O.R./L&D Clashing in C-sections

[Marie_LPN, RN]

That's the only title i could think to call this thread. And this might be long. (Also from my perspective, i realize)

It used to be that L and D did their own C-sections, and the O.R. staff only scrubbed on them if the Maternity floor was short-staffed. This was put to a stop because either some the L and D staff didn't get trained enough to know what to do (some only got one-case training for ALL of it, which isn't fair to the pt. or the scrub person to be put in that position)) and needed more training, or the sterile technique was horrible. So L and D doing the C-sections was halted for more training, meanwhile they had quite a bit of turnover of their staff, almost half from a year ago.

Well, recently L and D started doing the C-sections again, and the O.R. staff went back to being on a as-needed basis for C-sections (eitehr to assist or set-up for the case). Well, the other day, a scrub and circulator was needed, so i went down ahead of time to see if i could help at all.

This is what happened before one case even started (pt. was not in the room):

(after i introduced myself to the L&D scrub person, and received an eye-roll as a reply)

Me: "Which do you prefer to do, assist or set-up?"

Her: "I'LL set up because this IS my department"

Me: "Ok, can i help you with anything? Do you need anything"

Her: "No, hard as this may be for y'all to believe, we ARE capable of gathering stuff ourselves for our cases"

Y'all. Hmmm, ok.

Circulating RN comes in, offers to count with the scrub person, scrub person says "fine, whatever", and proceeds to count Allis clamps, then blades, then suction tips, retractors, then sutures. We're supposed to count 'sharps' (sponges, hypos, blades, sutures) first, then instruments, not a mix, and the circulator says "we should count all of the sharps before we continue to the instruments". Scrub person say "Whatever! When our own RN is in here, they don't give me **** over stupid stuff like this".

Count is finished (in the correct manner) and the scrub person proceeds to fold her sterile arms together behind her back to stretch. Circulator points out that the scrub person is now not sterile, especially since her arm touched an uncovered, unsterile table. Scrub person: "Oh, Christ, you people just come down here like know-it-alls and boss us around." Circulator "You're contaminated, either change or i'm going to your supervisor right now." Scrub changes, grumbled the whole time about "how stupid this is".

Circulator wound up going to supervisor anyway, after the case was finished.

This was pretty lengthy, but this is an example of what the problem is at our facility (others have complained about it in conversation). When you walk in the room, a lot of the times we get someone who is like the scrub person. (Not all are like that, there are a few that are polite, etc.). Has nothing but rude replies, rude attitude, you point out a break in technique, and some act like you're the troublemaker from hell. It's gotten to the point where O.R. staff pretty much dread having to go to L and D.

Am i saying it's all from the few in L and D? No, there might be some O.R. staff being rude as well and it just rises from there, however, what gets to me is the attitude we get when we speak up about something being unsterile. It's almost like it's no big deal to some, and that we're the bad guys for even saying anything (which is just too bad, because if soemthing's wrong, something should be done about it).

(Not to mention you need a chainsaw to cut the tension sometimes, sheesh.)

I'm trying to look at things from all perspectives. Is this a problem where you work as well?

[Marie_LPN, RN, LPN, RN]

Was this tech a surgical technologist or someone of the street who wss trained on the job to scrub C-sections?

How terrible. She is making all techs look bad and putting patients in danger! :angryfire

CST hired for the OB floor for C-sections.

Went to the supervisor today when i had a few minutes and mentioned what i've said here.

I know that the OR educators are the ones that are training the CSTs (or NOW they are anyway) in L and D, and probably by now they're blue in the face by repeating themselves. Curious to see what'll happen next.

[imenid37]

HI Marie! I enjoy your posts. I work at a hospital that does about 600 deliveries/year. We do not staff the OR for C/S. When I hear about your staff's problem w/ technique, etc., it makes me glad we do not do the OR end of things. The OR gets very sick of us when they've been called in several nights in a row or all weekend long w/ cases including C/S's. I know they are tired, but I don't want to pick up the task of doing C/S's too. I already do L/D, Nsy, PP, OB Pacu, Special Care Nursery, transport of moms to other facilities in high risk situations, stabilization of ill/premature neonates, and did I mention GYN pt's. -some as old as 90 years or as young as 12. My head is full. It would be hard for me to stuff another task in there, esp. something w/ so many steps as the OR considering that it is sometimes MONTHS in between C/S's. I don't want to be responsible if the count is off in the OR or anything else which can go wrong in there. I get sick of hearing about how this is "simple" and YOU (meaning the OB staff) should do it. I am grateful for the OR. I think we often meet under circumstances, as you outline, which are tense. In my case, stats in the middle of the night, or doctors thinking they can schedule elective cases w/o any consideration for staffing or the type and number of other cases going on. I encourage dialogue and continued education. You guys are the OR experts, maybe offer to teach people or provide written materials. Infection is no joke, we need to take sterile technique seriously. I'd also look at feasibility. If you are a small facility w/ a few hundred deliveries annually, maybe the ob staff can't be reasonably expected to be proficient in the OR tasks. I wish you good luck. I know it's hard and I get frustrated w/ the OR and am grateful to hear the other side. :)