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

HI just going to add my two cents here. We never mop floors, unless it is when we are on call. I think that RN's mopping floors is not cost effective, think about it... a highly trained individual paid $30/hr vs an aid $12- $14 an hour? Besides when we are turning over rooms we have things to do. Interviewing our next pt, adding whatever else we need to our case cart etc. Also a good time to send someone for coffee or lunch. We have about 8-10 aids, who swoop in to get the room clean. They can turn over our rooms in as little as 8 minutes or as long as 20 minutes, depending on how many rooms are out at the same time and how dirty the room is. ( It is what they are trained to do, and personally I know they will do their jobs much better than an RN, as they pay more attention to the details of their job, b/c we just want to get in there. ) I don't necessarily think that this is always good. ie, sometimes our tables are still wet with disinfectant, (supposed to be wet and left to dry for 10 minutes in order to be effective). I think that $4 million could have spent better elsewhere. What looks good on paper not always works out the way they planned in the real world. Bottom line, a good manager has the right people doing the right job. No it's not beneath you to mop a floor, but is it the best use of your talent/training and is it the most cost effective? Would you want the chef at your favorite restaurant mopping the floors and cleaning the restaurant between lunch and supper and then have him prepare your evening meal? Good luck and make sure you give us an update. P65

Hi Elly, My brother lives in Oxford County. An update on his condition, turns out he didn't have lung cancer, but some kind of a fungus growing in his lung!!! Have you ever heard of anything so crazy! He actually still has chest tubes in to this day. They should be coming out any time now. He has a nurse that comes out once a day to check on him. That crisis is now over. He has told me if they were able to identify what kind of fungus it was in his lung. If you know the name of a pain clinic I would love to pass it on. Thanks much P65 :kiss :thankya:

Hi sharann, I think that you every right to be "steamed" about that cavalier attitude. Sorry no room for 'tude like that! I don't work PACU but I do work OR. This is how it goes in our facility. RR nurses definitely have a nurse-pt ratio that is strictly adhered too. ICU pts go to ICU they bypass RR completely. When we are finished our case in the OR we MUST call RR first to let them know we are coming and do they have room for us. If they do not have staff or room for our pt, then the pt remains in the OR with a nurse and the Anaesthetist until such a time as they can accomodate our pt. On rare occassions (this is more likely to happen on weekends and on-call but has happened during the week) when RR is backed up the OR is put on hold and cases do not start until such a time as RR is caught up. I can guarantee you that if our nurses had to work in that kind of situation they would be filling out an unsafe workload report to CYA. I definitley would also be concerned about the legal liability if a pt ever started to go sour. Only with documentation to support your unsafe workload, do you have anything to cover you. What does your Union or national association say and what are their "workload" guidelines? You can count on that being brought up in a lawsuit and whether you and your employer aspired to meet or exceed those guidelines. Take care and hope things get better for you P65

Hi Stevierae, just one more thing I wanted to clarify is that in Canada we do not use surgical techs, everyone in the O.R. is a nurse, either R.N. (31 of us) or L.P.N. (3 of those gals). But that day may be coming as we are a publicly funded system, and licensed professional staff are +$$$$. One Surgeon thinks that trained monkeys could do my job. I told him I don't think so... a monkey's bladder is not big enough. haha, Take care and I look forward to reading more of your posts on the site

Good Morning Stevierae, yes we always try to staff with 3 nurses. This helps for break relief. Although we may be staffed for 3 nurses, once breaks start happening there are often two. Our third nurse comes in on the 2nd shift, 9:15 and then breaks start. I did say that I worked in Canada and that things here may be slightly different than in the U.S. Hope this clears things up.

