porsch65

On again with bovie smoke, I noticed that I posted on this thread over a year ago. Bovie smoke is a known carcinogenic. If you have concerns about this in your O.R. you could try raising this as an "occupational health and safety" issue in your workplace. If you are in the U.S. and not unionized try going through a state agency related to workplace health and safety. The facts are out there, and the equipment is out there too. We use "Valley Lab" equipment, and I am sure that any of the companies that sell smoke evacuators can help you by providing literature on this subject. Also try and get literature from A.O.R.N. or O.R.N.A.C. as I am sure the must have postion statements on this issue. If you push it a little bit maybe you will get some support on this very important issue. Good luck, P65

Good Morning and Merry Christmas/Happy Holidays to all of you at All Nurses. We had an interesting conversation at work the other night concerning the seemingly hight incidence of illness amongst O.R. Nurses in our Surgical Suite. We have a staff of about 30 -35 nurses. In our group we have had two nurses with carcinoid tumors, several with lupus, fibromylagia, thyroid conditions, t.b, and t-cell lymphoma. Several of our recovery room staff have had miscarriages. Once health and safety was called in (not occupational health who said nothing was wrong) it was found that the exhaled anaesthtetic gases were 10 x's higher than they should have been. Scavenging systems were installed and that problem seems to have stopped. But with all that we are exposed to bone cement, formaldehyde, x-ray, MRSA, VRE, ... is this just an "occupational hazard"? We have recently moved into a new building (2 years) some of us wonder if it was the old building. I find it interesting that in our town, a pop. of 45,000 two nurses who work in the same building in the same department come down with a fairly rare type of tumor, 1:100,000, another one comes down with a rare type of lymphoma 1:1,000,000. Some of these nurses are really young, 33, fit, marathon runners etc. Those who were asthmatic found that they had to use their inhalers more than ever before. Others are more tired than they had ever been than when they had worked on the ward doing 12 hour D/N shifts. So what's the deal? What is the incidence of illness in your O.R.? Anybody notice anything unusual or is it all "just in our heads". Just thought I would toss that out there and see what you all had to say. Best wishes to everyone for Happy Holidays and all the best in 2006. P65

Hi There, Just going to offer my 2 cents here. We moved from 30 year old O.R's to state of the art O.R.'s about 16 monthes ago. Our rooms are bigger now, better for all that equipment. The company that built our new building has built several O.R.'s around the country. Some things they did well and other things well... you can tell they didn't talk to O.R. nurses. We have booms in everyroom and most of our equipment fits on the booms. Each room has access to a PAC system, great for surgeons, but the hookup is kind of in the way of where we put our sterile field when we are setting up our cases. We have the Tulip system in two of six rooms so that your circulator can turn things on via a computer screen. Big waste of money as far as I am concerned because when you think about it, you have to go to the boom to plug everything in right, your bovie, smoke evacuator, light cords, insufflator, gas for drills etc. etc... so you might as well turn it on while you are standing beside the boom. The most important thing that I think is lacking in our O.R.'s is one completely clear wall where you can set up your sterile field. Right now there seems to be something against every darn wall. Drive's me nuts!!!! One differance I notice now from the new place and the old place, is that I can't hear a darn thing!!! We now have laminar air flow in every room and the walls are smooth. In the old place we did not have laminar airflow and the walls were tiled with grout. The old place seemed to act like a acoustic baffle for lack of a better word nutty or what, eh! As far as cords go, I'd love to see cords that retract back into your equipment after you used them, like the old fashioned electrolux vaccum cleaners. Boy am I dating myself or what. I'd like to see that with your monitor cords as well. We use Datex gas machine which were selected by our gasmen. The nice thing about the new machines, is I take the first blood pressure and my gasmen shows up two minutes later b/c he has a monitor in his office and can monitor anyone hooked up to a Datex monitor in the hospital, be they in Emerg, ICU or our theatres or Recovery Room. Sure saves on phonecalls and paging. We have flat screens on booms and slave monitor for the assistant. Very nice, nobody gets a crick in the neck anymore. And for me the number one improvement is the fact that we have real windows!!!! The windows also have no touch blinds between two panes of glass, for when you are doing laporscopic surgery. We are now on the second floor where as before we were on the first floor and had no windows. In the winter it seems like you go to work in the dark and then go home in the dark 8 hours later. I think I started to suffer from a little bit of SAD my first few years in the O.R. come winter. So having real light is a personal bonus for me. Every room is outfitted with boom for gas, boom with camera, insufflator, erbe, smoke evacuator, suction and is lazer ready. Each room has computer and we are slowly getting hooked up with med series 4. We have a fullsized two compartment warmer, for fluids and blankets in each room. There are also wall mounted cabinets for supplies such as sutures dressings, foleys etc. These wall mounted items can all be removed within a minute if we are doing a MRSA case. Saves on cleaning for our cleaning staff etc. and we then keep a minimum of supplies in the room then. All beds are electric and can be modified. In one of our rooms the light fixture has a video camera built into the handle. This was supposedly thrown in for free when we went with a new vendor for lights. The camera can be moved into any room with just a call to bio-med. We are able to record any surgery, as well as watch the surgery on the monitors. Only drawback is sometimes all the ciruclator or scrub for that matter can see is either the surgeons head or his hands. All of our doors into the sterile core have a sidelight window in them, I'd like to see a blind in the door, when you want to close those windows when you are doing laser. We have automatic main doors, some are two doors that swing wide open, and then we have some that are triple doors that slide onto one another. Don't really care for those, especially when people are entering back and forth and there you are sitting with your sterile field. We found that when we moved into our new place yes it was big and beautiful, but after a couple of weeks, it was a lot of little things, like what were they thinking? I would have liked to see the company come back to us 6 to 12 months later to do a survey and say okay, what did we do well and what can we do better. They come in with their ideas, and don't really take into consideration the end use or look at things the way the user will use the room. Each gasman has his own anaesthetic cart, and his stocked to his specifications and then the other standard stuff. We then wheel it from room to room from one day to the next. The floor above us is basically all crawl space for wiring, gas lines, etc. All the infrastructure is there for Hermes someday. Personally I think that could be a big waste of money, more to satisfy a surgeons ego, than practical. But until you use something, ...I'm sure I could be way off base on that one. Anyways I am definitely starting to ramble here... But the best improvements, would have to be size of rooms, one wall clear of equipment, windows, booms and departmental layout. Our surgical suite is laid out like a racetrack with the sterile core in the middle. I think the most important thing in building a new O.R. is to talk to the end user and make sure that it fits everybody's needs and makes sense.

