[rnoflabor2000]

I work in L&D and we have 3 OR's and do our own C/S. Do you think we would benefit from working in a main OR to acquire more experience? When things go wrong in the OR, we are scrambling like chickens with their heads cut off. Is that normal?

[VictoriaG]

Yes darlin', that is very normal! I was an L&D nurse for years, circulated my own sections, thought I knew what it took to be a circulator, thought it was normal for things to fall apart in a crisis.
I have now been an OR circulator for 3 years, and things are much different in the real world of surgery.

However, you are an L&D nurse, not a surgery nurse. L&D is your focus and C/S is not at all like general surgery. Instead of rotating to OR to gain knowledge, why not have a surgery preceptor come to you? A circulator could come to your sections and give you pointers that would concentrate on your area of expertise.

Just a thought.

[rnoflabor2000]

Thanks, VictoriaG, that is some good pointers.

[passionate]

It would be nice to hear that any RN involved in the surgical experience of a pt. considers herself/himself to be a perioperative nurse. Surgery is a specialty and it is my belief that all patients deserve a perioperative RN regarless of the dept. they work in. I often think OB nurses look at sections as an alternative birth route. This is not the case and caesareans are being given now as options to moms--there is alot of discussion re: the integrity of the pelvic floor, etc. Let's look at our current practice and be the patient advocate. I work in an OB dept. as a perioperative RN and am somewhat discouraged at the attitudes I see re: OB vs. OR. We need to respect each other's specialty and advocate for the pt.

[passionate]

I really do not agree with your statement. A pregnant surgical patient is still a surgical patient with all of the needs hemodynamically of any surgical experiece. While I agree that a baby is in the mix and that an OB nurse is absolutely pertinent I strongly disagree with the sentiment of a L&D nurse being "just" a L&D nurse. Every surgical patient deserves a perioperative nurse and until that is embraced I fear that obstetrial patients undergoing surgery may be getting less than a sterling experience. Please do your patients a favor, OB nurses, go into a well run OR, learn the AORN standards and embrace that your practice has expanded if you do surgery within your department.

[bifurcated]

this is a battle that seems to be fought over and over in the world of OR nurses and OB nurses. First, the OB nurse has got to understand that the OR nurse KNOWS how to operate..... the OR nurse needs to remember that the OB nurse knows about regular birth and babies. Where we seem to get screwed up is when the OB nurse needs to "allow" an OR nurse into "her" territory. We are not there to mess with you...... We are there(as OR nurses) to take care of a patient that use to be yours....... and is now MINE while she and that baby are in the operating room. OB nurses seem to take offense because the OR nurse will correct or just take over something dealing with the C-section. I would hope that if I had a lady delivering vaginally that an OB nurse would come and push me out of the way..... vag. delivery is not MY THING! C-sections are not yours. I have "helped" out in OB frequently on sections and have noticed that the OB nurse doesn't seem to respect their privacy much. the pt. is laying on the OR bed with their gowns bunched up under their breast while everyone is dashing around doing???? not sure what. No seat belt or worse the belt on their bare legs.That is THE PATIENT PLUS ONE. Keep her warm, cover her up, there is time to cath and prep and if it a crash section it just happens faster by people who are use to making fast decisions and prioritizing quickly, and still respecting the patient. I in over 30 years have seen a lot more negativity towards the OR nurses that are there to do their thing or help than I have the other way around. When I first started doing sections they all came to the OR...... we learned so much about both mother and baby. I have been handed the baby as a circulating nurse (no pediatrician ) and had to suction, compress the chest all of it until a doctor could get there. So to all the OB people out there, your best friend when you "have to do a C-section" should be the OR nurse who has specialized like you in a specific area. C-section's are not an alternate birth canal........ it is a BIG surgery that deserves experts just like everyone else that has their belly cut open whether it is for a bowel resection or a baby!

[WitchyRN]

Originally Posted by passionate

I really do not agree with your statement. A pregnant surgical patient is still a surgical patient with all of the needs hemodynamically of any surgical experiece. While I agree that a baby is in the mix and that an OB nurse is absolutely pertinent I strongly disagree with the sentiment of a L&D nurse being "just" a L&D nurse. Every surgical patient deserves a perioperative nurse and until that is embraced I fear that obstetrial patients undergoing surgery may be getting less than a sterling experience. Please do your patients a favor, OB nurses, go into a well run OR, learn the AORN standards and embrace that your practice has expanded if you do surgery within your department.

Well said. In my hospital, I got sent up to scrub C-sections for OB when they were "busy"(I put that in quotes because they'd call us because they hated to scrub them). The sterile technique up there was, for the most part, appalling. Not draping the mayo stand with the plastic cover "because we don't reach under it", trying to use opened but unused suture from a previous case on the next patient etc etc. I actually had a little run in with the head of their dept. because I wouldn't allow the opened suture from the previous case on to my back table. I was "just a tech" at the time so she thought I didn't know what I was talking about. Long story short, the nurse educator of the OR set her straight. C-Sections are surgery and should be treated as such, with all the necessary policies and precautions observed.

[USA987]

I am a former L&D RN who circulated and recovered c-sections and PPTL's. We would also perform rare D&C's. I am currently an OR nurse. I received all my training in the main OR and PACU. We had to go through ACLS as well.

Learning to circulate in the main OR was an invaluable experience. I also agree with another poster, if you are going to circulate you need to be aware and be held to AORN standards of care as well as AWHONN's standards.

We had a lot of wonderful circulators and scrubs and a few "scary ones" too.

Scrambling when things go bad? I think that is normal. Maybe you could try running mock drills to help everyone gain experience during a crash.

Good luck!

[passionate]

Dear, Dearest Bifurcated, You sound as if you know a wonderful OR nurse who is struggling with this issue even in this new millenium. It is good to hear from you!!!

[heather2084]

Just want to say how my facility handles this situation. A long timme ago L&D did their own c-sections, then it was handed over to OR. OR does the cases and there are always two L&D nurses in the room to handle the baby part. I strongly feel that C-Sections are a two part surgery and as such the surgery part should be left to perioperative staff and the baby part to L&D to do the same as they would with vaginal births.