OPCC

Can anyone tell me any thing about Ripley County Hospital in Doniphan??? How old is the hospital building, how many docs, are they a moving forward hospital, what are working conditions like, how are they staffed, what are they paying experienced RNs.....tell me what you can. Thanks for any and all help.

Our H&Ps and any pre-op labs are completed within the week prior to scheduled procedure by the patients local physician and then placed on the chart ready for our outreach surgeon who comes 1-2 times a month for scheduled procedures. Then I still have a hard time getting him to sign off the documents that have already been done for him. All they want to do is do the procedure. It makes me feel a little better to know that there are others out there with the same problems. I thought we were the only ones that were "failures".

It is REALLY nice to know that there are others out there with the same problems. I have been beating myself up for many things that happen in our OR dept and they really do not seem as bad as some of the things you all have talked about. We do only Amb OP surgeries and simple things at that.. We are a very small rural hospital with a surgeon that flies in once a month for scopes, hernias, bxs.... The doctor is usually late (traffic was bad, nanny did not get to house on time, weather problem). When he arrives he interviews the patient and signs the consent with the patient. Our H&Ps & pre-op labs are done by the patients local physician within the week prior to the scheduled surgery. The CRNA then interviews the patient and then the patient is taken from the patient room to the OR. We have no holding area (like we need one - not!). The CRNA does not put the patient down until the doctor is either scrubbing or at cart side when doing a scope. My gripe like all of yours is the fact that they take their own sweeet time coming to the OR from the floor. As I have posted elsewhere it is really a lip bitting situation when we have a patient on the table and the doctor is standing outside the doors talking on his phone about his housing project or scheduling a trip. I wish I had some magic answer for all of us. I can do all the QI studies I want and prove that he is the problem but in the whole scheme of things I am wasting my time because things will not change. If we push too much he may just decide not to come to our facility and being rural it is very difficult to get any coverage and he is a very good surgeon.

I work in an outpatient area and I handle the coumadin clinic for our providers. I would love to find other nurses doing the same thing and bounce questions off them.

:typing Thanks to all of you who have replied. I will add to my scenerio: I go out and pick up the patient after Doc and the CRNA have finished their interviews. The CRNA is always present on our arrival in the OR., patient is positioned and monitors attached and everything is ready to go - all for the Doc. The CRNA does not start the anesthesia until Doc is in the room. I really would be having fit if my patient was lying there under anesthesia with Doc out interviewing other patients or just talking on his darn cell phone. In our little hospital I know it is different than working in a big hospital with numerous surgeons and tight time schedules but our surgeon does not even start our surgery day until 9:30 am or 10:00. Between cases he is out in the pre-op area interviewing his next patients, talking to the family of the last case, seeing consults patients because that is when he wants to see them (in between his cases), on the computer internet, or on his cell phone or ????. How the heck does a person ever get a handle on the situation?? He is a great surgeon and we are lucky to have him come to our community on a regular schedule but I just wish things would move along a little smoother. Example: We have had a patient on the cart ready to start a colonoscopy and Doc is standing in the ante room talking on his phone while we all just twiddle our thumbs until he is ready.

Are OR forms have the the same set of times that you mentioned. I am looking at ways to study our turnarounds and on paper identify the problem areas of the process so it is in black and white for all involved. Thanks you are great help and seem to be a very good information source.

Yes - we page the surgeon ahead of time. Many times we page him several times. When you are the only surgeon- as we are a rural hospital and the surgeon is an outreach surgeon - he seems to take advantage of the situation.

Thank you for your reply. What I am looking at is our turnaround time and how to make it faster. Three distinct processes exsist within overall turnaround time. 1) Surgeon out to patient out. 2) Patient out to patient in. 3) Patient out to surgeon in. I am wanting to see how others would define the 3rd component, when looking at causes for delays. I want to think it should be the time he walks into the department as we are ready and he is messing around. How many times can you tell a surgeon you are ready. Again thanks for your thoughts.

Please correct if I am wrong in my difinitions: Patient Out - Pt. leaving the OR Patient In - Pt. being brought into the OR Surgeon Out - Surgeon has completed closing and leaves room Surgeon In - ??? Actual procedure start time by surgeon OR does it mean time the surgeon enters the OR suite??? I think my turnaround times are not too bad. My problem is we have the patient on the table ready to go and surgeon is talking on the phone, talking to family of the last case or seeing a consult patient... Is this a problem for any of you guys.

I was told in my eval that I have a perfectionist personality and that it may iritate others. YES - I do have an (anal) personality but it has served my patients well. Either it is done right and in the best interest of my patient or I will stand tall and take the heat until it is right. It upsets me when I see how accountability in nursing has slipped over the years. It seems alot of people have the "I, Me, or that is good enough, or let the next person worry about it". I am to the point of thinking about changing jobs because of these feelings. I have worked for the same facility for 23 years and always get high evals as well as very good support from the providers. Am I getting too old for nursing??

I work in a small rural hospital. We have a surgeon that flys in once a month to do minor surgeries and scopes. We have one OR that we use for both surgeries and scopes. We do between 5-10 cases per surgeon visit. Most of the cases are scopes. We start with our clean surgery cases first and the proceed to the scopes. Our CRNA does all the sedation for the scopes. We work with 2 RNs in the OR, no tech help. One RN circulates and the other scrubs/assists the physciam. On our surgery days we have 1-2 RNs and one CNA admitting, recovering, dismissing as well as checking in the consult patients that need to be seen. :angryfireThere are times I could just pull my hair out from frustration by the end of the day. Our scope patients are put in recliner chairs and taken to the OR and put back into their chairs after the procedure for recovery. Only surgical patients are taken back to the OR on carts. Our average turn over time is 15 - 20 min. from the patient leaving the OR, the room being changed over and the scope being cleaned to the next patient being admitted to the room. Do you think this time is unreasonable??? We spend alot of time waiting on the doc to come back into the OR. Do you think we are appropriately staffed? If not, how do you think we should staff for what we do. Also, I would like some thoughts on scheduling scope patients- admission to discharge when you only have one procedure room, minium staff and only 3-4 rooms for admit/recovery use.

Am I ever glad I found this site. I work in a small rural hospital. We have a surgeon that flys in once a month for surgery cases and scopes. We too are staffed with 2 RNs and CNA in the OR for scopes and surgical cases. The two RNs turnover the room and clean the scopes - no aides or techs to help us. We have one RN maybe two IF I am lucky and one aide to admit, recover and dismiss the patients as well as check in the consult patients for the surgeon. We do 5-9 procedures during the day which may include a surgical case or two depending on the month. QUESTION?? Do you think we are short staffed?? Also, would you tell me how you would schedule your patients time wise to come in for the procedures. I have many question but thought I would begin with these two. ALL HELP IS WELCOME! / opcc