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11blade RN

OR
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11blade is a RN and specializes in OR.

11blade's Latest Activity

  1. The level of transport is not the issue. The receiving nurse did not get report prior to the patient being dumped on the floor. What if all nurses are responding to an emergency on the floor at the time the patient is put in a room? What if the covering nurse has an emergency with her own patients, or is otherwise tied up and cannot get report or see the patient? If you, the transferring nurse, cannot document that you transferred care to an equally competent level of care (another RN), you risk charges of abandonment. A fax report to a fax machine does not meet that nursing standard in any state. Here's an example: Nurse A in ER faxes report to floor at 1145hrs. Nurse B (receiving nurse) is off floor on lunch break. Nurse C (covering nurse) doesn't get fax paper as she and every other able body on floor is passing out trays or helping feed patients. Transporter drops patient off in room unseen by floor staff (busy in patient rooms). Patient suffers some bad outcome after arrival on floor and there was a delay in nurse admitting pt to floor. Who's license is on the line? The transporting nurse. The receiving nurse could 'lose' the fax paper and claim there was no notice of transfer and no report given on patient.
  2. 11blade

    Concealed Carry...as a nurse?

    I can't give you an exact quote on commercial liability insurance, I would have to get that from an agent. I have discussed this with my personal insurance agent who doesn't write commercial. Civil vs criminal attorney? Depends on what you do with the gun when you whip it out. Reason out what you are implying about pulling out a gun on premises of any employer (paint store, donut shop, hospital) that has a written no-gun policy. I've attached a reference for your edification..... https://www.associatedbrc.com/Resources/Resource-Library/Resource-Library-Article/ArtMID/666/ArticleID/610/Conceal-carry-As-an-employer-what%E2%80%99s-your-liability
  3. 11blade

    Concealed Carry...as a nurse?

    I hope you have consulted your own personal attorney to make that statement. In the event of a worst case scenario, you shooting someone at your job site, are you SURE they will back you up? Does your employer have a gun carry policy? Does is specifically authorize you to carry a weapon on premises 'if requested' or is it the usual blanket 'no guns by anyone' policy. Your employers liability insurance policy costs a LOT more to have you on premises toting a gun around. These questions are better answered BEFORE there is an incident, not after when your doc and employer are standing in front of the TV camera denying they said that to you..just saying.
  4. 11blade

    I keep getting cancelled.. help :(

    I agree with others-apply for unemployment benefits NOW in the state you are working in. You may not even be able to get through right now, but keep trying. Some states have a waiting period for benefits, so you want to do this soon. It may take some time to get paid. I was lucky this past week. I spent all day on the phone Monday, got a live person. I had applied on line, but the online website directed me to call. I was unable to get through until just this week. I got submitted Monday by the live person, then the computer had to update overnight..a few overnights. I requested payment on Wednesday and actually got a payment (6 weeks) on Friday. Don't wait, you've earned that money!
  5. I hope you realize that this is textbook definition of abandonment. If the transfering nurse allowed this to happen, and, some harm came to the patient on the floor, the nurse would have to answer Board of Nursing charges, NOT administration. They tried a variation of this in a place I worked years ago. Manager said in am report that they were going to do a 'new' thing in transferring patients out of PACU to the floors. I, the PACU RN (also the pt's OR RN, too) would just write up a report sheet, fax it to the floor, and send the patient up with a transporter (non medical assistive person). I looked at the form, which didn't have a form number assigned by the institution and asked when it passed the forms committee. Mgr looked like a deer in headlights...'committee'. Any form or change to policy and procedure has to be passed by the hospital committe prior to being instituted. It gets reviewed, especially by risk mgmt (legal team), with yay or nay. She said it hadn't gone thru committee, so I told her I wouldn't be doing that until it did...end of that crap!
  6. 11blade

    Bedside / ICU Surgery (Decompressive Laparotomies)

    I would never have been a fan of this policy, until I worked at a Level 1 Trauma hospital last Summer. They built the 'new' ICU in a different building...a full quarter mile away from the OR!! Moving some of those patients with anesthesia trying to ventilate, O2 tank, IV tree of drips, traction, etc. to OR was just AWFUL. My only concern about doing those big belly cases bedside is the space to get equipment and setup in the room, and being able to keep the room cool enough. The floors and ICU rooms are like a sauna compared to the industrial A/C we have in the OR. I'm glad I wouldn't be scrubbed!!
  7. 11blade

