grimmy

i don't mind call all that much, as long as it's evenly distributed. where i work, it works out fairly well. one of my gripes with my workplace is that the management is practically non-existent. there are certain nurses and/or techs that have been in their "niche" for far too long, lord it over every and anyone, and need to be "sprung." i'm not saying fired, but geez, the micro-management by some of them is just beyond frustrating...or...they are consistently late, display poor practice, and no one has the cujones to do or say anything. a couple of our teams are in deep doo-doo because of this. no one wants to join the team(s), and the person(s) in question is (are)entrenched. the slow downward slide toward chaos is becoming precipitous. a little rotation, or mixing it up would be sweet, but i don't see it happening anytime soon. i sure do wish that those of us who are interested in going to aorn conferences would be able to go on educational leave, but only a select few get to go consistently. the only way to be guaranteed edu leave is to have a poster presentation get accepted. (believe me, i've been trying to get on research committee for over a year now). other than that (and that's a big item), i like my workplace. our schedule is fairly flexible with the options of 8, 10 or 12-hour shifts. call is pretty decent, but the pay could be better. i say this because the cost of living in this area, not to mention the real estate prices, are very high. we got a $0.35/hr raise this month for cola, but it seems like milk money. average home prices are over 250k, and that is out of the county. in-county is more like 300k, and the property taxes are pretty steep in the city. ah, well...i don't want to sound like a constant complainer. i love my work. these are the things that need some improvement.

i'm with you on that one. i have complained, it seems, without being heard, that most of my patients smoke, so i don't want to smoke the patient! why inhale that crap? i guess i need to press harder on this issue at work. i mean, for cripes sake, we diagnose and remove lung tumors every single day from inhalation factors...i don't want to be one of them!

i agree - counts are critical items in pt safety, and cannot be fudged for any blowhard. the fact that the surgeon and pa are pompous morons is another story. obviously they've had great nurses around (like you) to make sure that they have never to had to open anyone up to retrieve an item, or gotten sued over an item left in the body. we don't want to have to go that far to teach them a lesson, of course, so let blowhards be blowhards, and document. i hope you have a supportive management that will stand beside you.

i did sort of choose - they were desperate for people on a few teams, and i chose the one where i liked the people. i like most kinds of surgery, so that really wasn't going to be an issue. people that you spend 8-12 hours with, every single day, is what's really going to make or break you. in reality, when on-call, you have to be able to scrub or circulate just about any kind of case, so that gives me plenty of variety. if i had to get down to brass-tacks, i'd choose plastics/burns/maxillo-facial surgery as my favorite kinds, but right now i'm on the thoracic team. what's great about nursing is the ability to learn from each kind of situation, and apply it to the next...and when i get tired of thoracic, i will do just that.

i, too, live about 30 minutes from work, and it hasn't posed much of a problem for me. i think the only time i really hate it is when i'm called in, sent home, and then called back less than an hour later. it makes a commute in the dark that much longer. i'm actually moving closer to work next month, so that should eliminate some of that issue. there's also quite a few times when i know, before i leave work at 5:30, that i'll be back that evening. last night was such a case, because i work on the thoracic team, our surgical fellow got a page for an in-house donor, and we were going to keep the lungs, liver and kidneys. i went home, fed, walked and watered the dog, took an hour nap, and was back by 7:30 to circ the beating heart organ donor. i got relief around midnight, and went home and didn't get called back. easy money, interesting case, and so it goes.

i, too, prefer the hanging bags. the scrub typically drops them in the kick bucket (which i line with the pack plastic bag at the beginning of the case) and during the case i keep track of them by putting them in the hanging bags. i've only been in a few cases where we had a lap/raytec count greater than 100 (our policy is xray when >70). i find laying out sponges on a sheet to be tedious, and a waste of space. with surgeons/staff moving around the room, and needing clear, safe walking room, the less on the floor, the better. generally speaking, i rarely have to count as many laps as needles, so this is not a huge issue. just yesterday, i had a 160+ needle count, and that was a major pain in the tuckus.

i'm hoping that the pt had anti-embolic stockings and kendall boots on, too (or did they use enoxaparin?) lack of blood flow, poor positioning, can all contribute to that sort of pain - what type of lithotomy positioning did they use? candy canes or yellowfins? i think they make a difference. it also matters when the pt is obese - there's a lot of pressure on the feet, back, and backs of the legs when an obese person is in lithotomy for extended periods of time. part of the cost of "doing business," i'm afraid.

you're not particularly clear about why you find nursing stressful - and yes, you will definitely find psych pts no matter what kind of nursing you do. the or (where i work) does require some moving of pts, but it is fairly minimal. if you like technical fast-paced work, that might be a place you'd like.

