Can Circulating Nurse Sit? - page 2

In Our usual practice, Only Anaesthetist, Surgeon, ORTechnician and Pregnant Nursing Staff can sit in the theatre. Scrub nurse and circulating never have a seat, I wonder...how abu other OR practice?... Read More

  1. by   blondiemay77
    I do take advantage of having a seat when there is time. It is not a big issue in our OR to sit down for awhile. Everyone does at times. It does seem like as soon as you do someone will ask for something you have to go and get. Of course here anest. wouldnt dream of standing!!!
  2. by   motherhenjjs
    I have been a perioperative nurse for 30 years. I have worked in ORs that didnt have chairs except for the surgical team, and I have been in ORs that had custom chairs for the circulating nurse!

    Sitting down during a case while you are circulating is absolutely acceptable. There is no standard relating to sitting while you are a circulator. Sitting down while you are scrubbed is a different issue. There is a very clear standard in regards to sitting while scrubbed. It has to do with your position related to the sterile field.
    I have had scrubs ask for a stool as soon as they start their day! I understand wanting to sit-especially if one has been scrubbed all day. I always offer the scrub a stool to "perch" on after all day. But sitting while the rest of the team is standing is against all AORN standards of Aseptic technique.

    I would never work in a OR that would allow a nurse to knit or crochet or bring in anything from the outside into the OR suite. If Stevierae was the OR nurse that he/she professes to be, they would not allow it to happen in THEIR department.

    You may poke fun at AORN, but they are the reason that OR nurses have the recognition and respect that they have today.

    There is nothing more frustrating when you are scrubbed to have a circulator not paying attention to the field and having to beg for everything that you need and that should be on your field.
  3. by   Ferret
    [QUOTE]Originally posted by motherhenjjs
    I would never work in a OR that would allow a nurse to knit or crochet or bring in anything from the outside into the OR suite. If Stevierae was the OR nurse that he/she professes to be, they would not allow it to happen in THEIR department.

    Sorry Motherhen, are you suggesting that all patients be transferred off their beds to an OR trolley at the entrance to the OR Suite? Beds come in without having their wheels cleaned, after travelling across the road or through some pretty dirty parts of the hospital, as do OR trolleys that have to pick up patients, without having their wheels cleaned. My books, or someone's bags or crochet is MUCH cleaner, and I for one have less of a gripe with them than the bed wheels, which nothing I know of can be done about.

    Don't question other people's professionality unless you know all the circumstances and willing to have your own reveiwed.
  4. by   stevierae
    LOL, Jason, thanks for standing up for me!

    I was in Navy operating room technician school 30 years ago. I remember so many things we did there--at the time, though we didn't yet know the term "standard of care," were done religiously-- that are now considered laughable--

    One of them was laying a Vesphene or LPH soaked bath blanket outside the entrance to the main OR, and outside each room, to "disinfect" the wheels of gurneys and "reduce infection rates."

    The OR techs and tech students on duty at night also had to clean the surgeons' clogs (clogs were really common in ORs of that era) with Vesphene and/or LPH every night--same rationale, supposedly; in reality, probably to give us "busy work" lest we have a rare idle moment.

    Another thing was that music in the operating room was absolutely forbidden--the powers that be at the time determined (on their own, not through a scientific study) that you could not listen to music and do an operation at the same time--in retrospect, it was kind of like saying that walking and chewing gum at the same time was impossible and unacceptable--

    The highest compliment you could give or receive when I was in the Navy was "He (or she, or you) really knows his s**t."

    Many years have passed. We now know that cover gowns, "disinfecting" the wheels of gurneys, or avoiding wearing street shoes, cloth caps or dangly earrings into the OR or bringing in books to read have little to do with nosocomial infections.

    In fact , it is well documented that nosocomial infections usually result from A LACK OF HANDWASHING ON THE FLOORS--POST-OP.

    Since then, I have worked in ORs where tight a**ed middle management had little more to do than walk around making sure the circulator wasn't reading in her room, or wearing a cloth cap, or left the suite not wearing a cover gown, or was wearing street shoes, or didn't put on shoe covers, or had earrings that were not entirely covered by her (non-cloth!) cap.

    I have also been fortunate enough to work in ORs where the management was extremely sophisticated--they knew our infection control rate was extremely low regardless of ANYTHING we did or did not do as nurses--probably due to the now widespread use of pre-op and intra-op antibiotics.

    I've worked in ORs where we kept our doors open during cases so that we could socialize with the crew across the hall during their cases. Zero infection rate.

