The Great Suture Tray Debate

Many years ago, when I was but a mere slip of a nurse, fresh out of school, shiny and eager to help, my first job was in an emergency department at a hospital some distance outside of Toronto. This hospital was exceedingly old-fashioned and its relations between physicians and nurses were authoritarian and gender-specific. This is to say, the doctors saw themselves as gods on earth, and saw the nurses as some combination of submissive housewives, brainless handmaids, menial drudges and/or doormats, a view, a bit surprisingly, endorsed by most of the nurses themselves. A nurse who thought for herself, in their view, was suspect, and one who questioned a physician, was definitely heretical.

One of the nursing duties at this emergency was to prepare the suture trays for the physician to treat a patient with a laceration. I would unwrap the tray, place it on the Mayo table, then add into various cups Betadine, chlorhexadine, and saline, then drop in needles, syringes, the sutures themselves (having ascertained from the physician the type and size required), then careful to maintain the sterile field, loosely rewrap the whole kit. A pair of sterile gloves — we were expected to memorize the glove sizes of each physician —  and a selection of local anaesthetic, lidocaine 1 and 2%, with and without epinephrine, would complete the set-up.

One busy day a physician, who was so superior that he refused to remember the names of the nurses, and would cringe if addressed by his first name, stormed out of the suture room. He was terribly angry, but then he spent most of his life in a state of terminal irritation, so it was hard to tell the difference.

What’s wrong, Dr. Connard? we asked.

“The suture tray isn’t set up!” he shouted. “How can I function if you nurses aren’t doing your jobs? Please, please set up a tray. Otherwise it’s a huge waste of time for me.” And with that he slammed the chart in the nurses’ desk and clumped off.

The suture tray was missing a syringe, easily accesible by opening a drawer at his elbow.

His behaviour, needless to say, was a revelation, a clarifying moment. Up to that point I had accepted the conventional view of nurse-physician relations, where physicians made demands and nurses meekly obeyed. But clearly Dr. Connard believed some things were too trivial or menial for a physician to do and therefore belonged to the sphere of nursing, that nurses, and indeed hospitals in general existed for the convenience of physicians, that his time was somehow more valuable than the nurses, that physicians were our superiors, that we needed to be taught a “lesson” by behaving badly — a whole raft of antiquated attitudes, in fact, contained in that suture tray. And so the suture tray, for me, became a symbolic of nurses assuming their rightful place at the centre of patient care, collaborative rather than submissive.

I swore then-and-there I would never again set-up a suture tray for a physician, and thus far, I never have.

But the other day, Dr. Contentious, God love him, told me he wished nurses still set up the trays arguing, essentially, that his time was better spent actually suturing patients than hunting around for supplies, and if he can work efficiently, then patients will move efficiently through the department. Probably because I like the guy, and he was presenting the argument reasonably,* I was willing to give the idea a second thought.

He’s right that searching out supplies is a waste of time and much could be done in our suture room to make supplies far more accessible — and that’s something as charge nurse I can work on. But I am still not convinced. The suture tray, in the first place, is supposed to be sterile — and I can’t guarantee the sterility of an open tray once I turn my back on it. I’ve caught patients poking their dirty fingers around inside. after all. And again, there are some interesting notions of whose time is more valuable, mine or the physician’s. In other words, if I am spending the five minutes, setting up the tray, it’s five minutes I’m not doing nursey things, which presumably would also hinder patient flow.

In short, it’s a draw. but I’ll make Dr Contentious a deal: I’ll drop the chip from my shoulder (or at least move it a little) and set up trays if I’m not busy, as long as he acknowledges that effective use of my time — and setting up trays is not in that category — is also essential for good patient flow.

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*An incidental object lesson for asshat physician: treat me respectfully, and you’ll get the same in return.