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NurseLumpia 2,053 Views

Joined Sep 12, '07. Posts: 60 (13% Liked) Likes: 9

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  • May 11 '11

    Petite,

    Thanks for making the points that you did. I was not suggesting that managers should be the best scrub/circulator in the hospital to be a good manager. I stated that I understood that staff and management roles are not interchangeable, nor should they be. I further stated that managers have different responsibilities, such as the ones you listed. I will repeat that I cannot imagine doing their job.

    The foundation of my point in the post that you quoted is that I expect my manager to not only have the ability to do my job, but also have the ability to be a resource person when things start to go South.

    If someone is going to be a leader of a team, they need to have intimate knowledge of the responsibilities of that team. In my experience, I have seen far too many managers that simply cannot function in the surgical suite.

  • Mar 26 '11

    If you can do a AAA you can do a heart.... dont let people scare you out of trying it... The main key for me when I take someone new in to try them out on our heart team is the willingness to learn. If they are willing and pick up on the stuff quickly they are good to go. If you want to scrub I would make sure to be nice and nonargumentative with the best scrub you have there. If you can get them to take you under their wing you are set. Be that way with everyone actually... if you dont know, ask... if there is an emergency type of situation going on and you dont know what to do then just stand back and ask after the fact.... You will have to learn to keep your ears open all the time. Dont ever stop listening to the field, all circulators should do this in any service but CTOR and CVOR you will bleed out in 30 seconds easy... just like trauma. You have got to be listening and available quickly to get what they need on the field and to perfusion and anesthesia.....

  • Mar 24 '11

    I agree with Argo. I think you will be more marketable if you learn CTOR. You will also be able to use more of your assessment skills when things start to go south. I know what you mean about becoming the "property" of the CT team, but since you already have experience in every other discipline of the OR, this experience would be better for you.

  • Mar 22 '11

    From my experience you are more of an asset and worth more on the pay grade scale if you do ctor. I do both but neuro has never helped me get $ offered to me. Im currently a clinical manager of or and coordinator of ct. Personally I think both of them are relatively easy. Ct is more fun. Neuro can be boring if you do alot of cranis. I prefer ct but will do whatever is thrown at me. I like the close knit team atmosphere in ctor. You get more emergent cases typically than your used to in main or unless you do trauma, especially if you have a busy cathlab. You will take quite a bit of call usually in ctor too.

    You already have a background in main or. Don't worry, you wont forget how to do those cases....

  • Mar 22 '11

    Quote from canesdukegirl
    I strongly believe that any manager should be able to run circles around their staff in the OR. The reality of the situation is that very few managers are able to perform the job functions that we as staff are expected to do well. Although I understand that managers have a different role, and that they are responsible for so much, I also believe that they should be expected to not only be a resource person in times of crisis, but also that they should EXCEL during these times.

    I have a hard time having respect for a manager that does not know the difference between a Kelly and a hemostat. C'mon, man! And when a surgeon starts yelling at the manager because he/she cannot keep up, hey...welcome to our world.

    I know that managers have a difficult job. It is not easy to be in the captain's seat. I cannot imagine doing their job. With that being said, if someone is going to be my manager, I want to know that they can do my job. I understand that our jobs are not interchangeable, but if they are going to nit-pick about policy and procedure, I want to know that they can walk the talk.
    I completely agree. Every place I've worked with the exception of two, the manager AND director can run a room. Where I'm at now, that is not the case. It is ****** at best. The other place I worked, same thing. We've been short staffed and when I ask questions, I get "I don't know" and not even, "I will find out". It's created distrust, lack of confidence, anger, and a broken team atmosphere. And major turnover. To the point where the brass is coming around and we are told what to say by the director in case we're asked how things are going. Really?

    In both cases, the director's office is miles away from the OR. I look to the director/manager to be a resource, to help make things run as smooth as possible. New docs and procedures come in and I think they should know how to get things setup/run, but in my experience I get "I don't know, go ask so and so". And then walking away.

