humblecirculator

Well, I didn't get very far at my facility about codes in our OR ... right now im in Jersey for a seminar, but when I get back home, I will email you the paper if you like ... its been a while since I've touched that subject, but if I recall correctly, the paper was very good (just a lil biased!!)

I suppose I prefer a closed-loop communication process when delegating (face to face and receive immediate feedback if there are any questions)...I look at written orders from NPs and MDs a bit different...but still, you are correct in that the bottom line is that patient care was compromised (thankfully without negative outcomes) - this situation would be a good root cause analysis...

I somewhat agree with Saude...not in defense of the CNA, but you as the RN did not delegate to the CNA properly from jump (to her directly -face to face)... The CNA's response to you, however, was unprofessional and plainly rude (if even from just a humanistic point of view)...I suggest "killing her with kindness" - this might sound evil, but one should keep their friends close and enemies even closer. I would not put it past a personality such as hers to attempt to 'sabbotage' you in some fashion (I have been a nurse for a while and I have not only witnessed such acts, I have also been a 'victim' to such). I don't particulary subscribe to revenge, however, by keeping your "eye" on her - you can sort of keep her on guard...and of course - you could simply write her up or request that she be written up...

I'm sorry to read that you categorize blood transfusion as "non-critical"... truly - any 'fluid' that we infuse into some's body is critical - the skin integrity is broken and risks for complications ensue: infiltration, phlebitis, air embolis, fluid overload - cardiac problems...etc etc etc is a wonderous machine that requires critical thinking on how to care for it when it is not in homeostasis

At my facility - we do mostly PPVs, laser, cryo, and scleral buckles...we are allowed 20 minute max turnover time (although the diopter lenses take thirty minutes in the sterris)...our eye surgeons all bring a private scrub with them - so we just put an RN to circ...I personally love the "eye room" because the mood is nice, the music is usually good, and no one ever bothers you...kind of a lost and forgotten fortress of tranquility...

Thanks for the feedback, I appreciate it! I'm wondering if perhaps I should include simulated malignant hyperthermia crisis...

If the management team offered you a chance to sit on a committee of sorts that deals with codes in the OR, is that something that you would be interested in?

How odd that this question has been asked because just recently I was involved with a code in the OR I work in...at this facility, perioperative RNs DO NOT have to be ACLS trained/certified, but I am. I think that the ACLS knowledge I have helped the code run smoothly... I am also working on a research paper about codes in the OR. I'm curious, if anyone is willing to give up some info: as perioperative RNs in your facility, does the policy require BLS or ACLS? Also, do you participate in mock codes in the OR to keep skills up? Any info/help would really be appreciated...there is not a lot of nursing research/literature on the subject!

The topic of 'losing skills' when one works in the OR speaks to my heart :heartbeat. I was drawn to the OR during an observation that I did a long time ago during nursing school. Even then, the 'nursing instructors' didn't support OR nursing, keeping the sentiment that 'OR nurses don't do anything' . What I witnessed was a nurse that stood 4'11" but had the personality of a 6' amazon...she commanded that the needs of the patient were top priority-she was constantly moving about the room, checking drapes, communicating with anesthesia, checking urine output, IVFs, watching the field like a hawk, documenting, answering pages, coordinating bloodwork, pathology specimens and results, keeping the surgeon 'in-line', showing the resident how to put his gloves on properly-it was AMAZING! From that point, I begged to do more time in the OR, only to be told that wasn't possible..., I just accepted it. I always kept the OR in the back of my mind, and one day, I friend of mine told me about an opening in the OR and that I should go for it-so I did and here I am!! I've worked in the OR for a little over 3 years and it's the only one that I've worked in (I have floated to OP endoscopy and our OP surgery center). Prior to working in the OR, I worked Hem/Onc and ICU step down for a few years; private practice urology and cardiology; nursing home charge, meds, and treatments; private home duty; AND I was a nursing assistant for two years on an Isolation med/surg (total care) unit. So when I came to the OR, I had quite a hefty skills set. I did go through a 'rollercoaster ride' of emotions and learning during my first year-there's ALOT to learn to succeed as a nurse in the OR. I think that if I came to the OR that I work in as a graduate nurse, I might not have made it through orientation (it was rough). One thing that I believe helped me was the fact that I had a developed a broad knowledge base of nursing care. That knowledge combined with new OR nursing knowledge, I believe, has produced a fine OR nurse ! Not to say that I think new grads shouldn't work in the OR, I think that if someone wants to be a nurse in the OR, then they should pursue it-whenever that is! Nurses that work on the floor, whatever their 'specialty' is, faces many challenges during their work day-the patient's family (which in essence is our 'patient' also) is breathing down your neck, etc OR nurses face challenges as well, they just aren't necessarily the same ones as up on the floors. We all have different skill sets and levels of skill-doesn't it make sense that if nursing itself is so diverse, wouldn't the skill sets required of nursing be just as diverse? Even from floor to floor, there are different skills that a nurse has to have-So, to say that you would 'lose skills' working in the OR is just ridiculous . You will build on the skill sets you already possess, gain new ones and integrate the two, just like you would do if you went from med/surg to the ICU. I think that this misconception rests somewhat on the saying that if you don't use it, you lose it...but you still do patient assessments of vitals (including pain), neuro, skin integrity, cardiac, respiratory, GI/GU, musculoskeletal, endocrine; interpretation of labs, etc. These assessments aren't performed necessarily the same, but they are still done. Since working in the OR, I understand the 'big picture' of a surgical patient-from pre op teaching to discharge and home care. Being a part of the actual surgical process of a patient's hospital experience brought it all together for me. If you can understand the disease process and understand the surgical procedure, then it is easy to figure out the pre op and post op care/teaching needed; its something I like to call nursing common sense. Of course tho, one can only gain this experience and skill set by becoming an OR nurse!!!:loveya:

