O.R./L&D Clashing in C-sections

[Marie_LPN, RN, LPN, RN]

That's the only title i could think to call this thread. And this might be long. (Also from my perspective, i realize)

It used to be that L and D did their own C-sections, and the O.R. staff only scrubbed on them if the Maternity floor was short-staffed. This was put to a stop because either some the L and D staff didn't get trained enough to know what to do (some only got one-case training for ALL of it, which isn't fair to the pt. or the scrub person to be put in that position)) and needed more training, or the sterile technique was horrible. So L and D doing the C-sections was halted for more training, meanwhile they had quite a bit of turnover of their staff, almost half from a year ago.

Well, recently L and D started doing the C-sections again, and the O.R. staff went back to being on a as-needed basis for C-sections (eitehr to assist or set-up for the case). Well, the other day, a scrub and circulator was needed, so i went down ahead of time to see if i could help at all.

This is what happened before one case even started (pt. was not in the room):

(after i introduced myself to the L&D scrub person, and received an eye-roll as a reply)

Me: "Which do you prefer to do, assist or set-up?"

Her: "I'LL set up because this IS my department"

Me: "Ok, can i help you with anything? Do you need anything"

Her: "No, hard as this may be for y'all to believe, we ARE capable of gathering stuff ourselves for our cases"

Y'all. Hmmm, ok.

Circulating RN comes in, offers to count with the scrub person, scrub person says "fine, whatever", and proceeds to count Allis clamps, then blades, then suction tips, retractors, then sutures. We're supposed to count 'sharps' (sponges, hypos, blades, sutures) first, then instruments, not a mix, and the circulator says "we should count all of the sharps before we continue to the instruments". Scrub person say "Whatever! When our own RN is in here, they don't give me **** over stupid stuff like this".

Count is finished (in the correct manner) and the scrub person proceeds to fold her sterile arms together behind her back to stretch. Circulator points out that the scrub person is now not sterile, especially since her arm touched an uncovered, unsterile table. Scrub person: "Oh, Christ, you people just come down here like know-it-alls and boss us around." Circulator "You're contaminated, either change or i'm going to your supervisor right now." Scrub changes, grumbled the whole time about "how stupid this is".

Circulator wound up going to supervisor anyway, after the case was finished.

This was pretty lengthy, but this is an example of what the problem is at our facility (others have complained about it in conversation). When you walk in the room, a lot of the times we get someone who is like the scrub person. (Not all are like that, there are a few that are polite, etc.). Has nothing but rude replies, rude attitude, you point out a break in technique, and some act like you're the troublemaker from hell. It's gotten to the point where O.R. staff pretty much dread having to go to L and D.

Am i saying it's all from the few in L and D? No, there might be some O.R. staff being rude as well and it just rises from there, however, what gets to me is the attitude we get when we speak up about something being unsterile. It's almost like it's no big deal to some, and that we're the bad guys for even saying anything (which is just too bad, because if soemthing's wrong, something should be done about it).

(Not to mention you need a chainsaw to cut the tension sometimes, sheesh.)

I'm trying to look at things from all perspectives. Is this a problem where you work as well?

[futuregaspasser]

Do you work in my hospital? LOL! That sounds exactly like what goes on here. Of course they (L&D staff) don't all act that way, but the majority do. Anytime one of our staff (from the OR) has to have a C-section they request OR to do it because a lot of their sterile technique is so bad.

On the other hand, our hopital doesn't have infections from the C-sections, so I guess it can't be all that bad.

[SmilingBluEyes]

I caution against this turning into a "tit for tat" , "us versus them" thread. These go south VERY quickly.

[Marie_LPN, RN, LPN, RN]

I caution against this turning into a "tit for tat" , "us versus them" thread. These go south VERY quickly.

That's why i read (and read and read and re-read) before i posted this thread.

Aside from making sure that i'm friendly, etc. i'm trying to figure out a solution to this problem.

[SmilingBluEyes]

I hear you-----but I have seen this happen before, e.g.. ED versus Med-surg....the whole thread had to be shut down at times.

it's a potential powder keg. It can get ugly---anytime you pit one group against another.

However: You make an excellent point: I have seen the territorial behavior between OR and OB nurses/staff many times in my career. Both sides have been wrong at one point or another. I think the whole thing is very unproductive and immature.