    Job security

    I've never seen the OR as a place of job security, and I'm going back to 1983 when I was offered a position to 'learn' OR at a small hospital. I've worked at many since (travel nursing) from one operating room to 35+ OR's Level 1 Trauma. Low census always has dictated how many bodies will be at work or off the clock. When I made the mental decision to only work for agencies in 1989, I thought things couldn't be worse than 1981-86, the Savings & Loan Crisis. Wrong. Many more financial hits coming about every 10 years have taught me that to survive economically I should work in what areas are not low censused until OR picks up again. I have audited charts, worked in occupational health, home health, some non nursing jobs...what ever it takes to keep cash flow. Through all of that, I weathered economic downturns on my own dime. I had never collected unemployment benefits myself, having counseled others to apply as soon as a job ended. This economic situation is a horse of another color. The problems we face today will not be solved by the end of Summer, or even the end of this year. A year from now, economic times may be even more dire, as cities, counties and states run out of funds to support the numbers of people disrupted by this game changing pandemic. If I thought I'd be back to work next month or even in July, I wouldn't have applied for benefits...that may not be the case. The lights may be green for increasing surgical case load in the month to come, but the patients that had insurance to pay for it are now out of work, and, don't have insurance coverage. Elective case load will not be back to levels seen pre Covid for many months or years to come. And then there's the safety issue. I'm reading on this forum of hospitals already rushing back to surgery without implementing proper safety protocols. "Three minute" wait for air exchange, "paper masks, not N95", wearing the same mask ALL DAY?!?, no dedicated housekeepers in OR,....do I really want to end my career on a vent in the ICU all for a hospital that doesn't value my safety? I'm taking the U.I. checks right now, hoping to see what the second wave of this virus is going to do.....
  8. I got to OR via the med-surg floor, first as a new grad, then after a stint as a night charge RN. I wanted to switch to a surgery floor for a change up and ended up in the OR. For years I thought all nurses going to OR should have at least a year on med-surg for the grounding it gives you...until I met a nursing student who broke that mold. Many students that shadow OR nurses look sorely out of place, not comfortable. This one didn't-she was excited about every case, never 'in the way' and by the end of the week, was actually scrubbed handing instruments on a simple case...amazing! It turns out she was a police officer in her former career, so that helped, but some people are just made for the OR and this was one of them. I happily recommended her to an OR training program in July of the year she graduated.
  9. 11blade

    Help with equipment

    The equipment used in those cases will be surgeon dependant. You should be looking at the case posting, surgeon and equipment list. If the preference cards are crap, which most are, make your own notes as you do cases with each surgeon. Note the posted name of the case and list the equipment needed. Best OR practice is if not sure, have it ALL in the room and THEN ask the doc which one they want. Yeah, it's labor intensive, at first. But the doc appreciates you don't have to leave to get something, and, you can adjust for the next time you do that specific type of case. Rule of thumb-Always have an ultrasound in the room on breast case, if the surgeon is a fan of that machine. Time elapses from Dr. ofc visit, to mammogram to actual day of surgery. Those lumps wax and wane sometimes-that's what the ultrasound helps with...finding the lumps at day of surgery so the surgeon has a mental image of how big/small they will go with extraction. PRO TIP-Watch screen when surgeon is using US probe. Note how many sutures you have on table vs how much breast tissue to go thru to get to lump. You might need more. The others-Faxitron, Neoprobe. Those depend on things happening with the patient in other departments. Usually the pt. goes to radiology to have radioactive dye injected and/or have a wire inserted under fluoroscopy to localize the lump. Neoprobe is reading the uptake of the iosotopes to lymph nodes for 'sentinel lymph node' biopsies. I'm guessing Faxitron is a brand name for a machine that is a box on wheels that you can do a small x-ray of tissue in the operating room so surgeon can see if she got all the target tissue. If so, Faxitron would be indicated with anything that is 'needle-localized', the procedure done in radiology BEFORE the patient comes to OR. If you are working with a surgeon that specializes in breasts, all day, every day...just have all the 'toys' in the sandbox and every one should play happy.
  10. Izaak ( 7 years experience...at what, exactly) has posted a statement from the AST. Nice, but the original poster of this thread noted that the people she would work with would be 'experienced' but not 'licensed'. I have worked with licensed and unlicensed operating room techs in my career. I much prefer to work with a tech who has been through a formal program, and, who did the extra step of obtaining a certification. In traveling work around the country I have found many less techs without certification grandfathered in the states that now require certification. There are still places that will train their own techs in states that don't require certification. The problem comes when you have the 2nd or 3rd generation of these, who only know how to do something 'because so and so taught me this way'....no critical thinking skills, limited understanding of sterile technique, etc.. And back to the AST position-they may 'believe' they do not practice the circulating RN in the room, state law and hospital policies say otherwise.
  11. 11blade

