"They" (AORN et al) always tell us "The circulator is in charge of the room."
I agree that that is the way it should be.
I believe that the circulator is first and foremost the advocate for the patient, and should have the power to say to the surgical team, if they feel a patient care environment or situation is suboptimal or dangerous:
"I will not proceed with this case until we get (fill in the blank) the proper monitoring equipment, better informed consent, an interpreter, more experienced personnel, the proper instrumentation, etc. This is dangerous patient care. I will not compromise patient care."
I think we have all been in a situation such as this:
Specialty hardware has not arrived yet for a case. Or, even better scenario: Frozen bone graft has not arrived from bone bank.
The desk says, despite your objections, "Just put the patient on the table; the rep called and says he is on his way." (The desk RN is probably under pressure, either from management or other surgeons, to keep the schedule moving.)
Then the case is well underway, you are ready for the hardware or allograft, and guess what: the rep or bone bank person is stuck in traffic across town.
Or, how about this one: You are scheduled to do an extremely dangerous and/or complicated case; one which you and the surgeon and your scrub have done many, many times before, and feel comfortable with.
However, on this particular day, an anesthesia provider is assigned whom you know has very little experience with this procedure, or, even worse, is one that you have seen get into trouble on a procedure such as this one before.
I feel that you, as the circulator and in your role as patient advocate, have not just the right but the responsibility to speak up to the surgical team as to your gut feelings, your rationale for them, and your suggestion as to who might be a better choice for this case, even if it means delaying the case until that more experienced person is available.
You should be able to suggest a remedy as simple as a room trade between the two anesthesia providers.
Yet, usually "the desk" or management somehow gets involved; either voicing their disapproval as to how you dared to make a patient care decision without consulting them, or, worse, overriding your decision.
I would really like to get a clear cut position statement from AORN as to just HOW empowered (legally) we are in asserting our patient advocacy roles and taking charge of our rooms, as we should be able to.
Guidelines are worthless, in my opinion-- OR mangement tends to interpret them to suit their own agendas. Even "circulator in charge of the room" is interpreted differently by different managers in the same OR.
It seems that the circulator is frequently discouraged or even prohibited from making independent decisions in his or her own room. What is with this lack of autonomy? Don't they trust our critical thinking skills and experience?
Sadly, I think this is a control tactic on the part of management; I think some nurse managers simply don't value independent thinkers, even if it means compromising quality patient care. They want to be the only ones doing any decision making in "their" ORs.
In theory, and when writing policies they espouse the "circulator in charge of the room" theory, but in practice they always seem to want to override the decision of the circulator who wants to delay the case over issues like these--even if the case is elective, and even if another case could be put in the room in its place, so that the schedule would proceed uninterrupted.
What is really bad is the situation where, instead of supporting the nurse who says "It is my opinion that we should not proceed with this case until conditions X, Y and Z are satisfied, and I will not do so until they are," management instead assigns ANOTHER nurse to the room who has no objection to proceeding--usually a nurse who is less experienced or is new on staff and is afraid of "making waves."
Generally, if there is a patient safety issue, or if I feel, in talking to the patient or his family that he or they have not had all their questions or concerns addressed adequately by the surgeon, I hold off on taking the patient to the room until I am satisified that those questions have been addressed.
The surgeons I have worked with respect the nurses who speak up to them and make their concerns known; we are a team, after all.
I would love to hear from all OR nurses as to your opinions and experiences in this matter.
To what degree are you in charge of your rooms?
Do you have the support of management when you want to hold off doing a case because of patient safety or ethical concerns?
Do your surgeons respect your opinions and gut feelings about why it might compomise patient care to proceed with certain situations as they stand?
Do they respect and support your role as patient advocate and nurse in charge of room, and validate the fact that you can and should be able to decide whether a case should be cancelled or postponed?
Do they even know that you, as the circulating RN, are the one in charge of the room?
