StikTie

sis...surgical awareness is on the increase...maybe because versed is being refused..I don't know..but I do know that where I am Versed is the DOC. For anesthesia providers it is heavily relied upon. I think anesthesia has become somewhat Versed dependent themselves...lol. They are very comfortable using the drug, it appears to be a drug of convenience because of its properties...it is just a great drug to accomplish thier objective of anesthesia plans.

The OR is a tough environment and it's getting tougher everyday. I agree with pain doc on his/er comments on patients trying to plan their care without having all the relevant information to make those kinds of decisions. The key phrase is "Informed Consent". This could mean anything to anyone. People have their own definitions of what that means...including health care providers and the definitions keep changing depending on the convenience factors at hand. I would suspect it to be entirely possible that the afore mentioned "arrogant CRNA" was acting on expediency as we all try to do in the OR. What Mr. SetHisOwnFx doesn't realize is that the CRNA knows the surgeon he is working with is like. In a way to sedate the pt is to sedate the surgeon! These guys get VERY cranky if the pt starts moving and writhing about on that very narrow OR table to the point that the surgeon cannot possibly put that screw or pin exactly where it needs to go for the best outcome for the pt. When I have a pt like Mr. SetHisOwn...I recognize quickly what I am dealing with...a person who has done some homework, read the books and is now convinced of everything he believes. While I applaud pts who educate themselves, which is an increasingly good idea, I must point out that no amount of self education can accurately give you the whole picture...the reason being...you have no actual flying time in the OR...we spend hours in there..we see it all...the unexpected ALWAYS happens...so while we try to respect the wishes of our patients when possible it is VITALLY important to realize there is a vast difference between being 'involved' in your own care and being RESPONSIBLY involved. My dear Mr Fix it...be educated...but for heaven's sake be wise with your knowledge...do NOT fight the people who are trying to help you. They really do know more than you do. There is nothing wrong with discussing options, however be very careful about trying to take control where you have no experience in good plans gone bad. You know what they say...He who tries to be his own counsel in a court of law has a fool for a client..well...I don't believe you to be a fool..but, perhaps a little foolish. Generally someone like you I would try to be very patient with and explain some of the realities that most people who come for surgery do not know and are not emphasized well enough in educational forums. Be Blessed and Be Careful...Good Wishes for the future...and Happy New Year!

In reference to an absent anesthesia provider when a straight local is preferred by the patient and there is no reason the procedure cannot be done in this fashion...so much the better. However, in some institutions the policy may state that anesthesia must be in attendance regardless of the type of "anesthesia" given. I think in many ways this is in place for the convenience of the OR staff. A circulating nurse cannot help keep the patient still or speak words of encouragement and get the surgeon and the scrub techs what they need all at the same time. It can get a little hairy. In my opinion...what makes it hairy depends on which surgeon it is

Thanks for your comments...I apologize profusely if the tone was unpleasant. The 'tone' was my sheer frustration and disappointment at what I see my beloved OR becoming. In regard to any 'ego' comment...that is truly a misperception. And in my OR I would never even be remotely accused of that from those that know me. Here's my routine...I tell the techs..tell me when you're ready to count...(I know they have to build their nest and get comfy in it...so do I...lol) I do the same at the close...let me know when you are ready to count...I make NO power plays unless it comes to something that 'in my judgement' either conflicts with the well being of the patient or protocol. I can understand how some could be tempted to think of it in terms of ego...I deal with them frequently enough...and dismiss them just as easily. They can think what they want...I keep my eye on the ball and mostly am successful at avoiding the whole distraction. Ego should never cloud the judgement of anyone..however, we see it all the time. Ex: Just a few months ago, I had a tech that seemed to be dragging her feet on doing a closing count. I said.."hey just holla when you're ready to count". She never said anything, so I walked up to the backfield and said, you ready to count? She looked at me and said, I'm not counting anything, I know where all my stuff is". I was trying not to be confrontational with her. I shouldn't have to be. I really could not believe she said that to me. She was one of these techs that had been around for years and had a reputation for telling the RN what to do and bragging about it. She terrorized other techs. Get the picture? I didn't think she should brag but if the RN didn't know what to do then...yeah tell her. But I did know what I was doing. I looked at her and I said very calmly, "well, I don't know where your stuff is, would you mind showing me?" So much for my attempt at tact...she had the nerve to look at me and say, "if you want a count...do it yourself'!! Ooops...REAL WRONG thing to say to ME. It was simple...I was done...I just said...you have two choices...either you count to me, or I will relieve you of this room and replace you with someone who will follow protocal." That was the end of that...she counted to me and I guess she was satisfied I could not be bullied...but she still does it to others...that is why I want RN's to stand their ground when it comes to techs like this...they are like rebellious children and will teach newbies to be like this. No ego here...simple common sense of right and wrong...clear judgement with alot of obvious frustration. Sorry for the tone...though...God Bless

