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No You are exactly where you need to be. You know you are on the right path when you are itching to be on your own. I would express this to your clinician or educator and let preceptors take a more distant check-in with you during the day. Have them check your work before the end of the day or at scheduled times during the day just to see if you had any issues or unusual things come up.

Instead of strapping arms or wrists tot the armboards we hold hands to keep the muscle relaxant and fasciculations from causing their arm to flop off and keep them secure until after they are asleep. Males are usually stoic and many will not show fear until they get ready to go to sleep you can tell by the way they hold their breath frown grit their teeth etc. Talking.g to them holding their hand many times makes things easier. You bring up a point though that everyone should honor wishes and we do try to do what we can.

Are you a nurse? Does compassion care empathy allying fears mean anything to you?

Most AAA's are now repaired endoscopically, in hybrid OR's where grafts are placed through the femoral with x-rays-even if ruptured, so back to your question. The backflow is handled by limiting the clamp time, doctor's must move fast. Also anesthesia regulates the blood pressure and fluid replacement during the case. It is not so much the backflow but the obstructive issues with lack of circulation to the periphery dependent on the aortic level of the aneurysm. Open abdominal aneurysm repair continues to have a high morbidity and mortality rate. The key is to have a physical to detect an aneurysm before it becomes the size of an orange.

Try to get into a residency program. There are many out there and that will train you well. Probably will be a time commitment after the program is completed, but if you want to really feel confident in the OR you have to stay for a couple of years to coming into your own.

When you first start you are afraid of everything-experience makes you competent. You are a novice. Open your ears and eyes and learn what you appreciate in nursing practice and what you would not want to emulate. There are nurses today that would never be my role models, despite their years of experience-others I would still like to learn from. The key to growing as an OR nurse is the learning. It never stops. It takes a year or more to feel fully confident that you can be put in any case and perform well. Give it a chance.

OR nursing is about more than skills. Someone asked me one day about patient advocacy in the OR while the patient has no recall of the nurse(s) who cared for them while they were anesthetized. Being a patient advocate in the OR is about ensuring that you do your job well. What does that mean? Think about putting on a play. You can't have a good play without a script or props or actors can you? That's what nurses do. They make sure that your properly safely working props are in order, you make sure that the actors in the room are credentialed, assigned correctly, if not you ensure that extra safeguards are there to make it work for the case and the patient, you communicate, collaborate, inspect, safeguard, then do the patient care skills that are required for you to do. You keep a little bit of stage fright for every case, so that you do your best-expecting and anticipating that things can and will go wrong. There is no complacency. When you meet the patient-their loved ones, you allay fears, you explain what's going to happen, what you will be doing, know the case, what's going to happen, quickly study the diagnostic or elective choice reasoning behind the procedure, review the diagnostic results, know the pertinent drugs, what the patient takes, how to mix and administrate them, you defend the rights of the patient that you have come to know in a very short period of time. You monitor aseptic technique. and on and on it goes. I cannot imagine when the conscience of a room goes to solely non-nursing personnel-the respect and care for the patient declines and all goes to saving money, time and disregarding proper guidelines. Fortunately or unfortunately-we are also scribe who document correctly and concisely about the procedure, personnel, supplies, drugs and solutions used. Why? We are the ones legally required to do so--why?? because the document and the patient are the only ones who will recall the outcomes. Anesthesia documentation has it's own set of guidelines. We help them remember too. Nursing is the most trusted profession year after year because nurses care. They care without judgement of the person. They care about their contribution to the surgical outcome of the patient as well as personal pride in their quality of skill-sets. God help us all when the conscience of the care goes away. It takes more than properly putting in an IV or foley-or if a nurse is judged on how quickly they can turn a room over. But only one who embraces the art and science of nursing and works to bring the two together to know how challenging and rewarding that can be. That takes time and commitment to the craft.

