What is going on in this OR?

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    I really am having a tough time. Been in the OR for over 15 years. Moved to a new state last summer, and recently went back to work in the OR. I am CNOR certified. Nicest group of staff you will ever meet, but I have never seen anything like this OR in my life.

    First, the prepping is god awful. The tech or the surgeon preps. They have no idea how to do it. I've seen surgeons go up around the groin area with the Chloraprep and then go over the incision site on total hips, or start at the nasty toes and go up over the incision site. Go over the booty crack when doing backs and go over the incision site. I keep saying something but nothing changes. They don't even have betadine scrub and paint kits. Don't even know what I am talking about when I asked where they were. If the patient has an allergy to Chloraprep, they just paint some betadine on the incision site. I have only been here a short time but spend more time in the director's office complaining than I should. Nobody knows how the beds work. They think I'm crazy when I went to take the head of the bed off and put it at the foot for lithotomy. They don't know how to tuck arms. They insist on doing it under the mattress and pulling back on the patients arms even though it causes nerve injury, they refuse to do it under the patient. When they were showing me their autoclaves, they didn't have the Bowie Dick or anyway to test them. Didn't know what I was talking about. They flash instruments with towels in the tray. I explained that you shouldn't do that, towels sterilize at a different setting and they just look at me. Someone brought in a fresh pan of instruments and they nurse said just grab the pan because the towels are wet. Well then the pan hasn't had enough dry time and isn't sterile! They don't have count sheets for their instrument pans, just a general number of how many instruments should be in there. So when the count is off, nobody knows what is missing! They don't know how to apply the tourniquet, and when the doc does nobody ever buts a drape or tape or anything around it to keep prep from seeping up under it. Speaking of prep, they don't let the chloraprep dry, they just immediately drape. If a case is delayed they cover their tables with sheets and just leave them for ever how long until the case goes! Shall I continue? I just don't know what to do. I was hoping maybe I could change some things, but it's not be received well. Nicest people I have ever worked with in an OR but seriously???? Any thoughts. My thoughts are to move on down the road...LOL
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  3. 18 Comments so far...

  4. 2
    How are they getting through the accreditation process? They have to know right from wrong to get through inspections, so that implies that even though they know the difference they are electing to be lazy and ignorant when they don't think anybody is watching them. Move on down the road my friend. Let those nice people have the job if their conscience can stand it.
    4100RN and none the wiser like this.
  5. 1
    I'm trying to figure out the same thing. I'm beginning to second guess myself, and wonder if I'm the one who is crazy. I just can't deal with it anymore. Thanks for replying, I'm beginning to think I'm nuts.

    And, furthermore, I would LOVE to see their infection rates. I have only been there 6 weeks, but it's gotta be through the roof!
    GadgetRN71 likes this.
  6. 0
    Is there an Infection Control specialist at the facility that you can bring your concerns to? Do they have a copy of the AORN standards?

    Good luck!
  7. 3
    No. Count. Sheet.

    Get outta there!
    4100RN, imaginations, and GadgetRN71 like this.
  8. 1
    Fracturenurse thanks for your post! I am going through a similar hell. I am also an experienced OR Nurse. I have my CNOR and have followed AORN Standards through my career. I have moved to a new state as well. I am torn as to what do to. What did you do with your situation?

    The folks I work with are nice people, but they have NO standards. The constant cussing is even done in areas where patients family can hear them. I thought about going to my Nurse Manager, but her language could rival a crusty old sailor!

    I am one of three people who actually change when we get to work. The others wear their OR scrubs to and from work. Which I guess doesn't matter when they wear exposed Long sleeves/turtlenecks under their scrubs. The Scrub Techs scrub in for cases with LONG SLEEVES! How is that even possible? They don't wear masks in rooms where cases are open and set up. One surgeon refuses to have the OR door closed while a case is going on.

    Eating . . . they walk around eating and drinking IN THE ROOMS! I even had an Anesthesiologist ask me to get him a fresh coffee! I explained "If I wanted to be a Coffee Barista I would apply at Starbucks, I heard the benefits were good." He was not very happy, but too bad! I cannot sink to their level and bring coffee into the OR. I just learned last week that they flash their instruments between total joint cases. While observing my preceptor prep a shoulder, she started in the pit and worked out. I mentioned these practices to another nurse who seemed to be more "with it" I was told "That is what pre-op antibiotics are for."

    Last week I witnessed our Rad Tech giving the Ortho Rep a crash course in running the C-ARM during a case so he could leave the room for a couple minutes. I stopped him when he got to the door and said that it was unacceptable for him to do that. He didn't see why.

    Anesthesia leaves the rooms for "potty breaks" with out anyone to relieve them. REALLY!!!

    Counts . . . They don't count suture needles under 11mm. There is only one Tech that counts suture needles correctly. The others count multipacks without opening them! Even when they are open they can't be bothered to count them individually. Last week I had a "seasoned" Tech drop plain 4x4's onto the mayo of a Student Tech! When I asked for them to be handed off and replaced with Raytec the Tech with "experience" thought I was nuts! The case was a thyroidectomy. I witnessed my preceptor not bother to count anything on a case. I could go on . . . and on.

    They do know better, as I was told not to do things like this when they were under audit. Seriously? Thanks for the warning?

    I have been there just under a month. My gut says "don't go back, just start looking for a new job." I have never just walked away from a position. I am sure since I am still on orientation they will just ask me to leave if I give two weeks notice. Any advice?
    GadgetRN71 likes this.
  9. 0
    Wow, and I thought my current facility has problems. It sounds terrible to say, but one person isn't going to be able to change these bad habits. It's going to take a sentinel event and you don't want to be there when it happens. I would run, and not look back,lol.
  10. 0
    If I were you , I wld find something else.. They obviously don't know standard precautions , sterile technique , or anytime of OR standards...
  11. 0
    Wow, just wow! I am speechless! I'd be on the AORN website printing material out like mad and handing it to your manager. The circumstances you describe are not only ignorant but downright dangerous!
  12. 0
    WOW, Twice!! I would run outta there so fast, their heads would spin! It's your license on the line, and you know what is safe for the patient, so don't let their crappy practices bring down your great clinical skills. I'm only 1 year into OR nursing and I love it, but all of what you're saying are even obvious to me, as a newer nurse. I'm so glad that my preceptor taught me well and hearing you talk about their horrible practices makes me nauseous to think that there are patients out there now with surgical site infections because of institutions like the one you're describing.

    You'll easily find another job with your skills. I'm sorry to hear that you're having a bad experience. Hope it improves somewhere else :-)


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