KayceeCA

I don't know the best way to get into the heart rooms, but I can tell you how I did it. From the first time I stepped into a heart room, I knew that was what I wanted to do. And I made that loud and clear. I let anyone, and everyone, know how much I loved hearts. I would hold heart until I thought my arm was going to fall off, and I'd keep smiling because I was in the heart room. I let the heart surgeons (some of them are satan, I swear!) yell and scream, but I kept on going, telling anyone and anyone how much I loved hearts all the while. I ran, not walked, to the heart room any chance I got. I took all the ridicule and scorn about "those snobby heart team people" and kept smiling, and being friendly, and willing to do just about anything else, although everyone knew I'd rather be in the heart room. It worked for me. Maybe it will work for you too. Just be ready for the "why would you want to do that"s and the "I wouldn't do that, I want a life"s. Just brush them off and keep going, because you know what you want.

I think the time outs at my facility are a happy medium. We cover some pertinent info (pt. name, surgeon, procedure, side if applicable, allergies, antibiotics received) but not too much. We also state that the consent, schedule, H&P, orders and pt. interview all agree. My only pet peeve is that some surgeons do tend to want to carry on with their own conversations and not stop and listen to the time-out. My tactic so far has just been to keep repeating "time out" in a progressively louder voice until I have their attention. But I really like the "I'm not wearing a bra today" line, so I think I'm gonna steal it. :)

I've had a couple of different experiences at hospitals where I've worked. Experience #1: 20 minute callback time, and we were expected to be there and ready to go in 20 minutes. It was a level 1 Trauma center in a rural area, meaning we got everything within a 2 hour radius, including farming and mining accidents (ugh) and bad MVA's on country backroads. We also did burns and transplants. We stayed super busy, and a trauma there was really a trauma. Experience #2: 30 minute callback time at another level 1 trauma center, but this time it's one of 6 trauma centers (3 level 1's) in the 8th biggest city in the country. Yes, we get traumas, but it's really pretty laid back, and the regular staff can handle almost anything that rolls through the door until the call team gets there. So if we're a little over the 30 minute mark, no one is going to blink an eye. We also don't do burns, peds, or transplants, so it really cuts back on the number of crash and burns, and get-here-now cases. I would suggest taking call for a little while with your eye on the clock, then see how things roll at your hospital. If you're at one of those places where time really is tight, then staying with relatives sounds like a good option.

Exactly. I went to nursing school later in life (graduated at the age of 36) so I had a lot of jobs before that in a variety of fields - waitressing, retail sales, secretarial work (in banks, real estate, hospitals, small business, large corporations), paralegal work, travel and tourism, city government, state government, military...you get the idea. I've never had a position where teamwork was as key as it is in the OR. As a previous poster said, it really depends on any given moment in any given case which position is "easiest" or "hardest."

I agree with everyone else...I listen to the sat level beep, but I don't do anything without direction from the anesthesia provider. I stand by ready to apply cricoid pressure, hand the ET tube, and lend a hand in any other way I can. But I leave the monitoring to anesthesia.

I ask on all GYN cases...and usually the answer is yes.

ShariDCST, I just wanted to thank you for taking the time to put together such a helpful post. There's some great info there.

I've been on the heart team for almost 10 years, working at 3 different hospitals, and when I circulate I never open cannulas until the scrub is ready for me to had them to him/her. I have scrubbed on occasion, and when I scrub I will ask the circulator to wait until I'm ready to have the cannulas handed to me. If it's something that I feel safe opening onto the field and the scrub is busy or not scrubbed in, I will open it onto the field. Other than that, I always prefer to open to the scrub.

I absolutely, positively, beyond any doubt prefer adults. Peds are scary because they can go bad so fast, and when they go bad they really, really go bad. The two babies who died on the OR table when I used to do peds hearts were the main reason I left nursing altogether for four years. The hospital where I work now only takes patients 14 and over, and I am so thankful for that. It takes a special breed of OR nurse to work with peds. Maybe you are that breed. I found out the hard way that I'm not. Please take my words in the correct context - this is only my opinion, and what does and does not work for me. Good luck to you whatever you decide.

I totally agree with fracturenurse. I've pointed out breaks in sterile technique to others (surgeons, scrub techs, circulators) many times and the response has always been something like, "thanks for having my back." I've also had others point out my breaks in sterile technique, and I've always appreciated it. There's no ego involved when the patient's safety is involved. And while I try to watch out for costs because I know it impacts my job security, it's far from the top of my list of priorities. The first thing is patient safety. Everything else falls somewhere in line after that.

I agree with everyone else - forget this experience and move on as though it never happened. There are obviously other issues going on behind the scenes that have nothing to do with you. No reputable employer will tell you you're doing a "great job" for 4 days then ask you to resign. And no reputable employer would expect a new employee to be oriented after 4 days. Four weeks would be stretching it, four months is more the norm, especially when you were open with them and told them you had not been in the OR for some time. Forget that this experience ever happened, know in your heart that it was their issue and not yours, and move on to bigger and better things.

A facility I am familiar with recently went through a lengthy legal battle and had to settle a class action lawsuit because someone said they were not being given the breaks they were legally entitled to, and the facility had no records to back themselves up because they had been operating on the honor system. Now, you had better believe that all of the hourly employees are expected to clock in and out, both at the beginning and end of shift and for lunch breaks. If an employee at this facility misses their lunch break, they can fill out a form and be paid for that time. ShariDCST did an excellent job of explaining the legalities involved in hourly employment. Thanks!

