11Blader

Four decades in the OR and the only pad burn I've personally seen was from a metal ground plate used on a patient who had surgery in Mexico. The bovie machine was some relic from the 1950s and they didn't have good contact with the skin, hence the burn. Plastics service was skin grafting the burned area.

The CMS bulletin isn't 'nebulous'. They state specifically that 'RN outside the room would not be considered immediately available'. Be advised that the CMS or AORN may publish statements but your state board of nursing is who regulates your practice. I would never accept relief for lunch by a less qualified person than an RN because it would constitute patient abandonment. Have I had a tech stand in while I used the restroom? Yes, only if there was no other RN available and I couldn't hold on any longer. I wouldn't leave for lunch, because by definition, lunch is off the clock aka 'not readily available'.

I would NEVER think of accepting a patient in the OR unless I had assessed them myself FIRST. I have more than once found: the wrong name bands on my patient, the wrong surgery on the consent, no blood consent signed, no marks on body vital to do time out AFTER patient is asleep, missing H&P=no clue what this patient's medical issues are, wrong, or missing allergies and allergy band. No blood band on, meaning blood not available for a case where we will likely need it.....the list goes on. Another fav- boxer shorts on a male patient who is having shoulder surgery. When we reposition them to sitting on the OR table for the surgery after intubation, those shorts are like a tourniquet on their junk. I could not make a 'Superstar" One year RN in pre-op understand that concept. She complained that I was 'upsetting the patient' with my explanation, so I was fired from my travle job....ROFL!

The items you listed will be used to INJECT a diluted Vasopressin solution into the uterus or near vessels close to the utero-cervical junction. You will dispense the 50 mls saline into the med cup. Then add the 20 units Vasopressin to the saline in the med cup. Other things that might be useful for cervical bleeding would be 2-0 Chromic on a UROL-5 or UROL-6 needle on a Heaney Needle holder, LONG toothed forceps (11" or longer), Heaney lady partsl retractors, a head light, long duckbill vag speculum and a scrub person who can hold retractors to allow doc to use two hands on the needle holder and pickups. If you note 300 or more cc blood loss, with doc no further along in controlling the bleed, call your supervisor for some help. The doc will need help, too, but your supervisor in the room can ask them who he would like them to call.

If the ESWL is done on the same table, without moving the patient, and, all the personnel in the room were present for the first timeout, I can see why you are questioning the repetition. In other institutions the personnel starting the case may not be the same as when it started (relief, lunches, etc). Or, the ESWL may be performed after repositioning on an outside vendors equipment (pt intubated and paralyzed) from a stent placement on the hospital's cysto table. With many moving parts it is more prudent to do another timeout before moving on to another procedure. Case in point. I did a job at a large Denver hospital that did not enforce marking the skull for craniotomies, in violation of their own policy. The RN Neuro Service Coordinator allowed one particular goofus surgeon to 'slide' on this policy. I personally knew a person who had wrong sided craniotomy for tumor surgery because of that kind of slip. I REFUSED to take the patient to the OR until that doctor marked the head, and, I had to get OR admin and RIsk Management involved to get him to do it. I have a colleague who was the scrub nurse on a wrong patient in the wrong OR case, at another famous Houston medical center long before timeout procedures were instituted. It may seem redundant, but there are many ways things can get missed, so another timeout isn't going to hurt...

The idea that your manager is okay with putting a brand new nurse into an OR without a complete orientation tells me they will NOT have your back when mistakes are made. If your manager had a spine, she/he would be putting their foot down to that nonsense. I would have a meeting with them and discuss a transfer OUT of that department since the ground rules have changed. You signed on, given that they were going to give you a proper training and orientation period. Their comeback will be predictable: some *** about being 'flexible'....yeah right. The OR is not a place to learn by trial and error. I had a long 9 months, that was that long because they kept bouncing me around from GI, to PACU, preop, etc., then back into the OR. Some of the surgeon's were slimy bastards, too-I grabbed one Iranian dude by the gown, after he fondled my boobs putting his gown on and informed him if he tried THAT again he'd be putting his teeth in a glass at nite! Hospital admin is putting pressure on OR management to crank up the case count to generate revenue for the hospital. I've seen a sleazebag mgr. roll a patient into a brand new OR RN's room from preop WITHOUT interviewing the patient, checking the chart...NADA! And who takes the fall for mistakes made? The nurse in the room. Get OUT while you can....and don't stop until you find a nursing job that will train you properly for the responsibility you will assume.