One Trick Ponies in OR

EricG · Oct 18, 2005

wow, they were great at what they "knew" and got fired for what they didn't? Interesting.....

While I have no clue whatsoever what the reason is they were let go for, I doubt it was the "one trick pony" deal, lol. I mean, c'mon, if they were great at what they did, they could learn new tricks right?

Just to clarify, I hate the OTP's. Truly I do...... but I am not against a TEAM approach that finds the same people working the same service repeatedly. After I took over our Urology service it went from most neglected (administrations words, not mine) to our happiest. Totally based on a team approach, consistency, and a good team that was always a step ahead of the surgeon as opposed to 2 steps behind. Specializing is not a bad thing as long as you have the foundation to do anything. Since we are a level 1 trauma center, anything and everything ~will~ drop in your lap sooner rather than later. Know your chit and no worries. :)

SFCardiacRN · Oct 19, 2005

Of all our nurses that "scrub" everything, only a couple of them scrub everything well. All the services have gotten so complicated that they almost need dedicated people. I do 95% cardiac but don't complain when in other services. I just know who to ask for a quick refresher. I do feel your pain when others try to get out of difficult assignments.

Marie_LPN, RN, LPN, RN · Oct 19, 2005

wow, they were great at what they "knew" and got fired for what they didn't? Interesting.....
While I have no clue whatsoever what the reason is they were let go for, I doubt it was the "one trick pony" deal, lol. I mean, c'mon, if they were great at what they did, they could learn new tricks right?
Just to clarify, I hate the OTP's. Truly I do...... but I am not against a TEAM approach that finds the same people working the same service repeatedly. After I took over our Urology service it went from most neglected (administrations words, not mine) to our happiest. Totally based on a team approach, consistency, and a good team that was always a step ahead of the surgeon as opposed to 2 steps behind. Specializing is not a bad thing as long as you have the foundation to do anything. Since we are a level 1 trauma center, anything and everything ~will~ drop in your lap sooner rather than later. Know your chit and no worries. :)

It was mainly a problem on weekend and night call, when you have someone on call who works in dental 5 days a week for years straight, and they're told to set up an Austin-Moore, and have no idea how to do it (which is what happened in the fish-out-of-water reference). Just my own experience, when i got assigned with the one girl, instead of her saying "i've never set one of these up, maybe i should learn in case this happens again" she says very quickly "I don't work ortho, so you'll have to set it up." Well, I've only done ortho for 6 months, she's been there for 11 years, i would think she is more likely to have the most experience, but apparently not. Plus, her reply (mainly tone of voice) seemed to say that if she could get out of doing it, she would.

Nothing wrong with specializing, but to me, i just think it's a good idea to have experience and skill in all areas, since you never know what can come through the door.

(One had been working there for 11 years, the other 13. )

Sarah, RNBScN · Oct 28, 2005

Sounds to me like bad management in the OR.

You get to work in one area???

Some should read the job description for the OR. I work with gals who have this mind set that they don't have to scrub anymore. Well....everyone in the OR who is a RN does scrub and circulating duties. You also rotate areas from gyne, ortho, gen or uro.

Allows continuity for all staff skills.

Allows for variety.

Prevents favourites (surgeons) from getting what they want because the nurses won't stand for it.

Stick together and support one another.

JLynnOR · Mar 12, 2006

I have mixed feelings about this issue.

Continuity, surgeon satisfaction, and efficiency often demand having people who've shown particular skill in an area in those rooms more often than others. I may be among the minority here, as one of the people who is drawn to ortho. My new hospital is currently fighting for survival, and among its competition is the surgery center co-owned by a large number of the physicians. Our case load is small right now, and we have a lot of doctors rotating through, so having staff who are super-skilled in the particular area doing those cases seems very important for earning future business from our new surgeons.

As much as I appreciate the importance of being well-rounded enough to do things competently in all specialties, I've worked with staff who preach the virtues of being "jack of all trades" when, in reality, they're assigned specialty-to-specialty more because of having a hard-to-deal-with personality than anything.

I totally agree with the previous poster who stated that doing something because you're good at it and like it is one thing--while doing something because you can't/don't want to do other things is a totally different story.

ortess1971 · Apr 9, 2006

That was my main beef in the original posting-I wasn't very clear...Nothing wrong with having a specialty, but you should be able to scrub/circulate the most common cases decently. How can you be on call and not be able to do a bipolar hip or a ORIF ankle? Some of these people have been in the same place for 20 plus years and cannot. And they have zero interest in learning, which should not be tolerated.

Marie_LPN, RN, LPN, RN · Apr 9, 2006

How can you be on call and not be able to do a bipolar hip or a ORIF ankle? Some of these people have been in the same place for 20 plus years and cannot. And they have zero interest in learning, which should not be tolerated.

I think that's my biggest gripe where i work now, people that have been there for years, taken call for years, have no idea how to use a smal frag set, and have no interest to either. Yet i've been there for close to two years, and i've know how to do that for a year and a half?

