ShariDCST

Curious - Who is "dianah" and why is she editing my page? The bottom of my page says "Last edit by dianah on Mar 1 : Reason: misspelling, add comment". I put that there myself when I corrected something - but my name isn't "dianah"....

Speaking from two different angles here. One involved 2 years of Air Force Jr ROTC in High School, involving lots of marching and mostly standing in formations outside for long periods of time. The first rule we learned was to not lock your knees while standing in formation, especially when it's warm. That's the easiest way to find yourself on the ground in a faint or make yourself nauseous. So make sure you are not unconsciously locking up your knees while standing for longer periods or when the rooms are particularly warm, which seems to happen frequently in certain circumstances. Move your feet around a little, and bend your knees from time to time, and if that's the issue, it should help out a lot. Speaking from an OR learning environment ~ Other advice regarding eating enough is right on the money, especially early in the day, and plenty of protein and carbs. Even peanut butter crackers and bananas and yogurt is better than Starbucks alone for breakfast. Your brain runs on glucose, and it's running on overtime while you're in such a high-stress learning-intense environment, so don't forget to feed it! I used to precept Surgical Tech students and RNs in the scrub role, and my first question after greetings each morning was "Have you had a good breakfast?" Those who had, did well. Others who hadn't, not as well. I started keeping peanut butter crackers or cheese crackers in my locker, and a package of those could make the difference the first morning. After that, a decent meal was prerequisite for coming in my room! There are lots of things you will be exposed to in the OR that you will almost never see outside of it, so don't be surprised if sights, sounds or smells or even associations that you never considered in advance produce troubling effects. I never ever was squeamish about anything anywhere, including blood, but my very first day observing in an OR, I found myself sitting outside in an anteroom, woozy from the smell of the Bovie smoke. I talked myself back in there twice, and refused to give in to it. It takes time to develop any kind of comfort level with new things, so be kind to yourself, and don't let anyone else bully or hound you into it before you're ready. If it seems to take longer than you feel should be "normal" then address it with someone with whom you have confidence.

I worked in many different sizes and types of facilities, from 3 OR county hospitals, to major metro teaching hospitals to a private 2 OR surgery center, and about everything in between. (I wasn't a "job hopper" ~ I worked as a "temp" or Traveling Tech for several years, in addition to some stints as a regular full or part timer.) A 30 minute turn over at any of them would have been a luxury. But, it depends on where you are, what kind of cases you do, and what sort of turnover help you have. One nice mid-range facility I temped at had a button on the wall inside each OR. When your case was over, and your patient ready to be moved, you rang the bell the same number of times as your room number. Turn over/housekeeping staff was waiting at your door to come in and move your patient, clean the room and set it up for the next case. Frequently any equipment you would need for your next case was waiting outside your door too, and brought in when the room was clean. They had quite a training program to learn what was what, where to put it, and how it all got handled! Nursing went with the patient out to PACU, and then to PreOp to take charge of the next patient, or if there were 2 RNs (usually) 1 came back to help get the room opened and going for the next case. Surgical Techs took care of getting instrumentation down to the dirty room, take a potty break as needed, pick up the next case cart and bring it in to open. (That is if someone hadn't beaten you to it, and was already opening the room by the time you got back to it!) The RN not bringing the patient was helping to open the room and do counts, while the other RN brought the patient. It worked beautifully, nobody stressed, and we were always well under 30 minutes at the same time. When my time was up covering for a couple of maternity leaves, I really hated to leave! Everyone was friendly, and we all helped out each other. Another place, there were a couple of docs always up our behinds for "FASTER FASTER!" turnovers. One had a habit of standing in the doorway and looking at the clock and patting his foot while watching us do all the work (grinning, of course.) Of course he was also frequently in the way. I broke him of it when I started handing him the mop, or a full trash bag to take out and down the hall. When he figured out that I was always going to put him to work if he continued to stand there, he began making himself scarce between cases! We also never had over 20 minute turn over times. There are lots of other stories, but it all boils down to who's in charge and whether or not they have your back or are only interested in kissing someone elses's ass while protecting their own at your expense. Employee and patient safety should always be #1 on the Hit Parade! Unfortunately, the almighty $ is what rules the game these days. Your only protection is to have each others' backs, and help out whenever and wherever you can. And the #1 rule in Healthcare is "Document document document!" If 30 minute turnovers are impossible to do safely, then make sure they know why! Find out where the process is failing you, and have brainstorming sessions on how to fix it. Try out what makes sense, and can be done safely, and if it works, incorporate it into your routine. (The "you" being collective here ~ not individual.) If not, throw it out and try something else. For instance: If you have to run all over hell and gone for supplies everytime the room gets turned over, figure out how to make turnover packs, or have a cabinet arranged to have all those supplies in one place. Linens, disposable trash/linen bags, suction cannisters and tubing and anesthesia circuits, and whatever else you use to change out the room. There's all kinds of ways to consolidate work. You have to figure out what works best for you. Good luck!

