Ferret

Whatcha pussyfooting with those little things? Something thick needs a heavy blade.. I was thinking a #23. Orthopaedic butcher cleavers... not vascular finesse :rotfl: And if anyone is going to hand out job descriptions, might I suggest your unit educator? Ferret

It's not all McLeod's daughters country, my wife loves the show as well. I just spent six months in Tasmania looking for a way out of the unrelenting heat, I love a bit of snow... which is a rare thing where I live. But yes, I have to agree with you, there are few places in the world I'd rather live. Things are similar here, including the helpless anaethetists... and do I need to mention the short-staffing issues? Classic. The amount of times I'd swear they were deliberately withholding... Mine would be the Neuro Registrar who would wait until the final count was complete before asking for his last suture... I never close off my suture count now until the dressings start going on. Ferret

Med/surg nurses work on the wards, perioperative nurses work in the operating theatres. The nature of their roles are extremely different, and you'll have to see for yourself during your course to start understanding. Your nursing course will prepare you for med/sug nursing, if you are interested in perioperative nursing try for a theatres elective subject. As for the good things, try Tell me something GOOD! . Sadly, this forum tends to bi**h about a lot of the bad things in our field, it is a good place to vent frustration to sympathetic ears. help! Are surgical techs and RNs the same?? and Verbal Abuse from surgeons in the OR as well as How many RN's scrub? for some good gripes. Bizarre! Bizarre! Bizarre! is a good look at some of the funnier aspects of our work, as is You might be an OR nurse if....... For med/surg benefits/disadvantages, ask on their section.... I hope this is helpful to you. There are no such things as stupid n00b questions, although searching the forums may find you the answers before you ask them. There are many similar threads, and sometimes asking your question on an old, similar thread, refershes the thread and allows for better understanding of the context. Ferret [edit; I didn't realised this site had word changers.. I changed an offending word so that it had some hint as to what it was, rather than being totally censored..F ]

I took/take you as a friend. I was pointing out that you had weakened (undermined) or disagreed with my comments, which was ironic when you said you agreed with me 100%. It just triggered my sense of humour, nothing else. Healthy debate furthers a topic, either between friends or foes. As a matter if fact, healthy debate can only happen between friends, as foes tend to rapidly degrade any debate into something distinctly unhealthy. Ferret [edit; The edit note in my last post was designed to SPECIFICALLY point out that the challenge/debate was not aimed at you, Corvette Guy (CG). F ]

We do all of the above, although the scout counting in is not that worried about being the scout counting out in many hospitals. Our ACORN standards state that three nurses should be in the room at all times that a patient is under general anaesthetic, the Scrub, Scout, and Anaesthetic nurse. Although as we have Anaesthetic Technicians here and on long cases the anaesthetic nurse/tech is not required to help the anaethetist, they often tend to do other things or relieve the scout for tea breaks, etc, so this standard is not always followed or hospital policy. You are welcome to come retire here, any time. We love experienced periop staff :chuckle Ferret

Hi Corvette Guy, I don't believe in quoting whole posts unless they are very short. Big posts that get repeated several times in forums just end up cluttering the thread up, when they obviously already have been read by anyone reading the forum. Thus, I tend to take small, relevant quotes and use them to elaborate further on the topic with new concepts, thereby adding to the discussion, rather than just parroting someone else's lines. You have undermined some of what I was saying here in agreeing with me 100%. BOTH the RN and the surgeon have responsibility for the patient, with the nurse acting as a patient advocate and taking care of the patient's safety. Examples such as "Time Out" and ensuring that the count is complete before closure if there is in any doubt are times when the RN can and should OVERRIDE the surgeon's wish to bully on and finish in order to protect the patient's safety. If the RN has a responsibility to override the surgeon, there are grounds for questioning who is in charge in that situation. The same goes for the Anaethetist being able to stop an operation, as well. There is no captain of the SS OR, it is controlled by consensus, all of the senior personel agreeing that it is safe to continue. Ferret Hehe, go on, :angryfire me... I'm interested in intelligent discussion on this contraversial issue. F [edit; the last comment is not aimed at CG or anyone in particular... F]

As promised, try How many RN's scrub? as well as What does "the circulator is in charge of the room" mean in your OR? and OR nursing QUESTIONS threads for more discussion. They're pretty cool threads to read, anyway. Have Fun! Ferret

Actually, in our roles as patient advocate, it is our role to challenge the surgeon about their decisions regarding patient safety if we disagree. They are not the "Captain of the Ship" any more, there has been legal precedent that makes the RN also responsible for the patient. The surgeon does have to listen to us when we stop the operation to find the sponge that they left deep in the abdomen, or find that blasted haemostat that some twit left clamped to something vital. We are responsible for our job, they are responsible for theirs. Our jobs overlap, as do our responsibilities. Maintaining the staus quo and defending the archaic "Captain of the Ship" concept is against the general thrust in nursing to gain respect as professionals in our own right. This weakens our ability to deliver the best possible patient care. Part of the training of a RN is to analyse and recognise the roles of the team in the workplace, and delegate tasks to those we judge skilled in performing them. I'm sorry to all the technicians and other nurses out there who might think otherwise, but the simple fact is that they do their tasks and have responsibility as delegated to them by a registered nurse, who also maintains ultimate responsibility for the patient and the actions of those delegated tasks. The surgeon has responsibility for the operation, registered nurses are responsible for the theatre. Ferret