    New Grad looking for fun tips

    Shoes-Look for a pair of shoes with Vibram soles. These are shock absorbing plus they are non slip on wet/greasy floors. You will be running to set up your next case before the floors are dry in a room...oops! yer on the floor! Meals in boxes or pouches that are shelf stable-You never know when you will be at work on-call, or, for how LONG. Some days, it takes longer to leave the OR to get food and eat than it does to grab something out of your locker and enjoy longer time sitting in a chair for lunch. If you buy expensive shoes, put them in a bag and LOCK them in your locker. This is a no brainer, just like locking your car door. Don't be lulled into thinking theft can't happen in the OR locker room by seeing all your co-workers lockers unsecured. They didn't buy the shoes you did... Every surgeon, every case-write down what you had to do, go find, organize for that case, for at least the first 3 months you are in orientation. Make quick notes during the day, then organize it into a flash card system that you can carry on you in a pocket. Don't rely on the computer generated preference cards that usually one person (not a nurse) updates 'in their spare time'. There is no spare time, cards are not updated adequately, anywhere. If you have your notes from the doc you worked with 2 weeks ago, you will look like a star when you can function on your own without having to track down that one RN or tech that 'knows what he/she likes'.
  12. 11blade

    Is This Normal "Training"

    You need to bail. They are expecting production rate of case load from you with minimal to no training. An experienced OR RN could function in that situation, but it is no place for someone who doesn't have a rounded OR background in the services you note are working there. That said, the work at surgery centers is not typically too taxing in that the surgeons are there every week, the staff usually knows their routines and the cases usually don't run longer than an hour, depending on what specialty is working that day. The thing surgeons always like about surgery centers is the streamlined pace-they can get quite a few cases done quickly (eyes, knee scopes, hand cases, etc.). The emphasis is on SPEED, all day, every day. That theme is going to be on STEROIDS, now that surgery centers are back open. Surgeons are impatient folk at the best of times, and, they've also taken a big financial hit over the past two months. They want to do their regular case load and MORE, to make up for time (and $$) lost. Think of your new job as Dancing with the Stars. You have just joined a cast of professional dancers that expect you to keep up with them at a manic Salsa pace....with no dance lessons. I don't see success in your future there, unless you get some bona fide training with another experienced OR nurse that would, at the minimum, cover all the types of cases they do at that facility.
  13. 11blade

    Nothing changes as long as you obey

    The wake up call most nurses have gotten (as if they didn't ALREADY know) is that management will sacrafice as many FTE's as it takes to preserve their own bonuses. The marching orders from the pointy headed ones in finance will be to push the envelope of safety with staffing numbers vs patient census as the screams for MORE VOLUME, MORE PATIENTS (with insurance, of course) come from the C Suites. Expect to see the suits in your clinical areas MUCH more in the coming weeks. Whether your work area is covered by collective bargaining or not, please read the linked article to find peace with yourself as we go forward into this 'new' not-normal workspace. https://www.zerohedge.com/political/nothing-changes-long-you-obey
  14. 11blade

    Nursing Is No Longer Worth It

    Amen, sister! The COVID thing has just exposed to the rest of the world what we who have been slogging along in this dysfunctional system have known all along. We truly ARE expendable! Advertise pay a few dollars higher than what some nurse in Podunk, Ms, Tx, La, etc. is making and they will drive nite & day to fill that position. Dangerous? No problem! Could lose your life, or, cause your family to lose their lives? Pay a few dollars more and there will be a warm body in that overcrowded ER/ICU/makeshift ICU in the PACU, etc.. I have worked contract for the past 20 years to be able to control my work schedule as to where and when I work. There is no work for what I do right now. There are 500 contract operating room nurses looking at or applying for the 5-10 travel jobs that are at places that you wouldn't take your dog to. I'm not just sitting out, but actively seeking work in any thing OTHER than nursing...not because I'm afraid of COVID19...I fear the idiots that are going to stampede the GDP (general dumb public) into operating rooms in ASC's and hospitals in the next two weeks. The NIH recommendation to add as much as 30 minutes to OR turnover times because of the droplet contamination during intubation and extubation is going to drive some surgeons WACKY, as if they weren't already whining about turnover time. That process change 'might' happen on the first day, until the big swinging dick in the OR screams at administration about turn over time. I KNOW that OR's will jump back to 'bidness' as usual, and then it's ON for the SECOND wave of infections. I left the last OR job I had in February, listening to idiot co-workers poo-poo the virus, "I'll just do the usual hot toddy tonite & I'll be good to come back to work tomorrow (through dripping nose and coughing)"....nice. I fear going to work with those morons MORE than going into a grocery store!
  15. 11blade

    Has anyone left nursing job due to COVID19 virus?

    Firefighters wouldn't run into a burning building without bunker gear on, and, police don't show up to a gunfight 'with a bandana' over their face. Why should we feel 'guilty' when we demand the RIGHT protection?~! I haven't given up on nursing just yet, but I'm spending this time off (no travel contracts for OR right now) looking at and applying for other jobs NOT in nursing. If I get something that pays my bills enough to keep me from having to deal with reptilian management ever again, I'm ggggone.
  16. 11blade

    Refusing Care of a COVID-19 Patient Due to Inappropriate PPE

    What state would that be? Order me to go to work? Please provide some reference for this claim.
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