nurse who has been trained to administer anesthetics. In Dutch we call a nurse who assists the ‘anesthesist’ an ‘anesthesie medewerker’ (which translates into something like ‘anesthesiology co-worker’). I decided to call this assistant to the Anesthesiologist the Nurse Anesthetist.
Although it is interesting that apparently the name and role of people involved in Anesthesiology is different in different countries or languages, the real eye opener was that both the Anesthesiologist and Nurse Anesthetist play an important role in the logistics of surgery in a hospital. The Nurse Anesthetist has the highest centrality in the entire network (see previous blog on nurses). He or she – there are also a lot of men who are Nurse Anesthetist, as opposed to other types of nurses who mostly seem to be women – decides at what moment the patient is called to the holding and later accompanies the patient from holding to recovery. The Nurse Anesthetist overlooks the process from ward to OR and presents himself to the patient as his or her ‘guardian angel’ (OK, this is what I call it, because it sounded very comforting when in the holding they say something like: ‘hi, my name is Peter and from now on I will be with you the whole time’). Further, the Nurse Anesthetist represents the Anesthesiologist in the Operating Room (OR), when the Anesthesiologist is not there. In short, the Nurse Anesthetist overlooks the process of the patient, accross the walls of the Operation Room (Theatre).
With regard to the Anesthesiologist, he or she plays an important role in making sure that the day program of the Operating Theatre (OT) runs smoothly. Even though this is the prime responsibility of the day program coordinator, the program coordinator consults the Anesthesiologist to discuss last minute changes to the program and asks them on occasion to first consult these changes with the surgeons, before he does. The Anesthesiologist has an interest in a smoothly running OT program, because he works in two operating rooms at the same time. Any unexpected delays or lateness in one OR have an impact on the other OR that he is working in. This is inconvenient and not in his best interest. In addition to his own interest, the Anesthesiologist is more qualified to discuss medical matters with surgeons than coordinators, who are not medically trained.
So, Anesthesiologists and Nurse Anesthetists tend to look at the whole OT system on a day, rather than just focusing on administering anesthesia for one patient in the OR. This perhaps makes the Anesthesiologist a hidden logistics power in the hospital system for surgery or patients.
In response to this blog I was happy to receive feedback from Anesthesiologist Marcel de Korte of Maastricht UMC+ in the Netherlands, stating that the system of Anesthesiologists working in two parallel OR’s is a typically Dutch way of working. However, often, in other countries it is the Nurse Anesthetist who switches between OR’s and the Anesthesiologist who stays in one OR. He adds that nevertheless, according to his view, Anesthesiology plays an important role in OR logistics.