brewerpaul

My feeling is that staffing is a management issue, so they should manage it instead of passing the buck downstream.

An obstructed kidneys, one or two, is always an emergency. Leaving it til the next day could lead to damage, especially if the patient has a history of recurrent obstructions. Luckily, as call cases go, they're pretty short.

Here in NY state there's a law that when a nurse's time on the job exceeds 16 hours in a 24 hr period, he/she must be relieved. This may apply to other workers too- I just don't know. Yesterday I was on call. Worked 7a-3p regular time and then ended up staying on call until 10:30p. That put me very close to my 16hr limit. If I got called in again last night, I'd definitely go overtime. I texted my manager, who was supervisor last night, and told her of the situation. She reminded me that when we're on call, we're supposed to have a "call buddy" who agrees to come in if we go over the 16 hours. I'd never set up a buddy. Is this how most hospitals do this? To me it seems ridiculous. In essence, when I'm on call, my buddy is really on call too. It means that they can't go away for that weekend, can't have a couple of beers with friends, etc. In essence this doubles our call! Any better suggestions? Thanks

We use warmed glycine or saline for turp or turbt procedures (depending on the equipment used). Our OR has a policy of leaving the bags of solutions in the warmer for no longer than 14 days. When they're put in to warm, we mark the outer bags with an "expiration" date. Although nobody really sure why, it seems that this policy is to prevent the warmth from leaching potentially harmful chemicals from the plastic bag into the warm solution. NaCl won't be chemically changed by body heat warmth, but I'm not sure about glycine. Question coming up... When we take out solutions that have been in the warmer longer than 14 days, some people put them back in the bins to be used for other cases unwarmed. Do other nurses here do that? Personally, I don't want ANYTHING in my OR with an EXPIRATION date less than the date of the procedure. I'm not sure if there is any real danger, but in the case of a malpractice suit, a prosecuting attorney could make a lot of trouble with that. Other people simply take off the outer bag which was marked with the expiration date. Does anyone know of any research or evidence on this topic? Thanks.

Yeah, if you work with a Doc who can take a joke, the battle is half over.

One of the things I'm qualified to do in our OR is run the CO2 and Holmium laser. When I have a laser case scheduled, I'll often say "I'm Laser Man" tomorrow, so my kids got me a scrub top with "Laser Man" embroidered over the pocket. I wore it today for the first time for a laser lithotripsy of a ureteral stone. The urologist has a good sense of humor and he looked at it closely, then looked at the manufacturer's name on the sleeve. He asked me if that was my logo. I checked and told him "No, it's YOURS". The manufacturer? Dickies...

I tried Danskos and found them too heavy for comfort. I usually wear Crocs (without holes on top) which are light and easy to slip off when I sit down. Otherwise I wear running shoes with custom orthotics and shoe covers.

Yes, the OR is VERY intense, especially for a newbie. There is so much to learn that bears practically no relation to any floor nursing you may have done. For months, I felt like I was drinking out of a fire hose... Hang in there and it WILL get easier. OR nursing is well worth the effort. BTW-- I always prided myself that I never took naps but now I often take one when I get home. I have a schedule similar to yours, and by quitting time I'm pooped!

We use Meditech too. It IS ancient, but it has all the stuff we need and it's pretty easy. For some routine cases, we even have it set up so we can load a lot of the default values right up front rather than entering them all by hand. Makes it nice when the case is something fast like a straight cystoscopy where the chart would otherwise take longer than the actual procedure.

I'm late chiming in (congrats on the job!), but I have one question for you, or anyone else in this situation. What would you want the circulator on the case to do if it was your Mother or child on the table? Act accordingly.

I'm curious how people out there handle patients in the OR who are on contact precautions. Sometimes we'll have, say, a foot ulcer debridement where the MRSA is actually in the surgical site. On other patients they may have tested positive for MRSA several years ago in a wound that has long since healed. However, BOTH are still on contact precautions unless they get "cleared". How do you handle these patients? Do you do the yellow gown and gloves thing every time you go in or out of their OR? Kinda tough to go out, take off the garb, grab one suture then re-don everything. This could happen 20 times in a case! In our OR, we bring these patients directly into the OR rather than letting them sit in our holding area. When we go to PACU, they get put into a separate area if it's not already occupied. However, we do NOT do the gown and gloves thing for all casual contact. What are you all doing?

If there was ever a problem and a malpractice case was started, you'd be glad your record said "sterile", even though it might not make any difference medically. Imagine a prosecuting attorney asking you"Yes or no: did you or did you not use sterile water during this procedure?" I rest my case ;-)

Jeez... if the possibility of leaving a sponge on the floor is an issue for your OR, whoever turns your rooms over REALLY needs a good talking to!!