    I agree...walk the walk

  • Mar 22 '11

    As long as I have been a manager I have circulated rooms. My current title is Clinical Manager but I do cases daily. I let the director do the meeting stuff and have a board runner that runs the board. When problems come up they can ask me to help solve it and I do.

    My prior job I was Manager/Director for 3 years and circulated 2 days a week minimum. I would be like a float person on other days and ran the board every day too. It really is not that hard if you can multitask. I can definately see how if you like getting caught up in politics and gossip you could totally get away from actually working and milk the title all you want.

    Personally as a manager/director I feel and have always felt that I should be able to do anything that any of my employees can do and be willing to do it. I can mop a floor, turn over an anesthesia machine, start lines, assist anesthesia, assist surgeon/scrub, circulate anything, do CS work.... whatever it takes..... I hate lazy people.

  • Jul 22 '10

    Dear surgeon,
    Perhaps you should take a course in effective communication for beginners. Despite popular belief, nurses cannot see into your mind when you suddenly decide that you want to change the surgery at the last minute. You just may have to 'gasp' descend from your pedestal to converse with the lowly nursing staff.

    It also helps when you inform all the OR team, not just your anesthetic buddies. Because believe it or not we work in the operating team too, though you may have to pull your head out of your ass long enough to notice our presence....yep we're the one's who ensure that you have the necessary instruments and equipment to do your operation.

    Oh and because your an ******* don't ever expect me to go out of my way for you again. As the saying goes, you've just shat in your own nest...

  • Apr 30 '10

    Until you've seen a bead of sweat roll off someone's forehead and onto the surgical field I don't think you can fully appreciate the need to keep the heat down in the room.

  • Apr 26 '10

    The resume is not the place for these skills. Every application I have done will have a skills checklist. Just generalize Your resume with "able to scrub most services and circulate all services" I would loose interest in a detailed resume like that. I like terms like energetic, willing to learn/teach/share skills, comfortable in my skills/ environment. ..... its supposed to br the cliffs notes of your career, we will get the full story later.

  • Dec 12 '09

    Dear preceptor.. I came to you smiling, full of energy and ready to tackle the last leg of my orientation journey, with your guidance of course. I haven't really gotten any inclination on where that guidance is at. You tell me what patients to take, and I take them. Then when I am at the bedside, communicating with the family (you know that rapport thing?), you decide that it is a great time to tell me *not to touch the patient*, or the machines for that matter unless you are there. What? I did not fall off of the nursing school wagon yesterday. I am new to your facility, but not a new grad. I did get a smug sense of satisfaction when the family told you it was fine and I was handling things.

    I see that you do not have any intention of assessing my skill level or evaluating areas in which I need assistance. In your eyes, I have no skill level or even brain stem function because every action on my part is met by you with some sort of resistance or interrogation. You cant wait for me to come out of the bathroom before you call the doc... making me look like some sort of fool that cant call the doctor. Lo and behold the toilet flushes and I am greeted with 75 orders, all of which you *write* but make me *do*. Although I am a critical care nurse, and am comfortable with bedside procedures, it is *imperative * on your part to ensure that I am educated on sterile fields and how to open packages. That makes me feel so great, especially with the doc at the bedside.

    Precepting with you has given me a great opportunity to practice dealing with "the cold shoulder, being aloof and unapproachable." I *know* that you aren't any of those things, just preparing me for when I run into someone who is. Thanks! I am now well versed in forced conversation, fake enthusiasm, and being lonely but not alone.

    I have been practicing my mental, telepathic and psychic abilities... seeing as how there isn't any verbal interaction between us, its time to take it up a notch. *places fingertips to temples* Can you hear me now?

    Here is an interesting thought. You breeze in, tell me how the lights have to be like this, and these lines need to be like this and so on. I am respectful of those requests. I like things a certain way too.. try to be mindful of that. The road goes both ways here. The same goes for documentation. Maybe you could ask me why I wrote a certain thing before you scratch it out and write error... although all the extra embellishments make my flow sheet look freakin fantastic, right?

    When I ask you about something, especially when its a policy and the rationale for not following it... I just love when you get mean and flash those *knowing* looks to all your friends at the desk.

