Thursday, July 26, 2018

A Dubious Award for Bovie Smoke Control

There is a cornucopia of awards for modern day nurses. I've previously blogged about this trend which seems to have proliferated to the point of ridiculousness. An organization supposedly representing operating room nurses is now offering an award for an expensive system that attempts to contain the smoke liberated by the cauterization of human tissue. They  have "partnered" with a commercial entity that manufactures these devices. The coveted award is called "Go Clear," and there are gold, silver, and bronze permutations. I can visualize the winners standing on a podium resembling an OR table in their AORN approved bouffant head coverings looking more like chumps than champs.  Any nurse that had the unmitigated gall to seek personal enrichment by huckstering anything by enticing folks with awards would have been shown the door in a vintage hospital.

After a cursory review of the literature, I found there is little in the way of hard science to prove Bovie smoke is harmful and no published randomized trials. Sure it contains some nasty substances and most folks find it unpleasant but old OR nurses would laugh in the face of someone selling an expensive toy to "go clear." If Bovie smoke is one of the worse things you smell as a nurse you must be spending too much time sitting in an office and please, don't get me started on nurse office sitters.

OR nurses were so acclimated to Bovie smoke they could correctly identify the type of tissue being cauterized by the scent of cautery smoke and regarded this ability as a badge of honor. Remember that old TV game show, "Name That Tune"  where contestants said they could identify the song in 3 notes or less?  Vintage scrub nurses played a variation of that game by playing "Name That Tissue Smoke."  Pleura was the easy one for me and I could name that tissue in 1 whiff because of the characteristic sweet/sour smell released by the smoke plume.

There are cost effective ways to mitigate Bovie smoke that do not involve the unsavory element of money changing hands. We were conditioned to believe nurses were meant to be poor and efforts toward personal remuneration were sinful. My what a different world today where patients check in and check out of medical office  visits with all the dignity of a Wal Mart Trip. Nurses have more money today but something has been lost in the process. Proud, caring professionals have been rendered mercenary automatons by corporate healthcare.

One of the most efficient Bovie smoke minimization  strategies has presidential overtones and it's appropriately called  the Clinton strategy; don't inhale. Just wait until that perilous  plume dissipates to resume normal respiratory activity. Works every time and doesn't cost a cent.  If you don't inhale it can't hurt you or cause adverse political consequences. Bill was unto something.

Surgical masks are designed to implement a barrier that prevent endogenous operator  bacteria from reaching the surgical site. Masks function both ways and  are also effective filters to block inhalation of Bovie smoke. As proof  I offer the post operative sniff test which involves reversing the mask and thrusting your proboscis dead center into the mask after a long case. Guess what? It smells just like Bovie smoke that's in the mask and not your lungs.

Oldster nurses were frugal by nature and trained to use existing resources to the maximum. If  you are interested in saving your hospital big  money there is post on my blog that explains how to perform a sterile procedure with finger cots. Gloves are not cheap. There is suction available on surgical cases so if you don't care for Bovie smoke just suction away with what you have. Be prepared to be belittled because tolerance of Bovie smoke was an expected virtue and self serving actions like this were seen as a public declaration of your lack of commitment to patient care. Nurses were expected to put themselves in uncomfortable  and self endangering situations. It was all part of being a nurse. A hospital is not Disneyland!


  1. OFRN, you need to realize the younger generation is an award centric culture. It started with toilet training, "You get a nice silver star on the chart if you use the potty." This tradition has followed them into adulthood and there are awards for anything and everything. Times have changed!

  2. I was pretty much raised on negative reinforcement and probably received a whopping for toilet training mishaps. It left me with lots of unhealthy coping mechanisms and a twisted sense of humor.

  3. Me too OFRN - parents were strict back then! But I think Anonymous above has a point... did you ever play "pass the parcel" at birthday parties, where each child got to unwrap the present but the gift itself was underneath many layers of wrapping and only one lucky child got to get it? They tell me now that there has to be a gift under each layer of wrapping so none of the little darlings feels left out. I guess we had to learn to get used to missing out in life sometimes! I don't think it did us any harm...

    I remember in nursing we were told "If the Charge Sister says nothing to you, you are doing OK. Don't ever expect praise".

    Different times indeed! Sue.

  4. Nurses learned at an early stage in their training to accept and almost embrace adversity. You are right Sue, a banner day was not getting belittled or yelled at by senior nurses. When I worked in the OR it was a great day if I avoided one of Alice's painful corrections.

    There were certainly no awards and nurses were conditioned to maintain a very low profile. It was never about the nurse or awards-it was always about patient care. The all time best reward was an occasional thank-you note from a patient for a special difference you made in their life. I still have a couple of these saved in a special place and read them when I feel down. They are like a special ray of sunshine amidst so much of the nonsense present today.

  5. I have some cards from long-ago patients tucked inside books OFRN - sometimes I forget about them and then get a nice surprise when I find one and re-read it after years and remember the patient..

    I remembered to do that when I was a patient too. A bunch of flowers and a card for a nurse who had been especially caring because I knew how much it means. While recovering from some pretty hefty surgery years ago I hosted impromptu parties in my room with the night nurses. I thought I had better confess to the Charge Nurse when I was hobbling around the ward one day and said "I'm afraid I've been holding parties for the staff in my room at night". She was a wise old bird and looked up over the top of her glasses at me and replied in a severe voice "So I have heard" and then just went on writing, looking faintly amused.

    She knew how important it was for her nurses to have a bit of fun sometimes!

  6. OFRN and Sue,
    Consider this an extra special note of gratitude. Your recollections mean a lot to me. Sometimes when I read your posts at night, it’s like a real and intelligent and caring bedside nurse is holding my hand and telling me that I am compelled to see past the bullshit to do it all over again. I think being a nurse for nurses is rather special, even if you hung up your stethoscopes a long time ago.

  7. Thanks so much for the kind words, Kathy. In these pandemic times it's refreshing to hear your encouraging words. I have great admiration for nurses working today. You have it so much more difficult than I ever did!