Mourkoth

Hold on there Ms. Critical, Lets cut the "I'm better than you finger pointing stuff". The chart was there in the room and I was the circulator. I just turned a few pages back and saw the old peri-op record. I'm not spreading gossip or anything. I believe in the "golden rule" routine. I wouldn't want everyone to blab if that had been my name on the first page. And as far as I know, the only other people that know the names are the nurse manager, and risk managment guy(or whoever the incident report eventually gets to). I'm discussing this for a different reason. Patient safety. I think that due to severe staffing cuts, longer hours and compressed workloads, safety is being comprimised. I'm simply asking if this is all in my head (and my hospital is unique), or is this kind of thing is a trend and actually happing somewhere else?

Hey, I've got a question. Do any of you have any safety concerns or have witnessed a compromise in safety since the economy has had a downturn? The reason that I'm asking is that I'm new to the OR enviroment and my experience is limited as I just completed my intern program two years ago. We have many good nurses in our OR. Our hospital is a level one trauma center and we do surgery 24/7. I have heard stories of "retained items" but have never seen or have been part of this. However just reciently, in the last two weeks, I was in cases where we removed retained items from previous surgeries. #1 was a lap, #2 was a lap, and #3 was two laps and a scratch pad. With mild curiosity, I reviewed the charts and saw that the first two were left by older more seasoned nurses. (ones that I had considered very conscientious). They had even charted that the last count was "correct". What gives, two years without even hearing about it and now three in two weeks? It makes me wonder, if people keep quiet, of if its on an off shift, just how many cases happen that I never hear about. When I see better nurses (ones that trained me), doing this, it scares me to death. I have noticed that managment is cutting housekeeping and core techs. We as nurses are expected to get more of our own supplies, to do more in cleaning our own rooms, and keep our turnover times short. Everyone seems to be stressed. Could this be the cause of a laxing in safety standards? Is this phenomena occuring elsewhere or at other hospitals due to short staffing or cutting costs or layoffs? Let me know !

Our hospital is a 24/7 level one trauma center. We have a variety of shifts in our PACU. 8, 10, 12hr and some call shifts. The manager tries to be creative and flexable to accomidate for the OR schedule. We usually have a mid-day rush as the first cases get out. Then we have another rush in the afternoon to deal with the more critically ill patients. We even have positions available... if you're intrested.

I graduated nursing school in 1985. I spent most of my career in the ICU setting, with 8yrs in the PACU. I was burned out and wanting a radical career change. I was looking to exit the medical field all together. My wife suggested the O.R. I went through our facilities OR intern program. I realized just how comfortable I had become with my ICU skills and how little this experience helped me in the OR. It was really hard! The learning curve was really steep, (for an old guy). Last month, I completed one calendar year of being on my own in the OR. Early on, I was really nervous about losing my ICU skills. I would moonlight in the PACU on occasion when they needed extra weekend help. I would start the IV for Anesthesia, (after their first missed stick). I was having trouble letting go of those skills. Last week, I passed a benchmark. It was our annual competency check off day. I let my ICU competencies lapse along with my ACLS. Now I am an OR nurse only! I have accepted that I will lose some of my ICU skills, but I have gained a host of new (equally difficult) skills as an Operating Room nurse that I aim to polish and hone to perfection. We have to accept that the practice of nursing is so vast now that we can't hope to stay current in areas other than our focus of practice. The days of "a nurse is a nurse is a nurse" is long over.

Hi there, We are a huge teaching hospital. Our ORs are really big and we don't limit number of student. We have 22 OR rooms and are building 4 more. I feel that regardless of the teaching aspect, the patient always comes first. As the Circulator, it is my responsibility to be the manager of the room. If I can't do my job effectively or I feel that we are not giving the best possible care, I can become an ass. There is a sane limit to numbers... especially large trauma surgeries. I will point to individuals who are not an active part of my team and tell them to leave the room. If it is a particularly chaotic I will thin the herd more. For example, we recently had a trauma with general doing an ex-lap on a pregnant woman with OB assisting, ortho working on an open tibia. Opthomology, comes in with his three assistants to take a look at the "cornea problem". I told him to take a quick look, lube it, patch it and come back when one of the other teams has finished. Anyone else, especially if they are not really needed, I send out. So many residents, other nurses, techs and even managers seem to just want to come in to "see whats happening".