Hi Shirley, Why not make your own? You can buy a pattern at the local fabric store, and pick out your own fabric. Or, if you already have a hat that you like, take it apart and trace a pattern out on cereal box-board. Your can make hats for very few $. I tend to be the seamstress in our O.R. I sell extra hats for $3 and it covers all my costs. Try making your own. It's easy and takes very little time, or ask someone to make some for you. It would still be way less expensive than buying store-made. Let me know how you make out. P65 :)

thank you for that most thoughtful response. You obviously have had experience in dealing with this issue. I particularly like the suggestion of having the bully go to EAP to understand their own behaviour. We have had incidences of targetting in our unit. The behaviours continue to happen. Our manager is invisible, and she communicates to us via e-mail. I would love to share all of this with her, but she in not approachable. All the suggestions that you have made are those that "have teeth". I think that I will print this off and send this to our HR dept and some others and perhaps my own manager. You sound like a wonderful manager that supports his/her staff which in turn supports our patients the most important reason why we are all here. P65 :) :)

Hi There! "Sterile Cockpit" is a term that is used in the airline industry. It is kind of a code of conduct that is adhered to during crucial periods of flight, namely take-off and landing. It came about because it was found that the majority of "incidents" occurred during these phases of flight. During these times it was deemed imperative that pilots not be interrupted during these times. There was no unneccesary talking or activity or distraction that would interfere with the function of the crew. Crew focused solely on their required duties during these critical phases of flight. I see a distinct parralell between the cockpit and the O.R. I would relate landing and take-off to induction and reversal, to first count and final count. So many times silly mistakes happen during these times and it is often a direct result of unneccesary distraction during critical phases of surgery. Counts should never be interrupted, there should be no talking during induction and reversal. The concept is similar to "timeout" from what I can gather. Focusing on right side, right pt. etc... I was just curious if some of you incorportated the two together as the article I read on "Sterile Cockpit" was of American origin, and I thought that it was cool that this practice went on and was adhered to.

