birdie22

At the end of the day, you cant please everyone. You can't be biased towards people you like (dont play favorites) and you cant be biased towards people you arent fond of (dont give someone a bad assignment just to screw them over). Treat everyone with respect and fairly. Also, while people might not understand your reasoning for the decisions you make (and you might not want to tell them), you always must have one that is justifiable and valid for yourself/management because people will question it. Good luck!

Sorry if this sounds silly, but what does all that legal jargon actually mean? He didnt actually give his opinion and make a decision correct? I'm studying to be an ACNP but dont really see myself in the ICU. I get it that the trend is for only ACNPs to work in the ICU. But what about the opposite situation....for example can an ACNP work in a specialty outpatient clinic like cardiac?

We are the worker bees and the queen bee(s) make all the decisions w/o regard to staffing is my motto. That being said, our charge nurses and manager will even go to bat for us, but the chain of command is way higher than them when it comes to OR $$$$. Do you have a union/mandation policy? Try to change what you have the power to...Odds are you arent going to change the way they do add on cases, but perhaps adding another call team, mandation policy so you its a fair record of how often people are being forced to stay over, etc.

Totally depends on the case and room layout. Are you turning the HOB 90*? We have some extremely outdated ORs that are super small yet have to accommodate all fancy new devices and technology that our surgeons "must have". You stand where you can fit and just always gotta watch your back (literally). Ideally, yes, the scrub should be opposite the surgeon, just makes sense in terms of workflow.

I was initially trained to always be right at the bedside when the patient is awake - that means when they are being intubated and extubated. That being said, it really depends on the hospitals culture/policies what the expectations are. At my current facility, it is not the norm to be at the bedside with the patient, but its habit for me from the other hospitals i have worked in. the nurse usually doesnt leave the room, but isnt necessarily there helping anesthesia w/intubation. If everyone else left the room, who was watching the sterile field? But thats another issue for another discussion...

Ive worked in a couple different ORs. One of them, none of the nurses scrubbed. ratio of staff was 50/50. Another one ratio was about 80 nurses/20 ST. So during orientation all nurses learned to scrub and we did so on a regular basis. At my current job, the ratio is more 50/50 but they still teach new OR nurses to scrub. I understand that its good to know the instruments, etc. but when the ratio of staff is 50/50, after orientation, the nurses loose the scrub skills they learned bc they never use them.

I cant speak to the billing/insurance questions, but I'm wondering what type of orthopedic group are you going to be working for? I currently work in the OR and will finish my NP degree next year. I would like to stay and work as an NP in the OR but it seems like that is hard to do. Is it an independent orthopedic group or hospital based? Ive been doing a lot of searching for NP jobs and cant find any in the OR.

do you all mind answering what speciality you're in? thanks!

Its trial and error. I think everyone's feet are a different. Personally, Ive used crocs, allegra, and regular old tennis shoes for a bit. I think it helps to rotate your shoes (like every other day wear a different pair). I have two in my locker that I switch between.

Of course you're excited and want to get a leg up, but enjoy the time off before you work, no need to pre-stress, there will be plenty of that to come!! That being said, honestly, some advice would be to learn that it will be challenging and difficult at first and dont sweat the small stuff. Be mentally tough and prepared to take criticism. You might (will) feel like an idiot a lot at first. That will sllllooowwwwlllyyy go away. If you can learn to be competent at work, the confidence will eventually come. good luck!

In the state of Ohio, you can work as an RN and still hold a NP license. I think the logistics of how to go about it might vary from state to state, but I think its doable in most places. A coworker is currently doing that in my unit (in Ohio). All she had to do was sign a piece of paper from the hospital stating she would only practice under the scope of a RN while working as a RN and not practice under the scope of a NP.

Nursing makes everyday decisions but anesthesia has the final call if there is a dispute.

I dont think there is one track that is the "right track". Whichever one you do is the choice for you. Im currently in an ACNP program and self doubting my choice often. Like you mentioned, you can do a post-cert in ACNP or you could also go for the ACNP and then do a FNP post-cert. Personally, I think the schools have WAY to much stake in the education game for NPs and control so much politically in terms of limiting NPs practices to locations. PAs go for one standard degree and can practice in any location, why do NPs have to specialize? Its limiting in my opinion. How is one supposed to know the exact place they want to work for the next 30+ years?

Im currently enrolled in a ACNP program. I actually have no ICU or ED experience so self doubt has become my middle name for the past 2 years. I still dont know if I'm in the right program. All you can do is take things one step at a time. Get comfortable being uncomfortable. It honestly doesnt matter if you have 1 year or 20 years nursing experience. You are learning a new trait with new responsibilities so dont let other people's experiences make you feel inferior. If you want to be an ACNP, do it. You are definitely smart enough. Its all just about hard work and dedication to get through everything. Always easier said than done - but try not to compare yourself to others, just to yourself. If you want to do it, then do it!

Definitely dont call them at home. If the nurse said the patient was fine before d/c, Id take her word and try and accept that. That being said, we usually use betadine solution for ENT cases just to be on the safe side where I work

OSU has state benefits, so I think that's why they get away with paying the least.

Ive heard the same thing regarding pay scale. Ohio Health offers the highest, and OSU offers the lowest.

We use both reusable metal safety belts and the velco one - circulator preference. There are pro and cons to both. Ive never seen a burn or other issue bc of the metal one. Regardless, i usually put the strap below the warmer.

Long debates at my institution about this topic. General rule, as previously mentioned, scrubs can only sit if the MD is sitting. The debate has recently come up in robotic cases. The MD isnt scrubbed in and the ST can often go over an hour without passing a single instrument. Should the ST be allowed to sit then? As far as circulators goes, there is downtime to sit. Just depends how good your picklists are (i.e. do you have to run alot because things are missing).

Generally speaking, if you are wearing sterile gloves, you can touch the part you just prepped to move it out of the way to continue prepping another area. If you touch an area with sterile gloves, you havent contaminated the body part but you have contaminated your glove on that hang, so you shouldnt touch any other things after you touch a body part. Your other hand can continue to prep out the area. Maybe try a different technique to hold the sponges so you dont touch the skin while you do it.

You can get specific trays from da Vinci for the scopes which do a good job. We leave ours in a fluid warmer to help with the defog. Most of ours break bc people aren't careful when it's resting in the warmer and lock it over or something. Especially at the end of case when it's more chaotic in the room people just throw the camera into the warmer and aren't paying attention. We now always clip and secure it instead of it just resting on things. Also the Xi is wayyyyy easier to drape. There isn't a camera drape and the scope it way nicer and user friendly

its a life saver in terms of room functionality. you can dock from any angle and the boom rotates. no more having to make sure the circulator can drive it into the exact location at the exact angle 10 minutes later. biggest hurdle is definitely the different supplies, different arm covers, arms, trocars, etc. pain to have multiple systems. also, as we have learned the hard way, the new scope is a lot easier to break...more expensive to fix...so start good training habits with the staff early.

I know a couple people in the program but dont know specific details on the costs, likes/dislikes. Generally speaking, online is very helpful for work/life balance but be careful because it takes a lot of self discipline and self guidance. You have to teach yourself how to navigate the website/portal and take the time to actually listen to the lectures and not just skim them to see what the assignments are. good luck!

You can work as a RN after you are a CNP in Ohio. Just cant work outside scope of practice...i.e. you are working a shift as an RN, you cant write scripts, pretty obvious.

unless you want to change specialties, dont spend the extra time/money going back to school, spend the time finding your NP job. keep looking for jobs, dont get discouraged. i didnt find my first RN job for 10 months when the market was saturated.