Circumcision at change of shift?

[Rhee]

I was just wondering what other hospitals do about this. Where I work, when the OB is ready to do the circ, that's when it happens.

This morning, an OB wanted to circ a baby at five minutes to seven, and all I wanted to do was finally, finally, finally crawl home and go to bed. However, I know that it needs to get done sometime, so off we went. The same OB wanted to circ another baby who was in the special care nursery, and he got upset that the nurse was not available since she was alone with three babies in the nursery and could not leave the room. He proceeded to tell me that change of shift is ridiculous, he needs to be at his office by eight, and there should always be someone available to assist him with circs. I understand that he has to get to his office, and I know that I get frustrated when I want to do things and the timing isn't right, but I don't think it's ridiculous that I want to go home after twelve and half hours of work instead of staying late.

This sort of turned into a mini-rant, but my tired, pregnant brain needed to vent. Anyways, I would like to know if other places always have a dedicated circ nurse (our night nursery nurse usually does this, but we only had a handful of pts last night, and only one baby in the nursery, so the nursery nurse got cancelled), or if circs are done at a certain time, or if there are any other solutions out there.

Thanks!

[CoffeeRTC, BSN, RN]

I'm not in ob, but this is just stoooopid. Like the doc's time is more valuable than the nurses? Can't your supervisors talk to this doc and get him to come earlier?

[rn/writer, RN]

At the hospital where I work, PCAs assist with circs. They receive special training, and some of them come in early (usually 6:30) to be ready for the early bird docs. We have 44 beds and two nurseries, so staffing is usually adequate enough for us to spare someone. Sounds like that is not the case with your unit.

Rather than snap at the nurses, this doc should be talking to your unit manager (he shouldn't snap at her either) to find a solution. If he knows what mornings he'll be coming in, maybe someone from days would be willing to come in early. Or a noc shift nurse could plan to stay late, with the key word being "plan." That implies some warning. Springing circ duty on a tired nurse at the last minute isn't good for anyone.

We don't circ our kids till they're at least six hours old, so most of the docs who are coming in know the night before. We don't know which doc out of a group practice will be doing the circ (meaning we don't know which timetable to go by because they're all different), but they know who's on call. If they could give you guys a jingle, you could plan accordingly.

Being a teaching hospital, we run into residents that are up anyway and want to do a circ at two or three in the morning. Or attendings that finish a delivery at 0400 and want to do any circs on their list while they're "in the neighborhood." We can usually accommodate them, but if we can't, we prefer that they don't turn into fussy babies about it.

At any rate, this doc needs to work something out with your manager that takes everyone's needs into account. I hope your manager is assertive enough to insist that her staff members' time is also valuable.

[mamamerlee, LPN]

Circs at SIX HOURS? OMG! Sure glad I'm Jewish, we wait until the 8th day. And I don't believe in circumcision as a general rule. Do it strictly as a religious preference.

BTW, long-term retrospective study done in New York revealed that the complication rate for circs done in the Jewish religious method was much less than those done by docs!

I thought that circumcision was starting to fall out of favor, and that many insurance co's didn't pay for it.

[rn/writer, RN]

Six hours is the absolute minimum. Rarely done at that point.

Putting staff hat on for a moment:

I thought that circumcision was starting to fall out of favor, and that many insurance co's didn't pay for it.

Because this is a highly controversial topic, I would ask that we limit discussion to the OP's questions about logistics and working with docs.

Here is a link to a previous discussion about circumcision itself that ran to 130 pages before it was closed:

https://allnurses.com/ob-gyn-nursing/the-circumcision-discussion-195222.html

[regularRN]

I'm thinking if the Md wants to circ at that time, he/she needs their PA to assist.

[burberrylover]

Circs at SIX HOURS? OMG! Sure glad I'm Jewish, we wait until the 8th day. And I don't believe in circumcision as a general rule. Do it strictly as a religious preference.

BTW, long-term retrospective study done in New York revealed that the complication rate for circs done in the Jewish religious method was much less than those done by docs!

I thought that circumcision was starting to fall out of favor, and that many insurance co's didn't pay for it.

I am not a Jew but when I was pregnant with my first (we were told it was a boy and were surprised when we had a girl) the first thing I did after the u/s was to get hold of a mohel(Ex and I had decided to circ) for that very reason. The rabbi was very open to helping us and in exchange we were prepared to make a donation to his temple. Alas, it was not to be....

[Justhere, BSN, RN]

Do you work at my hospital? We have a doc that loves to come right at shift change to to do circs. They just call us on the phone and say, I'll be there in 10 minutes please set all my babies up for circs.

Then we have to scramble around and get them ready. Some of them come like they said, but we had one doc one time call and have us set his kids up for circs and finally showed up an hour later. We have a designated room for the circs so the nurse that took all the kids down and had to wait is now behind on what she needed to do plus them kids being placed on the boards. I think the nurse said she bundled them up so they wouldn't get cold and loosened the straps some. But I thought that was just way toooooo long to wait. I would have been calling him and telling him to get there now because the babies were waiting.

[canoehead, BSN, RN]

Amazingly, where I worked OB we would put out all the supplies, have the babies available, and then when the doc showed up we'd just help them fasten the babies on the board, and the docs took care of the rest. They'd unfasten the kids and rediaper, and put them in the cots. Not necessarily dressed, or diapered snugly, but they had a blanket on and we were coming around within 5 minutes anyway to check for bleeding, and take away the trays.

Try laying out the stuff, and bringing in the baby and tell him to have at it...then check the baby and clean up the mess after report.

[NurseNora, BSN, RN]

When I was a young nurse the OB used to do the circs in the delivery room. I'm glad things have changed. In the hospital where I now work, the Ped providers all do them in their office and not in the hospital at all. That's an even better change!

By the way, my impression is that east of the Mississippi, the OB docs do the circs and west of the Mississippi, the peds guys do them. Is that so, or just how my particular experience has worked out?

I do know that I preferred it when the OBs did them. Obstetritions are also surgeons and used to handling surgical instruments. Pediatricians, not so much...

[rn/writer, RN]

Obstetritions are also surgeons and used to handling surgical instruments. Pediatricians, not so much...

Some parents seem surprised that the obstetricians do the circs (yes, I'm east of the Mississippi). When we explain why, we use the reason in the above quote. OBs actually have surgical skills and experience. Most peds do not. This must make sense to the parents, as they have all been satisfied with the explanation.

[mamamerlee, LPN]

As for the change of shift issue, where is the nursing management's backbone? Something like, Due to shift change, nursing staff may not be available between 645 - 800 AM. Please make every attempt to schedule routine circumcision outside of that time.

If stronger wording is necessary, make it 'will not', and drop the 2nd sentence.

Try to give them a week's notice. Let them know that they may bring their own assistant with them.