JoeTheRN

Thank you all for your replies. The L&D ORs are very close to the main OR, separated by 1 set of doors only. As for staffing, the section ORs would be staffed by main OR staff for regular cases and OB staff for deliveries. There would always be a second OR open and available for emergent procedures to take place.

Do any of the facilities you work at perform GYN surgical procedures in the L&D ORs other than sections? In our L&D we do C-sections & D&Cs. Does anyone know of any legal/regulatory issues that could come up if regular gyn procedures were done in an L&D OR i.e. Diagnostic Laparoscopy? Thanks for your input!

I am curious if anyone has any input in regards to staffing PreOp, Phase 1 and Phase 2 PACU. Our department is technically just 1 department. But, we have set staffing for each area: PreOp, Phase 1 and Phase 2. Does anyone work in a department where the staff floats to each area? If so, how do you schedule it and do you think it works well? I feel like we are pigeonholed by only having staff that will work certain areas. Any help would be greatly appreciated!

You have a patient who has had general anesthesia, they have a ride home but no one can stay with them at home. Where does the liability end? Can a patient who has had general anesthesia legally sign out AMA? Or would a hospital be required to admit them? Say their ride gets them home safely, but once they are inside they fall and hit their head. Was the hospital negligent by not ensuring the patient had supervision at home? Just some questions that run through my head.

First off let me ask, are you enrolled in an actual college that offers the ST program, or are you at a for profit facility and one of the few programs they offer is the ST program? Second, you make it sounds like your preceptor has multiple students since you say some are allowed to choose their assignments, but you are not? Or are you her only student? Also, have you spoke with your instructor regarding the issues that you are having with particular preceptor? Because if it truly is her, and not some kind of issue that you are having, then it needs to be addressed so that future students do not have to go through the same thing. During my nursing clinical rotation, we always rated our preceptors. If one was repeatedly abusing the students, they would no longer be used since that does not create a healthy environment. Any legitimate program should take you seriously if you are truly being harassed by a hospital staff member. However, you need to reflect on your own skills as well. It sounds to me as if you still lack some skills required to be a good ST (not knocking you and I may be completely wrong), you mentioned your first clinical preceptor said you did well but you "just don't connect", was this preceptor not entirely confident in your skills and just being nice, not wanting to hurt your feelings? If you are truly doing well in your lecture courses and you feel like you have the skills needed, then DO NOT quit! You are too close to being done! But, if you feel like you have some weak areas, does your program allow you to repeat certain courses in order to build your confidence? Good luck, never give up!

I only have experience with Ohio University Rn to BSN, but I have to say that I like the program. The cost is pretty good, I'm not sure if they do it or not, but many schools give in-state tuition to students who take online classes, and this program is ENTIRELY online. All the assignments I have done so far are APA papers and discussion posts. I love the 5 week accelerated courses, it makes the semester fly by! just google ohio university RN to BSN and check out the knowledge center, it can give a better idea of what you need. Also, during the week you can even chat with an adviser online and ask them questions too!

I would love to have a 30 minute window! Our goal is 15 minutes, but we average somewhere around 18. We have a couple of ortho docs who do hand procedures and the turnover in those rooms is less than 10 and we can easily do 15 cases in an 8 hour shift. The same with our cataract cases too, it seems kind of like an assembly line to me sometimes. As said before me, it's all about the money. Shorter turnover means a doc can fit more cases into a day and more cases = $$$$$ That is always the bottom line now days...

So I usually don't ever have a problem with PAs since they seem to be normal human beings as opposed to most physicians (residents/attendings) and they never have a problem answering a question, be it asking their name or what supplies/instruments the doc is going to want for the case etc... One thing I have learned in the past about residents is, if they are a 1st or 2nd year, they are scared to death and they are just trying to look like they know what they are doing, so don't take it personally, and be sure to let them know that a nurse can be their best friend or the greatest enemy! I have had a couple of residents who have acted like they have been an attending for twenty years, and all it takes is quick conversation with a nurse friend on the floor to make their lives miserable for a couple of weeks until they get the idea. Once they get past the first year or two they really lighten up and seem to be some really great people. Personally, I would welcome the fact that they want to position, put in a foley, etc... They are physicians and they are allowed to do these things, let them! You can spend this time helping your scrub, counting, charting, getting the room in order. If you get a new resident or med student ask them if they would be interested in "helping" you prep the PT, maybe they really don't know how if they are "ordering" you to do it. So, if you ask them for help, maybe they will take you up on the offer and make sure you walk them through it if the seem a little lost. The one thing I always say to someone when I don't know who they are is "Name and Rank Soldier?", we have so many med students come through, I only know half the people half the time... NEVER let it get to you when a resident tries to act like the "chief", they will learn their place and usually you guys will end up getting along pretty well.

So I have worked in the OR for about 8 years... I had a lot of OR experience as a tech prior to nursing school, so they hired me in as a new grad so it's the only nursing experience I have. Over the last few months I have been tossing around the idea of going the CRNA route. I work with CRNAs and they are all very supportive (more like telling me to stop wasting my time in the OR), my anesthesiologists included. They have all told me I have the personality and the ability to do it, however, I lack ICU experience... I graduated nursing school with a 3.7 so I feel like my grades are very competitive. What kind of barriers am I looking at being an OR nurse trying to get into an ICU? I feel like I would be competing with new grads for positions since I lack floor experience, but I have excellent references to back up my work ethic/skills in the OR and I am 100% ready to learn (although very nervous)... Also, if I want to go the CRNA route, is this something an ICU manager would look down upon if I were interested in trying to get an ICU position? Thank you guys for your help!

