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

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

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 (the infection rate was outrageous). 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, for various reasons.

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 (either 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 this scrub person. (Not all are like that, there are a few that are polite, etc., and i always say thank you and 'look forward to working with you again'). 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 something'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?

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I think this may be a universal problem. While we have never really encountered rudeness between the two, we (L&D staff) get the feeling that OR staff doesn't like coming up to scrub our csections. They haven't really complained about our technique, etc., it's just a feeling, I guess. Almost like, we're not as competent as they are.

That said, things are a changing. :chuckle We were scrubbing all our own sections, unless we were really busy, we would call OR for help. Now, due to a huge change in insurance contracts with the hospital network, OR's census is down, so they will be scrubbing all the csections on days, and one night a week. We have two OB scrub techs the other nights. It should be an interesting change. Right now, the nurses are required to scrub three cases a quarter. With OR doing most of the cases, I'm not sure what the requirements will be.

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.
I think this may be a universal problem. While we have never really encountered rudeness between the two, we (L&D staff) get the feeling that OR staff doesn't like coming up to scrub our csections. They haven't really complained about our technique, etc., it's just a feeling, I guess. Almost like, we're not as competent as they are.

This is the feeling we pretty much get. Like someone at work mentioned "Like we're invading someone else's territory".

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

It's universal. the wars have gone on since Christ was here I think (just kidding)

we resolved all that by doing our OWN csections. we have our own tech, circulator and assist. Central OR never gets involved unless there is an emergency.

I have no suggestions for you. Each side is horribly territorial and can be brutal. BTDT in the central OR. It was not fun for any of us.

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Our OR crew does all our cesareans. We don't have a labor and delivery crew. They usually even have a baby nurse. If not, I or one of the other OB nurses go. We have very strict sterile procedure . . the scrub tech would kick you out for what you described Marie. She is scary and very very good. :)

steph

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Sounds like that tech needs to go back to school. Breaking technique like that, is putting the patients safety on the line. If people are having to point out something like that, that is so obvious, she needs a HUGE refresher.

Sounds like it is a territorial thing. That may be hard to fix, but the technique thing definately needs to be fixed. Maybe a quick smack across the face too. :rotfl: Just kidding, but she needs an attitude adjustment too.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

technique does need to be impecable. THAT is a very good point!

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

Technique was the main reason the circulator went to the supervisor, but made a quick mention of the poor attitude when the break in technique was pointed out. Yes, it's frustrating, but it HAD to be corrected, and what distrurbs me is that if we hadn't seen this happen, i DOUBT she would have done anything about it.

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Was this tech a trained surgical technologist or someone pulled off the street and taught on the job to scrub C-sections?

How terrible! She makes all techs look bad with this kind of behaviour. :angryfire

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:rolleyes: At the facility were I work it is the Oppisite.... We in L&D have a better infection controll and if by chance we need to call in the main OR for an emergency Hysterectomy... They give us a big attitude...It is like they are comming in to a forgien land. I am a professional I know what I am doing in an OR in a Labor and Delivery unit.... but I will admit that when a hyster needs to be done, I may need help from those that do them every day...............I am as all should be concerned for my patient.....as a Circulator the OR is my room I am in charge..... it is my license on the line ...not the scrub tech or the LPN.or... the main OR team..unless they count and take over.... we all should be able to be professional and treat each other as such :coollook: :coollook:
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