    Precepting with you has been quite the experience, and as life goes, all things must come to an end. Now that our journey is finished, know that I will *never* forget you.

    Love, your preceptee

  • Dec 9 '09

    "AORN does not recommend home laundering of surgical scrubs. Taking surgical scrubs home that were worn in the perioperative area could result in transferring pathogens to the home setting. (1) If surgical scrubs have become wet or contaminated with blood or body fluids, the individual should change scrubs as soon as possible and send the soiled scrubs to the facility laundry or to a health-care approved laundry facility. (2)
    Studies performed on contamination of the hands of health care personnel, equipment, and clothing demonstrate that pathogens found in the perioperative setting present risks of transmission during home laundering. Studies indicate the following regarding home laundering:
    * More than 95% of laundry is washed in cold water. (3,4)
    * Only 15% of laundry is washed with bleach. (5)
    * Home dryers may not provide a high enough temperature to kill viruses and bacteria. (4,5)
    * Cultures of washing machines grew coliform bacteria (ie, 60%) and Staphylococcus bacteria (ie, 20%). (6)
    * A National Institute for Occupational Safety and Health study demonstrated that washing work wear at home poses long-range risks for families and communities. (7)
    * Sixty-five percent of nurses caring for patients with methicillin-resistant Staphylococcus aureus (MRSA) had contaminated uniforms. (8)
    * Health care-associated infection with MRSA and vancomycin-resistant Enterococci is spread via the hands of health care personnel, equipment, and clothing. (9)"

    http://findarticles.com/p/articles/m.../ai_n27434538/

  • Nov 3 '09

    I'm here to set the record straight. I am as much a RN as the next nurse and I do patient care. Operating Room Nurses assess, diagnose, plan, intervene, and evaluate their patients just like every other nurse. Let me tell you how.

    The RN specializing in Perioperative Nursing practice performs nursing activities in the preoperative, intraoperative, and postoperative phases of the patients' surgical experience. Based on the Standards and Recommended Practices for Perioperative Nursing--A.O.R.N., the operating room nurse provides a continuity of care throughout the perioperative period, using scientific and behavioral practices with the eventual goal of meeting the individual needs of the patient undergoing surgical intervention. This process is dynamic and continuous, and requires constant reevaluation of individual nursing practice in the operating room.

    Assessment

    The patient enters the preoperative area and is assessed by the preoperative RN. The perioperative RN (Circulating Nurse), then interviews the patient with particular emphasis on ensuring the patient has informed consent, has been NPO for at least 6 hrs. prior to surgery, and current medical history to determine any special needs for the care plan. The perioperative nurse explains to the patient what will happen during the operative phase and tries to alleviate any anxieties the patient and their family may have. The nurse develops a rapport with the patient that enhances the operative experience for the patient by building trust and assuring the patient and the family of the best care possible.

    The assessment includes, but is not limited to:

    - Skin color, temperature, and integrity
    - Respiratory status
    - History of conditions that could affect surgical outcomes (i.e. diabetes)
    - Knowledge base related to the planned surgery and complications that could arise
    - NPO status
    - What medications were taken the morning of surgery and the time taken
    - Allergies and what reactions the patient experiences
    - Placement of any metal implants, especially AICD's and pacemakers
    - Time of last chemotherapy or radiation therapies
    - Verification of patient's name and date of birth
    - Checking to verify all medical record numbers match the patient's name band and paperwork

    This information is then used to develop the perioperative nursing care plan.

    Diagnosis

    The nursing diagnosis is written in a manner that helps determine outcomes. Some nursing diagnoses for surgical patients are:

    • Impaired gas exchange related to anesthesia, pain, and surgical procedure
    • Potential for infection related to indwelling catheter and surgical procedure
    • Activity intolerance related to pain
    • Anxiety related to anesthesia, pain, disease, surgical procedure
    • Alteration in nutrition less than body requirements related to NPO status.

