All I know (LONG)

[grimmy, RN]

after my or experience on friday, all i know is how much i don't know. i felt hung out to dry, and while everyone told me about the potential for this experience when i first walked through the doors, it took a whole year for it to happen.

i spent 15 hours in the or on friday. i normally work 4 ten-hour days, so i usually get relieved at 5:15. not on friday. the head of the thoracic service, who was circulating, got relieved as she was ot. earlier in the day, she deemed this a "perfect learning case" for me. when she was relieved, she left without a backwards glance. :imbar the relief circ emphatically did not want to scrub as she was on the ent team. i was scrubbing for a procedure i had never scrubbed previously: a chest wall resection. i am, by nature, a little high-strung, but i rarely ever panic or go over the deep end, but i'll tell you that by 8pm, i was quite literally praying for relief. at first, i was mad at the surgeon, but after having slept on it a couple nights, i'm angry at the situation and grateful that the surgeon has as much patience as he did. we went through at least 6 staplers, and my back table was covered from hip to hip. there were two surgeons and a medical student. thank god for the medical student because she literally kept things from falling off the patient as i made a mad scramble to keep up with the surgeons' demands, which were fast and furious. when it came time to reapproximate the chest wall with goretex, the drill (to make holes in the ribs) malfunctioned, and the surgeon grabbed the drill out my hands before i could put the safety on. the drill bit flew out of the drill and landed on the pt. of course, it could have flown into the wound and into the aorta, but thankfully, it didn't. we got the drill working properly. they wanted fibrin glue, which i, of course, had never worked with before. that took me forever. the circulator said, "just put it together!" well, there are a couple ways to put it together and, of course, i didn't put it together the way the surgeon wanted it. thank goodness the bone cement and lead hand weren't necessary because i have never done that, either. of course, when i was finally relieved about 8:30, the case was nearly finished, and the needle count was incorrect. i have never felt quite so inept as i did that night. i stayed and went through everything to find that dang needle, and we found it (a 5-0 prolene) on the floor as soon as x-ray came through the door.

:angryfire i'm angry: angry that the patient could have really suffered from my lack of experience and lack of support; angry that i was put into such a precarious position; angry that my 1st circulator (essentially my superior) left without making sure that i could handle it; and angry that i don't even know how to learn more so that this never happens again. believe me, i'm going to go to someone (i have her in mind when she gets back from vacation) to get some real intense instruction privately. this can't happen again because the potential for a real disaster is high. i was told that i'll start learning about lung transplants soon, but i'm going to put the brakes on that tomorrow. until i get a better handle on the timing, pacing, and basic tools for these basic thoracic procedures, i don't trust myself. i'm totally freaked out.

[canoehead, BSN, RN]

Good for you. I agree with your assessment and give you a big high five for getting through the day. That was a horrible situation, and not fair to you or anyone else that was left without help. (especially you)

[suzanne4, RN]

When a case is that demanding, you could have used two scrubs and should have asked for it. And for the supervisor to leave and not consider you, is totally inappropriate. She made sure that she had coverage so that she could leave, it was her resonsibility to make sure that you had coverage as well. There is absolutely no way that you should have been put in that situation where neither the scrub or the circulator have done that type of case. At least if the circulator was familiar with it, then it would have been a tad easier, but safe?? No, and should be documented to your manager as such.

Where was the OR manager or director as this was going on?

You need to be fully trained in all aspects of thoracic surgery before they should consider trnasplants for you, as well as you need to have your comfort zone there as well....with the transplants, there is actually moe going on in the room, if you can believe it.

Sorry that you had to go thru this, but definitely speak up about it on Monday. Me, I would have had the Director on the phone on Friday night. It is also ultimately their resonsibility for what hapeens under their watch.

[grimmy, RN]

when a case is that demanding, you could have used two scrubs and should have asked for it. and for the supervisor to leave and not consider you, is totally inappropriate. she made sure that she had coverage so that she could leave, it was her resonsibility to make sure that you had coverage as well. there is absolutely no way that you should have been put in that situation where neither the scrub or the circulator have done that type of case. at least if the circulator was familiar with it, then it would have been a tad easier, but safe?? no, and should be documented to your manager as such.

where was the or manager or director as this was going on?

you need to be fully trained in all aspects of thoracic surgery before they should consider trnasplants for you, as well as you need to have your comfort zone there as well....with the transplants, there is actually moe going on in the room, if you can believe it.

