suckulator

One of our surgeons writes "choice" under the section about any assisting surgeons. He also writes "surgery as indicated" and calls it his "blank check"

The hair is clipped preoperatively as close to the time of surgery as possible as the skin can have microscopic abrasions and nicks that can breed bacteria. We clip hair to keep it out of the field/wound and out of the surgeons way. Also, some of the prepping solutions contain alcohol and must be completely dry before draping to avoid fumes being trapped and causing a fire. If the alcohol comes in contact with the hair you have to wait up to an hour for it to dry! Usual dry time is three minutes. You do not shave anymore because it causes to much trauma to the skin. AORN sets these guidelines by evidence based practice and each facility makes the policies regarding the hair clipping. We use just a standard battery operated wet dry clipper that you can buy at Walmart. Check out AORN recommendations regarding clipping and the SCIP initiatives as well. Hope this helps!

I finished my orientation about a year ago. It was the hardest thing I have ever done but has been the most rewarding. I urge you to just keep plugging along. You will never know everything and will learn and see new things every day. I learned more in the first six months than I have in my entire life even though I often felt like an idiot and wanted to quit often. If there are any other orientees you should use each other for support and hints on services completed. During downtime, have someone show you a few things pertaining to your current service (location of equip., supplies, trays). If there is no one around go into the sterile supply area and just look around. Eventually you will have it memorized. Seems impossible I know. I hated GU also! Usually short cases and no time to chart and the rooms get very cluttered and wet! Hang in there I promise it will get better. Unfortunately there is no book to study from, each facility is so different. The only way to learn is to struggle through. Wait until you scrub/circulate your first case and everything goes perfectly and surgeons ask for you to be in their rooms and are bummed when you aren't. There is no feeling like it! I feel very privileged to be an important part of the team. The things that we get to do and see are amazing. Think about it, it's a world very few people get to see, like another planet! You will get very close to your team members also.

Nursebrittyboo Crouse hospital in Syracuse NY has an Peri-op 101 program and hires many new grads. Finished mine about a year ago and if you hate it you don't have to stay but of course it is frowned upon. Their point if view is that if you are miserable they don't want you there. It might be a few months before they start another "academy"

We use Stryker endoscopy and we love it. We bought 17 OR rooms worth of equipment. The rep stayed for over a year in house and trained an IT person before he left. He was on 24 hour call as well. The same goes for implants too, very pleasant, always available, etc. Obviously, I wasn't in on the purchasing but the people who work with this stuff everyday are the ones to ask.

Wow Epi? I guess I will stop complaining!

Our hospital does not use the wipes but has ortho/neuro patients do chlorhexidine showers pre-op. at home or in the hospital if they are inpatient. I agree, if they are well enough for a total knee they should do their own bath. That's silly for RN to take the time to do that and you are right that it could make pt. more uncomfortable.

Yeah I know, we are using a combo. It's just not the same smooth induction and I would not want to have surgery right now. I'm sure as we go along AD will get better. We have used it for so long. Thanks for replies.

I work in a large hospital near Syracuse NY and apparently there is a Propofol shortage. Is anyone else experiencing this? So basically at the end of this week we will be completely out of it. We also do not have any Etomidate or thiopental for some odd reason. So we have to put patients to sleep with 5 ml Propofol (while it lasts) and then breathe them down which as you know people hate! We have been giving them a higher dose of Versed in hopes they won't remember.

Night shift is very hard on your body and mind. If you can start by changing shifts while you are looking for a new job it will help. I know it took you forever to find a job but it sounds like it is making you miserable. I finally switched jobs after seven years. It's a big step but I am so happy I did it. A doctors office is a great place to work while you get everything together. Good luck to you.

AAA's are just about the only surgical emergency left d/t advances in medicine. Have a colleague call the doctor while you are assessing. The worsening abdominal and flank pain can mean the aneurism has ruptured and the patient can die within minutes. It is worth the wrath of the doctor/surgeon to potentially save a life!

I work in the OR and circulate many TVH and TAH's. We always do a betadine lady partsl prep just prior to surgery after induction and intubation. I don't see the rationale of a betadine douche on the floor pre-op.

Before you sign up for the internship I would suggest shadowing an OR nurse. I was a NICU nurse for seven years before I started a periop. 101 course at the same hospital. I had no idea what I was getting myself into. Don't get me wrong, I love my job now but it isn't for everyone. A lot of the new grads have dropped out and even some of the experienced RNs. We have done 4 classes with 18 total nurses and half are gone within 3 months to two years. They are going to want to know that you understand the role of the circulating nurse. The role of the circulator first and foremost is to be the patients advocate. You speak for the patient when they are not able to. You will set up the OR with equipment/correct bed, set up the sterile field with the scrub person and count the instruments/sponges/etc., you will run around like your hair is on fire when you realize that they did not send the correct trays of instruments, you will also tweek the room with the surgeons "preferences" or whims in regards to every possible thing (temperature, music, where the draw sheet is on the bed, instruments), then when you only have 30 seconds before the case starts you will go see the pt. You will do a pre-op interview, check the chart, sign consents that you are legally responsible for, give pre-op antibiotics within the allotted time, all while anesthesiologist is trying to push the stretcher down the hall because you are taking to long. Oh yeah and most of the time you don't have the paperwork you need to legally go to the room but you will catch hell if you point out to the surgeon that he/she needs to sign this or that. Then you get to the room and help the patient to the OR table and assist anesthesiologist with induction and intubation. Then positioning ( which can take more than an hour and sometimes you will actually TAPE the patient to the OR table), prepping, and draping. You plug in the equipment/suction/bovie and do a time out simultaneously while delivering fluids and meds to the sterile field and anything else that was forgotten. You will finally sit down to start a mountain of paperwork and will have to run for a suture or scratch someone's nose. When procedure is done you will assist with dressings, extubation, and transfer to PACU. Now you have one half hour from the time the wheels of the stretcher leave the room to the new patient arrives to do it all again! I know this is a long and oversimplified description of a circulators job! I should mention that I love my job and the OR is a funny, crazy, silly, infuriating, frustrating place to work. But once your in your in and you will be a part of an amazing family. You are not just caring for one patient, you are taking care of the surgeon, scrub, anesthesia, and thinking about the next ten cases all at once. You are constantly assessing and evaluating. Some people say we are glorified gophers but they are not doing their jobs correctly.

I have been a circulator for almost two years and I feel that you should be respectful to a certain point. You don't want to tell the surgeons where to go and how to get there the very first time you meet them. I try my best to do a great job but if they are rude too many times I start giving it back to them. It feels really good sometimes and if you know what you are talking about and stand up for what you believe, you may just earn some respect. But I do agree if you are uncomfortable you should call your team leader or charge nurse. Our job is to speak up.