Thanks for your input, I appreciate it! I am getting ready in a few weeks to do a 140 hour clinical in a SICU at a level 1 trauma center-which is right next door to the facility that I work at now. Most likely I am going to apply to work on that unit after I finish my BSN in April...I was really hoping to stay at my current facility because the bene's are just soooooo good and I don't want to lose my seniority, but that's life I suppose:confused: Again, thanks for the input!!!

Hi Maybe some of your goals could be: become familiar with the equipment (bovies, fluid warmers, lasers, insufflators, light sources, gas sources)... become familiar with instrumentation and what it is used for(different clamps for different types of tissue)... understanding the role of the surgical team members (RN, anesthesia, surgeon, techs, aides, etc)... become familiar with different patient assessments according to the type of procedure that they are having...Hope this helps and good luck!! Humblecirculator!!

I've been working in the OR (non-trauma) for a few years now-I went there as a GN. I was an LPN for about 5 years and worked at a Veterans hospital on a med/surg hem/oc floor for just about all those years. I don't really enjoy OR nursing-it isn't challenging enough for me...I feel like my brain is dying!! Before I graduated nursing school, I thought about working in the ICU, but couldn't get hired...'you really should work on a floor first...' is what I kept hearing. I already did just shy of 5 years of floor nursing-yes, I was an LPN, but at a veterans hospital, LPNs can earn 'steps' and be 'certified' to do certain things...I inserted PICC lines for pete's sake...I was offered a job in the OR and I took it. Like I said earlier, I already had worked on a floor and really didn't want to do it again (even as an RN this time around). Now I'm finishing by BSN (done in April 09) and want to stretch my wings so to speak. No, I'm not interested in becoming a CRNA at the present-I ultimately want to teach. In my head, I think I'd be a good, maybe even a great critical care nurse, but I'm not sure because I suffer from anxiety and the occassional panic attack. I've lost so many great nursing skill sets because I do not utilize them in the OR (anesthesia plays with all the tubes and meds ). I can 'read' an EKG rhythm strip and I understand physiology. I've contacted the Nurse Manager of the ICU at the facility I currently work at, but she is convinced that I want to be a CRNA because I work in the OR; but I've got to get out of the OR very soon or else I'll become a dust bunny there!! Any advice from the wonderful critical care nurses on this forum would be very much appreciated!!

I absolutely love :redbeathe my Dansko Professionals. I have been wearing them now for over a year (not the same pair tho, now I have 3 pairs...) I rarely sit down (even at lunch) and I have to say that my feet, legs, and back have never felt better after a day in the OR. One downfall I would have to say about the DP's is that my feet get kinda sweaty, especially with cute lil socks...but with cotton socks (especially the Peds diabetic socks), sweat is not an issue!! Honestly tho, you'll probably have to go thru trial and error before finding the best shoe for your feet, legs, and back. I know a lot of peeps love those Crocs, but I've seen at least 6 people I work with get hurt in those things...the shoe stopped but they didn't...one even fell onto the back sterile table-and of course it was an ortho case with 7 trays of instruments that ALL had to be re-sterilized and obviously delayed the case... ****** off my surgeon and then I had to deal with his nasty lil temper tantrums for the rest of the day. I say back away from the Crocs:nono:

I worked the 'floors' for about 7 years before transferring to the OR (I've been in the OR for about 4 years now). I would have to say that the OR is NOT easier, just different! Yes, you only have one patient at a time, but that doesn't mean that the work load is easier. There are different skill sets that a perioperative nurse develops vs floor nursing skill sets; yet some skill sets are interdisciplinary. Some people think that the OR is a cake job, but take it from me, it isn't. The technology in the OR alone would make a 20 year floor vet cringe (I've seen it happen!!) Like some other posters have mentioned, there are BIG personalities in the OR and you really do have to let words go in one ear and out the other-otherwise you'll go home crying everynight and eventually quit. You can't be afraid to speak up when you see something wrong or when you have a 'gut feeling' about something. I've learned that most surgeons can respect the job you do if you do it with moxy!! I have to disagree with one of the posters who mentioned that you don't start IVs, listen to lung,heart,bowel sounds, etc...because that depends on the facility that you work at. I still do a quick assessment of my patient-listen to their 'sounds', look at their skin, are they A&Ox3, etc...perhaps I'm a bit overbearing, but I just don't take the AD's word. I think as a new grad, the floor might be a good place to start because you'll get your feet wet in the hospital environment and not as a student. Unless you know yourself really well and think that you can make a go of the OR. I wish you good luck and welcome to ...the most noble of professions!!

I think that male RNs in the OR do just fine. At my facility, the only male RNs we have are travelers, and they do a dandy job. They both seem to carry themselves with respect and dignity and they project that on to the patient. Like another poster said-most patients are fine with a male nurse, just as long as you don't let the surgeon cut off the wrong leg LMAO!!!