kiwi77

Wow---we could be the same person!!! I could have written this and I had to double check this post because everything you wrote about happened to me at the same time----this summer I also scrubbed in for a tech who called in sick-- a lami decompression first time in 20 yrs, and received compliments and was so proud that I still could do it..... also went to nursing school in the late 80's, also was a ST on open heart team, also am fighting a battle to scrub instead of always circulate, also live in SW US, and am saving my $$ to go to RNFA school and finding little support at work. Thanks for sharing your ups and downs and don't hesitate to PM me.

I am an OR circulator with expectations of becoming an RNFA within the next year.... however, as expensive as these programs are, am afraid of paying for one that doesn't deliver what they promise. One school whom I spoke with in particular has a long waiting list of almost a year. There are no other nurses in the OR where I work who are scrubbing or are RNFA's so I am not able to talk to any co-workers. I would very much appreciate any feedback from anyone who has already taken an RNFA course and has any words of wisdom for me. 1. Did your employer reimburse you for any part of the tuition? 2. Did you feel you got what you paid for? 3. Where did you get your training? Also, how have your co-workers treated you as you transitioned from circulating to taking on an expanded role? Some of the RN's and techs I work with don't seem to mind. They know I scrubbed for many years before I went to nursing school. I go out of my way to turn over rooms, mop and clean and yet a couple techs do whatever they can to undermine me and resent that I am in what they consider their territory. One in particular was irritated she had to hand instruments when another tech called in sick and I first assisted in her place, she tried to talk me into scrubbing out several times during the surgery. Saying, " I bet you would like to scrub out and get ready to circulate your other cases....(big, fake smile).....you can go ahead and leave." I told her I was fine where I was, that I was sure whoever was making assignments would take care of the the other cases that needed circulating. Even the surgeon told her to chill out and that he wanted me to stay. The OR where I work, there are no RNFA's and the scrubs aren't trained to first assist, however they fill the position anyway. They are not able to perform any first assist duties except exposure, cutting suture, holding retractors. My manager is 100% in favor of having me trained as an RNFA. I try to go out of my way to be a team player and I have been in this position long enough to realize there will be sour grapes no matter where you go. But with the shortage of circulators where I work, opportunities for me to scrub in are minimal at best--maybe 4 times in 9 months. Those of you that have gotten RNFA training---did things get easier after you actually enrolled and needed the required number of hours first assisting? I cannot get any opportunities to scrub unless someone calls in sick so most of the surgeons I work with aren't even aware I can do anything but circulate. I've found this everywhere I have worked. I've been an RN in the OR for over a decade and scrubbed for 8 yrs before that. I am wondering how I am going to find a surgeon to supervise me during my clinical practicum in order to get the required number of cases to complete the RNFA course. Maybe I am putting the cart before the horse but as I look at my situation, it feels like I am hitting a wall and I am not willing to let another year go by that I continue doing what I've always done and not feeling challenged anymore. There is a great deal of resistance from techs in the OR who feel threatened by an RN who can do their job, circulate and now wants to also first assist. Please PM me if you don't feel comfortable identifying a school by name. I appreciate any advice and feedback on this----thanks in advance!

I have not seen a policy iabout this issue and it is being debated in the medical exec committee meetings at present. The biggest problem is surgeons who don't see their patients before induction and send their PA's in their place. The surgeon claims to be either in-house or just across the street, calls his PA on his mobile and all I have is one persons word against another's. We've had patients anesthetized for 30 min to an hour, needlessly waiting for the surgeon who was "10 min away" to finally show up and scrub in. All this is documented on the patient's chart so it can be tracked if there was anyone who wanted to see how often this was happening. We do electronic charting and the statistics are very easy to track by administration. I am going to ask to see what if any policy exists to cover myself in the event that a patient does sue.

Yes, everywhere I work this has been an issue. I have not seen it be OK for anyone but a PA, resident, CRNA or anesthesiologist update the H&P. None of the OR nurses have taken upon themselves to update the H&P because our policy doesn't allow that. But guess who is written up first by risk management if the chart is audited and it is seen that the H&P wasn't updated the date of surgery? I've had surgeons tell me to not hold up the case, take the patient on to the OR, that they will update the H&P when they dictate after the surgery. Guess what? They forget and it doesn't get done.

