LPN in charge of OR??

mcmike55 · May 13, 2005

Kajama

I'm not sure how the governing body for OB differs from OR, but I can't believe for an instant this is right!!!

In Ohio, there has to be a RN in the circulation position for each and every case. And to put an LPN in charge of the entire unit, to me is crazy!!

Let me say right now, for the record, right hand on Bible, and all that, I LOVE LPN'S!!!! Several of my most favorite people to work with are LPN's, over the years I have learned sooooo much from them. I am a better nurse for working with them and learning from them.

That said.....I can't believe your state OB people, or BON people are ok with this. For all their experience, etc...LPN'S, to the best of my knowledge, are in no way, prepared for this role.

Her leaving when ever, etc, to me also says that she's not the person for the job. Leading by example, and all.

I would be VERY concerned about my license working under an LPN.

If Stevierae, and Shodobe are around,....join in here!!!!!

Mike

suzanne4, RN · May 13, 2005

I have heard of LPNs in charge of other ORs, but they actually had quite a bit of OR experience and management experience. Remember that you can be a Director of OR, and not even actually be an RN. A big facility in the Detroit area actually has an RT as the Director. Rules are that an RN must be in every room acting as a circulator, but management isn't mandated. Though most of us believe that it should be.

shodobe · May 13, 2005

I am a true believer that unless you have walked in the shoes, etc, etc.... then where can you come off as a person of real substance. I have heard of facilities having non-RNs as Directors and such but call me old fashioned, I don't buy it. With all my years of experience to go into a situation where a non-RN is dictating to me what to do is really ludicrus(?). I know there are a number of highly qualified LPNs who can do it all, but we still have to remember there are BON rules that have to be followed in each state. I wouldn't be able to take orders from an LPN, sorry that is the way I feel. There has to be a number of rules that are being broken in that OB department that need to be addressed, Management is way out of line to give such a position to just anyone who wanted it. Might as well give it to the housekeeper or a CS tech. Mike

chip193 · May 13, 2005

A manager in any department is based on the person's ability to act as a manager, not clinical skills.

Does there need to be a resource person for the RNs? Yes, the educator fills that role. But to make decisions on how to run the unit, how to schedule staff, and how to handle conflicts does not require an RN!

How many excellent clinical providers have turned out to be horrid managers? How many excellent managers are horrid clinical providers?

You're looking for an apple certification to fit into an orange role.

Chip

suzanne4, RN · May 13, 2005

Mike,

I agree with you...........years ago even got my pilot's license because I was going to be starting an air ambulance with a group of doctors that I worked with. I wasn't going to be doing the flying but I wanted to know all about the mechanics of everything. That is how I approach everything that I do.

But that isn't always how hospitals see it. They want a manager that can manage, and unfortunately it doesn't always work out to be a nurse. As stated above, the educator for the dept is the resource person as far as nursing policy/ procedure, etc. At many facilites, you never even see the Director, they are always in meetings with the upper floor. Or it can be a nurse that has never worked in an OR. Perhaps with PACU experience but took over management when the OR person left. I have worked under this type of manager also, and it has worked out just fine. Sure, she could not come in and give a break, but she made sure that there was someone else that could.......... :)

shodobe · May 13, 2005

I agree with Suzanne that a Director is someone who normally is not in the department all the time. No you don't need a person with a nursing liscense to schedule people and to tell who to give breaks to. But 9 out of 10 the assistant in any OR is an RN not an LPN. Some large ORs have persons with MBAs and MS degrees in health management and they are not usually an RN, this is OK because they are managing the business end of the department and not the nursing side. Still, give me an RN with all the years to back them up and I will usually follow them anywhere because they have done all that I have done. Most hospitals have a VP in charge of certain areas and this is where the OB department failed. The position should have been made the responsibility of the VP until a "qualified" person could fill the position.

Mike

stevierae · May 14, 2005

I dislike ALL management---both upper and middle. I think they are all a bunch of bean counters and are only in management positions because of the Peter Principle--they simply moved them upward to keep them from harming patients. The more degrees they have, the worse nurses they seem to be. I wouldn't trust one in any of my rooms long enough for me to even run to the bathroom.

I think management should stay in their endless meetings and away from us. They all seem to be clones of each other; they all speak the identical "managementspeak." I can only think of two great managers I have had, in 30 years. Both were RNs without any particular business or management experience; both could still scrub and circulate--very well, as a matter of fact--and they knew what we needed to get cases done--they'd been there. Those 2 were cool.

The others--I wouldn't give the time of day to. I never went to their "mandatory" before work meetings---I told them I was hired for 8 hours a day, and not a second more. I never did "mandatory overtime" either. The people that did were foolishly intimidated by them--I don't know why.

I don't speak to management unless I have to. If they initiate a conversation with me, I give them the shortest answer possible. I never, EVER volunteer anything about my personal life--I have seen them use that against people, come evaluation time; people who were vulnerable and confided in them, thinking they were empathetic. Managers are the most narcissistic people around--they use people only as a way to move up the corporate ladder.

