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