Hope this helps you out. I work in Canada, so things may be slightly different here than in the U.S. I work in a 6 theatre surgical suite. There are 31 R.N.'s and 3 L.P.N.'s, two of them just recently graduated. We all take turns circulatating and scrubbing. Don't kid yourself that we just sit at a laptop all day. We start out our day getting our room ready if it hasn't been done the night before by our call-team. Ususally we have three nurses to a room. Someone usually goes out to interview our patient. Make sure that they are NPO etc. The interview is very important, in that you are the last stop before surgery. Making sure of allergies, preexsisting medical conditions, what kind of meds they are on, not just RX but over the counter and "herbal" meds, and any other extraciricular street meds.Do they have any implants, pacemeakers, lenses in the eyes, plates, screws or mesh in their body. Is all their jewelery off, anything pierced. Is their lab work complete, have they been grouped and matched. Confirming which side surgery is to be on. Do they underdstand what is going to happen, is the consent complete and legal. Do they have questions? On several occasions I have caught things that have neccessitated cancelling the surgery until another time. You are the patient's advocate the entire time that he/she is under your care sleeping and awake. Your interview must be thourough, so that if there is anything that the surgeon or gasman isn't currently aware of you can bring it to their attention. You bring your pt. to the room, introducing the team to them. You do everything you can to make that pt. feel relaxed and comfortable. Many pts. are just a little nervous, who wouldn't be? when they come in for sx. You assist with the intubation and safely getting that pt. off to sleep. Depending on whether your case is big or small, you may have to assist your gasman with the insertion of various line, epidurals etc. This can be time-consuming and he/she needs your undivided attention. Sometimes depending if it is a really big case you may spend the entire case with the gasman. Hanging blood etc. If you are the scrub you need to set up your table for the case. You need to make sure that you have everything that you will need for your surgeon. You need to count and make sure that you keep track of everything that is on your table. When you are scrubbed you are joined at the hip with the surgeon. You have to pay attention to what is going on, you have to understand what you are doing for the pt. and why. You have to anticipate what the surgeon is going to need from you. You need to constantly to be aware that technique is not being broken, that your field remains sterile and orderly so that you can find what you need in a split-second when he/she asks for something. The circulator: an underappreciated member of the team. He/she is the glue that keeps everything together. The circulator has to take care of the scrub, the gasman, the pt. and the surgeon. A lot of responsibility. Keeping track of sponges and doing the count. He/she opens for the scrub at the beginning of the case and helps to get them set up. Doing prep for the patient, washing and painting the surgical site, right side etc. making it as aseptically clean as possible. Inserting a foley if required. Positioning the patient as required. Being mindful of positioning the patient to maintain skin integrity and prevent the development of bedsores, ( which can show up 4-5 days later after surgery if the patient has not been properly positioned). When the case is done you have to do a count and make sure that you have all your sponges, needles and instruments etc. You assist with transfering the pt. to the stretcher and take that pt. to R.R. or ICU. You need to be able to give an accurate report to the nures taking on that pts. care. In between cases when the room is being cleaned you as the circuator and scrub are already preparing for the next case. Getting your case cart ready and assembling and last minutes supplies that you may need. It is true that some cases ie lap choles etc. there may be lag time where it seem that you may not be doing anything but as Shodobe indicated you always have to be ready to go from a regular case to an emergent case immediately. One role that I have not touched on is that of the RNFA, perhaps someone with experience here can comment on that. Hope I have given you a better idea of what an O.R. nurse does all day. Pt. contact is limited, but I can not tell you how many times I have had a frightened pt whose hand I have held while they went off to sleep and again when they are waking up. Your role is the care of the pt is important. Maybe they won't remember your role in their surgery, some do, and if you can put that pt. at ease it so much better for their peace of mind. Again establishing that trust, as Shodobe mentioned between surgical team and pt. Working the O.R. is exciting and fulfilling. There is a steep learing curve and you are always learning. I don't know if you can get stagnant here. Best regards and I hope this helps you out. R.N.

Fergus 51 Thanks so much I emailed the Page to my Mom. I told her to make sure they asked the surgeon for a consult. I'm hoping they will step back and look at the whole big picture. He's going to have a long road ahead of him, and I don't think he can do it alone. Much appreciation, Ruby N.

I worked in an O.R. that was about 30 years old. (we are in new ones now) But before I came many of the girls that worked in Recovery Room did miscarry. The thoughts were that is was from accumulation of exhaled anaesthetic gases. Once a proper scavenging system was in place there were no more instances of cluster miscarriages. Just something to ask about

Well we had a unit meeting yesterday and were informed that we are no longer allowed to refer to Surgeons, Gasmen or Assistants by their first names. We were also informed that we were not allowed to talk about anything other than our "case". Our program mangager seems to think that we are not being percieved as professional when we refer to to the guys by their first names. Some of us think that this is a retalliation because one of our more prominent surgeons has recently been written up (three times) for harrassment. We think she is in his back pocket. Whatever he needs he gets. Special attention is given to this surgeon, she is in and out of his theatre when he is working. None of our other surgeons get this kind of special attention. Many of us feel that our department is ripped in half, morale is low. People feel like they cannot go to management with any concerns. When issues come up they are not dealt with, just lip service and no follow-through. Unit meetings are a joke. Everything is her agenda and none of our concerns. Many of us feel that this first name business is just another form of "control" that she needs to exercise over us. CRN's have no input and are never allowed to exercise their own judgement. They are never consulted, and are often "last to know" when things come up. Just wanting to know what goes on in other O.R.s. Maybe I'm totally out of line here. I think that anything that can foster a sense of "team building" is a positive thing. When you work closely with people and establish a rapport with them I don't feel that referring to someone by the first name is a lack of respect. Thanks for letting me rant.