ST and RN Advice Please

[staceyp413]

I am a 10 yr OR nurse and have scrubbed, circulated, and am back in management. This is the second OR I've worked in since I began my nursing career. I am trying to work on the TEAM concept and want any advice you might have.

Current complaints I see/hear the most from both sides:

The RN's get to the room late. The ST's don't go to the rooms when the RN brings in the pt to help w/transfer, positioning, etc. The RN takes forever to get the pt or come back from recovery. The ST isn't prepared and makes up for it by barking at me.

I'm a huge believer on 1:1 conflict resolution and my repsonse after listening will always be "Have you talked to the person about this?" Of course, the majority do not like conflict and then will go to their friend and complain and/or let it go and then the build up of animosity starts.

I'm not so far removed from the clinical setting that I don't remember how team work as a team but am challenged with ideas on how to get this message across and people to work together.

[ortess1971]

First of all let me say that I hear where you are coming from. I have just started circulating after being a scrub for 5 years(graduated NS in May) and this has been a problem in every OR I've been in...I don't where the teamwork concept gets lost but it does somehow. There is resentment sometimes on the part of the scrub because they don't feel valued and the RNs are stressed because they ultimately have the responsibility for what goes on.. This sounds harsh but I think the only solution is to have some set in stone policies about turnover times, people being in the room when they are supposed to, etc. It would be nice if you didn't have to micromanage like that but when you are dealing with strong personalities like those found in the OR, you have no choice. Good luck!

[steelydanfan]

Been there, done that.

My take..

ST's are NOT responsible for transporting or moving patients.

They are responsible for having the table ready, being ready to gown, drape and help prep as soon as the surgeon walks in.

The circ and the ANESTHESIOLOGIST are responsible for moving, bedding and securing the pt. onto the OR table.Nothing else happens to distract the circ until the pt. is anesthetised and the anesth. doc releases her.

The circ may then begin prep of the op site.

NO ONE gets to complain about the circ coming back late. The RR nurse may have not been able to take over immediately, the pt. may have had a complication, the report might have been complicated.

Circs are NOT required to help with room changeover (cleanup), that is the housekeepers job in collaberation with the ST. The circ will return to set up her meds and equipment ASAP as well as help with room changeover as able. This is a moot point if any other personnel is available.

Turnaround times are a goal, not a certainty. While surgeons want to be able to "go", and staff want to create a system; not all goals can be met everytime. Trying to "set in stone" turnover times is asking for trouble. Set targets, sure; set mandates, and get prepared to duck.

[ortess1971]

Been there, done that.

My take..

ST's are NOT responsible for transporting or moving patients.

They are responsible for having the table ready, being ready to gown, drape and help prep as soon as the surgeon walks in.

The circ and the ANESTHESIOLOGIST are responsible for moving, bedding and securing the pt. onto the OR table.Nothing else happens to distract the circ until the pt. is anesthetised and the anesth. doc releases her.

The circ may then begin prep of the op site.

NO ONE gets to complain about the circ coming back late. The RR nurse may have not been able to take over immediately, the pt. may have had a complication, the report might have been complicated.

Circs are NOT required to help with room changeover (cleanup), that is the housekeepers job in collaberation with the ST. The circ will return to set up her meds and equipment ASAP as well as help with room changeover as able. This is a moot point if any other personnel is available.

Turnaround times are a goal, not a certainty. While surgeons want to be able to "go", and staff want to create a system; not all goals can be met everytime. Trying to "set in stone" turnover times is asking for trouble. Set targets, sure; set mandates, and get prepared to duck.

Actually, people may complain about the circulator returning late if you have seen her sitting her butt down, making a personal phone call, having an extra coffee break etc. Also, the RN's at my OR are expected to help turn over the room and help do whatever needs to be done to keep things moving(I have mopped plenty of floors). Especially if you work in a big OR or work evenings-teamwork is key. I chuckled when I read that RN's don't help turnover-you'd make lots of enemies in my OR...

