chartleypj

I have worked in 4 facilities over the past 31 years, including working for the federal government. At each facility, a hospital policy dictated how long a consent was good, and under which conditions it would be nullified. Our consents were good for 30 days unless there was a specific reason to obtain a new consent i.e., change in surgeon, procedure, side,site, or change in pt medical condition/mental status indicating a need to revisit the consent. I hope this helps, Paula

Sistermike, The Worcester area has several large teaching facilities as well as a few smaller acute care hospitals. the city is smaller than Boston, yet retains some of the ammenities you might be looking for in a community. Housing is cheaper there than in eastern Massachusetts. Worcester is in south central Massachusetts between Boston and the Springfield area. Good luck, Paula

I have used Meditech and also found it to be user friendly after a learning curve. I like that the program allows for (I think 3 or 4) customer-defined screens so the program can be built to your specific facilities' needs. The key to Meditech (In my opinion), is in having your dictionaries built properly from the beginning, to support scheduling, OR documentation, materials management and billing as they are all tied together. good luck, Paula

I'm connfused; if you were hired for the 10:00 - 6:30 shift, then that is what you should be doing - and you obviously are not agreeing to this last- minute scheduling issue. What is your hospital's scheduling policy? Are you unionized? I have never worked in a facility in which the schedule wasn't posted for 1 month in advance; afterwhich, a schedule change could only be made after asking the staffer to accomadate the schedule. Something seems amiss if the nurse manager cannot schedule staff in advance of 1 day to cover her department. Good luck with your dilema, Paula

You are right about the control we have over who leads us. We only have control over our own behavior, our moral, ethical and interpersonnal conduct in the workplace, and this is where every nurse can try to make a difference. When I think of myself as 'powerless' (which, BTW, is a common issue in this female-dominated profession), I am not empowered to practice nursing professionally or collaboratively. Nurses working in an oppressed culture is part of the problem. We need to learn how to get to 'empowered' I agree, there are differences between OR's regarding working conditions. I believe the tone of the department is dependant on it's leadership. If a leader sets a standard of professionalism, teamwork, respect, autonomy, and collaboration, and it values each employee, the result will be staff productivity, satisfaction and efficiency. If the leader removes barriers to providing safe appropriate care, (all those stupid things that get in the way-i.e., lack of supplies & equipment), nurses can focus on just providing nursing care. When this occurs, the staff nurse is more inclined to feel empowered. It takes all of us to create a successful unit; our leadership is paid to 'lead' us, and as far as I am concerned, many do not have the skills necessary. Pj

In my experience, as well as my humble opinion, systems errors negatively impacting perioperative care are inherent in all OR'S. Test driving a new job for a month may not uncover issues pertinent to that department. Job- hopping might provide a respite from the insanity of trying to provide safe nursing care, but in the long run it just contributes to nurse-burnout. Fixing the system errors can improve the work environment. To elaborate further, the answer lies in effective nurse leadership and support, team-building, autonomy, and respect among colleagues. Our nurse administrators need to fix the day-to-day system errors so we can focus on providing safe, competent perioperative care. In my 30 years of practice, I have had ONE effective nurse leader. (4 different jobs). The rest have been oppressive, controlling, passive - aggressive, disrespectful, unfair with assignments (favoritism) and my all time favorite - they practice performance-punishment. that is, if you are efficient at what you do, you do more and others slide. Is it no wonder that nurses leave nursing in droves. Management need to step up to the plate here. Pj