I've been following this thread about surgeons giving the "go to the OR" order and how it's handled differently in each hospital but haven't seen this problem addressed yet. We're having issues with surgeons calling from their mobile phones, saying "go to the OR, I'm 10 minutes away." Their PA makes the incision and performs 30-45min of the surgery. The only MD's in the room were the anesthesiologist and the resident whom I think was a 1st year. The surgeon strolls into the OR to do the major part of the operation, however, was not around to supervise prior to that. In some cases there is no other MD in the OR as we use CRNA's and the only people at the OR table are a tech and PA. The pressure on the other circulators and me to go along with this is tremendous. My boss backed me up and told me to write up the surgeon----which I did. That has made me very unpopular with a few surgeons who know I wrote one of them up. On my nursing notes, I have to put the time in and out for every member of the team as well as what time the incision was made and the time of "time out". The difference between incision time and surgeon entering the OR was almost an hour. Is this isolated or happening everywhere? Where I work, no one calls the OR to notify that the doc is in the building so I have no proof that the surgeon isn't still on the interstate. The CRNA or anesthesiologist puts the patient to sleep, the patient is positioned,the PA and/or resident start the surgery.....none of the RN's I work with think this is a problem. My boss however does and is getting a lot of resistance from surgeons who say they were always immediately available, if not in the OR. In one case, one claimed to already have talked to the patient pre-op and was in the building although he had not because I was with the patient for 45 minutes and never saw him in the holding area. I just want to follow policy and not jeopardize patient safety or my license. I would like to know what other circulators are doing when faced with this.

The hospital where I work has an intraop order sheet with all that you've mentioned on it. The circulator ticks the box in each category for type of local, drains, foley, specimen, etc. Then signs and sticks in chart for surgeon to co-sign. This covers us for the drugs we pour on the back table, the type of irrigation used, pre-op antibiotics given....works real well.

Reading these examples of heartlessness from healthcare employers who advertise themselves as caring and compassionate (at least if you're a patient) reminds me of my own nightmare. As said before, this is unfortunately not an isolated incident. It also seems that once a nurse is seen as "damaged goods" by management, no matter how good the nurse's previous record of employment is, it's just a matter of time before TPTB come up with a "reason" to terminate him or her. Get targeted and there's absolutely nothing you can do that's good enough. In some cases it seems to come out of nowhere, but other times, you see it coming a mile away. In my own case, I learned early on how the system works. An honor roll nursing student, I was forced to file a grievance against my nursing school to return after an MVA (drunk driver hit me) and surgery which caused me to miss an entire semester. After the school board ruled in my favor, I was back in class and graduated without incident. While in school, my employer promised me a job after graduation on the unit where I worked as a nurse tech----gave me the shift I wanted too instead of going straight to 11-7. Six months later, newly pregnant with twins, my HN called me into the office and told me they didn't have a spot for me and to "come back when your life settles down a bit". I hadn't thought to get her verbal agreement in writing and I was devastated. To prevent the loss of my health insurance, I had to scramble quickly and find another job in the same hospital on a unit where the news of my high risk pregnancy had not yet become common knowledge. I stuck it out until having to go on bedrest and then resigned to work at another hospital when my maternity leave was over. 12 years later, at another hospital, I applied for FMLA at the advice of my boss because of debilitating migraines. I wasn't calling in any more than the rest of the staff but I was told to do it or I might be fired. I began seeing patterns of discrimination, and brought the proof in writing to the ethics officer who opened an investigation and was in agreement that my suspicions were true. The end result was altho I was being targeted, written up for bogus reasons, got the lowest yearly evaluation in the department after previously getting the second highest, I knew nothing was going to change. With such a low evaluation, it now affected my yearly raise and when money and security are involved, the time was right to leave. It's sad to hear so many similar stories of nurses who gave their all for their jobs and in return, get the shaft. I am sure it happens in other industries but it seems especially cruel because of how much of ourselves we give as caregivers.