Obstructive nurses

canesdukegirl, BSN, RN · Jan 25, 2011

Petite-I get that a lot too where I work. For some reason they seem to be really bitter and I can't understand why. Holding and OR nurses seem to view each other as "us v. them" and I wish that would stop. They no doubt see us OR nurses as high and mighty and bitter too! We are all there for the patient, and I think that focus gets lost in the shuffle.

If you are the circulating nurse, it is NOT your duty to ambulate the pt to the bathroom or get them into a gown. You check the consents, check that the pt is marked and verify that the pt understands and can tell you what kind of surgery they are having. You have so much to do and you have so many other tasks to complete before the patient rolls in to the OR.

We all have our own tasks that we must complete FOR THE PATIENT to ready them for surgery. If one link in that chain is broken or keeps snagging, it has a domino effect on the rest of the patients we are there to serve. It puts the surgeons behind schedule, it makes the entire surgery schedule lag behind, it puts the OR staff in a position to where they cannot go home on time because everything is running late. The anesthesia provider gets sick of waiting around, leaving someone with the message "page me when you guys get it together" and then you can't find them. If this happens often enough, the surgeons will start complaining to the NM, the NM will get an earful from the VP, and the VP gets an earful from Patient Relations. It ends up costing the hospital valuable time and results in a bad reputation for the hospital when patients rate the service that they received as poor. Then the patients will discuss their experience with their friends, and word spreads quickly. The hospital's revenue goes in the toilet and the nurses end up with no raises for the year, YET AGAIN.

We seem to shoot ourselves in the foot, because the big picture I just described is not taken into account. We so focused on winning the fight (it is YOUR responsibility, not MINE to do XYZ) that we lose focus on winning the war...which is patient service.

So here is what I think should happen: the NM needs to have a pow wow with EVERYONE in surgical services. The NM must clearly and concisely lay out the tasks of each service. There should be no room for interpretation here. Expectations regarding who is responsible for what should be voiced and enforced. If a meeting with the staff in surgical services is too overwhelming for the NM due to the sheer number of employees, then the NM can meet with the Team Leaders to discuss this and then disseminate it to their staff.

It seems so easy on paper. If one service does ABC, then the other picks up on DEF, then there should be no problem. It's kind of like a relay race...everyone must do their part and do it well in order to get to the finish line. The reality is that there are so many people in surgical services that there are bound to be communication problems.

At a large university hospital that I used to work at years ago, this was a huge problem. The NM decided to rotate ALL staff through each service so that everyone could get a taste of what duties were expected of each service. One day, an OR nurse would be assigned to partner with a holding nurse. Then the holding nurse was paired with the OR nurse the next day. We all had to go through holding, OR and PACU. It was eye opening.

Thanks for bringing this up, Petite. It is a problem in most ORs, I think. How can we brainstorm to resolve this?

Argo · Jan 25, 2011

my easy solution for this as a manager was to get rid of the "holding room" RN. I hired another circulator in that position and rotated nurses through it on a weekly basis. Other nurses outside of the OR, this includes PACU, OPS, PreOp, will never know how much stuff the circulators have to know and do to prepare for a case. Circulators can and will do the other jobs at the drop of a hat, try and throw a pacu/preop nurse into the OR and see what happens.....

1) Just ignore them and go about your job and do theirs too. 2) When the other team members ask whats going on just tell them,while pointing to the offending RN, in a matter of fact way that your having to do this other nurses job while having to do yours too. 3)Write the other nurses up, if its there job then they should be written up for not doing it. 4) if nothing happens by doing the above just go sit in the OR and wait until the patient is ready, when they ask what is going on tell them that the other pre op nurses are still getting the patient ready and you cant take them until they are done..... If the manager/director allows the pre op people to be lazy/useless/waste of spaces then you might as well soak up those easy $$ too. lol (j/k about the last part, kinda)