CVOR: How many nurses to an OR?

[SweetSouthernLove, ASN, BSN]

I have always had two RNs in my CVORs, which I feel benefits both the surgical staff and patients. I was curious if this is a common occurrence all over especially due to nursing shortages. We staff CVOR with 2 RNs, 2 scrubs, 1 PA/ARNP and this is the same way that call is set up as well. 2 RNs come in, 2 scrubs come in. It is the only way I have ever ran a CVOR, but again I have not worked in a facility where there was only 1 RN for this type of room.

Now with that being said, I have done open AAA repairs alone with myself and one scrub and two surgeons and it was an on-call situation and CVOR was standby. They eventually wound up calling in a second circulator but that was because my call shift was about to end. I stayed and helped the relief but she would have been alone otherwise.

Is there a protocol for this? Is it AORN standard to have 2 circulators? How do nurses feel about this?

[Rose_Queen, BSN, MSN, RN]

We have 1 circulator and 2 scrubs staff. Surgeon brings own PA. If we have a floater, the floater will help get the case started (place foley while circulator counts if RN, help with prepping if RN or ST). Honestly, if I had 2 circulators in a CVOR case, I'd be even more bored during the bulk of it. Our surgeons aren't the fastest, so there is lots of downtime while the case is happening. We keep the rooms well stocked so there is hardly any running, anesthesia has their own Pyxis within the OR so they don't need meds from anywhere else, and even for those cases we need supplies that aren't routinely kept in the room (aortic grafts, femoral cutdowns for redo cardiac surgery bypass access) we have carts we park right outside. I can take care of making a room needs list to restock, document my case except for implants and surgery closed and patient out of OR times, and have looked up my next patient by the time we're on cardiopulmonary bypass. There really isn't anything for a second circulator to do.

[cue.eyeroll, BSN]

Thanks for posting a comment Rose Queen. I'm considering a new job in an adult CVOR, and I'm told they are short on staff and have been running the heart rooms with 1 circulator and 1 scrub. It'd be an entirely new adventure for me if I accepted, so I just had no clue if that was a bad situation or not.

[RNMikeMiller]

Usually 1 circulator and 2 scrubs, crna and surgeon is most teams. @Rose_Queen Do you have a male floater to put in foley for male patients and a female floater for female patients?

[Rose_Queen, BSN, MSN, RN]

Most days we don’t have a floater at all. No, we do not segregate by gender for foley insertion- it’s a nursing skill to be able to place male AND female catheters.

[RNMikeMiller]

@Rose_Queen Funny that you do not segregate by gender because one of our female nurses demanded to have all-female team because she didn't want a male putting in a foley. Different when your the patient. Have you ever had a male put a foley into your badder?

[Rose_Queen, BSN, MSN, RN]

You’re beginning to go off the original topic. If a patient makes a request, yes we will try to honor it. Most of our patients make no such request.

[RNMikeMiller]

1. @Rose_Queen

[RNMikeMiller]

Rose I notice that you did not answer the question if you ever had a male insert a foley into your badder. Most patients do not make that request because you did not ask the patient. Put yourself in the patients position and see how it feels. Healthcare at that the focus and most important thing has since long been forgotten...”the patient."

A nurse who worked in surgery for many years made this confession: “They will wait until you are asleep to remove your gown and place the catheter and when you wake up you'll have that gown back on like nothing ever happened.”

[MunoRN, RN]

On 2/12/2020 at 7:51 AM, RNMikeMiller said:

Rose I notice that you did not answer the question if you ever had a male insert a foley into your badder. Most patients do not make that request because you did not ask the patient. Put yourself in the patients position and see how it feels. Healthcare at that the focus and most important thing has since long been forgotten...”the patient."

A nurse who worked in surgery for many years made this confession: “They will wait until you are asleep to remove your gown and place the catheter and when you wake up you'll have that gown back on like nothing ever happened.”

Mike, are you under the impression that otherwise your gown would remain on during a surgery like this?

[skyasthehigh]

Our standard is to have 2 circs and 2 scrubs in on most of our cases. The primary circ will be in on the majority of the case, and the float circ will help with initial counts, getting the room ready and providing breaks or assistance during the case. I think its really helpful to have 2 circs during bigger cases. We're able to run labs down and get blood products and needed supplies much quicker. Sometimes we get by with 1 circ and 1 scrub on some simple vascular cases if we're spread a little thin that day.