Help! Surgery center standards

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Help!!

The last 5 years I’ve spent at a 14 OR hospital, gotten my CNOR, and I feel that they almost always tried to adhere to AORN Standards of practice. I recently got a job at a surgery center (switched for better pay, no call, better hours).

Im on orientation and am worried about some of the practices I’ve seen here...

1. Allowing surgeons to sign consents after patient is in the OR

2. No SCDs on general cases unless over 2 hours

3. leaving the door to the sterile core open ALL DAY

4. wearing fleece jackets from home in the OR

5. Not floating heels or using gel under heels

6. Not mopping floor between cases

7. NO nurse to nurse hand off in pre-op

8. not charting bovie or tournequet number in chart

For those of you who have worked in ASCs before - tell me , is this the norm?? trying to understand if maybe this is just how it’s done everywhere or if these are signs of a bad career move ?

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Specializes in Operating Room, CNOR.

This is NOT the norm, this is attrocious and should be reported. Oh my goodness. I have worked in two ASC's, and both were very aware of AORN standards and did their absolute best to uphold that. You are in a dangerous environment and your license could be at risk here. I would bail immediately, personally. I have worked OR for 10 years, and also have my CNOR. Yeah... not normal, not okay.

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@skydancer7 I quit this morning, my gut was telling me it wasn’t right. Thanks for confirming this :) I know my AORN standards and even went to the leadership on my first day on the job to question what I had been seeing... they didn’t seem to care and suggested that “in time I’ll get used to it”. I handed my resignation in the next morning ... only lasted 3 days there but now I’m scared to check out any other ASCs. I guess next time I’ll ask for a shadow day before I accept a position.

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Specializes in Operating Room, CNOR.

I am happy for you and confident you made the right call! Remembering back now, there was one ASC I went to that I quit within a week because of similar unsafe conditions. But certainly not all ASCs are like that. It is possible to find good ones. You might consider working in one that is attached/part of a hospital? I know of three hospitals in my area that have an ASC, and they have to follow the same rules as the hospitals. I worked in one of those and it was top notch, no cutting corners. I guess it depends on your area and what's available. Good luck to you!!

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Crazy thing is, this place was attached to a main hospital! I think the rules were bent particularly because it was 49% surgeon owned, and only 51% hospital system owned... you live and learn ??‍♀️

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Specializes in Operating Room, CNOR.

Yikes! Makes me wonder what their main OR was like. Yeah surgeon owned can be like that but not always, so don't let that deter you too much from finding a better ASC. They do exist

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Specializes in Informatics.

A little bit late to the party but I just started working in an ASC after working in a hospital OR. At first I was excited for the no call better pay, but I am increasingly finding inconsistencies with how things are done, and I am way more stressed out than when I was working at the hospital. This new job is making me even question if OR nursing is for me.

1. Scrub techs handing surgeons countable items before I even have a chance to count with them. Later throwing items away before I have time to do a closing count with them. Coming from a hospital environment counting when the patient is in the room is foreign and somewhat uncomfortable for me as I do not feel this is something that should be rushed.

2. SCD orders not being prominently displayed (we are all paper based charting and there is supposed to be a yellow flag displayed on the chart) sometimes this doesn't happen and the actual order sheet is buried among over 50 other pages that don't pertain to the OR. This has been missed before and I really feel to most people this isn't a big deal when it is missed.

3. Anesthesia providers not checking pregnancy tests on patient's, and when one has been done, refusing to wait for the results before giving Versed. There is a box that should be checked on the paperwork and I am unable to check it if they do not comply with the standard of waiting for results, so it just reflects poorly and could be a legal issue if it turned out the patient is pregnant.

I have brought these concerns up to management but they just shrugged them off and said you'll get used to it.

Should I just be stepping my game up to accommodate their faster pace, or is this abnormal.

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Our #1 job is to keep patients safe and to be their advocate!

I hate when management doesn't take your safety concerns seriously... you need to find a facility that values your attention to safety and doesn't dismiss it.

Secondly, No you shouldn't be handing uncounted items to surgeons and it is best to wait for the HCG test to be back on your female patients unless of course it is an emergent case. And even more than a legal issue, if they actually are pregnant benzodiazapines are contraindicated in first trimester women.

I would recommend knowing your AORN standards/getting a copy of the current recommendations. Those will be your best lifeline when going to management with these issues. Even better yet if you are eligible sit for your CNOR exam.

You need to be able to finish your work day and go home and sleep at night with out worrying about this kind of crap, and if leadership isn't on board and supportive of their staff then it may be time to move on.

Good luck to you, I know it is hard... I just quit after 3 days because of feeling like my employer valued turn over times over patient safety...

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