    I've worked in ORs where not only did I read during cases, but the surgeon would yell over to see what I was reading today, which would prompt a discussion among the team regarding what everybody was currently reading. If the patient happened to be awake and alert, he or she would participate in the discussion. Zero near misses, sentinel events, med errors, wrong site sugeries or infections that could be traced back to the OR.

    I have never been chastised by a surgeon, anesthesiologist or my scrub for reading. Let's face it, most cases are pretty boring--I have done them hundreds of times before--if I don't know what should be on the back table and /or instantly available, I should not be in the room in the first place.

    I know my s**t. They know I know my s**t. If I didn't, I wouldn't be in the room. I have my ears attuned to any slight change in the monitors--if there is even the slightest change indicating a problem (desaturation or a cardiac arrhythmia) I am out of my seat and up there with anesthesia in a heartbeat, assessing how I can best be of help.

    If anesthesia needs drugs or fluids, or my scrub laps or suture, I am right there--they don't need to ask once, let alone twice. I can look up occasionally and assess the situation, because I know my s**t.

    I know how the case SHOULD go, but I am also aware of and prepared for what COULD go wrong--therefore, it doesn't fluster me, and I don't need to stress about what MIGHT go wrong. I know my s**t, and I will react accordingly, and in a timely fashion, and without anyone having to prompt me.

    I have worked in ORs where surgeons operated the entire time with earphones to a cell phone in their ears, talking throughout the entire case. Did it concern me? No, because I had worked with these surgeons before--I knew they knew their s**t. I knew that they could operate and talk at the same time--we all can, if we know our s**t.

    I have worked in operating rooms where the anesthesiologist had lunch brought in, and ate it at the head of the table. Did I care? No, because I know that, contrary to popular belief, items (food, books) brought in from the outside--or masks taken off long enough to eat--have no relation to post-op nososomial infection.

    I have worked in operating rooms in situations where, when I was the scrub, the surgeon would be grumbling under his breath, "Why is SHE in our room today..." referring to the very anal circulator who, although her eyes were glued to the field, had no clue as to what we were doing up there--because she didn't know her s**t.

    There are too many operating room nurses that don't know their s**t, so instead they cling to citing what they learned 30 years ago as gospel-- things that are the subject of another thread--"Sacred cows that need to be laid to rest. "

    These are the operating room nurses who are slow; don't take CE courses; don't scrub, maybe CAN'T scrub; are not up with current procedure; about whom the surgeons grumble, "She really needs to retire...WHY is she in our room today?" --they feel so free to judge everyone but themselves.

    Oh, and the nurse that I mentioned previously that used to do needlepoint and/or crochet when she was the circulator?

    Not only was she one of the favorites among both surgeons and scrubs, but she has been--for 30 years-- a very important author and editor for AORN, JCAHO, and NAON, as well as being a high ranking Army Nurse Corps Reserve officer whose expertise is highly respected and sought after--both during peacetime and wartime. She really, really knows her s**t.

    So how about you, motherhenjjs?

    Do you know your s**t? Are you really certain that you do?

    When is the last time that you took a CE course to learn something on your own--not simply because it was required?

    Do you know how to start an IV in an emergency when access is difficult, or are you one that says "That's anesthesia's job?"

    Are you ACLS certified, or do you feel that basic life support is "good enough" for the role you play as part of the surgical team?

    Why not conduct a poll among the techs, surgeons and fellow RNs you work with--it might just prove to be a real eye-opener.
    Last edit by stevierae on Feb 1, '04
  5. by   POPRN
    Once upon a time I disagreed with Stevierae on this very post!!!!
    I am so sorry Stevierae!!!! I totally agree with you!!! nurses who know their shi* can sit!!!! and should sit!!!! I don't bring books to the OR but I do look on the computer( they are in the room to take up space only, we don't do charting on them) I read the patients chart. I do pay attention to the sounds on the monitors and look up from time to time. A good nurse and scrub can communicate without words. with just a look the nurse can see what is needed on the field, laps or suture etc... and hold up the item and the scrub with nod yes or no.
    Once again stevierae...I applaud you!
  6. by   carcha
    can I come work with u Stevierae?
  7. by   fab4fan
    This sounds a lot like the ideas people have about codes...that they are all drama, when in reality they are often the opposite (at least in my exp.).

    Stevierae would be welcome at any of my local hospitals, with or without crochet hook.
  8. by   stevierae
    Originally posted by fab4fan
    This sounds a lot like the ideas people have about codes...that they are all drama, when in reality they are often the opposite (at least in my exp.).

