maxxilla

If a patient tests positive for MRSA in the nares, do we treat them like we do all patients placed upon contact precautions? I was taught that terminal cleaning was required and that personnel should be (1.) notified, and (2.) given appropriate PPE. My facility and director say that "we treat ALL patients like they are contact precautions" (we do not). Thoughts?

I tried this for a month and was miserable! I worked for a plastic surgeon who's office had its own surgery center. I was in charge of all things clinical; it almost sounds prestigious or impressive, but mostly it meant I had to babysit an inexperienced scrub tech and LVN. The LVN worked the front office (she is young and pretty) while my middle aged self worked in the back.) She would interview patients and run to the back to ask questions. I had to teach her how to start IVs, insert foleys, etc. (She was he first person I've ever witnessed insert an IV and bend it into a fishhook shape in the process.) . (The remainder of my time was spent running the surgery center and being an OR nurse.) In summary: I think the experience is very dependent upon the surgeon and the other staff s/he has chosen. In the OR you can escape a doctor when they grate a nerve. In their office you are trapped with them. Ditto their staff. Your hours are dependent on theirs. If their finances take a downward turn, your job is at risk. Also, I found the scut work tiresome and mundane.

...consists of one young woman, who is there to turn to? I work for a physician-owned surgical hospital affiliated with a larger organization. My manager is manipulative, pitting employees against one another, lying, eavesdropping, and other fun stuff. While I was new, she was all smiles and good behavior. Now I am experiencing all that she has to offer. The position above her is newly vacant, and HR is one person. Since I haven't been particularly amenable to playing her reindeer games, I am on her target list. Because we work in surgery, she has the power to control where, when and with whom I work. She uses this to move me around constantly almost as if she wants to keep me from befriending surgeons and staff (everyone else has predictable schedules, and my co-workers have made it known to me that I am highly capable and a quick learner, so I don't think I am getting booted out rooms). In situations like this, where there is no higher authority to talk to (or for my manager to answer to), is there anything I can do to protect myself? Or should I cut my losses?

Yes. I was a super user at the last two facilities I worked at, as well as being one of the people to work on conversion to a new system, programming it etc.

I certainly did not mean to come across as arrogant. I do not feel like an expert. In anything. That was simply what I was told as a reason for my hiring.

...and I hated middle school. I recently started working in the operating room at a large hospital. The operating room is broken up into pods, so that we end up working with pretty much the same small group of people everyday. This can either work out to be highly enjoyable and efficient, or it can drive you to drink. I find myself in the latter group, as well as being an unwilling cast member of "Mean Girls 2: The ******* are Back". I am not new to OR nursing, but I am being either deliberately ignored or condescended to by scrubs and nurses, at least one of whom just graduated. For example, one scrub will ignore me and wait until anyone else enters the room to ask for stuff. She then makes a big showy production of it by only addressing them by name, thanking them profusely as if no one else was willing to help her. Oftentimes I am less than 3 feet away and looking at her. Others are less passive aggressive, and just act openly horrible towards me. I have tried offering support (I am the "IT expert"), helping people out, and laying low. I have tried to be friendly and funny. They are not interested. I do not fit in: I am not in my twenties. You could trade me in for two of them. I feel like I can't talk to my pod manager. All of the queen bees are buddies with him. Yesterday we had a mandatory meeting that no one told me about. Everyone gathered together, in front of me, and left for it (including the manager). I didn't find out until later where they were going. I am desperate. I would love to leave, but my husband currently has a temporary and low- paying job. We barely make even the most basic ends meet.

I can't say any books will be "exciting", but if you are up for the investment, Alexander's is great. Much more detail than the pocket guide on procedures and what circulatory do.

