A Day in the Life of an OR Charge Nurse

[canesdukegirl, BSN, RN]

I love my job.

At least, I keep repeating this to myself when my day goes something like this:

While changing in the locker room, I am bending down to pull my jeans off of my legs, and two staff members ask me if they can go home early. Umm...can I get dressed first, please?

The night charge nurse exclaims, "Oh my GAWD! I am SO GLAD you are HERE! We had a crazy night, so forgive me if I forget to tell you something important. I'm sure you'll work it out."

The schedule is crazy busy; packed and stacked. I finish going over plans for add on cases with the anesthesia charge and start implementing the plans. Every OR but one has started, and things are going smoothly. Then my trauma pager goes off. "39 yo f rollover MVA, HR 145, BP 60/40, intubated. ETA 15 minutes air." I have to hold the only room open. I alert the surgeon, and he rips me a new one. "But my patient was getting an epidural, and anesthesia failed at the first attempt! We would have been in the room already if these knuckleheads could get a freaking epidural placed! Why am I being punished for their mistake?!?" The ranting continues for another 10 minutes. I cut him off to dash down to the trauma bay.

When I get back, a staff member comes rushing up to the charge desk, and breathlessly says, "I have a problem! You need to come to my OR RIGHT NOW!" My HR increases, wondering what sort of chaotic mess I was about to encounter. I go with him to the room, and he points accusingly to a med student. "HE isn't wearing hospital issued scrubs! Do something!"

On the way back to the desk from the OR, I hear a staff member cursing and yelling about a newly implemented policy. I step into the OR and notice that the patient has not yet been induced. While pulling her aside and pointing out that the patient was still awake, and her behavior was inappropriate, the surgeon storms into the room and asks what the bleep is taking so bleeping long to get his case started.

I make lunch assignments and post them for the evening staff. Two staff members start quarreling with each other about how unfair the assignments are. "I've done more off-service reliefs than YOU have!" I have to stop what I am doing to referee the spat. I pull out the assignment sheets from the previous two weeks and show them that they have had an equal number of off-service assignments.

The anesthesia charge is incensed, and demands to know why OR 3 hasn't started their case yet. Since I have been putting out fires, I don't know the answer to his question, and he becomes even more angry. "Well, aren't you IN CHARGE?" After troubleshooting, I find that the patient is a prisoner, and the DOC was late getting the patient to the hospital. I communicate my findings to the anesthesia charge, and he accuses me of not being vigilant when it comes to DOC patients, because they are "notoriously late, Canes. You know that. You should have called them first thing this morning!"

An emergency ex-lap gets posted, and I tell the new attending that they have to bump another attending, and as protocol states, she must contact the attending directly. She looks at me like I have three heads and exclaims, "It's an EMERGENCY, Canes! I don't have time to barter! YOU do it!" And then she rushes off.

Three o'clock rolls around, and I make relief assignments. One staff member tells me that they have no idea how to circulate a spine case, although their competency sheet has been checked off for spine cases. Another staff member stomps his foot, curses loudly, and complains that he always gets the worst cases, and "aren't there other people that know how to do this case? Why are you always picking on me, Canes? What have I ever done to you?"

A surgeon approaches the desk, his face red. "Canes, there is NO MORE SOAP in the men's locker room. Can't you do something about that? We kinda need SOAP in the LOCKER ROOM!"

"Canes, phone!" the secretary shouts. I pick up the phone to answer a hundred questions from a rep that is scheduled to be in the OR the next morning. Meanwhile, a staff member has approached the desk in tears. "I need to talk to you NOW!" she says. I finish up the call (finally) and ask her what's wrong. She states that the circulator whom she was to relieve isn't being nice to her. I leave the desk and resolve the dispute-which was whether or not the OR jacket was supposed to be completely buttoned while in the OR.

Two evening shift staff members call out at the last minute.

Five o'clock catches me off guard. We have too many rooms running, and I have to ask for volunteers to stay and finish cases. Most don't (totally understandable) and a few agree to stay. The same few that always agree to stay. I feel badly that I don't have enough staff to run the rooms, and worry that these few staff members will get burned out.

