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By Stephen W. Earnhart, RN, CRNA, MA
CEO, Earnhart & Associates, Austin, TX
There is a little-known phase in our industry and operating arena called, “The Captain of the Ship Doctrine.” It is intimately important to understand because it can explain some quirks of our surgeons and perhaps improve your day-to-day dealings with them.
This doctrine came from the Supreme Court of Pennsylvania in 1949 when it ruled that: “... it can readily be understood that in the course of an operation in the operating room of a hospital, and until the surgeon leaves that room at the conclusion of the operation ... he is in the same complete charge of those who are present and assisting him as in the captain of a ship over all on board, and that such supreme control is indeed essential in view of the high degree of protection to which an anesthetized, unconscious patient is entitled ...”
Many older surgeons are strong believers in this doctrine and demand it be followed by every member in the operating room, whether they are aware of it or not. I know that from a legal standpoint, courts will uphold this doctrine. If something goes wrong in the OR, regardless of who is at fault, the surgeon is always the point person and culpable.
If you follow this doctrine, the surgeon is responsible for the temperature in the room. AORN standards cite 68-72 degrees, but the surgeon can override that for certain procedures if they so choose.
Many operating surgeons like music played in the room. Anesthesia often may not be crazy about the choice of music or the volume, but it is not their say. It is the captain’s choice.
Those are just two examples of many. You can probably list dozens more. Often, there can be clashes between certain regulations (state and federal) that override a surgeon’s preference, but short of that, the surgeon is the boss. My own experience with the issue is that there are some surgeons who will push this to the limit, but the vast majority know their bounds and stay reasonable, not letting it go to their head.
(Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Earnhart & Associates can be reached at 5114 Balcones Woods Drive, Suite 307-203, Austin, TX 78759. Phone: (512) 297-7575. Fax: (512) 233-2979. Email: firstname.lastname@example.org. Web: . Instagram: Earnhart.Associates.)
Financial Disclosure: Consulting Editor Mark Mayo, CASC, MS, reports he is a consultant for ASD Management. Nurse Planner Kay Ball, PhD, RN, CNOR, FAAN, reports she is a consultant for Ethicon USA and Mobile Instrument Service and Repair. Editor Jonathan Springston, Editor Jill Drachenberg, Author Melinda Young, Author Stephen W. Earnhart, RN, CRNA, MA, Physician Editor Steven A. Gunderson, DO, FACA, DABA, CASC, RN, CRNA, MA, Editorial Group Manager Leslie Coplin, and Accreditations Manager Amy M. Johnson, MSN, RN, CPN, report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.