Yes, sterile technique needs to be strictly adhered, and non-OR nurses can be very guilty of having less than optimal technique. If you see a lot of violations, maybe an inservice would be in order for OB staff. I understand your concerns. One possible suggestion: Get with the managers and see if you can make it happen---an inservice and/or meeting of both groups. Open lines of communcation by meeting with each other and airing out differences. Communication is so important.

And, on that vein, it would be nice if in some ORs, the staff there were a bit more welcoming to OB staff. I have been made to feel VERY out of place and treated as if I were stupid in some ORs ("don't touch anything in blue" in a very snide voice by some, for example). If non-OR nurses are routinely breaking sterile technique, again, an inservice that is documented for each participant, is in order!

You see, I see both sides here. What are some of your suggestions that would make both sides more amenable? I am sure you have some great ideas.

Thanks for understanding Marie!

[SmilingBluEyes]

Do you work in my hospital? LOL! That sounds exactly like what goes on here. Of course they (L&D staff) don't all act that way, but the majority do. Anytime one of our staff (from the OR) has to have a C-section they request OR to do it because a lot of their sterile technique is so bad.

On the other hand, our hopital doesn't have infections from the C-sections, so I guess it can't be all that bad.

how about an inservice for the OB nurses then? Consistent break in technique is nothing to blow off.

[USAFRN 13]

In my hospital, OR staff do all the C-sections. L&D staff will help with getting the patient into the room and onto the bed, but that's about it. It's a little more work for us but it works out pretty well, there's really not much tension at all.

[SmilingBluEyes]

Where I work, we OB staff our own csections in our own suite. We have the tech, the assistant, and an L/D nurse circulates. We are inserviced here and there as to proper technique for scrubbing the patient and handling instruments/supplies to the tech, as well as counts. It's important it is done right and It works well. No clashing there. On the rare occasion we need to use central OR to do csections, they treat us pretty well there. But then, all we do is "baby catch" downstairs, and we stay out of the way of the OR staff in the suite.

[enfermeraSG]

Where I work we staff our own C-sections, we have our own cert. surg techs trained for L&D etc. We had quite a bit of turn over about a year ago and got a lot of newbies (nurses). There was an uproar from the techs that circulators were contaminating left and right and they didn't seem to have any knowledge about OR sterile technique. Our solution was to develop a series of inservices and a brief summary of sterile technique rules which we laminated and hung on the wall. Most of the staff was very receptive and were very willing to right their wrongs. In most nursing schools now there is little to no training regarding OR conduct. SG

[SmilingBluEyes]

Where I work we staff our own C-sections, we have our own cert. surg techs trained for L&D etc. We had quite a bit of turn over about a year ago and got a lot of newbies (nurses). There was an uproar from the techs that circulators were contaminating left and right and they didn't seem to have any knowledge about OR sterile technique. Our solution was to develop a series of inservices and a brief summary of sterile technique rules which we laminated and hung on the wall. Most of the staff was very receptive and were very willing to right their wrongs. In most nursing schools now there is little to no training regarding OR conduct. SG

great suggestions, thank you enfermera!

[tntrn, ASN, RN]

We staff our own c/sections in our Birth Center as well: with a Certified Scrub Tech, an RN who circulates. What exactly is the assistant, what do you do and how do we get one? We do have a nurse who comes in for the baby, but she is gowned and gloved so of no use to help do anything.

Our gas-passers thinks the circulating nurse should have everything of theirs ready for them. I guess making sure the patient and baby are okay isn't enough for them. Hey, if I have time, I can start to do some of that, but it's their job, not mine. Is that what your job as assistant is?

Our only problem with OR/L & D is not the OR at all. It's with one or two of our OB's who will schedule a section, when they know we don't have the staff for it. Until last week, they were scheduled with the OR and we got notified. NOW they are scheduled with us, and we notify them. If there's a conflict with anesthesia coverage, then things get switched around. Some docs seem to think that staff just grows on trees and that the staff we have should be willing and able to come in and work whenever they decide to do an elective procedure of any kind.

[sunnyjohn]

Was this tech a surgical technologist or someone of the street who wss trained on the job to scrub C-sections?

How terrible. She is making all techs look bad and putting patients in danger! :angryfire