our stringers change depending on the pan, but most begin with scissors, drivers, and work on down to sponge sticks and cv clamps. we had to go to additional pans when it was just too darn heavy to lift the rib instruments. we rarely use doyens and fenestrated chest retractors, but they're in there (and weigh a ton). i'd never thought to put the stringer "backwards," and i wonder if i'd be able to see them from the field...regardless, i don't necessarily want to change my habit, since it works well for me, and as a team we have to agree on setup changes. we scrub each other out for lunch and shift changes, and having a standard setup facilitates the relief process. i think what i'd love about the whole backtable add-on or shelf system would just be places to stash the stuff i don't use everytime, but when you need it, you need it sorts of stuff...like specimen containers or telfa, the marker, dressings i want to stay clean, etc. i do have stash places now, but they're not necessarily easy to access. and, especially for those 2 or 3 part cases, like esophagectomies, and mediastinoscopy/lobectomies, my extra mayo is stacked to the roof!

no fakes, no long nails, ever. even if i could wear nail polish it would be scrubbed off within a day or so, and why bother? i'm so used to having short clean, squared off nails that i clip and file them once a week to keep them healthy. i even get a paraffin manicure now and then, particularly in the winter, to keep the cuticles in good order.

i absolutely hate commuting, and i have less of an issue with it than the op - i am 30 minutes from work. even so, i'm looking at buying a home closer to work for many reasons, including the commute. i listen to npr, my ipod, have plenty of java by my side - but as for the time, i have to leave the house at 6:20 every morning. in addition to the actual drive time, i have to park 7-8 minute's walk away from the front door, plus i have to change into scrubs when i get there...add to that finding equipment in the morning, etc. i work 10 hour days...the other bad part of the commute: paying for gas..ugh.

speaking of australian nurses, we have a travel nurse from australia, and she has mentioned the back tables they have with multiple levels and "side pans" that attach to the back table. well, i want one! maybe we have them in the us, but i haven't seen one - i've been sheltered - and maybe they cost more. she also laid out her stringers backwards, that is, with the business ends of the clamps facing the back of the table. this was so that the circ, who would be at the back of the table, could easily see the clamps during a count. i love meeting nurses from different places because of the different ways to do things. i learn a lot!

well, go to your local american lung association website or second wind http://www.2ndwind.org/ you could also get a picture of lungs and have the baker shave the cake into that form...or forget about the form of lungs altogether and think of something that reminds you and/or your mom of a breath of fresh air...something symbolic of what she can do now that she couldn't do pre-transplant. congratulations on 10 years! from a thoracic surgery nurse to you and your mom.

as someone who works with surgeons everyday, its hard to imagine not talking with them. imagine having to deal with residents who think they know everything, too! in reality, of all the surgeons i work with, the vast majority are decent, if not a joy. there are a couple of whiners (which i hate), and only a couple of loudmouths. since i also answer their pagers during a case, i can say that some nurses' fear is so obvious. they talk fast, i can barely understand them. sometimes they forget to mention the pt's name, just a room number. yes, be prepared, have information available, but remember you're talking to a person who wants to be treated like a person. for instance, i answered a pager that had just had multiple pages over the span of 2 minutes - all with the same text message - room 4012x - sticu 911. so, i called the sticu. i could barely hear the person on the phone over the blare of bells, laughter, etc. so, i repeated myself, asked what the page was regarding, the surgeon was scrubbed. the rn yells into the phone, "the pt is in respiratory distress, i'm transferring them to the po..." and she hangs up. hmmm... i got to the bottom of the matter within 15 minutes...i called the intern. but why did i have to go through all that? you see what i mean, i hope.

i'm not interested in m/s primarily because of poor staffing issues. i feel like i cannot possibly do a great job because i wouldn't have the time to do it right. there's also a limited technical aspect to the job which i would miss. i crave technical stuff, gadgets, hands-on, etc. there's a certain amount of pacing that i enjoy, too. this is why the or suits me so well. most days i have the right amount of time to spend with the pt and their family, there's plenty of variety in type of pt, different staff, surgeons, specialty, etc. i also have two jobs in one: scrubbing and circulating, and i really like both. i'll also confess to loving the dramatic nature of surgery. i have a short-attention span, and waiting for things to happen is stressful for me.

i would think this would qualify as a verbal order. goodness knows that i run them through the or constantly. yes, eventually that md has to sign off within a certain time for the orders, but a ua seems to be a petty issue.

[color=darkslategray]i would wonder what your facility's policy is regarding hats brought from home. where i work, several people wear hats (some home-made) from home, and pledge to wash them between each wearing. of course, they must adhere to the basic precepts of being of non-shedding material, with no portions falling below a certain point of the neckline. i think much would depend upon whether or not you scrub, too. no portion of any headgear should interfere with a sterile field.