Wow. To be perfectly honest, it sounds like a disaster waiting to happen. It looks like there are two options. Either Adminstration keeps on blindly as they are, simply hoping nothing bad ever happens to anyone, and putting their necks out for trouble, or some kind of mandatory coverage is established. I don't know where you are, or what kind of population your hospital is serving, but in today's litigious climate, it wouldn't take much to generate a major lawsuit, while someone suffers the physical consequences. None of this is on you of course, but it sounds to me like whomever is in charge of it all needs to wake up. With only one OR it would certainly seem there isn't big demand, but the fact that it's there at all generates an expectation of service. I can't imagine a 21st century facility that wouldn't be able to cover its OR "off shift." Unless it's turned into some sortof "Surgery Center" for legal purposes, that doesn't provide 24/7 care. I'm curious what the docs think about the inconsistent coverage? Wishing you good luck!

Curious ~ what makes the difference between a weekend that has scheduled call and one that doesn't? Now, before anyone says "it means one weekend is covered and one isn't" that's not at all what I mean. Obviously if some weekends have been scheduled, why aren't all of them? Does it have something to do with who is making out the schedule? With who has already worked and who hasn't? Also, I'm having trouble with the concept of not "wanting" call because one has already done their three 12's. Call has always been over and above the hours already scheduled for regularly worked shifts from 7A to 7P, and I have worked just about every size hospital, from major metro teaching hospital to small county hospital (one where OR call began at 3P on Friday and ended at 7A on Monday when your regular shift began, and another even smaller where almost everything got sent to a larger metro area facility about 15 miles away on weekends), to surgery center. Nobody (almost) really "wants" call in addition to their shifts, but it's always been part of the job. There needs to be at minimum a scrub person and a circulator, where the circulator (or RN scrub) or even a floor nurse can double up as PACU nurse. How are the weekends being staffed now when nobody "picks up" an unscheduled weekend? Who comes in? How are they located, and what happens to the patient in the meantime?

I was a CST for a group of 12 Podiatric Surgeons at their surgery center for over 5.years, and for the procedures you mentioned, no stirrup was ever used. In fact, it would have made the whole procedure very awkward and clumsy, and would have served no purpose at all. An ankle distractor, as previously mentioned, was used for ankle arthroscopies, but no stirrups were used for anything procedure-related.

Most of the time the propofol is known as "Milk of Amnesia"! Great stuff - I have had it myself and it always does the job with no bothersome side effects.

Your call requirements depend entirely on the facility where you work, their staffing levels, the kinds of cases and surgeons they have and so on. Every facility has its own quirks and idiosyncracies concerning who takes call, how long, how often, what your callback time limit is (how many minutes to get there when called in), how much your call pay is (pay just to BE available), how much you make if you do get called in per hour (different from call pay - this what you get if you actually do get called), the minimum number of hours for which you get paid if you do get called in, the breaks between end of call and beginning and ending of your next shift, availability of call (sleep) rooms, motels, hospital-provided apartments, etc., etc., ad infinitum. The best source for information about what your particular expectations should be will be your nurse managers and coworkers.I used to scrub in a medium-sized county hospital OR that only had day shift regular staff. Everything else that happened between 2:45 PM and 6:45AM was done by THE call team of one scrub tech/CST and one RN circulator. Weekends began at end of shift Friday, and ended beginning of shift Monday morning. So, we had many instances of scrubbing round the clock, (especially when one particular Ortho doc was covering call - it seemed he would never actually schedule anything - all his cases got done in the middle of the night! And I'm not kidding!) including techs doing our own instruments up, until it was time to start the next day. If you could be spared, you'd get sent home first thing, if not, you sucked it (and a lot of caffeine) up and kept on with it until they could send you home. We had a 30 min callback limit to get there. The call pay realy stacked up - I had quite a few paychecks that showed much more in call pay than regular earnings. But I was too tired to enjoy it! After I left there (this was early-mid 90's) they finally decided they were too busy to keep that up, and started forming a second shift to help spread the load. This was also before the significant proliferation of free-standing and hospital owned Ambulatory Surgery Centers. They have one of those now too, and get the lion's share of the surgical cases that used to go through the regular OR's via the Day Surgery section. Not too surprisingly, a vast mass exodus of staff fled to their facility. The only things that get done now at the hospital are the total joints, and anything else the patient must be admitted for afterwards. Check with your managers and coworkers to get a feel for their requirements, and their actual needs, which are frequently NOT the same thing. Also, when you will be expected to start taking call. You have to be able to work fairly autonomously in order to function well during some emergency in the middle of the night, so it could very well be up to a year before that happens, depending, of course, on where you work. I spent time traveling as a CST as well, and no two places had the same needs. Call frequency also varies depending on available staff, so adding several nurses to the mix can make it less frequent for everyone. Good luck!