HI Everyone, Just a couple of quick questions. Would really appreciate the point of view of nurse managers. Do any one you run units that have or had low staff morale (for whatever reasons), and what did you do to facillitate a positive change on your unit. My next question has to do with "targeting" or bullying. Have you ever had a staff member who targeted another staff member and how did you deal with this to prevent further such behaviour and how did you support the staff member who was targetted. Thanks very much for any input you may have to offer. P65

HI Shirley, Thanks very muchfor the web-site, very helpful. I'm from the "Great White North". I guess we have been doing all these things all along, just didn't have a title for it. I was wondering if it was more than what we already did. Thanks again for your response P65

HI this is the first time I have posted a new thread of my own. Usually I have just read yours to learn new info and find out what others are doing in their own O.R. I'm interested in knowing if anyone of you practice "Sterile Cockpit" or "Timeouts" and if you could give me feedback on to what your practice is. We currently do not have this in our O.R. but I think it is something that should really be looked at. I'd appreciate any input. Hope this isn't one of those "duh" questions. "Timeout" was mentioned in a previous thread and I'd like to know more about it and all that is involved. Thanks much, Porsch65

Wow, the more I read threads on this forum, the more I realize how good I have it and that I should quit whining about the the little things that go on in our O.R. All after-hours must be booked through the anaesthetist. He is the gate-keeper of the O.R. We have an emergency classification system, E1, E2, E3. E1's must be done within 4 hours, E2 within 12 or 24, (not sure of that one) and E3 must be done within 48 hours. We have a sessional room that runs during the day for emergencies that come into the O.R. during the day. That gasman is on for 24 hours and is in house during that time. The "on-call" staff are on from 15:15 until 23:30 and 10 - 6 on weekends and are on call until the next shift come on. If a surgeon wants to "bump" a case he must speak with the surgeon who was to go next with his case, this is an expected courtesy between professionals. In the end the gasman has the final say. Slated cases are ususally done by 3:30 or 4p.m at the latest. If a slate is running grossly over, cases may be cancelled. Staff are asked if they can do overtime, not told that they are doing overtime if slates run late. We do not do "locals" with the call team after hours. Considered a strict no-no. Elective cases are always done on a slate. VIP's are done just like anyone else, on a slate. Their name however may not appear on the slate beside their procedure, for privacy, but again this rarely happens. Occassionally if slates run late for unforseen reasons and cases are running late in the sessional room, on-call staff may be late going for dinner or may not get dinner at all. This rarely if ever happens. Staff staying late and doing overtime are entitled to a free meal from the cafeteria no questions asked. if staff can not get to cafeteria themselves, nursing supervisors procure them a meal and bring it to staff room, so that staff have something to eat in between cases. I think you guys and gals are really taken advantage of, and definitely caught in the middle. My hats are off to all of you for maintaining your professionalism despite sometimes a difficult work situation. porsch 65

Hello Sharann, at our facility, the patient marks the site with the surgeon's intials. once in the theatre we then have the patient verbally tell everyone in the room which side we are doing, i.e. right knee, right breast etc. the consent is also then shown to everyone in the room, scrub, ciruclator. hope this is helpful, porsch65

In our facility, locals are not done after hours or on weekends when we are on-call. The rational behind this is that we are "on-call" during those times for emergencies only. Anaesthesia is our gate-keeper so to speak during these times, as he/she is the one that surgeons must book their cases with. It would not bode well with our administration to have to call in another team should a genuine emergency come through the door. Doing "local" cases using "on-call" staff after hours and weekends is considered a mis-use of the call team and is not permitted. Hope this is helpful. Porsch 65

HI, we don't use the vending machines, there was talk of it before we moved into our new building but we opted not to use them. In our new building the surgical suite is a locked unit. Only open from 8 to 4. The office is right at the entrance of the dept. and there is always someone at the front door. Rooms such as the ofc, the locker rooms must be accessed by a valid swipe card. Only those with "access" can get into our dept. We rarely see anyone outside our dept wearing our scrubs. Like a previous poster said it's usually the docs and or residents who are seen wearing them outside of the dept. Our PM has pretty good control over the situation. Has not been an issue since we moved to this new building where things are locked away. Before this in our old building the OR was wide open and anyone off the street could walk in. Some of the girls had issues with shoes and clothing and purses going missing. Never an issue now.

HI there, I say go for it. If you are really interested in OR Nursing keep applying until you get in. Ask if you can be an observer for a day or two, to really firm it up if this is really for you. Don't let anyone discriminate against you b/c they think you've been gone too long. We had a gal who had been out of it for 10 years. She did her nursing refresher course and her "practicum" in the OR and has been with us for a year now. She is doing great, in fact she is going to be my new call-partner at the end of April. I have no reservations where her abilities are. Good luck and keep us posted. P65

:chuckle hahaha, isn't nice to be able to be selective Take care, P65