ideas-ambulatory surgery set up

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    Hello, I currently work in an ambulatory surgery center and am wondering how other facilities are set up to facilitate patient flow. Currently, we have a set up with the second recovery area being used for admissions and discharges on day of surgery. Once a patient is admitted, we move on to the next patient assignment whether pre or post op. In the meantime, the physician may arrive with his paperwork including orders. Because we are busy, we may not get back to the chart to take off the orders which is now causing some distress for the OR nurses. They come out to get the patient and feel as though it is our responsibility to stop what we are doing and hang an antibiotic, give heparin, etc. while they are waiting. Unfortunatley, this is adding to that sense of OR vs PACU mentality. Can anyone give me any ideas of how your unit is set up- do you have nurses specifically for admissions, if so what do they do with their down time? Is it the expectation that the OR nurse pick up where the PACU nurse/admission nurse left off? Many of us feel that because we are all RNs that it should be a continuous flow with each nurse picking up where the last one left off. Thank You.
    Mrs. SnowStormRN likes this.
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  3. 9 Comments so far...

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    Where I work the nurses are cross trained in all areas. They pick up a patient and follow the patient all the way through from admission to discharge and then pick up another. This is the best utilization of all staff....keeps everyone working and no turf battles.
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    Laxmon, we must work at the same place! We have some of the same issues at the ambulatory center I work at! I am an or nurse though I am interested in peoples responses too!
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    How many patients do you usually have in one day? I am kind of confused.

    I've worked two different ambulatory surgery units. Both had nurses assigned to either admit or discharge not do both. The admit nurse would stay the admit nurse until all patients were admitted. If your schedule is so low that the admit nurse has a lot of time between admits I would think she could help out discharge with the awareness that she went back to admit when the surgeons arrived. I would think there would be some tasks the admit nurse could work on in her down time? We have to get charts ready for upcoming surgeries.

    OR nurses focus on their OR room, make sure it is ready, they don't help admit the patient unless they are told that is an expected part of their job!

    Admit and discharge nurses cross train, but OR nurses are specific only to OR every where I've worked.
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    I am a Nurse Manager of Pre-Op/PACU at an ambulatory surgery center in Texas. My admit nurse is always busy...she has the least downtime of any other nurse in the facility. Of course she is responsible for pre-admission phone calls (the phone calls made prior to DOS to gain patient health hx and offer pre-op instructions...a very time consuming chore BTW)...and she admits patients for their surgery.
    I agree with brownbrook, Admit and discharge nurses cross train, but OR circulators are specific only to OR...and that's how I've seen it everywhere I have ever worked.
    I will add that the OR and PACU are specific nursing specialties and most nurses in these specialties don't necessarily know or float to the other. However, Pre-Op nursing is indeed a type of nursing that almost any RN/LPN/MA can learn, train, and perform because it's a 'task' oriented job. But I say that with the intent of stressing how the admit or Pre-Op nurse needs to be a capable person with critical thinking skills...an admit nurse needs a large knowledge base of information...at least in my facility because we are a multi specialty facility with many different surgeons who require different pre-admit testing, prepping for surgery, different paperwork, and processes....an admit nurse needs to work fluidly through all these various situations, and work fast and productively while providing safe care and good service to the patients.

    From my experience when Pre-op admitting gets backed up, slow, or in a bind....that has a ripple effect to the whole surgery center...and it's not a pretty environement.
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    Hello,

    I also work in a surgery center and the pre/op nurses also cross-train as PACU nurses. The OR nurses, as said above, are strictly in the OR. However, that does not mean they cannot help out if there is some downtime for them (usually in am). Once the cases start, with expected quick turn-overs, it is almost impossible for them to have any downtime. As for continuing care, if it is something as simple as starting an antibiotic, there is definitely no need for them to "wait" for the pre-op nurse to do that. The orders usually don't read "to be given in pre-op", as long as it is within one hour of "cut time". Where I work, anesthesia starts it, but again…any RN can do that, as long as they document.
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    Here is an example of our day:
    we have 4 RNs each with a 615 pt for a 715 surgery time. Each nurse has about 3-4 pts at various incoming times. We get them ready (iv, shave, hang abt, teds, etc). OR nurse comes at 0715 to pick up pt. Then pt goes to OR, we get ready next pt for surgery. Then maybe your first pt comes BACK from surgery as you are trying to get 3rd pt ready for surgery. Then you have to stop and take report on that pt and go back to getting ready 3rd pt. Then another pt comes back as you getting 4th ready. Depending on type of anesthesia they may or may not go to PACU, so you could get 2 pts back at same time while admiting a pt!!! Then you hope someone will come help you! The nurses hate it and we want change. But HOW??? OR nurses work only in OR. PACU only in PACU and outpt can crosstrain to PACU if they want to learn it. I would LOVE to get ideas on different setups of outpt dept and hopefull take to administration for change!
    Mrs. SnowStormRN likes this.
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    can any of you give me some ideas (ways) to search for ambulatory surg jobs in my area? i am having no luck! i am really interested in a couple of hospitals in my area. thanks!!
  11. 0
    Quote from GAPLNC
    Where I work the nurses are cross trained in all areas. They pick up a patient and follow the patient all the way through from admission to discharge and then pick up another. This is the best utilization of all staff....keeps everyone working and no turf battles.

    that's how it is where I am.. We are a small community hospital, 47 beds. We have 2 O.R, PACU, ambulatory area. I am trained in O.R (scrub/circulating), PACU, Endoscopy, Ambulatory, pre-op, putting IV's, etc. It's nice when you can do it all ! maybe not at the same though lol
  12. 0
    Quote from RN North Carolina
    can any of you give me some ideas (ways) to search for ambulatory surg jobs in my area? i am having no luck! i am really interested in a couple of hospitals in my area. thanks!!

    how are you searching right now? try going to google or some search engine and type "same day surgery or ambulatory nursing", etc.


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