I miss a two o'clock meeting with my quality initiative committee. I send a brief email to the chair, explaining that it's been crazy, and apologize for my absence.

"Canes, phone!" the secretary shouts. I answer the call, and it's my Nurse Manager. "Don't forget that you have to do that inservice for the evening staff regarding the new protocol." I have my inservice notes loaded onto a thumb drive, and spent three hours last evening preparing it. I plug it into the work computer, and it's not reading. Error message. No data. I try to piece together new notes, but keep getting interrupted. I have to reschedule the inservice.

It's now six o'clock, and I realize that I haven't eaten, nor have I gone to the bathroom. As I walk toward the locker room to pee and grab a granola bar out of my locker, the trauma pager goes off again.

"I love my job", I say to myself as I run down the hall to the ER.

[avaloncar, BSN, RN]

Wow...intense. But once you can still say you love your job is all that matters.

[Rose_Queen, BSN, MSN, RN]

And too many days like that are exactly why I gave up my charge role.

[canesdukegirl, BSN, RN]

SWR-

I don't blame you one tiny bit! It's exhausting.

However, I find that I am most productive when I am crazy busy. I could certainly do without the "manufactured drama" from staff members, and the skewed perception by staff/surgeons/anesthesiologists/managers, et al, that I am responsible for everything that goes on in the OR-like replacing the soap in the locker room, delayed cases resulting from inadequate paperwork (H&P, consents, lab work), fixing the tube station (which is down, once again), adjusting the temperature/humidity at the request of an irate surgeon, or providing extra staff when there are none.

I enjoy the challenge of thinking on my feet, problem solving, and collaborating with staff. That's what keeps me going back every single day.

Oh, and I forgot to mention that the extra dollar an hour for charge is an extra special incentive

[kguill975, MSN, APRN, NP]

Do you work at a county hospital in Houston? Just kidding, but it does sound a lot like my job. Days are crazy, and whereas I never liked charging on days, it's a non issue on nights. Makes being a night charge nurse so worth it. No prima donnas, no favoritism, and no non-sense.

[Rose_Queen, BSN, MSN, RN]

No prima donnas, no favoritism, and no non-sense.

Wish that's how it was as evening shift charge! It seemed like the prima donnas were worse- I need to bump him and do my case/He can't bump me, I need to do my case/What do you mean I have to wait- who cares about that trauma?/etc. Now, I do work with a bunch of prima donnas (heart surgeons- need I say more?), and days where we don't have cases drive me nuts, but I love it much more (and that $1/hour I lost? Don't care the teeniest little bit). And that doesn't include the drama from the staff. We didn't have regular evening shift staff, everyone had to rotate- and everyone ******* and moaned about it the entire time.

[Surgery182]

You're a hero for doing it. They couldn't pay me enough to charge/babysit. Thank you for stepping up and doing it so that others don't have to! It really is a thankless position most of the time.

[Ilovethe80s]

I love my job.

At least, I keep repeating this to myself when my day goes something like this:

While changing in the locker room, I am bending down to pull my jeans off of my legs, and two staff members ask me if they can go home early. Umm...can I get dressed first, please?

The night charge nurse exclaims, "Oh my GAWD! I am SO GLAD you are HERE! We had a crazy night, so forgive me if I forget to tell you something important. I'm sure you'll work it out."

The schedule is crazy busy; packed and stacked. I finish going over plans for add on cases with the anesthesia charge and start implementing the plans. Every OR but one has started, and things are going smoothly. Then my trauma pager goes off. "39 yo f rollover MVA, HR 145, BP 60/40, intubated. ETA 15 minutes air." I have to hold the only room open. I alert the surgeon, and he rips me a new one. "But my patient was getting an epidural, and anesthesia failed at the first attempt! We would have been in the room already if these knuckleheads could get a freaking epidural placed! Why am I being punished for their mistake?!?" The ranting continues for another 10 minutes. I cut him off to dash down to the trauma bay.

When I get back, a staff member comes rushing up to the charge desk, and breathlessly says, "I have a problem! You need to come to my OR RIGHT NOW!" My HR increases, wondering what sort of chaotic mess I was about to encounter. I go with him to the room, and he points accusingly to a med student. "HE isn't wearing hospital issued scrubs! Do something!"