"Snitch" means tattle tale. Police use them (usually the snitch gets something in return) to get the skinny on people that they can't get to tell the truth or share the reality of what's going on. Poorly performing managers use this type of person to put the ear to the ground for them. That is a dangerous proposition. Once that tattle-tale is exposed to the rest of the group (which most suspect anyway), false rumors get spread and the real issues go underground. The trust is lost and everyone suspects everyone else. Terrible environment.

It is tough to confront someone during work when you are dealing with patients and so much to do. These types of issues take focus off and makes life miserable and too stressful-really unnecessary. If management feeds into this, keeps a record of it and then surprises with these comments at a peer evaluation without a forewarning or allowing one to correct behaviors then that is a problem of management for sure. People should know if their behavior is distressing to others and allow them to correct or make amends. You never know what's going on with a person on a given day. Get to the bottom of it, and get involved in order to mediate and allow the parties to air their differences. Managers who take innuendo and gossip as truth should not be managers. "What you permit you promote"-so the wise people say.

It may vary from state to state. I would check your state's medical practice act to be sure. This may become more prevalent when staffing issues arise or if in a very rural area with limited resources. To be safe, if the patient is stable and not emergent, I would wait until there are qualified rad techs available. Dr. may be mad, but then call your supervisor to back you up on the possible delay.

Well we've gotten off track once again. To set it straight. LPN's have less education but have a similar skill set. The RN has supervisory roles of all those who are not RN's and also do initial patient assessments and meet requirements of job skills and responsibilities set by each individual state. RN's are paid more, have more possibility of career advancement. LPN's also have the capability to advance, but are limited by state statutes. People choose vocations based on their ability to devote time and money to levels of education. Each person has the ability to advance to higher levels of education at any time in their lives as situations allow or if driven by personal motivation. No judgement here.

Doctors will use less expensive help and will design programs to allow others to take over the RN role. Nurses have yet to define effectively what value we bring to the table on a daily basis. Yes there are studies to provide evidence that having RN's bring better patient outcomes...but ask an RN to define the value they bring to the table and you will find task oriented statements rather than the value. If you think about it, the caring part of the nursing role can be accomplished by just about anyone, but the science behind what you do, keeping up with new drugs, treatments, and safety separate the nurses from laypeople or those with less training. Nurses are more than run and fetch it people. We can question orders because we know how to separate what is safe from unsafe, what has an adverse outcome over what is desired. We understand the whole person rather than just the problem so we can plan care that would optimize health for people. I think it is high time that nurses articulate their value and be able to readily answer "What is a nurse?"

To get back on track. The number of patients entering health care with untreated/undiagnosed chronic diseases is on the rise and is expected to increase dramatically with the new health care law implementation. If this expectation is true, then health orgs must anticipate the need for improved nursing education, improved on-site orientation efforts, better ideas on service demographics, and improved health communication within the communities served. Pay for performance, care non-payment for re-admissions is a constant threat now and orgs need to understand that it is not only the nurse's responsibility but all players are in it-that includes nutrition, therapists, pharmacy and medical. That means that the org must catch up to the snowballing effect of this new challenge-which only a few hospitals and community public health services are on top of. To reduce staff at this time is non productive, and will in the long run cost more money. Even the small things will save the orgs money and guarantee solvency to pay staff for needed services. Smart and collaborative leadership pays off and the biggest thing in my opinion that is lacking is those nurses who are not truly passionate about leading. You don't have to have a formal title to lead. Those with titles have to listen to the grunts, assist in removing barriers to getting the job done. Quickly. Instead of piling on, get rid of the redundancy-the paper work-the fear and get in there and be available, knowledgeable and compassionate instead of "I got mine...now you get yours".