    Planning

    Planning the patient's care in the operating room is focused on patient safety. The nurse gathers supplies needed for the procedure according to the surgeon's preference card, positioning equipment, and any special supplies needed as determined by the nurse's assessment and the patient's history. Preparation assures that the nurse will be able to remain in the surgical suite as much as possible to provide care for the patient. The nurse leaving the room is avoided as much as possible, but unforeseen circumstances may require the nurse to leave to obtain equipment or supplies. When the patient is brought to the operating room and transferred to operating table, patient comfort and safety are the priority. The nurse provides warmed blankets for the patient and applies the safety strap across the patient. The surgeon is called to the OR suite and the "time out" is performed with the patient participating. Items verified in the time out are the patient's name, date of birth, allergies, procedure to be performed, correctness of consent, site marking, if applicable, and any antibiotics to be given within one hour prior to incision. The patient is instructed to take deep breaths before and after anesthesia to maintain oxygen saturation above 95%. Strict aseptic and sterile technique are maintained throughout the surgical procedure to reduce the risk for postoperative infection. The nurse remains at the bedside during the induction phase and holds the patient's hand to help reduce anxiety. The patient is reassured as needed.

    Nursing Intervention

    The circulating nurse and the scrub nurse/technician work as a team to protect the sterility of the operative field by maintaining constant surveillance. Any breaks in sterile technique, such as a tear in the surgeon's glove, are remedied immediately.

    The nurse provides for patient comfort by placing warm blankets, remaining at the patient's side until anesthesia has been successfully induced and the anesthesia provider releases the care of the patient to the surgical team. At this time a foley catheter will be placed, if indicated, using aseptic technique. The patient will be positioned and all pressure points will be padded to prevent altered skin integrity. The surgical skin prep is then performed aseptically and allowed to dry before placement of the surgical drapes. Fumes from a wet surgical prep can form pockets of gas that have the potential to be ignited by a spark from the electrocautery used in surgery.

    Prior to the surgical incision, the anesthesia provider initiates the infusion of the antibiotic ordered by the surgeon. A preincision verification performed by the circulating nurse rechecks the patient's name, the surgical procedure, the site/side of the procedure, the antibiotic infusion has started, and the prep is dry.

    Evaluation

    The circulating nurse monitors the patient vigilantly during the course of the perioperative phase which includes preoperative, operative, and postoperative stages of surgery. He/she is responsible for the smooth transition for the patient between these phases. Evaluation of the patient's response to the surgical intervention is ongoing and continuous. Have the surgical outcomes been met? If not, reassessment takes place to plan further.

    Conclusion

    The patient under anesthesia is totally dependent on the surgical team for their well-being. The perioperative nurse advocates for the patient. He/she is their voice during the surgical intervention.

    Whether scrubbing, circulating, or supervising other team members, the perioperative nurse is always aware of the total environment, as well as the patient's reaction to the environment and the care given during all three phases of surgical intervention. The perioperative nurse is knowledgeable about aseptic technique, patient safety, legal aspects of nursing, and management of nursing activities associated with the specific surgical procedure being performed. OR nursing is unique: it provides a specialty service during the perioperative period that stresses the need for continuity of care and respect for the individuality of the patient's needs.

    Beth, RN, CNOR
    ASN Degree with Honors from St. Petersburg College, St. Petersburg, FL
    Staff RN

  • Apr 20 '09

    Will you be expected to cover other specialties when you are on call? If so, you certainly need at least a brief rotation through those areas.

  • Apr 11 '09

    It's great that they're impressed with your skills. However, I personally would want more experience in a broad range of services before committing to one. I would at very least ask to finish my orientation through the remainder of the services.

    I don't know how your on-shift and on-call time works, but if there's any chace you'll be working outside the ortho department it would be good for you to have your basic skills down in all services.

    I think it makes you a stronger OR nurse to be able to function in all the services, rather than just being specialized in one.

    However, after a year or two I think specializing in an area is a great idea.

  • Apr 11 '09

    Being able to work in a variety of specialties is always an asset to just being, "the person who scrubs hearts". It sure makes marketing yourself easier.


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