Can you keep up with fast pace?

  1. I'm working in a free-standing surgicenter and I feel like the quick turnovers are at times unsafe or more conducive to making mistakes. For instance I got a call tonight from my supervisor asking me about a specimen that was sent out on a patient last Friday. She was a local gyne case which ran over into another doctors time who does epidural pain injections. I didn't have some insurance paperwork to send with the specimen because the doc had the chart and we needed to quickly turn the room over and start the pain doctors six cases. After the six cases were done I ran and got my paperwork and had the secretary at the desk call for a pick up for the specimen all the while I was at the desk and saw she made the call. Even later I noticed the bag with the specimen was gone. There was some question about the specimen and she was inquiring if I had sent it. I didn't log it in the spcecimen book because frankly I forgot. I assured my supervisor that I did not leave the specimen in a corner and had the courier pick it up. I'm slightly paranoid now wondering if something got messed up. I just feel like all these fast turnovers don't let me have a chance to think things through and make sure all my t's are crossed and i's are dotted. Did I get my out times? Did I leave any blanks? Did I really see that the consent was signed? For such a responsible job and our license on the line I think it's such a crap shoot if we remember to do what we have to do. Thoughts?
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  2. 14 Comments

  3. by   BernadetteRNBSN
    i am a fast pace person in general, but when it comes down to doing what i need to do to protect my license I take the time to check it all out. and so what if we add a few minutes to our turn over time, shoot! the viralcide used to clean the rooms needs 15 minutes any way to be effective. and for @%$& and giggles i sometimes have the surgeons help turn over the room while i'm checking over my mound of paper work.

    in all said, take the time to protect yourself.
  4. by   Marie_LPN, RN
    Oh if i have to hear about turn-over time one more time...

    We're always hearing about how we can get faster. NEVERMIND the majority of the time that the delays are caused by docs, but it's about how us nurses can improve this problem.

    Our turnover time is typically a half-hour for most cases, except for vascular and total joint cases, which leave a room a mess.

    When the supervisor read a "suggested" list of how to improve turnover time, one nurse raised her hand and said "Um, excuse me, when are we supposed to pee??" Yeah, really, i want to know.

    It's never the curculator who pushes for fast turnover time. It's the asst. supervisor. I've never pushed for a faster time, because, like the OP pointed out, going too fast can lead to an instant error. I think the hospital can afford a few late minutes, than an incident report as a result of the whip cracking over our heads.

    (Head 'em up, move 'em out, RAWHIDE!!)
  5. by   SFCardiacRN
    Today we waited for an hour for the surgeon to show up ("stuck in traffic"). Then his 1 hour case took 3 hours. Then he had the nerve to ask for a quick turnover for his to-follow! The entire room was cracking up as he skulked out of the OR.
  6. by   ORSmurf
    I was a scrub for 8 years and finally finished the RN program this May. I've been orienting to circulate and have to say the most uncomfortable part for me is keeping up with the fast pace. I feel great some days, then other days I feel like I'm drowning and can't keep up and go home near tears... I know that's all part of being new. I just hate feeling so pushed/rushed all day.
    Christine
  7. by   SFCardiacRN
    Congratulations on passing the NCLEX. I think former scrub techs make some of the best circulating RN's. Now you know that we do more than open supplies and answer the phone!
  8. by   carcha
    After many years in the OR I have decided that nurses are their own worst enemy. We rush between cases, run down corridors, do two tasks at once, miss meal breaks, so on and so forth. Lets face it we are the ones to blame when we stress ourselves out so much that we end up worrying that we have forgotten something. I am guilty of exactly the same thing but am improving rapidly to a point that I completly shut my room for an hour last week so that all the nurses could have a decent lunch break as we had no relief. Lets start to look after ourselves and not worry about the surgeon being happy that we've finished or started their list on time. This problem is global, I really think as nurses we are somehow conditioned to believe that the most important result is surgeon satisfaction. Now I look for patient, nurse and surgeon satisfaction and if it means a short delay, so what the work gets done but by less stressed nurses.
  9. by   ORSmurf
    Thanks. You're right - I had no idea how much I didn't know about what a circulator does. I think it would be a good idea to have all our scrubs shadow a circulator for a day or two to get more of an idea of what they actually do. I'm guilty of thinking that it would be less physical... boy oh boy was I wrong there! I've also got a lot more bruises than ever before :imbar

