Forced to Assist in C-Sections

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I work in the operating room as a circulating nurse of a smaller rural hospital (5 ORs). We are on call throughout the week and on weekends. Currently, when we are on call we are also on call for the OB department to assist in C-Sections. However, as a nurse that doesn't scrub I have no experience, skills, or adequate training related to anything occurring during a C-section. Despite myself and others giving pushback regarding this issue the director is hard set on forcing us to be on call for another department and to be in the room during a C-section. How can one go about fixing this issue? Our associate managers have tried to fight the issue as well with no head way made. My current plan of action is to talk with HR during my next shift. Along with this, I have made it explicitly known that I will be refusing. There are currently no repercussions and the director has mentioned that it will be addressed when the time comes.

offlabel said:

Who circulates when you're not on call? I suspect dual role L and D nurses that have less training and experience in OR nursing than you do in C-Sections. If they do it, you can certainly do it. This is the reality of small, critical access hospitals. In the end, it's abdominal/pelvic surgery with all of the attendant risks for complications therein, and that's really all you need to know. If you had to take care of the baby, that would be a different story, but you don't. 

So you're saying L&D nurses can also come down to the OR and circulate any case? OB has their own call team and we have been told time and time again that they are adequately staffed. However, they still call us. I even heard recently that their call person was able to refuse the call and then we got called in. Of course L&D nurses have less OR experience but they have substantially more experience with C-sections as it is the only case they have to do. In the end, I am not trained or competent to be apart of a C-section. 

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gigi_rn said:

Do you scrub in the OR? Sounds like orientation to that unit would solve the problem. Not knowing where their supplies are kept is a pretty low-level excuse.

I don't scrub in the OR. Orientation to the unit does not solve the problem. Not knowing where supplies are is not my "low-level" excuse. I am not making excuse I am stating facts that I am not orientated, trained, or competent to perform a C-section placing the patients at undue increased risk. Management has not provided a solution on how to stay competent in C-sections. 

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Promacta said:

So you're saying L&D nurses can also come down to the OR and circulate any case? OB has their own call team and we have been told time and time again that they are adequately staffed. However, they still call us. I even heard recently that their call person was able to refuse the call and then we got called in. Of course L&D nurses have less OR experience but they have substantially more experience with C-sections as it is the only case they have to do. In the end, I am not trained or competent to be apart of a C-section. 

Sounds like the two options are quit or get fired (or just get competent, it's not rocket science).

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offlabel said:

Sounds like the two options are quit or get fired (or just get competent, it's not rocket science).

Understandable, but as I keep stating our management has not provided any solutions to being or staying competent in this role. 

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Specializes in NICU, PICU, Transport, L&D, Hospice.
Promacta said:

Understandable, but as I keep stating our management has not provided any solutions to being or staying competent in this role. 

Why aren't you competent in circulating if you are a circulating nurse? 

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toomuchbaloney said:

Why aren't you competent in circulating if you are a circulating nurse? 

Because I don't circulate OB services that occur in another department... 

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Specializes in NICU, PICU, Transport, L&D, Hospice.
Promacta said:

Because I don't circulate OB services that occur in another department... 

So that means you aren't competent to circulate? Not being willing to do something is not the same as incompetent to do something.  

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toomuchbaloney said:

So that means you aren't competent to circulate? Not being willing to do something is not the same as incompetent to do something.  

Never said I wasnt willing. You must just be overlooking where I've mentioned numerous that I haven't recieved the training to fulfill this roll nor has management provided solutions to the training issue

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Specializes in NICU, PICU, Transport, L&D, Hospice.
Promacta said:

Never said I wasnt willing. You must just be overlooking where I've mentioned numerous that I haven't recieved the training to fulfill this roll nor has management provided solutions to the training issue

It's hard to miss that part.  It's not clear why you need someone else to solve your training issue.  

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Specializes in ER.

You are 100% right. Any situation you are put in where you feel for whatever reason that patients are being put at risk due to inadequate knowledge/competency, should be assessed. If no training is being offered I would speak to OB people and ask them to train you- if that is an option for you. You can also look for courses that offer periop OB training. There are options out there. Until you find something that works for you, make it clear that you will not be able to participate in something where you are not prepared to act if an unexpected emergency would occur.

I am fully with you on the fact that nothing matters more than our and our patients safety. Keep up your good work!

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Promacta said:

So you're saying L&D nurses can also come down to the OR and circulate any case? 

Just a question for some context...are the scrubs OB scrubs? Or are they main OR scrubs...either way, they're the ones that matter because they're the ones that are actually doing the work of assisting the surgeons. The circulator just gets stuff and counts stuff and writes it down. If the scrubs don't care, the circulator shouldn't. 

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Specializes in Adult and Pediatric Vascular Access, Paramedic.

As someone who worked in L and D for a few months, before deciding it wasn't for me, I can understand the OPs concern.  As new L and D nurses we were expected to learn both the circulator role and scrub role during c-sections, and it was VERY stressful trying to learn how to do those things AND how to be a competent L and D nurse on top of it.  

That being said, my question for the OP is, will there be a trained L and D nurse in the OR to care for the patient post section?  Will there be a "baby" nurse as well in the OR?  What will your responsibilities be as a circulator?  Honestly, the scrub role is very stressful initially, but once you learn the procedural steps and what to hand the physician and first assist it is easy peasy, but remembering all that takes time, as does becoming proficient at it.  If they are not offering you ANY training with an OB scrub/circulator then I totally agree this isn't safe.  It is definitely  not safe to expect an RN with zero L and D experience to care for a OB patient during/post C-section, that is extremely risky!!    In the L and D OR, as the circulator,  we had to get the patient positioned for their spinal, then after that position them with a wedge, check fetal heart tones, put the foley in if they didn't already have one,  check the baby warmer set up,  document everyone's in and out time, do both time outs,  count all sponges/instruments multiple times, PLUS post c-section IN THE OR  monitor uterine tone and check amount of bleeding, give meds to support the uterine tightening back down, change Pitocin to new bag, DOCUMENT all of this,  and deal with emergencies as they happened.   Obviously this nurse will be circulating at night, which means the C-section will be urgent or emergent leaving little time to sit and think about set up and counts etc.   Not sure if the Op will be expected to scrub as well, but this is not a good learn on the job situation at all, and this is risky!!  

My message to the OP is DON'T DO THIS unless they are going to adequately train you AND there will be a L and D nurse with you at all times!!   If they expect you to scrub as well then they need to put you in the L and D or for at least two weeks to scrub with an experienced nurse or tech!!  This is insane!! 

 

Annie

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