sorry that you had to go thru this, but definitely speak up about it on monday. me, i would have had the director on the phone on friday night. it is also ultimately their resonsibility for what hapeens under their watch.

unfortunately, we don't have an or manager. we haven't had one for some time (since before my time here). leadership is a major sore point at this institution's or. the charge nurse was, well, at the board, i presume, trying to arrange for relief. i couldn't exactly call to find out. as far as our or leadership goes, the interim person is not a nurse. he is an administrator. while i am sure he is an intelligent person, he has never done a nurse's job. i have been stewing on this whole ball of wax for the past 36 hours, and i am formulating a plan. my expectations for change are not exactly high, but i will do what i can do. i will write an email to our clinical director, but again, i don't know if this will p*ss off more people, and make matters worse for me. all i know is: this cannot happen to me again.

[suzanne4, RN]

It actually doesn't matter if the Director is a nurse or not. They know what the responsibilities are of the staff as well as who can do what. Or at least they should. To be left in that predicament is completely inappropriate. For the charge nurse to be at the desk and not coming to check on you either is not right. I have been working OR for too many years and this is just not acceptable, for the patient that is on the table ,as well as you.

I have worked with Directors who were not nurses in the past, and that was really never an issue. They definitely would never have approved this. They do know what is safe and what is not. I am surpirsed that the surgeons did not so anything about it. The CV docs that I worked with would never have allowed this to happen. They actually would have made the supervisor delay her vacation, if need be.

[OnCall4Life]

Wow Grimmy, sorry you had such a bad day. Kind of sounds like what happened to me on Friday also. Our 2 hour Thorocotomy turned out to be 7 hours. Plus the surgeon had a new partner with him that he was showing off to. So I feel your pain. I think we only went through 3 staplers but lots of refills!!! I think it is prettly lousy that your hospital put you in that kind of position. I agree you should go talk to someone. Unfortunately that happens a lot!! I'm not afraid to tell my supervisor that I don't know how to do a case and that they either get someone in there to scrub with me or I can go relieve someone else that can do the case. It seems that you guys need to get together and do some team nursing. Since you don't have a real OR supervisor maybe you can form teams like an Ortho team, a General team, a Chest team and whoever is in charge of that area can either help coach a team member or find help for that team member. I've seen this done in large OR departments. The head of the teams meet in the morning to organize and assign appropriate personnel to their rooms. Once your team leader says you are profecient in that area they switch you to another team to learn that area. And the surgeons like the idea of being involved in the teams also. It's just a thought. Maybe something similar could work until you get your permanent OR supervisor. Good luck!!

[gcruz]

Unfortunately this happens alot.You have every right to inform whomever is in charge that you are not comfortable doing the surgery.And if they still make you do this ,be sure to document that you did inform the person in charge(Just in case somehing went wrong)I would also inform the surgeon that you're uncomfortable but that you'll do the best you can.

[grimmy, RN]

we do have teams. our thoracic team has only just come about in june, and the team leader only arrived a few weeks ago. i have the least experience of the 3 of us. some of the surgeons want to be an active part of the team, and others expect miracles overnight. i think the main problem is a lack of coordination with the team leaders and the charge who does assignments for the next day and/or between shifts. it would have been sweet if the charge nurse (who makes assignments) knew that i needed someone experienced to relieve me pronto - that, or assign a circ who knew a lot more than the person who came in. regardless, it is not just a single person creating this kind of charlie foxtrot. its certainly bad enough that the staffing levels are at a bare minimum, and our case loads are getting higher.

i just want to thank everyone for listening and helping me to get my mind around this experience. please continue to have patience with me. being a baby nurse at 40 years old, i am grateful i've had some previous life experience. i would never have made it this far without support from kind people out there.

[suzanne4, RN]

Just do not put yourself in a position where you jeopardize your license.

It is the same as if you always worked in a CVICU, then floated you to a Neuro ICU where they gave you a patient with two ventriculostomies. And you had never been around them before or used them. This can be considered the same.............

It is not fair to you or the patient.

[carcha]

Been there done that and it stinks. I have found no satisfaction in it and learned nothing at all. Its an awful situation to be in but I put the blame if I can use that word on your team leader. To have sorted herself out and left you so long is totally inappropriate and unprofessional. However I think if you ever find yourself in that situation again make sure in plenty of time that you have relief coming. I now having learned the hard way like you, never ever start a long case without letting my circulator know I will want relief. If you dont say anything then why expect anyone to care. Its not how it should be but thats the way it is. Cheer up, there are a lot more fulfilling days then downers I promise you that.