Or you could just open gloves first, putting them on the bottom under the gown. No need then to slide things round, less risk of contamination, and is an easier flow to work from top to bottom. This is the method we were taught by a seasoned OR nurse/instructor in our 2 year program and by our clinical instructors, and the one I used for over 15 years.

Never did it either way actually. There shouldn't be anything on top of your gown at all except a towel before going out to scrub. I always gowned and gloved myself, so gown had to be accessible first (after the sterile towel of course) and gloves were close by already thrown out on the table or in a basin, but you can't pick up and move gloves from the top of the gown without contaminating the whole thing. (Once you touch them to move them out of the way, where do you put them down?) So, you can have both open, and nobody has to give you anything as long as you're gowning then gloving yourself, and as long as you can get to the gown first without contaminating either one.

I used to scrub at a small county hospital with 4 OR's, one of which was a dedicated eye/cataract room. So we usually just counted the other three. There was a female GYN surgeon who absolutely had to have every posssible instrument in the building for every single case, no matter how simple. She would actually come in the room early while the scrub was settting up to see if she might possibly think of something that wasn't already there. "Dr Kitchen Sink" was the running joke for her. The circulators were sick unto death of running for, and opening up, everything she decided she wanted on a whim, "just in case" it might be needed immediately. We (scrubs) were sick of having to send half the department downstairs for processing after her cases, and possibly leaving other surgeons short of something for their own cases. Usually, if they wanted/needed something that wasn't available at the moment, they knew she had been there first! (Some things the scrub and circulator agreed to refuse to open, but have available in the room IF she needed - but almost never did - because we knew it would be needed for another case/doctor later on that day.) One of the nurses came in one day with the little plastic kitchen sink out of her daughter's dollhouse. We wrapped it up and sent it through EO processing. When it came back, we took it in the room for her first case of the day. As soon as we got started with some simple thing or other, the nurse opened the lithtle pack and passed it to the scrub's mayo. "There - now you have everything you could possibly need for your case!" There surgeon looked at it, and laughed. "Yeah - my husband has always told me I'm high maintenance!" From then on, she was a lot less demanding, and the "kitchen sink" was a subject of laughter from then on....

Nothing said here that I can see has been aimed at all of any particular group of individuals. No intent to paint a wide swath with a big brush actually exists. I do believe however that there are more than should exist of young teens - male and female - who have not been taught at home about the truth behind sexual activity because their parents were likewise never educated by THEIR parents because THEY were either embarrassed, or ignorant of the facts, or that sort of thing was just never discussed, or any combination of the above. You can't expect people who were never taught themselves by their own parents, and who have never acquired that ability on their own, to know how to talk effectively to their own kids about what is to many such a touchy subject. It's also a matter of many of the children of children becoming another of several generations into the culture of welfare dependence, and this is all they know, so they continue to proliferate that culture. The concern - not so much judgement - but the concern for, and the fear for these children is that there simply aren't enough resources to go around to educate them in the manner best appropriate on how to identify and avoid the traps of unmarried teen pregnancy and the poverty it engenders. We are all affected by it, either directly or indirectly, and as a society, we all need to take some kind of responsibility for helping to fix it as much as possible. I have spoken of those of which I am personally aware. But just as not all married parents are great at being parents simply by virtue of marriage, so also not all unmarried teen mothers are ignorant, stupid (be careful of the difference there), welfare dependent, and/or bad parents. Again, the fear and concern is for those lacking even the most basic of information about themselves and their self-worth, their bodies and the biology involved in its function, and the lifelong consequences to themselves, their childen and their families of poor (or absent) decision-making skills. Care givers may take part of the blame, but just because a young woman calls and says she is the patient of a certain physician and is well towards term does not mean she has been seeing that doctor for prenatal care since just after conception was identified. The young women to whom I refer frequently have no prenatal care or caregiver until very late into their pregnancies, and some not until they arrive at the hospital in advanced labor. This does not give the overburdened caregivers of these youngsters much time to provide a comprehensive course in human female anatomy, physiology and the reproductive process. All those things, in a perfect world, would have already been managed by caring, intelligent parents for the moral and ethical aspects, and thoughtful, not-overburdened teachers in a well-equipped school setting for the biological aspects. But, also in a perfect world, this problem would not exist at all. Cultural expectations of finishing ones' formal education and establishing oneself in the world of occupation successfully have been fighting against basic biological directives for centuries, and will continue to do so. It's how we guide succeeding generations through it that will end up making the most difference.

