nurseboudin

You've tried talking to him...I've worked with some people who've been unreceptive to feedback, they usually hang themselves. I personally would wait it out. It's hard talking to someone who doesn't have insight. Might as well bash your head against a wall a few times. Can one of the physician leaders help out? How about engaging him on a 360 feedback project?

Hard work, lots of networking and soaking up everything I could like a sponge. Education, certification, conferences. Flexibility, solution oriented (no complaining), and always smiling. Politics w drs other Rns and patients.

Actually, I've been there before. It can get overwhelming and frustrating so I feel your pain. Know that it will pass, it's not personal, and I've never sent someone to the board or peer review that was doing what was in the best interest of the public. We are all accountable for our own actions. You can't do anything to her that she didn't do to herself. Your job is to protect the patient, not the nurse. It is easy to lose sight of sometimes...but hang in there! You can do it.

It took me a few years to get the salary I wanted. I did a few things beyond getting my MSN, got a specialty certification, participated in Research, served as a representative in my local AORN chapter, volunteered for community service events... It helped my reputation as a leader and the networking was amazing. I care about my profession and my teams. As a result, the money followed. I never felt entitled to a certain salary. I always worked for it until I eventually named my price and they knew I was worth every penny. You can try another market. I know we always want nurse leaders in Dallas. I was in leadership in a previous career, but this is a different industry and really- my previous leadership was NOTHING like nursing leadership- I have to send people - nurses and physicians- to peer review based on my own clinical knowledge and expertise in my area. This requires knowing the standards of care, facility policy and procedure, and the state's nurse practice act. Maybe you should look at other nurse leaders credentials and experience in your area and see how you size up, I think you might find you are being offered what they think you are worth.

Management ebbs and flows. He may not last. But done is done. Is stepping down an option? Getting out of the rat race and focusing on patients for the next couple of years?

I've always done them sterile. The patients are at great risk for infection to begin with. We should make our best effort to keep all the bugs off.

We had to do them all. Many smaller hospitals don't have specialized teams, you should try them all if you can.

I am an OR manager, and I've been involved in two sentinel events to conduct a root cause analysis. It doesn't matter if you leave the room or not. A retained item occurs after final wound closure. In both events we reviewed, the patient wasn't out of the room AND was not woken up...but the physician had to go back in to retrieve the item. It's not practical to leave a wound wide open while counts and recounts are done, nor is it the safest practice. Our policy clearly states that wound closure may begin as final count is being done, but cannot be completed until the surgical team has confirmed that all counts are correct. The rule boils down to this: Don't throw the last stitch or staple until counts are finalized.

I just found out that I'm 5 weeks pregnant. Has anyone been through a pregnancy while working in the OR? I don't have the luxury of moving to another unit, as my job has a call requirement.I'm actually paranoid and scared. This is my second pregnancy- the first ended in m/c at 12 weeks.

As a surgical services nurse manager, I say ABSOLUTELY NOT! The scrub is responsible for adhering to specific standards as defined by their job description, not residents or other MDs. I will delay a case if I don't have staff. If this is a frequent occurrence, you may need to adjust your staffing targets.

Document, document, document. I am furious for you. Being promoted from within is difficult. Sometimes, you can give them an "opportunity" to improve via an action plan. Failure to comply with all elements in the action plan will result in immediate termination. Engage HR on your experience. They can help you get your ducks in a row and keep you from breaking any laws.good luck!

I liked all of your comments and appreciate your perception about nurse managers working rooms; however... much of this depends on the staffing structure, size of the facility, etc... I am a nurse manager and when I started this job, I thought, "I will participate in the work and even take call with my team." That didn't happen because it simply wasn't possible. The numerous meetings managers have serve to advocate for the work of their teams. I ensure that during slow times, as opposed to being sent home, they have other opportunities in various other departments. I review productivity of staffing and utilization of block times. I answer for missed SCIP measures. I answer for staffing problems. I answer for customer satisfaction ratings. I make sure the broken stuff gets fixed. I monitor the renovation of the OR. I hire and fire. I make the staff schedule. I ensure quality measures are met. I balance budgetary requirements. I beg for money. I beg for FTEs. I write people up. I have to round on 40 employees, about 25 surgeons, and keep DETAILED records of every financial, quality, service, and employee interaction that I have. I set up competencies, inservices, and mandatory training requirements. I audit periop records. All this while running the board. I could go on.... I can scrub and circulate ANY room. However, it is not something I am comfortable with while having to run the board. I would not expect a scrub or circulator to mop a floor or transfer a patient when an OR aide is available because it might mean not being able to bring instruments back or not being able to see the next patient right away. It could delay room turnover. And GOD FORBID that happen! Anyone is capable of mopping and transferring, but it is all contingent on workload. I would recommend everyone read the job description of their manager. Ask yourself what the organization's expectations are of this position. Unless an issue of patient safety arises, there is no need for me to circulate or scrub if I have ensured competent staff are in place. The respect of my staff is earned not because I do the work, but because I am a strong advocate for the excellent work that THEY do. I know the AORN standards and I hold them to those standards. I am certified in my role, continually pursue higher education, and ensure my team has the opportunity to participate in evidence-based practices, go back to school, or get their own certifications. I hold them to a very high standard. That is what I feel management is for. Advancing the practice and ensuring the highest standards of patient care in my clinical area.

Yeah, I agree in that it doesn't seem safe. Nor does keeping a patient under anesthesia for prolonged periods of time: count times have exceeded 40 minutes in some cases. That's just painful. We are looking to revamp our count policies for these cases. Do you know if anyone in your organization has developed a creative way to make the process more efficient?

Does anyone have an effective count policy for 360 spinal cases? Our staff is extremely frustrated with counting trays upon trays of instruments, implants, individual retractor pieces, etc... These counts take forever, but are deemed absolutely necessary. Has anyone implemented alternate setups or found a way that makes this process more effecient without compromising patient safety?

In my opinion, I think it's vital in any area of practice to know the standards of care established by the professional nursing organization, state board, and ESPECIALLY your organization. The whole team is accountable for what happens in the OR. My advice is when you work for an organization, make sure they are supportive of the nursing staff, include nurses in decision-making, and don't put up with those (even physicians) who have poor standards.