I have done some legal consultation on cases where nurses were calling the doctor for patient problems and the result was that the patient had a bad outcome due to the lack of physician courtesy toward the nurses on the phone in the middle of the night. The nurse documented, reported the doctor's response and the doctor had to deal with the consequences. He could not blame the nurse because she (in this instance) had the correct factual encounter documented and involved her supervisor who also appropriately documented the behavioral responses of the physician. You are there for the patient, that's all. Doctors know you are the eyes on their patients when they are not present-even though they are rude at times-they know it. You cannot solve the issue on your own. This behavior should be addressed by higher ups if it is a persistent problem. Unfortunately it is demeaning, devaluing and devastating to the patient in some instances when care is delayed and they are made to suffer unnecessarily. So my advice is to remember why you are calling, and don't take it personally. If it does become a personal attack ("you are stupid to call me about...") you should address it with the doctor with a supervisor present. NEVER alone.

I've worked in many settings and in many different locales and have found paradoxically that appropriate staffing numbers do not always tell the tale. I have seen limited staffing perform better than when fully staffed why? Maybe because it's a sink or swim issue of everyone having to really work together to get the job done. If staffing mix is not resolved, you will see fast burn out and quick turnover, especially if you don't streamline the workplace to resolve hardship issues, bureaucracy, and unnecessary steps in the nursing role/functions. So many things can be done to make a place of work more efficient, but leadership (I have found) is lacking. People are in fear of using creative solutions without formal consent, while we tout critical thinking skills, we don't give permission to fully use those skills. It's painful and you must always look to the systems, workflow, adequate ability to take a break, or eat a lunch/dinner in peace; meaning you have to have enough staff to provide relief so that workers can stay focused and alert/less irritable and be able to work together as a team. Unless an organization really wants to retain staff, they have to look at these issues of workflow, redundancy, support staff, and be serious about it. Not just constantly be on a recruitment journey paying bonuses etc. We have enough satisfaction surveys to show what needs to be done, just do what is necessary. If leadership is lacking, get people who have the right skills for the job. Have a balance of experienced and inexperienced, pay people a good wage, and provide an environment that is safe and well laid out. Listen to the employees who stay, and implement their suggestions within reason. Most times they have the answers, not someone that never works in that environment.

The divide between managers and bedside nurses is growing. More responsibilities with less support-the scoring, the specialty nurses who believe that their specialty should be a priority and the onus is on the admitting nurse. Very little time to give appropriate documentation, and the endless additions without any subtractions. And the managers still ask, "What is it that is keeping you from documenting effectively, accurately and timely?" We have said the problems many times over and it's like beating your head into the wall. "Is it the workflow?", "Is it the lack of support?", "Is it the redundant documentation?", "Is it the acuity of the admitted patients?", "Is it the lack of staffing so that you can't grant you enough time get your training done?", "Is it that we are so short that I can't approve your vacation request?" YES YES YES YES and again YES. The answer is-get out of the way, simplify the documentation to adequately reflect the care, or physically and clinically strong to stay adept enough help out. Listen to the nurses in the trenches. There is too much time spent on trying to meet an unrealistic interpretation of the mandates by regulatory agencies that control the money. There are ways to think creatively to make the nurses' work easier, more meaningful and less stressful. Nurses "own" skin breakdown???? Not if you can't get away from the computer enough to turn the patient or get them up out of bed. Nurses spend a tremendous amount of time thinking of workarounds-just to get the amount of work done to find that balance between work and life. Now that's a problem. Just think, if patients had more nurse time, the satisfaction scores would be higher and the quality would be better-now find a way to make that happen. That's the 10 million dollar challenge.

It is hard to pass judgement on nurses on the OR who may leave someone exposed for a period of time while attending to others. It takes a strong patient advocate to put the needs of the MD's and others on the team behind the patient. Each nurse is different and must explain their rationale for doing things in the manner they do. While it may seem inappropriate, we don't know all the particulars. It is easy to be an armchair quarterback in these forums.

It seems we have to practice two different sets of civility rules at home and at work. If outside of the work environment, we would not or hopefully would not tolerate someone talking abusively to us. But at work, we have to take it. The only way to protect self and others from that situation is to report and have it in writing-sent to the appropriate managers-keeping copies for personal files. Eventually these types of doctors are reprimanded or remediated in some way. It doesn't always work out in the immediate, as there are consequences. There are times when principle rises over everything else. I understand about SBAR, etc. But life and situations are not always scripted and we slip into our "outside of work" form. I defend myself and my intent to take care of the patient over any script. We are not perfect in every situation. We apologize too much for every little thing-my opinion. We are working and in the line of work what we have to do is not imposing on someone else-just part of the job.