The scout nurse is our rough equivalent to your circulating nurse. They do the count, open the setups, act as patient advocates in assisting with positioning and ensuring that pressure area aid are used, etc. In most situations the scrub nurse has to be a registered nurse, while the scout can be a Enrolled Nuerse (EN) which is roughly equivalent to your LPN's. Some hospitals train their EN's to scrub after a designated period of time as a scout, like a year, or a course for the purpose. In that situation, when an EN scrubs the scout must be a registered nurse. That is the only time here that the scrub is not in charge of the theatre. Most times, the scrub/scout swap roles each case and take scrubbing in turns. I was a EN/scout for a few years before I got my degree, and to me scrubbing is the best part of perioperative nursing... certainly the most fun, anyway. Some posts on this forum suggest that your circulators assist the anaethetist in intubation and such, we have anaesthetic nurses or anaesthetic technicians to do that. Nurses here tend to either work Scrub/Scout or Anaesthetics/Recovery, with little crossover. I'll see if I can dig up some old posts I did here last year that discusses the differences in a bit more depth for you. Ferret

In Australia the scrub and scout do it. It is preferred that tha same scout that started the count finish it, but not mandatory. How it is handled varies across hospitals, some hospitals are very strict about doing a changeover count when the scout is relieved, which seems a bit ludicrous, and of course there is always a changeover count when there is a change of scrubs. Unlike the US, here the Scrub nurse, not the scout or curculating nurse is the senior nurse in charge of the theatre. Ferret

I love the look of relief on a consultant's face when they walk into the room and see someone thay recognise on their team. I love the teamwork, the close relationships between nurses, surgeons, anaethetists, technicians, cleaners... this is a really close-knit team that might take some time to work out the kinks, but when they do... never on the wards will you find such a close relationship between all levels of staff. The things bitched about on these forums, I believe, are the exception to the rule, and if you read the replies, often lots of people are saying that the people who have problems always have options for dealing with them, including going to other places where the team dynamic is different/better. I believe that a majority of people are in this forum, and this specialty, because they love their work, and have devoted many years to pursuing it. Read between the lines in all this bitching, and you'll find a lot of love for all aspects of perioperative nursing, and you'll find a lot of people telling you why they do it, and believe you me, it's never for the money... none of us get paid enough. I love scrubbing, the feeling of satisfaction in taking on a long and challenging case with big loan sets and keeping everything moving smoothly, keeping track of all my accountables and being able to hand the surgeon whatever s/he wants within moments of him/her asking for it, if not before. I love knowing the operation and the surgeon so well that we don't need to communicate about the surgery, and can be gaily swapping dirty jokes while the serious work is carried on swiftly and silently at a totally different level. I love scouting, watching the operation, knowing the entire theatre block like the back of my hand and also being able to anticipate the course of the operation and the needs of the scrub and surgeon/s. I love taking on new people to the theatre block and showing them the ropes, then encouraging them to do things for themselves, and watching them grow in confidence and the field. I love the times that the surgeon is stumped, and you offer a suggestion that turns the course of an operation from a difficult one into smooth sailing to the end. Theatre nursing is seriously fun, and I know darn well I'd be useless on the wards and bored out of my wits as well. Thnings are a bit different here in Australia compared to the US, but 'tis still theatre nursing. Be well, have fun. Ferret

Good humour and chocolate.... I remeber a particular list years ago that was busy, hectic, but the Surgeons and always kept in good humour and took it in turns to bring a couple of bars of chocolate along. Yeah, I know that having chocolate in the theatre is against regs, and so did the managers... but they were always bribable with a bit of .... Chocolate! That was years ago, but still I remember that weekly list with a smile :biggringi Ferret

In the Law components of the nursing degree in Australia, it is strongly stressed that "Contemporaneous Documentation" ie something written down as it happened or as soon as possible after is considered one of the strongest forms of evidence in a lawsuit. By all means, write an incident report and boot it to management, here all incident forms have to go up through the channels and be investigated. But also write details up in your diary, which allows you to keep a contemporaneous log of all that goes on that affects you, and, unlike incident reports, can log minor situations and irritations that build up to create a comprehensive image of the real situation. Ferret

That's the same in all hospitals here in Australia that I've been in (5). Generally, your scrubs are far more likely to come in contact with patients, blood, and pathogens, then your hats, and are made of a special material (high thread count) and are processed by the appropriate hospital cleaning systems beacuse of that. As hats are there purely to stop hair floating around the operating theatre, or into a sterile field or surgical site, it doesn't matter what they are made of, as long as they catch the hair, so often they are made of cheap disposable crud. Therefore you can replace them with anything clean that does the same job, namely a cloth hat or scarf that is worn for a day then laundered. It's not really a double standard, it's based on the difference in purpose and use of scrubs v's hats. Ferret

I'd suggest that sweet chilli sauce might make her more palatable. Some people just don't get the whole ritual of sterility, others need calm and patient coaching, others need to consider an anaesthetics/recovery career... I don't think that doing a med/surg placement before the OR would make that much difference, as the best, if not only place to learn sterile technique is in the OR. Either get this nurse to do a periop course or accept that you are going to have to be really patient with her. She needs to learn her job, and teaching her that is not eating your young. It's forcing her to do unnnecessary things to comform to the tradition of nursing in yout facility that is eating your young. But in the end, don't forget the chilli sauce. Ferret