Our goal is 30 minutes However it rarely happens. Our schedulers seem to be oblivious to the proper flow. For example they will schedule a femur fx with an OSI traction table then to follow they want a vascular case with the radioluscent table which is at the other end of the building. (We have 24 OR rooms running). Or they schedule a abdomen washout on a VRE patient then a total shoulder to follow. The room must be terminally cleaned and the ortho setup gathered. When it would make better sense to schedule the VRE and MRSA cases last or in the same rooms and the ortho procedures to be done in the same room so that we could use the same table for consecutive cases. That would be too easy!

Hey, I wouldn't leave the room for anyone, especially if it was a non-emergent case. I'm very new to the OR enviroment, but I've seen night shift call where real emergency cases come in and the nurse starts another. The nurse will get another room going. Almost always, the OR nurse will get on the phone with the supervisor or call a PACU nurse over to sit with the first patient until she gets back. (I've reciently transfered from PACU to the OR).

Hey, I have an informal poll, or a question for everyone. We reciently had an incident in sterile processing where there was some hair found in one of our drills (after processing). We were opening for a crainotomy and there was a hairball on the head of our Anspach drill. the manager assumes it was not a problem in sterile processing and instead it was a nursing problem resulting in no nurses are allowed in sterile processing unless they are wearing one of the hospital issue paper surgical hats. Cloth hats are banned. It doesn't matter that almost all of the doctors wear cloth (designer style) hats and it is perfectly acceptable to have cloth hats directly over a surgical wound. It is not acceptable to go where dirty instruments are processed with a cloth hat. Which gets me down to my long winded point. Is cloth hats allowed in your facility or is the standardized paper hat the only allowable hat?

Well, I'm saying it!! I won't mention any names, but I work at one of the two level one trauma centers in the state of Oregon. We never count anything from the tray on any extremity case. We, as responsible nurses, count (to ourselves) the smaller things that go into a patient (only on large abdominal cases) to make sure that they come back out. If there is any question at all from anyone on the operative team, we simply get an x-ray. It is not the hospital policy to count instruments. I've been there for eight years and I've never heard of "instrument" ever staying in a patient beyond the end of the case. I'm not saying that it is probably a good idea as a scrub, to be accountable of your instruments. If you have to count them just like laps and rays, then by all means count them a dozen times. All I'm saying is that my hospital doesn't require it. And I challenge anyone to find the famous quoted standard from the AORN that says that all instruments must be counted. If you can come up with this, I will gladly show it to my superiors, and petition to change the current policy.

If it is an Emergency case and the patient is from the ER, then a consent in not absolutely necessary. It is preferable but not necessary. If it is an in-patient and the case is not an emergency and the physician had ample time to get a consent, then the OR nurse shouldn't allow the patient to go into the OR without a proper signed and very specific consent. The Circulating nurse can hold up the works until the paperwork is in order.

This debate is really not about patient safety. It is really instrument accountability, and cost containment. In a big OR, instruments sometimes get lost. Someone has to be accountable (or to blame). If it were simply a patient safety issue then we would do an x-ray at the end of each and every case. I work at t 500 bed trauma center and we don't count any instruments.

Maybe the patient marked the site as a joke. I had a patient who was getting a Left total hip done. He marked on the Right leg, "No not this leg, this is not the one. How about you walk around the table and if you are still standing there reading, maybe I don't really want surgery done here." I read his lengthy note on his leg (written with a sharpy) and we both laughed.

Whats a count sheet? I'm new to the OR and we count Laps, Rays needles, TW's loops, hypos, kb's bovie tips, scratch pad, ect. We don't however count instruments.

I think that sometimes it is ok to throw off your raytecs. If I don't plan to use that many rays in a case. I will count them with the circulator and then roll nine of them up real tight with one long unfolded ray. If they are not used in the case (and remain ten) they stay rolled up until the end. The circulator and I agree that they were counted at the beginning of the case and are still rolled. Therefore, at the end of the case, we can throw off the whole ten without counting them (individually). This may not be completely within the guidelines of the AORN standards but, If the case is started and ended with the same scrub and circulator and the rays were counted at the beginning and rolled... they both can agree that the original ten is there without counting.

I worked for 6 years as a director of nursing. With experienced nurses there was no difference. If they were both new grads, I'd go with the ADN every time. JDTaylor