Abstinence education has never functioned as intended, and given the social structure as it is, it never willl. Too many other things would have to chaange first, and those aren't going to happen either. What I mean by that statement is this. Abstinence won't be taught by the schools because that involves getting the schools involved in trying to teach a very specific set of social values to children whose parents either: A. Don't want the schools teaching such a value structure to their children because it's not something they themselves believe in, or B: they don't want the schools trying to take over their jobs as parents when it comes to teaching any kind of values to their children even though they abdicated that responsibility already when they became too busy to parent the children they gave birth to; or C: the parents don't have a clue what abstinence means, and don't care to learn either. Then you've got the media running amok, glorifying and congratulating unmarried celebrity couples/parents at evey turn, turning unmarried parenthood by teenagers into hit TV shows, where kids don't associate what they see happening to others JUST like themselves, because they are somehow different or special or immune to the facts of life that affect the rest of us mere mortals. If it were more than a "perfect world" concept, there never would have been any need for homes for unwed mothers in the days before the concept of unwed teen pregnancy became cause for parties and celebrations.

Yes - I know. I'm just daily horrified by the apalling ignorance that young women and pre-teens are living in. Because of developing physical disabilities, I have been forced to leave the OR's and do something less strenuous. My last two years were spent in the L&D dept OR's of a huge metropolitan teaching hospital. The things I saw and heard and dealt with there made me wonder which century we were living in - or they were. I have since become a doctor's answering service operator, and I get frequent calls from obviously very young teen girls who are trying to reach their OB doctors because the are now 38 or 39 weeks along and they are now having the worst pains they ever felt in their "privates" and their stomachs, some with "water coming out" of them, and they have no idea why, and they are scared to death. Sometimes, Grandma said they should call their doctors about it. But they are totally clueless about why any of this is happening, or what it means. The whole thing makes me very sad, and concerned about the mixed messages and ignorance that is still proliferating among our children, a lot of it coming from the media. There's also a culture of ignorance, selfishness and lack of accountability among too many young men too. Sadly, they are dooming themselves to lives of poverty and continued ignorance, and it seems to be getting much worse the more time goes on. We as a society have made so much progress in other areas over the last century. Why not here?

I love the alternative metals for wedding rings these days. If you check out ebay, you can find quality vendors on ther who make titanium and tungsten bands in every imaginable shape, thickness, width and design. If you're not sure which to try, titanium is exceptionally lightweight, while still strong, durable and scratchproof. Tungsten is heavier and denser, and gives a feeling of substance along with the other qualities. Youu can even find them plated in 14K or 18K gold if you prefer the yellow gold look. I have several of both kinds, and I love them all.

Have seen this numerous times myself, when they approached me to be gowned and gloved, there's a wedding band tied into the scrub pants string, gleaming in the lights. I made it a habit to remind them "Don't forget your wedding band when you're all done - your wife will kill you!" And it always seemed to make an impression - I got thanked more than once for that little comment, because then they did NOT forget! Especially helpful with med students and residents who hadn't gotten years of experience with it yet.

I ran the loop of a sturdy rubber band through my rings, and then back through itself, in a larks head knot. Then used a sturdy safety pin to pin the other end of the loop with rings safely together inside the cup of my bra. The rubber band is gentle on the bands of the rings - can't scratch them like a safety pin would directly - and I've NEVER left my bra in the hospital scrub machine!

Or enough chlorinators...........

So, this female PCT was obviously old enough/grown up enough to be having periods of her OWN - makes me wonder (just for a second, mind you) how she manages her own "feminine protection" at those times?? Hoping it's some kind of pad - I can't imagine her confusion at trying to properly maneuver a tampon!

