Stand your ground

[StikTie]

i just want to encourage all or circulators to stand your ground in that or suite! you know what is right and what is wrong! you have the authority to execute in your judgement, if a corner can be cut and how much it can be cut.

i am getting so tired of scrub technicians (whether certified, bonafide or calcified) who walk into an or and think they can 'decide' what to count, how to count and in some of the most outrageous very wide open chest and abdominal cases, if to count!

circulators...you are in control. but if you give control of that or over to a tech who has figured out they can intimidate you...you will some day find yourself explaining to the board of nursing why you let the tech call the shots! ( not to mention the judge)

i respect the heck out of my techs and i do not "pull rank" on them unless it is absolutely necessary. i have only ever had to do that two or three times in my career. i train new rn's in the or all the time. one of the very first things i drill into their heads is that everything that goes on in that room is the responsibility of the rn.

sometimes i get these hot shot techs who've been here, been there, been doin' it 30 years...well that's great. personally, i don't care if you were born into the world doing it and have the psychic ability to absolutely "know" where all your sponges and instruments are...you will still do a count as many times as i require which is equal to my satisfaction that we do have everything.

my techs have learned to appreciate and respect the way i run an or. it took them a while to realize that i have no 'pets'. i require all my techs to count the same way. i do not 'trust' sylvia cause she's been doin' it her way for 40 years.

i tell my techs...you can set up your field any way you want as long as it's integrity is maintained and does not potentially jeapordize my patient's well being should their break come up or they are going home before closing.

increasingly i am seeing rn's turning over the counting duties to 2 techs and the rn is out of the room. i saw 1 tech counting to the other tech and the tech's back was to him as he was putting new sheets on the or table...c'mon people...we are the ones who go to court if something goes wrong and we are idiots not to realize the awesome responsibility that we carry. surgeons are going to bellyache...they are taught to intimidate the inferior...it has never worked on me where ever intimidation has reared it's ugly head...we live in a sea of intimidation...we all had better learn ignore the whinings and whimperings of those around us. if we do what is best always for the patient...then we are in fact protecting everyone else's behind. surgeons are no exception!! they absolutely will perform a surgical scrub before they gown/glove and put their hands inside my patient. they will not be permitted to use blue/green or any other towel to put inside the body cavity unless it's a disecting aaa!!!! wishbone or backbone...which do we have?

[RNOTODAY, BSN, RN]

WOW! What a rant! I just hope you know that the techs do not work under your license. And the sole responsibility of what happens in the OR falls on the surgeon, not the nurse. Now, I haven't been in the OR long, but I do know that! If an ST is giving you problems and not doing their job properly report them. If they are certified or have been trained then they should know what to count and when and how to maintain their sterile field. Sounds like you have a problem with the ST's you work with and you should really let your supervisor know if they are not doing their job correctly...its not your license on the line, its the patients well being. A person like the one you described has no business being in the OR or anywhere else where they are responsible for a person!

Ummmmm....please, before going back into the OR,for your own sake, and for your patients and everyone elses who works with you, review what you have just said, and get the CORRECT info. :uhoh21:

wow.

[nurseontheloose]

i wish i had your back bone, i am a wimpy jellyfish that lets EVERYONE walk all over me. i am not a stupid person, i am an intelligent person, but also do not know everything. any suggestions in helping me develop a spine?

[valifay]

Well, thats how it is where I am. Our techs and nurses don't battle and share the responsibilities of the OR when the surgeon is not there. Any questions are directed to the surgeon if we are not sure and the cut isn't made unless we are all on the same page. Maybe I'm just lucky enough to be part of such a great OR team...Idk? All our techs are certified too, so that might be the difference. But that wasn't really my point, sorry if I ticked anyone off. But, if your tech is not doing there job correctly, you really need to report them. You are putting patients at risk if they continue with poor technique. And if your hospital is holding you responsible for the tech, then you really need to speak up since its your butt on the line.

[Marie_LPN, RN, LPN, RN]

But that wasn't really my point, sorry if I ticked anyone off.

It's not a matter of ticking people off, it was the matter that you were stating/implying that the nurse (RN circulator) isn't soley responsible for what goes on in the room, and that is higly false.

[Marie_LPN, RN, LPN, RN]

Any questions are directed to the surgeon if we are not sure and the cut isn't made unless we are all on the same page.

Our cuts aren't made until the circulator "times out", and the anesthesiologist says "go ahead" after the surgeon says "ready?" to them.

[ortess1971]

Well, thats how it is where I am. Our techs and nurses don't battle and share the responsibilities of the OR when the surgeon is not there. Any questions are directed to the surgeon if we are not sure and the cut isn't made unless we are all on the same page. Maybe I'm just lucky enough to be part of such a great OR team...Idk? All our techs are certified too, so that might be the difference. But that wasn't really my point, sorry if I ticked anyone off. But, if your tech is not doing there job correctly, you really need to report them. You are putting patients at risk if they continue with poor technique. And if your hospital is holding you responsible for the tech, then you really need to speak up since its your butt on the line.

By and large, the nurses and techs don't battle in my OR either because most us realize that we all have a job to do and we are all valuable. No one here is trying to attack you, but you are failing to realize that the RN being responsible for the room is not the exception, it's the rule and is in the circulator's job description in most, if not all, facilities. She can report the tech for not counting all she wants, but that count HAS to be done, no questions. If that means she has to be very firm about it, than so be it. Certification, by the way, looks nice on paper but it's not the same as a license and I certainly didn't get recognized for it, financially or otherwise. Trust me, if most surgeons had their way, they wouldn't do a time out. You should see how our docs whined at first at having to mark the correct surgical site. It took circulators putting their foot down and telling them that the patient doesn't leave the holding area with out the site being marked. Sure, that made a lot of circulators look b#@chy and mouthy but that's the kind of nurse I would want advocating for me, not one who's going to worry that she's going to offend someone's pride.