We are still filling ours in the OR. I guess word that pharmacy has to fill anything over 100mL hasn't spread here yet. It's definitely a "pain" (sorry, couldn't resist) having to open all those bottles, although we do have 50mL bottles so we only have to open 6 for the pain pump we use. We only have one surgeon who routinely uses pain pumps for his gastric bypass patients, but he does 4 or 5 gastric bypasses a week, so we have to fill them pretty often. I'm glad we don't have the type of pain pump that requires 12 bottles to fill. Ugh! We had an OnQ rep tell us that larger bottles were becoming available. He also mentioned the pre-filled cylinders. It sounds like that's going to be the way to go, especially with the standards changing to where we won't be able to fill anything over 100mL in the room.

Amen to that!

It makes me so sad to read about how some ORs are run, and so thankful that the OR where I work doesn't do these things. We have a regular call team which is utilized only for traumas, plus a heart team which can also be called in for traumas if the first team is in use when a second trauma comes in. The call team does stay to finish cases that run over, but only if there isn't enough evening staff to run the rooms that run over, which is rare. We don't have any surgeons who routinely run past 9pm or so, thank goodness. It is definitely taking advantage of the staff to routinely call in non-call team employees who haven't been receiving call pay to be on standby.

We have a couple of surgeons that do this. It used to make me nervous, but not anymore. I just go about the business of getting my patient ready for surgery. If the surgeon wants to sit back and watch, that's fine by me. I'm not going to cut any corners just because the surgeon is hovering. As a previous poster said, once the RN is finished, the surgeon can start the operation, but not until then.

I do the same thing, and I totally agree that there isn't any harm in stopping by to check on a previous patient.

I knew when I started nursing school that I wanted to work in the OR. Rather than wait until I graduated from nursing school, I checked area hospitals to see if there were any opportunities for nursing students to work in the OR while still in school. I found a hospital that had a nurse externship opportunity in the OR, applied for that, and was accepted. For the last year of nursing school, I worked in the OR. I knew that as an extern I had an excellent chance of being hired in the OR upon graduation, and I was. Not only was it an excellent opportunity to get a head start on my OR orientation, it took away a lot of my worry about whether I would be able to go straight to the OR when I graduated.

We have 11 rooms in our major OR, then 4 more in outpatient surgery. Our typical room breakdown is 3 ortho rooms, 1 trauma room, 1 cardiac room, 1 cysto room, 2 neuro rooms, and 2 general rooms. We have one room that is not currently being utilized as an OR. We store our robotic supplies as well as some of our ortho supplies in there. The plan is to reconstruct that one and the one next to it into one big room and make it a dedicated robotic room. That'll be nice since it's a real pain dragging the robotic carts up and down the hallway. The last OR where I worked was a freestanding outpatient surgery center, and we had 8 rooms. The hospital before that was the major OR of a large university hospital. We had 12 rooms in the major OR - can't remember how many in outpatient surgery since I never worked there. The breakdown in the major OR was 2 heart rooms, 1 trauma room, 2 neuro rooms, 3 ortho rooms, 1 cysto room, one laparoscopic room (laparoscopic was just becoming popular at that time), and 2 plastics rooms. General could be done in any of those rooms with the exception of 1 of the heart rooms and the trauma room. The first hospital where I worked also had 12 rooms. Four of those were dedicated heart rooms. I can't remember the breakdown of the other rooms since I worked primarily in the heart rooms.

We do a "retained laps" documentation when the laps were left in intentionally by the surgeon, in a trauma where he/she knows the retained laps will be removed at a later date. Are you sure that's not what you're seeing? I have not noticed any break in professionalism at my facility. I find it hard to believe that OR staff would become lax with regard to counts and patient safety, regardless of the economy. Karen

Same thing here, although this is the first hospital where I've worked that did this. It's nice to know what may or may not be coming our way. The times I've been sent, I just made sure I stayed out of the way of the ER nurses and waited for the trauma doc to either clear me to leave or let me know what we'd be getting in the OR.

I'm left handed, and I agree with the other responses. You will pass with both hands, depending on the situation and the best angle to get the instrument to the surgeon. Passing under versus over will become more natural with time. The thing I struggled most with, and still struggle with, is cutting. Scissors were made for right-handed people, and even after years of experience, it's still difficult for me to cut suture. I do the best I can, use my left hand because I simply cannot cut with my right hand, and angle the scissors in the way that I've found to work best (although not great). Don't worry...your motivation, determination to do the best job possible, and overall skills will make up for any minor glitches your lefthandedness may cause.

We never did at the other facilities where I worked, but we do where I work now. I agree that it's an excellent practice, because it's amazing how many times we find holes. It's especially important in total joint cases, and that's where it's really emphasized at my facility, but most of us have taken to checking during all procedures. We do hold the wrap up to the light also, because it's really easy to miss a hole in the textured blue wrap, but it stands out clearly when a pinpoint of light shines through.

Same here. I've seen the openers made specifically for opening meds, and the nurses who have them always say "some rep" gave it to them, but I've never had the good fortune of being around when a rep was handing them out. I checked around several medical supply stores to see if I could buy one, but was never able to find one.

Amen! That's my biggest complaint about our OR doors too. Some of these newer beds are so wide, it's impossible to get them through the doors with the rails up. Then you have to maneuver down the twisty, turny OR halls, with obstacles around every corner, to get to PACU. Ugh! I guess that complaint is for another thread though.