ASC vs. hospital OR

[usnwbama]

I have been a nurse for 5 years (the majority of that time as a preop, circulating, pacu RN in the plastic surgery ambulatory surgery setting). I have been offered a job as an OR circulator in the inpatient hospital about 25 min away. 11a-7:30p M-F plus call. I've also been offered a job as a circulator at an ASC that is 45 min away from home. 7a-3:30p M-F no call. Have any of you ASC circulators once worked in the hospital OR? Which do you prefer?

My only concern is my lack of experience with any specialty other than plastics and the ASC being a very fast-paced environment. Also, it doesn't sound as if my orientation will be ideal. But...I really like the sound of no call. Any advice?

[brownbook]

I am no expert but no one else seems to want to give your question a try.

I think a lot of the fast pace ends up being keeping up with the paperwork as opposed to doing a good job as a circulator.

I hated being on call and would go with the ASC job. Take home their perioperative forms and get used to what goes where. Ask the experienced nurses what parts of the paperwork can be marked as not applicable. Or look over old charts to see what other nurses have done.

In charting there is so much redundancy. A by the book nurse might tell you to fill out every line and box, experienced nurses in a fast paced setting will hopefully tell you what has to be checked or filled out versus what can be left blank or "n/a."

Get through your busy day even knowing the paperwork might not be completed or perfect. Keep a list of your cases and find out where the charts go at the end of the day. Maybe even on your own time go over them and "buff" them.

[maxxilla]

I know this is almost a year old, but I'm replying in case it's applicable to anyone.

In-patient ORs will obviously have a wider variety of patients: the sickest, the under/uninsured, poly pharmacy like you have never have imagined. Common to all surgical patients: they don't report all of their meds/what or when they ate/if they do illicit drugs.

Since hospitals are more staffed, you get more help with turnover, etc. You are required to be less of a jack-of-all-trades.

Hospitals seem to de-emphasize speed in turnover in comparison to ASCs. YMMV depending on the type of facility.

Of course call is a big difference. More hours involved but also more money involved.

[Rose_Queen, BSN, MSN, RN]

I know this is almost a year old, but I'm replying in case it's applicable to anyone.

In-patient ORs will obviously have a wider variety of patients: the sickest, the under/uninsured, poly pharmacy like you have never have imagined. Common to all surgical patients: they don't report all of their meds/what or when they ate/if they do illicit drugs.

In patient ORs will also have a wider variety of patients because they can accommodate both outpatient and inpatient surgeries whereas ASCs can only accommodate outpatient.

Since hospitals are more staffed, you get more help with turnover, etc. You are required to be less of a jack-of-all-trades.

You obviously don't work with me! Not all hospitals are adequately staffed to assist with turnovers or sometimes even staff all rooms. As for the jack-of-all-trades, that will vary from facility to facility. Some will have staff stay within a single specialty team, others will be placed where they are needed regardless of the specialty. Additionally, depending on how call is structured, the people on call may be responsible for whatever rolls through the door.

Hospitals seem to de-emphasize speed in turnover in comparison to ASCs. YMMV depending on the type of facility.

Again, I beg to differ. Anytime staff is assigned to a room and there is not a patient in it, the hospital is losing money. My facility grades us daily on turnover times. We aren't meeting their (impossible) expectations.

Of course call is a big difference. More hours involved but also more money involved.

ASCs generally do not have second shift; this means that those who are working may not be relieved. With inpatient/hospital ORs, staffing patterns will affect amount of call time spent working. If the facility staffs several teams on second and third shifts, call teams may rarely be needed and therefore only get paid the small amount to be on call (we're set at $2/hour). Small community hospitals that don't offer complex surgeries but rather transfer those patients are less likely to spend call hours working. Staffing patterns and types of surgery offered will affect hours much more than ASC vs. hospital.

[maxxilla]

Well, we can just agree to disagree based on each of our experiences.

I have yet to work in a hospital that did not have a cleaning crew; I have worked in an ASC in which there was only us.

"Long" phaco's at my last ASC were 15 minutes; at the hospital, if we could get preoperative paperwork done and the patient situated in that amount of time I felt like pulling out the party hats.

Yes, time is money at both facilities, but when the doctor has a vested interest (read: ownership), s/he is a little more motivated to get that stuff done.