If I am ever called into management's office, I have one question only, "Do you have a complaint about the way I deliver nursing care?" The answer is always, "No, BUT..." I am out the door before they can finish saying "but." If they don't have a complaint about the way I deliver nursing care, then they have nothing they need to address me about. There is no issue. I have nothing to say to them.

One thing I hate about management is when they try to act as if they are your bosom buddies--you all know the kind; they sidle up to you and put their arm around you. I make sure to react with disgust, (it's real) and pull out of their grasp. They are NOT my friends, and I do not appreciate their familiarity.

All that said--I don't have a problem with charge nurses, or team leaders, or "the desk;" whatever you want to call them--as long as they are team players, and don't start acting like management. I'd rather they did the crummy job of running the schedule than me--I have no desire to be important or argue with docs about why they can't get their case on before another doc gets HIS on. I just want to be a worker bee, and stay in my own room. Let the new grads who want to feel important run the desk---they are welcome to it.

I have nothing against LVNs, either--many are outstanding nurses. However, I think to be a charge nurse in the OR, you should be an RN, so that you can give breaks to the CIRCULATOR, should the need arise, or, should the need arise, be able to circulate your OWN room, rather than letting cases stack up. Also, in CA, LVNs are not allowed to assess patients, so they wouldn't be much use as a circulator.

How many times do you hear the charge nurse say, at, say, 7 p.m.--"We'll have to call in the call crew at 11---we don't have enough circulators to open another room" and you think to yourself, "What's wrong with YOU? Can't YOU go circulate a room?" There is no reason they couldn't go in, transfer the incoming calls to the room, and run "the desk" from there--"the desk" isn't going to disappear if they get out of their chair for an hour or two....I mean, what do they think we do ON CALL, when there is only one circulator and one scrub there? I guess there ARE ORs who actually have a "desk" person on call, particularly on weekends, but, to me, that's really an unnecessary expense.

Shodobe does evening charge all the time. I am betting he doesn't stay glued to "the desk" as some charge nurses do.

shodobe · May 14, 2005

Hear, Hear! I am always in a room, well not always, but pretty close. I have to have my nose in everything so I know things are getting done. We do have a day charge who finds it diifficult to go into a room or start a case because she has to "watch" the desk. Waste of time. I do have a very good relationship with my director because she originally was the inservice co-ordinator when I started and she has worked her way up the ladder to, now VP of Nursing. We don't see her as much as we would like to because she is out in the hospital doing her thing. Unfortunately, the day charge is responsible for a lot of stuff, much to our dismay. Mike

stevierae · May 14, 2005

I do have a very good relationship with my director because she originally was the inservice co-ordinator when I started and she has worked her way up the ladder to, now VP of Nursing. We don't see her as much as we would like to because she is out in the hospital doing her thing. Unfortunately, the day charge is responsible for a lot of stuff, much to our dismay. Mike

Yeah, wherever I have worked, the nurse educators (or inservice co-ordinators) were really cool, and awesome RNs. None of them had any desire to be management--they really enjoyed teaching, and making sure eveerybody in the department became well-rounded.

mattsmom81 · May 14, 2005

I would be worried working 'under' a LPN, I would worry that when the shyt hits the proverbial fan, someone will blame the RN. Basically I don't trust upper level management, who is famous for turfing responsibility. Texas BNE rules governing LPN scope of practice made it easy for facilities to turf stuff to the RN. I don't know about other states, and the regs may vary.

So...anyone in this situation, make sure you know your OWN BON's rules and regs involving the relationship between LPN's and RN's in the workplace. The facility may be asking you to do something that is not on par with BON regulations, and may get you in trouble someday. JMHO.

If my boss were a BA in management non nurse I would be less worried, the fact there is a less educated nurse 'in charge' would create a problem for me.

stevierae · May 15, 2005

Yeah. Here's the problem with management in the operating room: they "talk the talk" about how the RN is in charge of the room; (true) we are the patient's advocate (also true.)

Then, whenever a doctor gets on their a**, they become Ms. Milquetoast, practically falling at the doctor's feet and kissing them---"Yes, doctor, yes, doctor, of course, doctor, you're in charge and we appreciate the revenue you bring to this hospital, doctor; you're absolutely right, doctor; in fact, you're ALWAYS absolutely right, doctor." They are incapable of "walking the walk" and standing by their RN staff, and saying, "Good. I am glad to hear she is doing her job, as a patient advocate. You need to do YOURS, doctor, and respect the fact that the RN is in charge of the room--and her main concern is patient advocacy---not moving the schedule along for your convenience."

Then they go and chastise the RN in the room for whatever the issue was---usually it's one involving patient advocacy (Dr. insisted on bringing the patient to the room; circulator refused because critical lab work was not back or patient had not received truly "informed" consent.)

But let one thing--even one thing-- go wrong, such as a patient's family's complaint that they felt their family member was rushed into surgery without having all of his or their questions answered---and all of a sudden the RN is on the carpet--after all, it's her room, and she is in charge, once again (but only when it's convenient for management--that is, when they need a scapegoat.)

Boy, do I dislike and mistrust management. Can ya tell? :rotfl: