OR Nurses being deployed in the ward during downtime!!!

[tryx]

I've been working as an OR nurse for almost 13 years now. I am currently working mainly in the after hours acute Obstetric OR of our hospital for the last 10 years now. I am a senior nurse and have been coordinating this OR for the last 9 years every shift.

We cater to all obstetric emergencies 24/7 and have patients literally arrive to our doorsteps without warning being wheeled by midwives or surgeons themselves e.g abruptio, cord prolapse, PPH, etc. Most of the times though we get a phone call and a booking form via fax if they are not too urgent. We then call for the orderly to pick up the patient once we have received the booking form.

We have 3 nurses on the floor everytime after hours with the back-up of an on-call nurse. Except during staff sickness when we cannot get a replacement, we only have 2 nurses on the floor with a 1st and 2nd on-call back-up. We also have an anaesthetic technician on-call (5 minutes away) who is called in for every case.

Most often than not, all 3 nurses on the floor are RNs. On the odd occasion, we have 2 RNs and 1 Enrolled nurse. During a case, 1 nurse scrubs, 1 circulates and the other nurse assists the Surgeon. Once the case is finished, the nurse who assisted also does the recovery of the patient.

Now the problem is this, during downtime, we are now being asked to go out of the surgical suite to relieve and help out in any of the wards if they are short staffed. We don't do patient load but do tasks like vital signs, answering of bells, showering patients or doing a "watch". All of this while on standby for any acute/emergency obstetric procedure in theatres. Note that only 1 operating room nurse goes out every time leaving the operating room always with 2 nurses. If we get a case, the deployed nurse will be contacted through a cellphone and is to drop everything and proceed to the OR. Also note that most of us have never worked in the ward before coming to OR. I myself have never worked in the ward for the last 13 years.

Of course, all the OR nurses here are not happy about this. All are however doing it because of the threat of disciplinary action. I am very reluctant to do this. I feel that we are compromising patient safety by causing a delay waiting for that 3rd nurse to arrive. I know we can start the case with 2 nurses but because we are offering a service where you need to have 3 nurses on the floor everytime during after hours, the third nurse would have made the case faster in an event of severe fetal distress or bleeding and therefore might have prevented a baby from dying or having permanent brain damage or the mother from bleeding to death. If the hospital feels that 2 is enough, then why roster 3 nurses everytime? Also what if the phone system goes down and we cannot get hold of the deployed OR nurse thru the cellphone? Further delays right? Yeah it might not happen in hundreds of year but it can still happen. I would not risk it for that matter. I was never trained nor being paid to increase risks for patients.

Another thing, the deployed OR nurse won't have time to change her scrubs. Which we feel is increasing the risk of infection as well to the surgical patient and the newborn as that nurse has been exposed to the rooms of sick patients in the ward. This small breakdown in infection control can have devastating consequences to the patient.

I have worked in many different ORs here and overseas for more than 13 years now and have never been asked to do such, downtime or not. We specialised in OR and applied for a job in OR now we are being used as a pool nurse for the entire hospital to cover staff shortages in the ward. We did not sign up for this. What would you feel? Is this accepted OR practice? Does this happen to your hospital or have you heard of other hospital doing it in your area? Would you do it?

This has only been introduced 2 years ago when a new OR manager stepped in. There was no expectation for us to cover the wards by previous OR nursing chiefs prior to her.

Thanks for any response.

[ebear, BSN, RN]

Hi,Tryx!

I had a hospital here in the U.S. try that crap one time. The O.R. is very highly specialized (as you well know). Just as med-surg and ped nurses could never walk in and function in the O.R., and are not expected to, O.R. nurses could not be expected to function in other specialties competently. It is crazy!!!! The staff where I used to work flat out refused, citing incompetence and putting patients at risk. The hospital finally backed off when we threatened to resign as a group. You are also quite correct in the infection control issue of scrubs. Good luck! You all must stick together.

[mikethern]

My life motto is, "if you don't like your life, then change it." If you don't like your workplace, find a new one. Try to figure out if another job would make your happier.

Nurses are in high demand. It is stupid management to do something that might really piss nurses off. Instead, hospital management should be thinking, "what can I do to make my nurses happy so they never want to leave this hospital."

I did a travel assignment at a hospital that made nurses build instrument trays in central sterile whenever there were no cases. They asked me to extend my 13 week contract. It was very hard not to laugh in their faces.