[Marie_LPN, RN, LPN, RN]

We had one circulator who thought that in between every case was HER time to get a cup of coffee and have a seat while everyone else cleaned up and turned over the room. Made enemies in 2 days. Was gone in less than a month.

I've helped bring the pt. in the room. I've also helped the MDA.I pull in equipment as able, i make sure everything is there for the case if able. I also get extra stuff that MIGHT be needed, to have it readily available, so someone doesn't have to go several feet down the hall to get it. And also cleaned rooms.

As long as it's legal, i'll pitch in and help where ever it's needed.

[staceyp413]

Thanks for the helpful comments. I too mop floors, count, help lift and transfer whenever I can get away from the board and surgeon's issues that they need to share..........I'm not sure of my title other than the one I gave myself when I began my career in the OR...........YOU KNOW WHAT Magnet!!

[RANCH GIRL]

Here's my :

First, I would review and update all policies, procedures, and job descriptions and make sure that all expectations are clearly delineated.

Then I would schedule a staff meeting and/or have each staff member individually review the updated material and sign for it, acknowledging that they understood it.

If you have to "remind" someone about their responsibilities as a team member, I've used what is called the "sandwich" technique. Have you heard of it? Start out the conversation with something to the effect of, "Sally/John, I really appreciate blah, blah." Then, as clearly as possible, explain that they need to help transfer a patient, turnover the OR, or whatever it is that you happen to need to counsel them about. Lastly, end the conversation on a positive note. And remember, while the nursing theory parallels the management model (plan, organize, direct, and control) these types of situations need to be directed and controlled.

That you asked for the advice/opinions of STs as well as RNs really demonstrates that you do value STs as part of your team, and this is clearly a credit to you. Please let me know what you think of my suggestions and hoping all works well for you. :icon_hug:

[RN Zeke]

I am a Surgical Technologist, will graduate ADN school in May 07. I mopped floors, moved patients, to and from the or, circulated, taught new RN's where the lab was and where to sign when they got blood ( ST's can't sign for blood). and have had a few Dr's that mopped the floor and got the patient also. It is all team work, respect each other's position and never think you are too good to do a job. That is one way to make a name for onself, and it isn't a good one!

[oldornurse99]

At my hospital policies are made as to turn over time, time in the rooms in the morning etc. A goal was set for turn overtime. It was part of everyone's evaluation whether this goal was met or not. If it was not met it reflected on all of our raises.

[mkmdbm7]

I am a manager too, and we had similar issues in the past.

We are small, and our dept. is the SPD, PACU, OR, and GI lab....so, EVERYONE is responsible for performing ALL duties.

When I first hired a CST here (we had always used LPN's in the scrub role in the past...) the one that was hired was of the mind set that she assists with surgery-that's it. That is what I was trained to do-if I wanted to be a housekeeper, I would have been a housekeeper, blah blah blah.

She was soon on everyone's #1 hit list, and I was quickly becoming frustrated.

I began making it a point to be in the rooms where she was during the work day, and assisting with the duties for awhile....processing trays, turning the room over...I did this for awhile, then we had a team discussion.

I explained to them that I was not asking anyone to perform duties that I would not perform myself (hard to argue that point) . I also explained that the patient is the priority, and it is EVERYONES job to ensure high quality care *BTW - to safely move a patient , it takes ideally 4 people, and three at a minimum-at our facility this is RN circulator, CST or scrub nurse, and anesthetist).

Because we are small, we will absolutely perform ALL necessary duties, or I am afraid it is OK for them to go somewhere else to work-that simple.

If a CST is avialable , he/she better help move a patient, and an RN can certainly help wash down equipment and open supplies.

Lack of team work would never work in our facility-

Kathy

[Marie_LPN, RN, LPN, RN]

the one that was hired was of the mind set that she assists with surgery-that's it. That is what I was trained to do-if I wanted to be a housekeeper, I would have been a housekeeper, blah blah blah.

We have one of those, too, actually whines if she's scrubbing second on a case.