    EXACTLY!!!! EXACTLY!!!

    What is it with some people that are so freakin' intense they can't relax and have a laugh or a good time at work--Everything, EVERYTHING is a crisis--no matter how mnay times they've done it, it's like the first time for them--always has to be a major production--

    Sometimes I want to take people like that gently by the shoulders, look them in the eye, and say, very calmingly, very soothingly --

    "You've done this case before--hundreds of times. You'll do it again--hundreds of times. It's just a case. It's NOT A BIG DEAL. Just relax--"

    Then maybe give 'em a good slap--

    Buncha da*n drama queens.
    Last edit by stevierae on Feb 5, '04
  9. by   Ferret
    G'day All,

    I have to say, that once a good level of trust and rapport are built up between scrub and scout, it is amazing what can be achieved in terms of anticipating needs, signalling for ligaclip reloads, sutures etc. One time springs to memory during some boring cases most of our communication was by signals, including starting a series of paper/scissors/rock games (I said it was boring...), when we'd never before even thought of the game, let alone talked to each other about it.

    Aaahhh, Teamwork, great when it works, a nightmare when you hate the other members of the "team"....

    Adiau, Jason
  10. by   stevierae
    Originally posted by Ferret
    G'day All,

    One time springs to memory during some boring cases most of our communication was by signals, including starting a series of paper/scissors/rock games (I said it was boring...), when we'd never before even thought of the game, let alone talked to each other about it.

    Ah, Ferret, you would fit right in in my favorite ORs. Too many people have forgotten--or never learned-- that it's OK to lighten up and have fun at work.

    One of my favorite scrub techs--a delightful and incredibly smart young man, and a great team player--plus an absolute whiz in every spinal instrumentation case known to man--he was, when I worked with him, all of 24, yet I learned something from him every single day--things that made me think, "Da*n, I like the way he does that--what a great idea" and influenced me on numerous occasions to change MY way to HIS way.

    Anyway, one time he was scrubbed on a very complicated spinal instrumentation case--and they were gettiing repeated X-rays and stepping away from the table.

    When he stepped away, he stood next to the surgeon--

    And as the two of them faced me, I saw that the scrub had written on his gown, with a big arrow pointing directly at the surgeon, who was oblivious:

    I'M WITH STUPID.

    A good laugh was had by all, (including the surgeon, who laughed the most) and it made the rest of a very complicated and intense--and, yes, boring--case a lot more fun.
  11. by   Ferret
    G'day All,

    Over time i've worked out that if you PRETEND you know what you're doing, people assume you do, there is less pressure, and you have time to work out your next move. I've always been praised for keeping a cool head in a crisis, and not freaking out when RN's much more senior are running around like chooks with their heads cut off. (Most recently as a student RN on the wards) An old trick I learnt as a volunteer in St. John Ambulance, amazing how effective it's been over the years.

    As for stressesd out people, the most amazing case I saw was when a VERY experianced clinical nurse specialist scrub/scout in charge of ENT theatre, burst into tears when a registrar dropped his end of a drape, she rushed out of the room and took some time to calm down. I knew she'd done the case thousands of times before, and I was happy to hand her another drape..... weird. I never did work out if there were other issues in her life at the time, I sure as hell hope so, otherwise she was taking the job WAY too seriously.

    Have Fun, Jason 8^)
  12. by   orrnlori
    I scrub and circulate. I've worked with some great scrubs like the one with the message written on his gown. Some people just make the day go so much better.

    A good circulator can easily sit during cases, our program has no problem with it. Because I scrub as well, when I circulate I always have some supplies they "may" need nearby. I watch the field and almost always dispense what is needed before it is even asked for by the doc or the scrub. I sit every chance I get. I'm 48 years old but I think nursing years is more the equivalent of dogs years, thus I feel 98 many days.

    I work at a university hospital because I love the autonomy given the nurses, I love working with residents, and it's so much more relaxed than being out in the private world. I would never work anywhere where the circulator was expected to stand. If the circulator wants to knit while the case is ongoing, that's fine as long as she's johnny on the spot when I ask for something as a scrub nurse. I expect my coworkers to work as hard as I do and I expect them to be attentive to the case. You can still have music playing, you can still tell jokes. Yes, surgery is important stuff, but nothing says you have to be miserable doing it.
  13. by   lorijay
    In our OR we sit but some people don't approve. However we always make sure we are able to hear and see whats going on on the field.

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