ASC nurses please give your input----is it like this everywhere?

[paigeRN1962]

I am an OR circulator with over 18 yrs exp. working in a new ASC since the doors opened 6 weeks ago. I am one of 2 circ. and spread so thin as to affect patient safety IMO. Yesterday I was called on the carpet and formally written up for not completing documentation and having 2 absences in 2 months. The day before this write-up, I worked 11.5 hours straight without a break, sat down once to use the restroom, and took care of 9 patients having surgery, 4 of which were under 5 yrs old, 3 were laser cases. I circulated without so much as a 10 min. break or any help whatsoever from my DON. Her only contribution to my day was to come into the OR 3 times, while I was in the middle of lasering, to demand I answer her RIGHT NOW, as to why we were running an hour behind. When asked to wait for an answer because I felt the patient, laser and surgeon at hand were my focus and prime responsibility, she got huffy and said DR. Bigshot was on the phone and wants to know RIGHT NOW. I said, Sorry but he will have to wait, this patient and this doctor is where I have to put my focus, I will deal with explaining late turnover time later. She wrote me up for this and said I was disrespectful and inappropriate to her. I told her and the administrator that I stand by my judgement call and that unless the hospital is on fire, I am not going to deal with her phone call issues while I am circulating a laser case by myself and that I will tell Dr. Bigshot the same thing if he were standing right here and that I doubt he was aware of what I was doing when he called and asked these questions. I am trying to respond in writing to these issues because it will go in my personnel file and I feel I am being put in an impossible situation.

I have pointed out some safety issues that jeopardize patients and my license and these still haven't been resolved. Such as lasering with one nurse in the room; being told to pre-chart to get my documentation done; not having an adequate amount of instruments to open a patient should there be complications during laparoscopic surgery (perforated bowel, hemorrhage, etc). I feel this has led to retaliation towards me. My DON is extremely defensive and is unable to circulate and unwilling to come out of her office long enough to learn. She tells me I am clueless as to all the responsibilities she has yet she is unwilling to hire or assign a charge nurse. This DON is very young, inexperienced and manages through intimidation---threatening to fire anyone who calls in sick. I have worked in an ASC before and never experienced such chaos or lack of follow-through----just lots of blame and finger-pointing. We are constantly out of basic supplies and cases are improperly scheduled by a temporary inexperienced scheduler. The other nurse I work with as well as the techs are all overwhelmed and each been to the administrators office to complain to no avail.

I don't want to resign yet because I've put a lot of effort into getting this place going and yet I feel my DON is so intimidated by me that she would cut off her nose to spite her face rather than fix any of these problems because she didn't see them first. She tells me she thinks I am an excellent nurse, very good with patients and know my job but on the other hand, has put me in an impossible situation where I am spread too thin to take care of patients safely. To be written up for failure to complete documentation after the 11 1/2 hour day I just described, makes me feel there is nothing but frustration ahead. How can I possibly be expected to work under conditions like this and still get all the documentation done (2 pages plus more on the computer, plus update preference computer cards and doctors orders, to name a few) All my patients had good outcomes, no errors were made and the doctors were the reason for late start times it was later determined. Anyone have any advice to help me defend myself and not feel so beaten down? Also where can I find information regarding the laser safety issue and the issues regarding inadequate instrumentation to do laparoscopic surgery? Thanks for any help and sorry to ramble on so much but I am tired of going home exhausted and in tears almost every night.

[PedsRNBSN]

Well....I don't know what to say except...RUN! I now work in an ASC and just learned to circulate and it seems that every day there is a "fire" that i have to put out, but it ends up not being that big of a deal and my job is incredibly NOT stressful and I love it. .....no chance of you looking for work in Atlanta huh? Anyway, you could sit down and talk to your DON and higher ups about it, or you could simply look for something that fits you better....and makes you happy! Good luck

[SFCardiacRN]

I have to agree with pedsRN. Too many good jobs out there (esp. OR) to put up with all that. I does not make you a quitter to seek better employment. Besides, I quit a similar situation in a private OR and they greatly increased my pay and reined in the office manager to get me back.