Janet E Groll

Find another place to practice your nursing quick. You will be the one left out to dry if something GOD forbid were to happen to one of your patients. Look what is happening to those poor nurses and Drs in New Orleans. I heard on one of the news programs that the hospitals down there in a statement said, that they do not condone nor do they stand behind them in what occurred after Katrina. But where were their backup generators, not on the rooftops where they should have been, being in a flood plain. They are responsible just as much as the government in their abandonment of those patients, nurses and Drs. But the nurses and the Drs will be the ones who pay the ultimate price, not ever having peace of mind, because thay couldn't help those patients. They did all that they could do under the circumstances, and I do not believe that they purposely caused harm to any of those people. Even after the government finally arrived to evacuate the patients, they put some of the most critically ill patients on the side of the road where there wasn't medicine or help for them for days and people continued to die on the roadsides. The Drs and nurse still did not abandon those patients, even not knowing where their own families were. You worked hard for that license, and for what it stands for, don't let anyone put it at risk, there are safer institutions out there, find one. Good luck and don't become discouraged.

Find another place to practice your nursing quick. You will be the one left out to dry if something GOD forbid were to happen to one of your patients. Look what is happening to those poor nurses and Drs in New Orleans. I heard on one of the news programs that the hospitals down there in a statement , that they do not condone nor do they stand behind them in what occurred after Katrina. But where were their backup generators, not on the rooftops where they should have been, being in a flood plain. They are responsible just as much as the government in their abandonment of those patients, nurses and Drs. But the nurses and the Drs will be the ones who pay the ultimate price, not ever having peace of mind, because thay couldn't help those patients. They did all that they could do under the circumstances, and I do not believe that they purposely caused harm to any of those people. Even after the government finally arrived to evacuate the patients, they put some of the most critically ill patients on the side of the road where there wasn't medicine or help for them for days and people continued to die on the roadsides. The Drs and nurse still did not abandon those patients, even not knowing where their own families were. You worked hard for that license, and for what it stands for, don't let anyone put it at risk, there are safer institutions out there, find one. Good luck and don't become discouraged.

I started in a busy trauma center as a nursing student with one semester of nursing in. I was fortunate to have been taken under the experienced nurses wings. I was also in the float pool, so as a student I worked on all the floors and ICUs. When I graduated from school I stayed in the float pool and worked all specialties for about 11 years, then in 1990 I went to the OR for an interview, during the interview I was told "you have no OR experience, we are really looking for a nurse with some experience". I then looked the director in the eyes and stated " How do you expect me to aquire the experience if you are not willing to hire me and train me"? I was hired on the spot. I can function independently in all areas of the OR. This includes both scrub and circulating. From ortho, neuro, and hearts to renal and liver transplants. I also harvest saphanous vein and first assist. My specialty now is hearts and I can honestly say that the "old fashioned way" of spending time on the floors has helped me in my career. I can speed through a chart and find the problems immediately. The other day the anethesiologist was prepping my patient for an epidural preop, when I walked in and I reminded him that my patient had active aspergilosis, where an epidural is contraindicated, lest you introduce the fungus directly into the CSF fluid where it will then go into the brain. I was able to avert harm to my patient, which is the whole reason I do what I do. I also continue to read journals regularly, so I can keep up with new treatments and find so much information thats helps me to completely understand the different systems involved in disease processes. I also keep the communication lines open with my Drs, the floor nurses, infectious disease, labs, blood bank and pharmacy. I also take my heart patients up to the floor with anethesia so that if the nurse or respiratory have any questions I can answer them in person. The hours are long, the pay is good and my coworkers are my family when I'm not at home. After all you end up spending more time with them than your own family. I'm not saying you should spend time on the floors before going to the OR, it just worked well for me. It is so much easier these days to go from school to the OR than when I tried. We hire direct from school where I work and some make really good OR nurses, and some you don't want to work next to. But I guess that goes with the experienced nurse also. You really have to work in the OR, there is no room for the lazy nurse in the OR. Make sure you have good preceptors and a good OR educator and you will do fine. Good luck!