Issey, I think it is natural to have some anxiety about anticipating new challenges. It is not clear from your post how long your orientation period is, or how much nursing experience you had prior to going to the OR, so I will respond as best I can. Over 30 years ago, I was 'baptized by fire' in the OR; I had no real organized orientation plan, and surgeons were not nice. I was put on my own very early on without any clue as to what I was doing. It took me about one year to become comfortable with the basics, and about another 2-3 to become much more proficient in understanding all the intricacies of various surgical procedures. In addition to this, technology changes rapidly and so the learning continues. I have a broad base of knowledge regarding procedures commonly done many years ago as well as knowledge of the newer, endoscopic procedures done today. There were many days I wanted to leave and not return; it was stressfull and I felt stupid and useless. Like many things in life, there is a learning curve with perioperative nursing. Having said this, I learned to prioritize by working with older OR nurses who based their practice on AORN standards and recommended practices while adhering to hospital guidelines. It helped tremendously to be paired with a very experienced surgical scrub tech for cases. It helped tremendouly to understand what the surgeon was doing; anticipating what the surgical team needs BEFORE they need it is essential to facilitating a case. I bought "Alexander's Care of the Pateint in Surgery" as well as "Comprehensive Perioperative Nursing" by Gruendemann & Fernsebner to help with the learning. I joined AORN soon after going to the OR and I read the AORN journal every month. Prioritizing is essential in the OR. to do this, I think about: 1) Pt safety and privacy - what do I need to do to provide a safe environment from the time I set up the room until I transfer to patient to PACU. 2) Collaboration - check with the surgeon and anesthesia about positioning if this is a concern, as well any extras he may need for the case. 3) Aseptic technique - how will I accomplish this before and during the procedure. 4) Anticipitation -knowing what the surgeon is planning to do along with his preferences (sutures/implants/cautery settings) will help you be ready. This will come in time, and preparing for you assigments by familiarizing yourself with procedures prior to doing them will help. 5) organization -after 30 years, and 4 different facilities, I still keep a notebook and jot down any information intergal to facilitating cases. In addition, keeping your room 'uncluttered' i.e., keep the floor clean so you don't trip over cords, trash, extra unnecessary furniture strew about. Line up drains, sutures,dressings, etc so they will be ready when your scrub asks for them. 6)Working knowlege of equipment - know what equipment you will use for a case, know how to troubleshoot it, and know who to ask for help in the event you have a problem with it intraoperatively. As for the soft-spoken docs or the mumblers, I go right up behind them to ask a question or hear their response. The scariest nurses and techs I ever worked with are those that think they know what they are doing - they did not know what they didn't know -if you get my drift. instead of asking, they charged forward, often making mistakes and aggravating the surgeon to no end. So, be open to suggestions, read up on procedures prior to circulating them, and ask if you don't know. Your confidence will come in time; you will become more assertive as you develop some proficiency in perioperative nursing. Good luck, Pj

Chole, I wonder if your preceptor or nurse manager knows how you feel? the OR can feel overwhelming initially because there is so much to learn. Can you orient full time? As to the condescending residents and surgeons; there is a fine line between not taking things personally, and allowing someone to be disrespectful and unprofessional - even in the learning environment. do a goole search on horizontal violence to learn more about curbing unwarranted disrespectful behavior in the OR. I felt much like you do, during my orientation, I persevered and I am glad I did. Hang in there, it will get better. Paula

Congratulations! I agree with all previous posters. In addition I would suggest you join AORN, the National association of PeriOperative Nurses. Here you can attend meetings, colloborate with other periop nurses and enjoy the monthly and very informative journal 'AORN'. http://www.aorn.org Also, do not take things personally, as the atmosphere in the or can be brutal at times. Be assertive rather than aggressive when dealing with colleagues. Educate yourself about 'horizontal violence' in the workplace in an effort to ward off passive -aggressive, condescending behavior. Ask for more orientation - especially if you will cover shifts with limited numbers of knowledgable staff. (If that's the case here). Good luck and welcome to periop nursing! Paula

These issues which occur in every OR every day around the world are precisely what creates nurse burnout. I agree, this is a systems issue and until some type of root cause analysis is done with concrete solutions implemented to improve efficiency, and productivity, resulting in improvement in staff morale, as well as patient and surgeon satisfaction, more nurses will leave nursing. PJ

The average age of a perioperative nurse is slightly higher than the national average of the general nursing population at 47 years. Having said that, I have worked with OR nurses in their mid-sixties who could work circles around others half their age. I think your expected longevity in the perioperative setting is a purely personnal choice. I hope this helps, Pj

Alexander's Care of The Patient In Surgery is a wonderful reference. Surgical positioning is as much a personal surgeon preference as it is dictated by anatomy. Having said this, I will tell you that I have done many elbow pocedures with the patient in semi-fowlers and the arm draped free across the pt. chest. good luck, Pj

Incorrect counts on 5 different cases is real cause for concern. Placing blame, and then disciplining staff for mistakes will not fix the problem. Education, including rewiew and perhaps revision of the hospital count procedure might improve the situation. Do you adhere to any of the ARON recommended practices in your OR? I adhere to AORN RP's to the extent my facllity will allow. Are your sponges/ laps in packs of 5 or 10? It is so easy to double-count when handing countables during a hectic case. Also, saving all wrappers ( I know, a little cumbersome) might help in documenting the numbers of packages opened during a case. Good luck, Pj

pstar, If the disposable item says it is for 'single use only', I am not sure the hospital is offering your patient the same standard of care by not offering each patient a 'new' one. For example, given 5 're-uses ' per item, each 6th pateint gets the 'new' item and pts 2-5 get 'uesd' items. In addition, I would think the item must be cleaned according to Mfg. specifications if it were to be re-used. Also, the company may not stand by (legally) their product if it is intended for one-time-use and it is not used according to the way it is sold. Just my food for thought, Pj