And bipolars and Austin-Moores or Thompsons? I learned in one set-up how to do those. And i work with some peopel that spend more energy trying to get out of learning how to than to actually learn it.

SuesquatchRN, BSN, RN · Apr 9, 2006

Could someone explain to me the difference between a scrub nurse and a circulating nurse? I thought I knew, but I don't. So I was told, anyway.

TIA.

debbieuk · Apr 10, 2006

the scrub nurse is the one who works the sterile field, monitors the surgeons and patients and supports the surgeon, passing instruments etc. they are in charge of the trays of instruments, swabs, needles and ensures that the same amount are at the end of the procedure than at the beginning. the circulating nurse is the scrub nurses support. they ensure that the scrub nurse gets everything they need to enable a safe operation to be performed. they monitor what is happening and anticipate the needs of the nurse and surgeon.

as for the OTP's we had a situation the other week where a new starter had to scrub for a trauma case as the senior RN who had been there for 15 years claimed she couldn't do it. managment have now decided that we have to change specialities every 6 months to keep our skills up.

EricG · Apr 11, 2006

debbieuk,

You left out a couple very important attributes of a circulator. We are the patients advocate during procedures. We are responsible for the safety of our patient, not just "support" for the rest of the OR team.

I just felt the need to add that because many times I see circulators that, to myself, I question whether they practice the above comments.

Now, as far as the OTP thing. Due to ~MY WIFE~ getting a huge job promotion and having to leave UF & Shands Jacksonville (My heart is still there), I am now working in a 9 OR "bread and butter" facility circulating and scrubbing on the rare occassion. The almighty dollar sucked me into this small facilty as opposed to Duke wihich is 20 min. away. After spending a year of my life knowing nearly as much about urology as the attendings I worked for due to their never-ending diligence and teaching me everyting I could absorb, I walk into work each day not knowing which service I will be working in.

One thing I am thankful for is the one day my service didn't operate, I was working other services and of course trauma call at my former place of employment was always something new and exciting. (tinge of sarcasm, as we all know after a few GSW's, stabbings, MVC's too get pretty repetitive.)

I miss my old job and my OTP (I really wasn't I swear ) status, lol. I miss being a part of our organ procurement team, I miss alot. But one thing I will take from this experience is the fact that I now circulate most every service and have had the opportunity to scrub more now that I have left a teaching facility.

I now know I will do at least 10 lap chole's a week when I used to do one a month, lol. I look at this facility and my career as a professional another stepping stone. I can easily go to Duke, get hired into their Urology service and be in my comfort zone again, but I think I will stick this current job out just to be certain I will never be an OTP. I have said it before and I will say it again. A circulator should be able to work any service whether they are the best or not is of no consequence. It's the same basic outline we work from day to day, service not included. Interview pre-op and glean any extra info you can that may be pertininent but at the same time establish in 2-3 minutes a level of trust between either your patient or the family, assess, and sign off per your facilties policy. See them back in the room after anes. has already given them some versed and it's actually fun to chat it up with my patient.

Typically I could never do that in my previous place of employment. I was alwaysy tracking down a resident for consent , etc, Our pace allowed me to review the chart, check for an h&p and a consent (surgical, blood) A a preceptor I always preached a 3 minute pt interview and assessment.

But, there was this one day that based on a certain set of circumstances I spent way too much time with the family and patient in pre-op. His daughter and I were kinda flirting, etc.. (and I apologize if this brings anyone down, but I relive it continuously). Our first case was a Nephrectomy. I was very close with the surgeon (my team of course) and we were about 15 minutes late getting started over a resident not getting consent.As our CRNA and student are rolling into the room, my Urology attending and the Anes attending are openly arguing of the late start. My personal thoughts are that Dr X was pushing a bit and made a mistake. A couple silk ties on the renal artery slipped off. We went from smashing pumpkins to crickets pretty damn quick. The patient was lateral and we coouldn't open his chest. He had only dropped a liter of blood but he had an MI immediately. He had a history of cardiac issues and apperently other local hospitals decline to take the case. The longest 2 minutes of my life was walking downt eh hall to the isolation rooom where wwe had her husband for viewing and she was screaming "you killled my husband" the entire time.

My post had gone on too long and I am rambling, for that I apologize. But nothing in my lifetime will ever make me forget the look on my attendings face when he asked me "now what do I do?" 4 grown men bawling their eyes out. I still talk to cj (my attending) as we bonded that day and have remained good friends. There is nothing routine about surgery and I am glad I faced the scenario so early in my career.

ok, I am done running my mouth.

SuesquatchRN, BSN, RN · Apr 15, 2006

Thanks, Debbie. That's what I thought but I was told I was wrong.

Hmmm.

cwazycwissyRN, RN · Apr 16, 2006

Thanks, Debbie. That's what I thought but I was told I was wrong.
Hmmm.

Suesquatch, you will find England and the USA, to be different, that may be where the confusion is setting in.