I too was a college instructor. I was teaching my students the art, splendor and fanghood of the operating room environment. I had students that ranged in age from a very young 18 to a lively 53. I too had frustrations with at least two of my students. Being a very seasoned OR nurse for a great many years I am usually very direct, blunt but caring. The medical profession, no matter what facet you teeter on, is tough. Any student of the course really needs to understand to make the cut you better have more brains than brawn and more brawn than brass. We have standards. I try very hard to make my students understand this simple fact. There is a recipe...you cannot omit or dilute the key ingredients or the result will be a fall instead of a rise. There are no 'short-cuts'. You simply meet the criteria...or you don't. The choice always lies in the hands of the student. We encourage and make ourselves available to our students...we send that transmission...some recieve and some don't. Some very simply put are not 'cut out' for this business. It doesn't mean they are stupid or some other degrading label. It just means that maybe they discover through the course of the journey they would be better suited to something else. Sometimes, we have to reassess our students in the same way we do our patients. Some improve and some don't. Maybe that student hasn't stopped long enough to ask himself if he really still wants this? Sometimes a DNR is a helpful thing to offer a student if all other attempts to revive him fail. Just like we give our patients options and let them make the informed decision for their best quality of life, we should also offer the same to our students. I would love to see all students enjoy the greatest of success, but let's face it we can't inspire those who want someone else to do the work for them or make it easier for them or allow them to think that someone will magically come along and save them from the fall. We can care, encourage, pray and teach...they have to do the learning. Take a break teach, you're doing your job...now he needs to do his...

Absolutement!! There have been several recent and not so recent studies that do seem to indicate this exception to the rule of go "clean to dirty". It is believed as CIRQL8 has stated...the aerosolization contaminants from the lady partsl canal are released into the air when extracting the sponge stick and therefore lands on the abdomen...so prep the dirty and then prep the clean...times they are a changing...

Amen to that

I'm sure we all could think of many theories as to the why of this surgeon's peculiar desire for a bookwalter...however, there is at least one other possibility...we have a surgeon who asks for "xxxxx" to ALWAYS be in the room. If he walks in and sees it missing...he begins to put on a show...sometimes it can be as simple as an excuse to go on a tirade...who knows?

Yes, as a matter of fact I do. Thank you Marie. But I will feel even better when I see us stand together for the good of everyone concerned. And congrats to you for persuing your RN...and God bless you and keep you

i just want to encourage all or circulators to stand your ground in that or suite! you know what is right and what is wrong! you have the authority to execute in your judgement, if a corner can be cut and how much it can be cut. i am getting so tired of scrub technicians (whether certified, bonafide or calcified) who walk into an or and think they can 'decide' what to count, how to count and in some of the most outrageous very wide open chest and abdominal cases, if to count! circulators...you are in control. but if you give control of that or over to a tech who has figured out they can intimidate you...you will some day find yourself explaining to the board of nursing why you let the tech call the shots! ( not to mention the judge) i respect the heck out of my techs and i do not "pull rank" on them unless it is absolutely necessary. i have only ever had to do that two or three times in my career. i train new rn's in the or all the time. one of the very first things i drill into their heads is that everything that goes on in that room is the responsibility of the rn. sometimes i get these hot shot techs who've been here, been there, been doin' it 30 years...well that's great. personally, i don't care if you were born into the world doing it and have the psychic ability to absolutely "know" where all your sponges and instruments are...you will still do a count as many times as i require which is equal to my satisfaction that we do have everything. my techs have learned to appreciate and respect the way i run an or. it took them a while to realize that i have no 'pets'. i require all my techs to count the same way. i do not 'trust' sylvia cause she's been doin' it her way for 40 years. i tell my techs...you can set up your field any way you want as long as it's integrity is maintained and does not potentially jeapordize my patient's well being should their break come up or they are going home before closing. increasingly i am seeing rn's turning over the counting duties to 2 techs and the rn is out of the room. i saw 1 tech counting to the other tech and the tech's back was to him as he was putting new sheets on the or table...c'mon people...we are the ones who go to court if something goes wrong and we are idiots not to realize the awesome responsibility that we carry. surgeons are going to bellyache...they are taught to intimidate the inferior...it has never worked on me where ever intimidation has reared it's ugly head...we live in a sea of intimidation...we all had better learn ignore the whinings and whimperings of those around us. if we do what is best always for the patient...then we are in fact protecting everyone else's behind. surgeons are no exception!! they absolutely will perform a surgical scrub before they gown/glove and put their hands inside my patient. they will not be permitted to use blue/green or any other towel to put inside the body cavity unless it's a disecting aaa!!!! wishbone or backbone...which do we have?

Dear Mommy...Your OR situation is where the rest of us are headed...The operating room has some strikes against those who "live" in there. Operating room personnel are 'hidden' from the rest of the hospital. Bad things go on in there that no one 'outside' has any clue about. The only ones that do know, are us...all of us who brave the abuse (although some days/moments, not so bravely), everyday we don 'the scrubs'. God, I could say so much more. But, on some level...anyone who works in this environment could write their own book. I for one am thinking seriously about it. Actually, I even thought about opening the doors of our OR's to the public in a very exposing way via newspaper forum...I realize of course in doing so my career would quickly dissolve faster than any quick absorption suture we know about. I would not want to ruin anyone's credibility or reputation however, I would like to think that it would shake up some hospital administrators and stock holders...What do you guys think...? Would we dare?... From what I have seen...I doubt there would be many to step up to the plate...OR nurses are some of the toughest around...iron spine and a steel mind...who all happen to have bills to pay...administrators know this and also know that when it comes to taking care of our families...we are vulnerable....some of the toughest minded nurses have turned to jelly when their job was threatened...and I can't blame them. They have families to feed. So did I but...I left them (administrators) shaking...it can be done...