Yes, and especially in cases with implants.

Knee high, often with TED's underneath

Fook'em! I just do it whenever possible. The waiting area is very near the OR and right on the way to where we pick up our next patient anyway. Besides, I'm the nurse who gets the most positive patient satisfaction feedback despite being in the OR for a relatively short time, so I guess management thinks I'm doing something right...

I agree that you should try to train in as many areas as you can. We have a small OR, so we all do everything (we don't do open heart,major trauma) If you can only do one, general might give you the most variety and should be pretty marketable, since just about any OR will do general cases.

Very well said (you others too). I came to OR nursing from a totally different world: I was a practicing Podiatrist for 30 years. Podiatry is ALL ABOUT patient contact since you see many of your patients month in, month out. I've treated as many as 4 generations in one family-- you almost become a part of the family. I do miss that long term contact, but the quick intimate contact of the OR is very satisfying indeed. One thing that I do (although most of my colleagues don't) is try to go to the waiting area after the case and have a brief chat with the patient's family. Even though the Doc has been out to tell them the outcome of the case, the family invariably REALLY appreciates hearing it from the nurse. Give it a try if you don't already do this.

Does anyone know where I can download a Universal Protocol compliant timeout form/checklist that incorporates all aspects of the protocol? If it's not downloadable, would anyone be willing to send me a paper copy of your institution's paperwork? Thanks.

Hey Tiffany-- don't you just LOVE cases like that? As an aside, you mentioned not being able to read the consent in your dream-- in fact you can't read anything correctly in a dream! If you do and try to read it again, it will change. People who are into lucid dreaming use this as a test to see if it's really a dream or waking reality.

Anyone else here have dreams about the OR? I have them all the time. They're not usually bad dreams, and often they're pretty funny. Mostly, they involve running around like a chicken with it's head cut off, trying to do all the stuff that everyone wants me to do, all at the same time...

Even though a patient doesn't have a cardiac history, it doesn't mean that they don't have cardio issues. There are plenty of first heart attacks out there just waiting to happen. Seems like a sensible enough precaution to me-- I'd want that kind of thoroughness myself if I was going under the knife.

Here's one that OR staff will appreciate (and it's not even dirty!) After years of working as a successful Gynecologist, a surgeon decides he's burned out and wants to try an entirely new profession. Since he's always been an automobile buff, he decides to become an auto mechanic. He goes through mechanic's school and eventually takes his final exam which consists of dismantling and then reassembling a car's engine. When he gets his grade for the exam, he is surprised to see that he got 150%. He goes to the professor and asks how this is possible. The prof replies: "Well, you took the engine apart perfectly, so I gave you 50% for that. Then you reassembled it perfectly, so you got another 50%. I gave you 50% extra credit because in all of my years of teaching auto mechanics, I NEVER saw anyone do this entirely through the tailpipe!" Can't wait to tell that one to my favorite Gyn guy next week!

Our OR is starting to make noises about starting this stuff too :-( Don't get me wrong, I'm all in favor of making sure the right patient gets the right operation. It's just that whenever bureaucrats get the germ of a good idea, they seem to carry it to ridiculous extremes. I've been in healthcare for over 30 years, mostly as a practicing podiatrist, and I've seen it again and again. A syringe washes up on a beach in New Jersey and within no time at all there's a huge raft of new regulations regarding "hazardous medical waste" and whole new, huge, expensive and cumbersome industry is born, despite the fact that there is little credible evidence that anyone has ever been injured by this "hazardous" waste. The rules are often totally arbitrary too: if a hospital doesn't double red bag a single gauze square with some blood on it, they're liable for all sorts of large fines, but a private individual can throw bloody bandages out on the street and apart from a littering fine, there is no punishment. Sorry, I'm just venting... Yup, time outs are a wonderful idea, but let's not get ridiculous about it!

This is my midlife crisis job change...After 30 years as a podiatrist, I'd had my fill of running a solo medical practice in the face of ever increasing governmental regulations, dwindling insurance reimbursement and growing expenses. In nursing school I really didn't like floor nursing. I hate that type of multi-tasking: keeping track of multiple patients, multiple meds, calls to and from Docs, etc. In the OR you certainly multitask, but it's all focused on ONE case at a time. Do that, hand it off, and move on. This job suits me to a tee! The teamwork aspect of it is terrific (we have a wonderful staff). The one thing I really miss is the patient care continuity-- I always wanna know how the patient made out a few days, weeks, or months later. In my podiatry practice, I had patients who I'd treated for many years, sometimes treating up to four generations of a family.