    Quote from SFCardiacRN
    Congratulations on passing the NCLEX. I think former scrub techs make some of the best circulating RN's. Now you know that we do more than open supplies and answer the phone!
  10. by   paigeRN1962
    Quote from carcha
    Lets start to look after ourselves and not worry about the surgeon being happy that we've finished or started their list on time. This problem is global, I really think as nurses we are somehow conditioned to believe that the most important result is surgeon satisfaction. Now I look for patient, nurse and surgeon satisfaction and if it means a short delay, so what the work gets done but by less stressed nurses.
    AMEN to that! I am sick to death of my NM harping on us about turn-over time.......then griping that I am getting over-time because my computer charting wasn't completed before the end of my shift and says, "Are you still here?" :angryfire (in spite of bilateral carpal tunnel repair surgery less than a year ago due to computer charting ). Doesn't seem to matter that I ran all during the case to get stuff the tech didn't get because s/he didn't check the card. And yes, I used to be a tech so I do understand both sides and I do look at the card and some techs really resent being asked to check things together. I work with one particular tech who opens her instruments, back table and thats it and then sits at the desk with the supervisor, gossiping about the other employees. Last week she told me she had everything ready and I went about dragging more stuff into the room and doing everything I could before the patient was rolled in while she sat and watched me and couldn't care less.......only to find out that half the stuff wasn't even opened and this tech has such an attitude that to try to work with her and get her to double-check our pull for the case is impossible. She looks at me like I am crazy if I ask her to bring in another piece of equipment----as if that is not her job. It has been written up and the supervisor always protects this tech as the tech is her brown-nose favorite. Do we take it to the next level-----of course we have and it gets us nowhere. I have taken to documenting every incident, every snide, disrespectful remark and this is the only way to cover my butt. Are there other nurses here who get blamed by the tech for not being prepared and while you are out of the room, the tech tells the surgeon you are the one at fault? the thing is that a lot of docs believe this as many of them don't understand the teamwork involved or that many techs think their job ends with opening up their back table instruments and then they go off somewhere until time to scrub. Please don't flame me---I used to be a tech and I am not generalizing ----when I work with a tech or scrub nurse who is a real team player, it's amazing how smooth things go and we all have a good day. But unpreparedness on the part of either the nurse or the tech can significantly slow down turn-over time.
  11. by   lesrn2005
    Brand new nurse here-finishing up my orientation on med-surg-this is where I'll stay for at least a year. I have a quick question-if I ever need to document snide remarks, insults, work relations or anything to cover my fanny, where would I do this? A lot of the posts I read always talk about documenting to cover yourself, I of course always document pt care in computer and pts. chart. What about the rest?
  12. by   paigeRN1962
    I write what I want to remember in my own notebook with dates and details that does not specify a patient's identity as I have heard that these can be deposed as evidence if there is a lawsuit. When I feel I have enough to show a pattern of abuse either from a co-worker or a doctor, I take it to my NM first. I always follow the chain of command but I had to go over her head as did a few others in order to get a doc called in to the CEO's office and reprimanded for harassment and unprofessional behavior. Time will tell if his attitude and actions will change. An internal investigation is where this should start because sometime these things can be taken care of without going any further with it. Of course none of this ever belongs in a patient chart, only objective observations and interventions----no commentary or finger-pointing. I've heard of doctors doing this in order to place the blame on someone else for something and it usually ends up biting them---lawyers love this kind of stuff.
    Writing someone up is a rare thing that I have to do because usually the peer pressure causes most people to get back in line because they hear the talk going on and it gets pretty ugly and no one wants to be known as the reason everyone is miserable.
  13. by   grimmy
    Quote from orsmurf
    i was a scrub for 8 years and finally finished the rn program this may. i've been orienting to circulate and have to say the most uncomfortable part for me is keeping up with the fast pace. i feel great some days, then other days i feel like i'm drowning and can't keep up and go home near tears... i know that's all part of being new. i just hate feeling so pushed/rushed all day.
    christine
    [font="book antiqua"]that kind of organization takes time. even today i am only getting it narrowed down, and when a really goofy case comes the system is thrown out of whack, and you're back to square one. i do try to get my day started on time, at a bare minimum. i am particularly peeved when anesthesia is delayed because they suddenly decide to offer an epidural. this is can put things back for an hour or more because there is an epidural team that takes forever to get things done. this sort of decision should have been made during the anesthesia interview the night previous! who does the surgeon look to when things are late? me. all in all, the people i work with are wonderful. i have a pct who knows how to read a card, get equipment in the room, and restock. she is great at assisting in positioning, and that helps me out immensely. but, even with all of the good people i have around me, things get backed up, equipment fails, pt conditions vary. and...most of all, we're human. it is never going to be perfect. i believe we have to give ourselves that benefit, and accept it with as much grace as possible.
  14. by   Pam RN
    "You need to write faster!" exclaimed the doctor. I was keeping a record during a Discogram and she, the doctor was reading numbers and information to me and shouted at me in a snotty tone of voice, twice, that I need to write faster. Well, I guess I'm just too slow for this job then. Call me what ever you want but I guess I can't keep up anymore. I can't multi-task, I write too slow, I can't get the patients to the room fast enough. Maybe I need to go back and do long cases in the hospital rather than short quick cases in the surgicenter. I feel like I can't keep up and now I've been shouted at for it. :angryfire

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