Have you considered/investigated going to either Surgical Tech school or an ADN nursing program (Associate's Degree in either one) and then taking that 2 year degree to whatever college in your area that you can get a Bachelors Degree in Health Care Management in 2 more years? It's even possible to do that at some major online universities as well, and even brick and mortar campuses offer an ever-increasing catalog of online programs. If management is what your eventual goal is, then Health Care Management is a huge, booming program that should fit in well with your plans and their future needs. Surgical Tech school would give you an excellent technical background in what goes on in the OR and you'll get a full scale inside experience in what goes on there in a way that would suit remaining in SPD and going into management with a Health Care Management degree. Either way, you're going to spend about the same time in school, and IMHO, surgical technology would give you the focus you're after, since what you want to end up doing does not involve direct nursing patient care in the long run. Best wishes on whatever you decide to do!

if SPD/CPD staff are responsible for processing them, might want to check the records and see #1, who signed off on doing them, and #2, if they have new processing staff members. Regardless of the situation there though, it sounds like some sentinel event occured in the cleaning, handling and/or processing of those items. SOMETHING happened that is going to be shown as a common thread across the board. Perhaps they are supposed to be done in STERAD, and somebody shot them through an autoclave? The damage reports and/or processing records will tell the very expensive tale soon....

call-back in the middle of the night, on a weekend (why are these always in the middle of the night on weekends???) some joker came in through the ed with vague complaints of "abdominal pain." to make a long stupid story shorter - after a brief exam, and some abdominal xrays, he ended up in the or, general anesthetic, in lithotomy, so the surgeon could use empty sponge forceps and a self-retaining retractor to reach into the guy's rectum and remove most of the contents of a can of aerosol "crack filler" (aptly named!) it's that foamy stuff that you use to fill cracks in woodwork and to insulate gaos and open spaces on the outside of your home. you just spray it into the area, and it expands a lot and takes on the shape of the space it is filling, then gets very hard. the one saving grace here was that the guy - at least we assume there was only the one party involved - had managed to jam an empty roman meal bread bag up his behind first, open end to the outside of course, to catch the stuff although it did not keep it from swelling up to max capacity. it took a while to get all that hard foam out of his backside, and then do a quick "bag-ectomy." he stayed on the med-surg unit for 36 hours to be evaluated by not only a gastroenterologist, in addition to the general surgeon who did the original removal, and a mental health care specialist. then he got to go home, and i think he moved out of town shortly after, because nobody ever saw him again! can you imagine running into your surgeon or one of the nurses who took care of you at the grocery store some day? not i - i think i'd have to head out of town myself!

"right - and you used up the last one we had/all of it when you did that - so now it's gone!" "in which parallel universe?" "must have been a different hospital - we haven't had any here for (fill in the blank) weeks/months now." "you must have been asleep for weeks/months then - because that's how long it's been since we've had any here." choose any or all of the above - whatever fits your particular needs/mood/facility policy/etc................

just got an email from rnweb, and this article is front and center....... although this doesn't just apply to any one particular facet or specialty in nursing, there seems to be some pretty serious concerns with it here, and i thought i'd pass it along for your consideration, as food for thought....... http://rn.modernmedicine.com/rnweb/article/articledetail.jsp?id=617102&ts=1250534351918

the first person who discovers how to do the last thing you mentioned effectively - "tell this surgeons to sleep for at least 5 minutes so they would get a clear mind...and please teach them to acknowledge their mistakes.they are not gods and goddesses.." will have the undying gratitude of the entire medical staff of every hospital/surgery center/medical institution in general on the planet............i wish you luck. mostly they are looking for a scapegoat so they can maintain that "god-like" image that they are infallible and can do no wrong. the ones who do that stuff are very insecure about themselves and can't deal with blame for doing something less than perfectly, or with the fact that they are indeed human beings just like the rest of us. heaven forbid they get knocked off their self-styled little pedestals by being like us ordinary mortals. but we all put our scrubs on one leg at a time, and sometimes they need a reminder that we are not "underlings" or "peons" - but there to help them do their jobs. btw - "flying kelly/forceps" in the or can amount to assault and battery on staff if it actually strikes someone. assault if it doesn't. it depends on the situation, and the willingness of the victim/target to prosecute. it's happened before. i tolerate no flying instruments in my or from anyone. another annoying and dangerous thing they like to do sometimes is messing around with the mayo stand without my knowledge or permission. sharps are dangerous, and i need to know where every one of them is every second so none of us gets hurt. if i get a "grabby" surgeon, then i move the mayo out of his/her reach, smile and ask them kindly to let me know what they need, and i'll be sure to have it ready for them and in their hands before they can get the words out, but please do not grab instruments off the mayo. if they persist, then i back away from the field. inevitably, the want to grab without looking at what they are doing, and that's when someone gets hurt, or instruments get knocked off the mayo and either land on the patient - bad - or on the floor and are contaminated. takes a pretty thick skin to survive in the or - i think it comes with time and experience. don't worry too much - it sounds like you care a lot and are very conscientious. i think you'll be fine.