Prioritizing is really important. First off let me say I do not like to get caught with me pants down at the get go so, the first thing I do for myself is check my patient and their chart. Make sure the preop check list is complete, this one form has alot of info on it. Look for the anesthesia workup because this too will have a lot of condensed info ie: past medical history, abnormal labs, allergies, and such. then I look for my permits, surgical and blood. Then I look for the face sheet to match up the medical record number and the hospital number, and identifiable markers, to include name and birthdate. You would be surprised how often these do not match. Then I look at the history and physical to make sure I have all the information needed to help my patient( I had a case today where the anesthesiologist was about to do an epidural on my patient in the room and I took the attending aside to remind him that my patient had an active aspergilosis that would be introduced into the csf fluid via the catheter during the epidural. He thanked me for knowing this info and from stopping him from making a mistake) Know your Med Surg even if you have to read journals to keep abreast. And have a good repore with your surgical staff( your will be made strong in the operating room.) Next I look at the lab printout and the EKG. I also look for the preop order form, this tells you what kind of antibiotic the surgeon ordered, if a foley needs to be placed, pneumatic stockings and so forth. I then call the bloodbank as a check for me to find out if a sample has been sent off, then I confer with the anesthesiologist, based on the pt's H&H to see how many units he wants either set up or in the surgical suite. The surgical schedule will tell you the special equipment needed like Microscopes, mayfield headrest, steath for example if you are doing Neuro by chance. I like to arrive in my division about 15" early to gather supplies find out who I'm working with and pull any other supplies I may need like suture and drugs and have it all in the room. This sounds like a lot but if I pull what I need, and it turns out my coworker is alittle "lazy" I still spend less time out of the room gathering supplies that they figure I'll get for them anyway. Less traffic in and out of the rooms is better for my patient during surgery anyway. So then while I'm doing my patient check my coworker is opening all the supplies, and when I come into the room it falls into place, you do the best that you can tying up everyone, counting, helping anesthesia, putting the stockings on then the foley, positioning the patient with all agreeing on the proper position and padding( this includes the surgical staff, anesthesia, and nursing) you have to make sure you have done everything to prevent harm to that patient intraop. After positioning then you put the grounding pad on & prep the patient, tie up the surgeons, after they drape you hook up bovie, abc, suction and headlights. Call a time out prior to incision to make sure you have the correct patient and that all involved agree on the site, and procedure. Call for blood products and make sure everyone is taken care of, then you can start your paperwork. (a little clue- when you are gathering your info in holding or ACU, start writing on your paperwork, allergies, past medical problems, surgeons names and anesthesia names, nurses and tech's names. Makes for less you have to write if the case is a short one, where you run the whole time, and you just don't have time to do paperwork during the case.) Remember you are the manager of that room, limits ins and outs of the doors during the case, any distractions ie: talking and phones ringing, make sure you check all your equipment prior to use time so that you are not to blame if the equipment fails and there is a delay in the surgical start. This sounds like alot of work but after a while you are proficient and surgeons ask for you in their rooms. Not to mention you can be proud and sleep at night knowing you did a good job for that patient. It really doesn't take that much time after you develop a pattern. Always remember--That which doesn't kill you makes you strong.( and they cannot kill you.) You will have fun and you forge close personal relationships with your coworkers, they all spend more time with you than their own families, esp.if you take a lot of call or work in a busy institution.

Technology is great in teaching hosp. Sometimes in the OR the residents are a pain, you already have so much work, but find yourself always cleaning up something for them. You have to track them down to get permits signed and for verification of procedures at the beginning of the day only to find they have changed the whole OR schedule and they would not have contacted you about this, had you not called them first, but who do you think gets blamed by the attending?

You know with this nursing shortage, management is hiring a lot more people "off the street" and putting them at bedside. This is a strange and dangerous practice. If someone is acting crazy or constantly blaming others for their behavior they become a liabilty for their instituion. I think if your immediate management doens't help you with this crazy individual go to HR or administration with you valid complaints. Some people should just not be at "bedside". I was in a case once where we were performing a routine laporscopic procedure that took a terrible turn, we had to scramble to open the patient to get the bleeding under control,(about 15 people hurried into the room to help) anyway during the change of disposing of the laporscopic stuff and opening the laporotomy equipment things were flying off the scrubb nurses table. One bloody trocar ended up hitting an orderly on the foot, now the scrubb nurse didn't mean for it to happen but during an emergency things get chaotic, as we all know. Now the orderly wasn't hurt and his OR shoes were protected with shoe covers, but what he did next surprised even me, who has worked level one trauma centers most of my career, in a busy metropolis. He got really mad and tried to"jump bad" at the scrub in the middle of this emergency, he raised his shirt like he had a piece tucked into his pants. No one else seemed to see this, but first rule of thumb in nursing is be subjective at all times so as not to miss important information when caring for your patients. I immediately sent him out of the room for some piece of equipment that I knew we didn't need. After the emergency was under control and my patient was safely in the PACU, I not only went to the immediate supervisor, I went to administration. I didn't know if the guy really had a gun or not, but I didn't want to find out. So I say speak up if this person is a nut, until someone hears you. The life you save just might be you own!

I feel like nursing can be a great career choice still. You have to study hard and not get into the profession for the wrong reasons. It won't make you rich, and some days you just want to go home and scream. Some of the new nurses getting into the profession have done so because of all the wrong reasons, and I really have a hard time relating to them. They have been fazed out of other jobs and they find that they can raise a family on a nurses income, and that is the only reason some get into this field of work. They are dangerous to everyone around them, their work is sloppy and they expect the nurse relieving them to clean up behind them, and the patients are the ones suffering the most from this particular type of nurse. I still love my profession, and even tried to talk my niece from entering the profession, by bribing her with tuition if she would become a veterinarian. She declined my offer saying she wanted to become a nurse just like her aunt, because she has seen the differences I make in my patient's lives. You just always have to remember we are truely here for the patients and without them, well I don't know. Always be conciensious about all you do, never do anthing to harm anyone, and if you have to make waves to protect the patients then make them. There have been all too many changes in this profession just in the past ten years, and if we all fight together to retain our profession as it should be, we can be heard. I have found that in nursing that changes occur and staff gets dissatisfied, but not enough of them stand together as one to say, enough already! Why is that? Someone please tell me. One insructor once told me, when I saw something as a young student nurse that I didn't agree with, she told me, don't make waves now, wait until you are an RN, and then you can truely change the sysyem, well I'm still waiting, and now the only thing I can control is how I behave, and how I live with myself at the end of the day. Good Luck! Don't give up on nursing if you truely believe in it and yourself.