Wouldn't you have to reimburse the hospital for training you in Periop? Also, you would probably be burning that bridge by leaving the hospital after they invested so much money in you. However, if you have no intention of returning to that area, and that hospital is not part of a large corporation, it may not affect you in the long run. That being said, it is very nice being close to home. If you have (or will have) kids, a support system is irreplaceable. Also, consider the fact of call: ASCs do not often require call. To answer your original question: no, I have never been offered more pay because I can do da Vinci, but it does make me more marketable.

Wow. I am more confused than ever. I am still waiting for the BON to call me back. It seems like the opinions of the board are: you are at risk of board sanctions, MYOB or get fired, everything is fine just fine. I guess only the BON has the final legal say. And if I get fired, do I really have a choice ethically? What if someone died while I was out of the room? Just FYI: the LVN had never started an IV before starting there recently. The scrub is fresh out of the box as well.

Adding to the list of disrespectful managers: my last manager -- "We don't HAVE to give you guys a break at all. Check the state law." After cutting the fictional two-15 minute breaks/one-30 minute break dream to 30 minutes, and threatening to cut it lower or eliminating lunch altogether. We were working 12 hour shifts at a trauma hospital. So let's not feed the staff, eliminate any restroom breaks, and hope for the best. Great plan.

Ok, so maybe that wasn't the most objective thread title, but it is certainly the most honest. I am already struggling with the "personality" of my new job working as the sole RN at a plastic surgery center, but we have reached a new low. I need to get opinions on whether I need to start job searching, trying to change things or???? Amongst many other tasks, I circulate. By law, in my state (Texas), only RNs can circulate unless they are "directly supervising an LVN" to circulate. The other day I was ordered by my surgeon to go to lunch during a case and be relieved by the LVN. I protested and explained. She said I was wrong and made me leave. (Being an anal-retentive RN, of course I documented every aspect of this event.) So yesterday I asked our office manager, who has worked with the surgeon the longest, the best way to approach her with my concerns. I told the manager I did not want us to get shut down or sued. She not-so-politely "informed" me that I was wrong, and that according to AAAASF (the surgery center accrediting body) we were fine, and that the surgeon's husband (also a surgeon) sent his RN away all of the time. I was not trying to start a fight (honestly!), but I felt like this needed to be addressed. (I mean, I work with mostly nice enough people, but I am not giving up my license for them.). So I emailed the manager a copy of the state health code and law stating all of the facts. No response. Tumbleweed blows by. The rest of the day was short and snappy comments, but NO emails regarding anything whatsoever were returned, some of which were crucial to running this place. Should I take this to be indicative of some kind of immature corporate culture? Should I let it go for now? What did I do wrong? HELP

I am a new employee at an office-based surgery center that I thought was my dream job, but it is starting to feel like more of a nightmare. I had no breaking in period, but the surgeon is already upset because I didn't tell the anesthesiologist the contents of her cart. This anesthesiologist has been working there quite a while, and I think she should know where stuff is so patients don't die and stuff. Insert eye roll. I am supposed to train the fresh-out-of-school LVN, but not waste time letting her do it with actual patients. How she is supposed to learn to start IVs, I'm not sure. It's not exactly a see one, do one, kind of thing. I am also responsible for all OR supply ordering, but not spending very much money, but never running out of stuff. And ordering stuff for hospitals. And medical records, but I don't actually get access to the program for them except for a short period each week. Oh yeah. And surgeries. I almost forgot that I am a circulator. Is this normal for ambulatory settings? I've done ASCs, but it was nothing like this. Forgot to mention that I am the only RN. So 8 hour surgery? Don't drink fluids that day unless I want to cath myself.

Right, but having the number is not the same as having a replica of the license. maybe there aren't as many issues with imposters in other states.

Right, but that is copied and placed in your file. Your resume/ portfolio gets passed around to everyone interviewing you, including but not limited to management, co-workers, Administrative staff, etc. I'm just telling you what we were repeatedly told throughout nursing school.

Also, if it appears that you are not super cautious with HIPAA-related info, a job in which you will be required to deal with large volumes of patient information may be wary of hiring you. Better to be safe.