Interoperative care is a highly specialized area. Patient care is methodical and almost ritualistic, which results in a unique culture in the operating room.

Certified Registered Nurse Anesthetists (CRNAs) are advanced-practice nurses who are certified in administering anesthesia. Depending on the state, they may practice without physician supervision. Due to a widespread physician shortage, advanced-practice nurses are taking a more prominent role in healthcare delivery-including the field of anesthesiology.

While healthcare continuously progresses and evolves, there are still remnants of "old-school" hierarchies that exist between physicians and nurses and yes, male and female providers. Some physicians have difficulty coming to grips with a nurse practicing at an advanced level and performing the same work as medical doctors. Additionally, tensions run high during a surgical procedure. Everything must be precise and organized to allow for the best patient care outcome. The strain of this considerable responsibility often brings the worst out in people- and a hierarchical environment doesn't help matters.

In healthcare, new practitioners sometimes must "prove themselves" to experienced staff to earn respect. This is true for new doctors, nurses, and APRNs. There are many anecdotes of nurses and APRNs verbally biting back when they are snapped at by a physician, and the hostility stops. However, it's not acceptable for any verbal abuse or harassment to occur in any setting, including the operating room. It doesn't matter if the culture is "old-school" or not. If discussing the issue directly with the surgeon doesn't end the behavior, it should be reported immediately to a supervisor or hospital administration.

It's important to realize this hierarchical culture does not exist everywhere. In fact, the increasing prevalence of advanced-practice nurses, including CRNAs, coupled with new physicians entering the workforce (who have likely worked closely with advanced-practice nurses during medical school and residency) has led to an increasing amount of respect in the workplace.