ENT perioperative RN vs L&D OR RN

Editorial Team / Admin · May 27, 2017

I don't have any experience where I've only worked in 1 specific specialty like that, but I've asked to have your post moved to the OR forum so that those who are better in the know can answer.

ColdHandsWarmHeart · May 27, 2017

Thank you!

Fiona59 · May 27, 2017

ENT minors are stress free. Septos, Tonsil, adenoids, ear surgeries. All elective, all routine. Most ENT surgeons are pretty laid back. Opthamologists not so much.

L&D OR? Emergency C sections. High risk, high stress. You are responsible for two or more lives.

FurBabyMom, MSN, RN · May 28, 2017

I guess it depends on the facility and patient population. Both could be potentially high risk.

Sure, tonsils, adenoids, PE tubes, etc seem routine and low risk. And for the *most* part they are pretty predictable. However, the patients can either make them routine or anything but. See also the Jahi McMath case. If it's all patients who are thought to be low risk, healthy, likely to be day op patients, sure, probably is routine. If the job is at a hospital caring for medically complex kiddos, it may not be as low stress as you'd initially surmise. Most patients having tonsils, T&As, PE tubes are kids. Some are infants. Situations can become critical exceedingly quickly in kids. ENT would be available, so hopefully they work well with anesthesia and jointly manage their patients. Pre-ops are generally pretty easy, intra op could still be very stressful (depending on the patient and situation) and I'm relatively inexperienced with post-op. Another consideration with kiddos is that not all kiddos are brought for surgery by their bio parents and due to circumstances such as adoption, being a ward of the state, etc, very little might be known about kiddo's family medical history. Patient could end up having a MH reaction where there was thought to be little to no risk due to no available family history. Just a consideration.

L&D? Probably more consistently high stress, especially where emergency c-sections are concerned. Scheduled sections may not be as inherently stressful as emergencies (though this is generally the case no matter what type of procedural area you work in). The degree of urgency or emergency will also dictate the stress level. Is it a section because mom is worn out and failing to progress but baby is stable? Or is it a section because baby is decompensating? Both urgent but I would imagine not quite the same situation. I don't work in L&D, but I have worked in a level 1 trauma center with tons of resources for years now. Our sickest c-sections are done in the main OR due to availability of resources. Even though I don't work in L&D, I know that our L&D staff is another of the main groups using emergency release of blood products or putting patients on massive transfusion protocol. We've been sent to L&D to help in the OR up there if things go bad and we have free staff.

In L&D you'll probably become more familiar with instruments as you will likely have to count them regularly. ENT, maybe not so much.

I would say that the OR is not a stress free environment at all, there is no place in the OR (or periop) that is really stress free. I float enough and have had enough years of experience that I know that nothing, not even the most routine situation is really as routine as it seems. There are days everything goes as planned, and days where nothing goes as expected. I have seen little routine "nothing" cases end up where a patient is coded or we can't extubate at the end of the case because the patient isn't maintaining their airway. Patients have anaphylactic reactions, patients have MH reactions (not often, but it can happen).

kinbari08, BSN · Jun 2, 2017

I work at a peds hospital where we do lots of ENT elective cases. We usually don't do an IV on ear tubes unless the kid has some reason we should do one. But I've placed an emergent IV in many ear tube cases because the kid laryngospasms and cannot maintain their airway so anesthesia has to give succinylcholine. ENT to me is pretty chill though. Our attendings are all very nice and it's mostly residents and fellows doing the cases.

I can't comment on L&D since I've never worked it.

Nursey1108 · Jun 12, 2017

I currently work in a ASC for an ENT surgeon, we do facial plastics/reconstruction and ENT cases since the MD is dual certified. I'm the only RN and I do pre, intra, and post op care for 2-3 cases then office hours which I then do immunotherapy injections. It is fast paced but it's usually the same cases everyday-

S/T/FESS, sinusplasty, balloon sinusplasty, with a mix of facelifts, blepharlpasty, and tip rhino/ and rhinoplasty. Patients usually stay 1-2 hours in the PACU before they're d/c home. It's not bad but again you are limited in the type of cases you see.