I took it as as getting more bees with honey-and ruby may have more to say about it.

Social grease? What are we greasing up for? Look inappropriate is inappropriate, professional is professional. You must stick up for yourself and the patient. We don't bother doctors on call-they know it's part of the territory. We should not apologize for doing our job and reporting the facts or the need for further orders. If this was a male to male interaction, the doctor would not talk this way. I've seen doctors dress down a female nurse, then in the same situation at a different time with a male nurse, act nice and professional. What you make excuses for allows more abuse to exist. I have been blamed for many things, and I can take a lot. What I won't take is my character being trashed or any threatening talk or body language. I have taken many doctors to task when that happened and reported a few. If some said they were going to beat my head in, my first inclination would be to say "Excuse me? Did I hear you correctly? You will do what?" To gain respect you have to demand it and treat others as you would want to be treated. When the line is crossed, follow the hospital policy and keep a paper trail of documentation concerning the behavior concerns.

I can only speak for myself, I still feel a reverence at a death. It is a spiritual event in the circle of life. Nurses have a honor to witness life and death and be a part of those events. Even if someone is 98 or a stillbirth, I still get somewhat emotional. I also get emotional when I've just been talking and laughing with someone and then they die. It reminds me that life is precious and it turns on a dime, no matter what technology or treatment we may use to prevent death, it still comes. I ask myself, did I do my best in caring for this patient? Did I make their last moments as comfortable as possible? Did I connect? I have seen my share of death, and I hope to never become desensitized.

The future looks bright for those nurses who possess critical skills and additional specialty training. Many will not value your training because there is a long tradition of OR nurses being so task oriented, but that is changing. From an ICU nurse myself, I feel that ICU training is one of the best springboards for any area you want to pursue. The assessment skills are above any other and that can alert you to subtle signs of something going wrong. You are in tune to alarms and can anticipate that anesthesia may need assistance. You also are used to looking for problems associated with blood loss, pre-op lab values that may spur you on to asking questions about what the surgeon may be needing relating to additional orders or pre-emptive, proactive supplies or tests that may be needed during surgery. While many in this posting already have stated that they don't like bedside nursing, I would rather say that I like the one-on-one approach to care and that the pre-op connection and assessment that you have with the patient is paramount to patient satisfaction and alleviating some of the fear associated with surgery.

My hospital is not a Magnet facility and we do hire ADN's for the OR and other nursing positions. We even have LPN's in other areas of the hospital.

I wish I had been the supervisor that night-I'd have called him back and had a meeting with him and his section chief as well as my senior nursing officer and we would have demanded an apology AND recommended further action. No one speaks to my nurses in that way. Don't forget nurses need to stand up for one another, especially new nurses who aren't quite as thick-skinned. There are NO stupid questions and most of the doctors I know will not check their own peers, so we have to ensure that the nurse's focus remains on the patient and not trying to recover from some threatening doctor who definitely has issues beyond what we can control. That type of behavior is not tolerated and must be written up and documented for further reference to substantiate patterns of behavior.

When you are new and trying to talk to someone on the phone-you may ask an innocent question that could set someone off. For myself, I'm not walking on egg shells with people if I need an order and I need to report something to you I am going to ask clarifying questions. Are you familiar with? Some admitting doctors have never even seen the patient. So thinking that doctor's these days know everything about who they have their name on is ludicrous. I've even had doctors ask me, "Remind me who is this patient? Describe them to me. Oh yes I know now. Continue." So this doctor has no justification for his response and I don't need to stroke his or her ego at any time. I am a professional and hope that I would be talking to one on the other end of the line. I cannot abide advice such as... "you should have never said this or that"-that places blame on a nurse who had no way of knowing what was coming.