On the way back to the desk from the OR, I hear a staff member cursing and yelling about a newly implemented policy. I step into the OR and notice that the patient has not yet been induced. While pulling her aside and pointing out that the patient was still awake, and her behavior was inappropriate, the surgeon storms into the room and asks what the bleep is taking so bleeping long to get his case started.

I make lunch assignments and post them for the evening staff. Two staff members start quarreling with each other about how unfair the assignments are. "I've done more off-service reliefs than YOU have!" I have to stop what I am doing to referee the spat. I pull out the assignment sheets from the previous two weeks and show them that they have had an equal number of off-service assignments.

The anesthesia charge is incensed, and demands to know why OR 3 hasn't started their case yet. Since I have been putting out fires, I don't know the answer to his question, and he becomes even more angry. "Well, aren't you IN CHARGE?" After troubleshooting, I find that the patient is a prisoner, and the DOC was late getting the patient to the hospital. I communicate my findings to the anesthesia charge, and he accuses me of not being vigilant when it comes to DOC patients, because they are "notoriously late, Canes. You know that. You should have called them first thing this morning!"

An emergency ex-lap gets posted, and I tell the new attending that they have to bump another attending, and as protocol states, she must contact the attending directly. She looks at me like I have three heads and exclaims, "It's an EMERGENCY, Canes! I don't have time to barter! YOU do it!" And then she rushes off.

Three o'clock rolls around, and I make relief assignments. One staff member tells me that they have no idea how to circulate a spine case, although their competency sheet has been checked off for spine cases. Another staff member stomps his foot, curses loudly, and complains that he always gets the worst cases, and "aren't there other people that know how to do this case? Why are you always picking on me, Canes? What have I ever done to you?"

A surgeon approaches the desk, his face red. "Canes, there is NO MORE SOAP in the men's locker room. Can't you do something about that? We kinda need SOAP in the LOCKER ROOM!"

"Canes, phone!" the secretary shouts. I pick up the phone to answer a hundred questions from a rep that is scheduled to be in the OR the next morning. Meanwhile, a staff member has approached the desk in tears. "I need to talk to you NOW!" she says. I finish up the call (finally) and ask her what's wrong. She states that the circulator whom she was to relieve isn't being nice to her. I leave the desk and resolve the dispute-which was whether or not the OR jacket was supposed to be completely buttoned while in the OR.

Two evening shift staff members call out at the last minute.

Five o'clock catches me off guard. We have too many rooms running, and I have to ask for volunteers to stay and finish cases. Most don't (totally understandable) and a few agree to stay. The same few that always agree to stay. I feel badly that I don't have enough staff to run the rooms, and worry that these few staff members will get burned out.

I miss a two o'clock meeting with my quality initiative committee. I send a brief email to the chair, explaining that it's been crazy, and apologize for my absence.

"Canes, phone!" the secretary shouts. I answer the call, and it's my Nurse Manager. "Don't forget that you have to do that inservice for the evening staff regarding the new protocol." I have my inservice notes loaded onto a thumb drive, and spent three hours last evening preparing it. I plug it into the work computer, and it's not reading. Error message. No data. I try to piece together new notes, but keep getting interrupted. I have to reschedule the inservice.

It's now six o'clock, and I realize that I haven't eaten, nor have I gone to the bathroom. As I walk toward the locker room to pee and grab a granola bar out of my locker, the trauma pager goes off again.

"I love my job", I say to myself as I run down the hall to the ER.

Wow, you sound like an amazing charge nurse! I can only imagine the level of stress you are under on a daily basis. I have kind of a neutral relationship w/ my chg nurse. Overall I think she's in a tough spot bc she can never make everyone happy. I think ppl sometimes fail to realize that although their needs are their priority the charge nurse has to weed through everyone's priorities and make tough decisions. It's hard doing that when you have 30-40-50 people to try to please. So I try to stay out of my charge nurses hair and just do my job :)

[samswim4]

Sounds EXACTLY like my day. "I love my job..."