How is your OR staffed

[egien]

I work in the OR and we have recently moved our hospital to be part of a "mega-hospital". This new hospital houses an adult and pediatric hospital, a research centre etc etc… There have been A LOT of changes and we (all the nurses and staff) find that we are even busier than before. We do a great deal of transplants, cardiac cases as well as vascular, gen surg , gyne and plastics. During the day we are staffed appropriately, sometimes there are even extra nurses ( which is always nice to have). Evenings were once staffed with 5 nurses; now we are down to 4. Nights are only 2.

I just wanted to know how other places are staffed and how other ORs ensure that their nurses get their breaks.

Evenings and Nights have been particularly busy (read its been insanely busy) with regular emergencies as well as a great deal of transplants and cardiac cases. So its been hectic for the evening and night nurses. There have been a lot of overtime and call-backs. Sometimes the night staff just goes all night without breaks.

Hope people will share!

My colleagues have been trying to get admin to make changes. Change come slow. So hoping to be inspired by other hospitals and hear what makes your work place truly work.

=)

N

[Rose_Queen, BSN, MSN, RN]

Very tight on day shift right now- many people have left, vacant positions aren't getting filled.

Evening shift used to be better staffed. They have since decreased levels by 1 nurse and 2 STs and now only staff 2 teams from 7p-11p. Means a lot more staying late for the call teams and even some days begging for volunteers. Two teams on call

Night shift staffed by 1 team 11p-7a, but a call team comes in for every case to ensure another team available for trauma/emergency. Two call teams, so if one is in and leaves, the other gets called in if needed before calling in the first team again.

We do not do transplants. Level 2 trauma. Cardiac has a designated team that covers its own call.

[WhoDatWhoDare, BSN, RN]

What are these mythical things you refer to as "breaks?"

In all seriousness, it sounds as if you need more personnel. Did they explain why your nurse staffing went from 5 to 4 on evenings? Has anyone performed an analysis showing the amount of OT and Call that is being used and compared that cost against what another nurse would cost?

What about the detriment to morale? Has that been voiced? At some point people will get burned out from constant call, OT, etc and may start looking at other hospitals. Are there other hospitals? Perhaps your leadership doesn't care because they know there isn't anyplace for the people to go?

Somethings going to give. Help your leadership to understand it's better for the patient and for the bottom line (dollars and cents) if they were to staff appropriately.

[egien]

I lol at your first line!

Thats what it feels like at time on the weekends (some evenings and nights)

Morale has definitely been affected. People have started leaving (some for other dept and some for other hospitals). So we do hire NEW people but it takes so long to train in the OR

I feel that most of my colleagues are so close to being burnt out that they truly do feel like the higher ups do not really care. Or they (the higher ups) just don't get it!

How is it staffed where you work?

we usually have 8 hour shifts (7-15:00; 7:30-15:30; 10:00-18:00; 15:30-23:30; 23:30-07:00)

now I hear whisperings that they are talking of taking away our night premiums.

Another thing that makes our job sometimes impossible is being the Nurse in Charge and trying to be a circulator in a room. Is this just where I work or is it like this across the board?

[egien]

Your set up sounds very interesting.

Please elaborate. Is there a nurse in charge in these teams?

a lot of the stress begins in the evening, when the some elective cases run over time and the evening staff has to contend with elective cases AND the emergency cases that start coming in. With only 4 nurses we can technically run two rooms in the evening. Often we keep our 10-18 on calls to stay to finish cases.

Does having these on call teams where you work, help with the work load? If they do get called in, do they have to work the next day?

[WhoDatWhoDare, BSN, RN]

I lol at your first line!

Thats what it feels like at time on the weekends (some evenings and nights)

Morale has definitely been affected. People have started leaving (some for other dept and some for other hospitals). So we do hire NEW people but it takes so long to train in the OR

I feel that most of my colleagues are so close to being burnt out that they truly do feel like the higher ups do not really care. Or they (the higher ups) just don't get it!

How is it staffed where you work?

we usually have 8 hour shifts (7-15:00; 7:30-15:30; 10:00-18:00; 15:30-23:30; 23:30-07:00)

now I hear whisperings that they are talking of taking away our night premiums.

Another thing that makes our job sometimes impossible is being the Nurse in Charge and trying to be a circulator in a room. Is this just where I work or is it like this across the board?

I work in a hospital that isn't staffed 24 hours a day. We do perform transplants, so the night call nurses are regularly being called back in for these. Don't ask me about weekend call... Holy smokes. It's almost a guarantee that if you're call on the weekend, you're going to be in the OR.

That said, we have Mon-Fri shifts that are 6:45a to 3:15p, another shift that comes in at 11a to 7p, and the evening shift that is 3 to 11p... That's about it. Obviously, we are most heavily staffed during the day shift.

It's unfortunate that you guys are already feeling the attrition from people getting burned out.

[citylights89, BSN, RN]

My OR is going through the same problems with low staffing and people leaving for greener pastures. I attribute it to $$$.

[Argo]

It is only going to get worse. There are less hospitals training OR staff and more staff leaving the OR. This is good and bad for us that continue to work in the OR. The pay and need stays high but the hours and call burden get higher too. What you really have to do is find a good nurse or 4 that you are willing to train and give them a quick crash course in OR to get them functioning on at least general surgery to ease some burden. After that they can move on to other service lines until eventually after a year or so they can do anything but at least on busy days you can have them circulating independently in easier rooms.... I did this in my first OR that I was a director in and trained about 8 people in this 5 OR facility over about 2-3 years. That staff is still there 6 years later even though I am long gone, I could go back to this place any time and get a job again as staff or administration.

The hospital and administration will push you and your staff as far as you are willing to go. Why? because it makes their accounting and money people happy. They have a bunch of stats and numbers that they crunch daily, weekly and quarterly that show your productivity and the higher the number is the happier they are. Your director(however much on your side they seem) will want that number percentage high too. They will get bonus on how high this number is. If you guys are continually willing to be spread so thin then it will just get worse or stay status quo. When it comes to places that do this regularly, the squeaky wheel gets the grease. When they start having to cancel cases then they will start thinking twice. Finish your case and go home at 1530 after its done, do not get guilted in to staying for another case. If all the staff start to do this they will be forced to actually hire new people. I guarantee you they are getting an application here and there, they just don't act on them(unless your in some rural setting in the middle of nowhere). If not they can always call an agency and get some travelers.

When I left my last management job there were about 15 staff that followed behind me, the hospital quickly changed its policy and hired travelers again for the first time in 5 years.