[color=darkslategray]i, too, am dealing with this where i work. some folks are content to leave things as they are because this manager is a "known." they're more afraid of the unknown quantity that could be brought in from somewhere else. frankly, for my situation, its a big mistake. this manager we've got now caters to the surgeons, okays things that seem out of his league to okay, and doesn't know where his limits are or should be. where i work, we all know that this is one person who will not leave until they find him keeled over at his desk one morning. sad to say.

[color=darkslategray]i think chemistry is extremely important. you cannot fully understand acid/base balance in the body without chemistry. additionally, knowing and appreciating basic med calculations, drip rates is basic chemistry, even if you're calliing it by another name. if you don't have a grasp of basic chemistry i believe your pt teaching is limited, and you have sold your nursing skills short. pharmacology is another branch of chemistry - many nursing specialties have strong roots in chemistry, and will touch every single thing in the nursing profession: ct, pet scans, mri, dialysis, every single med you'll ever give, the chemicals you wash your hands with, radiotracer chemicals for cancer detection, infusion nursing, oncology....the list goes on forever.

[color=darkslategray]ok- here it comes from an or nurse... you are hardly alone in your fears. most patients who come to the or in fear are afraid of this very thing. agreed, we do have great meds available for anesthesia, and much of what happens through the preoperative phase is typically forgotten because of versed. its a good thing. in a perfect world i'd tell you you'll be 100% fine, and not to worry. it's not a perfect world. the good news is that in the past 2 years that i've been in the or every single patient i've had has recovered from anesthesia...every single one. not everyone is extubated immediately, but all of them, even the lung transplants, have made it off the vent. there are some extremely rare instances of funky anesthesia events, but they are really rare - less than 2% of all pts have them, and typically half of those occur in children. so...your odds of waking up postop are extremely good...excellent, in fact. i've had 5 surgeries, 4 with general anesthesia. you wake up with cotton mouth, feeling like you've got to pee...and then you fall asleep again. then you wake up in your room or in pacu again. by then, you're ready to talk and the nurse hauls you out of bed for your first walk. :chuckle

[color=darkslategray]you may want to look at the work of one of the professors (where i work) who had done significant research on skin breakdown in the minority geriatric population. his name is courtney lyder and here are some websites of various lectures he has given. http://nursing.unc.edu/departments/oma/events.html http://www.findarticles.com/p/articles/mi_qa3977/is_200103/ai_n8941149 http://community.nursingspectrum.com/magazinearticles/article.cfm?aid=13666 good luck, and happy hunting!

[color=darkslategray]its my understanding that in certain places (mayo clinic comes to mind) that all their postop pts go through what looks like a "car wash" of an x-ray machine as they go to pacu - this is how they get away with not counting instruments/sponges, etc. it also takes care of the post-op cxr, too. much faster turnarounds, liability issues, etc. your mileage may vary. at my hospital, we get portable chests while the pt is in pacu.

[color=darkslategray]not at my facility, though it can be requested, depending on the case. for my team (we do thoracic surgery) we do require postop cxr - some facilities do xrays on all pts. a lot depends upon facility policy.

[color=darkslategray]a lot depends on your geographic location, etc. if you're a member of aorn, go to http://www.aorn.org/careers/default.htm and click on salary calculator, and sign in. put in all the pertinent info, and for your location, education, facility, etc. the regional comparable salary/wage will show up.

[color=darkslategray]oh, the little things...and they are insidious. they creep into your vulnerable, insecure soul and nag at you. i remember all too well. i was scrubbing a micro/neuro/spine case, something i definitely hadn't done more than a handful of times. the instrument heads are extremely small (micro, yanno), and very hard to see. oh, yeah, and the room is dark. and...the instruments are dark blue. so, the neuro resident asks me for something like, a penfield one....mmm...i know a penfield four....so i guessed. it was an incorrect guess, and he hands it back and haughtily says, "i asked for a one." i apologized and said i don't do this everyday. well, that was all he needed to run over me with the following snide comment: "yeah, i can tell." at that point, the circulator, who was much more more assertive than i (at the time - i've since grown some cujones) said - "help her out, dammit - she's trying to help you!" a far more obvious incident would be the cardiovascular surgeon who, when called away from a carotid to fix a bleeding iliac that another surgeon mistakenly severed, literally ripped off his gown, threw every bloody thing piece by piece to the floor, yelled "f#*k!" stomped out the door, kicking the giant metal scrub sink outside the door, and it rang for a good 20 seconds. i wasn't too happy to have to pick up his bloody clothing from the floor, certainly. and the scrub, an evangelical christian, didn't appreciate his language. but we knew why it happened - and yes, he acted like a child. we actually laughed while the scrub sink was still ringing. the trick to all of it is to not take it personally - something that's really hard to do when you're learning, and you feel particularly stupid. just remember, its usually not about you.