Just trying to get some input from you guys. What is your current Surgical Attire policy? Our hospital is beginning to implement a lot of the newer AORN recommendations and is meeting a lot of resistance. i.e. no surgeons caps, wear jackets, etc Also, if you follow the "all non scrubbed personnel wear a jacket" in the OR portion of the recommendation, how do you handle scrubs, surgeons, etc.. once they have broken scrub? Do they have to keep a jacket in the OR to wear once they take off their gowns? And how are you supposed to wash your hands if they get soiled? Dispose of jacket, wash hands, then get a new jacket? I have TONS of questions! Thanks for the help!

There is a TON to learn in the OR, and don't expect to know it all after 6 weeks of training! You definitely have a long way to go, but take your time, lots of notes, and you will be fine.. I would HIGHLY recommend joining AORN and become familiar with all the basic recommendations, especially in regards to the nurse who calls you out for wearing your jacket while prepping. As long as you are wearing it properly, AORN suggests that you ALWAYS wear a jacket in the OR, even during a prep. Keep your head up and if you have any more questions, feel free to ask! Below is the link to the AORN surgical attire recommendations: http://isgweb.aorn.org/ISGWeb/downloads/CEA12503-0001.pdf

Does anyone have or participate in a policy & procedures committee in their OR? We have never actually had one in our OR before that consists of the staff members from all of our departments -> Preop, OR, and PACU, and I am kind of looking for some guidance from others as to what types of things are discussed and what are the roles/responsibilities of each staff member that is on the committee. Thanks for the help!

Our weekend call is as follows. Since we only have first shift we are on call 1500 Friday till 0700 Monday morning. The call team consists of an RN, Scrub, and Nursing Assistant. We only have one call team as well, so on the rare occasion, cases can really stack up on us!

I personally would not recommend studying the day before the exam. I tried it, but I was so nervous that it was a complete waste of time for me. In nursing school I Was the one who always had my books with me right before an exam, but it definitely was of no use this time around! As for which resource helped me the most, I would definitely say the Lippincott Q&A. I felt like the questions were definitely similar to the NCLEX and the content was great. The Lippicott book has over 6000 questions if you count the CD, I went through the ENTIRE book and my brain was fried at the end but I really felt prepared. Thank you to everyone for the support! And good luck on the NCLEX!

I have worked in the OR as a tech for 5 years and we have had walkie talkies (motorolla cls1110) for about 3 years now. Everyone is given a small earpiece to wear as well. Everyone was pretty resistant at first, we had nothing before, but now they are fantastic and I couldn't imagine not having one. We communicate when a PT is en route to the OR, even our scrubs wear one (usually they dont wear an ear piece) so the nurse can communicate to the scrub regarding Latex allergies. We are a teaching hospital, so our anesthesia residents can call the attending before they wake the patient up. We also can communicate to the other staff if a procedure is going from a scope to open so that we can have assistance with converting. At the end of the case we can get lifting, cleaning assistance as needed. And in the rare occasion that something goes wrong, you can say "ANESTHESIA ROOM 7 STAT!!!!" and every anesthesiologist knows exactly where to go rather than hitting the staff emergency button which is only activated in the OR, so if an attending is in PACU and we need help, then they hear us. Overall great investment in my opinion.

It really wasn't as bad as what I thought it would be. To me, it seemed very similar to all of the practice questions I did, but I also did thousands. I was so burnt out at the end. I looked over all of my labs and cardiac rhythms/cardiac meds the night before the test for about an hour but I was pretty nervous, so it was a waste of time. I decided to sit back, relax and try to get a good nights sleep. I was pretty nervous in the waiting area, but I was number 3 in line so I didn't have to wait very long. Once the test started my nerves were completely gone by about the 5th question and it felt just like any other test I took while in nursing school. Overall, I Would say that there were about 5 questions that I felt like I had absolutely no clue on, but on all of the others I know I had at lease seen the material once. The SATA were the hardest for me since there is always that one answer that, to me, could swing either way. I got to #75 and took a deep breath before hitting next and it went to #76!!!! My heart sank, so I took a quick break and then got back at it. I finally got to question 82 (which I will NEVER forget that question) and I clicked next and the computer screen went blank. I was 100% sure I got the last question right, so I felt on top of the world when I left the testing center. The best piece of advice I can give is just read over as much material as you can, try not to spend too much time on one topic. And remember, this test is just an entry level test to guage safety. There is a 90% chance you will pass! Those are GREAT odds!

So the first thing I did was change my username now that I have passed the NCLEX!!! I tested last friday and my license showed as active on Sunday!!! This was THE MOST nerve racking experience of my entire life, I was more nervous for this than for my wedding or even the birth of my first child! Anyway, it took me 82 questions and I was done. I had a TON of priority and SATA questions. It seemed to me that they definitely made up the majority of the test. Delegation and contact/droplet/airborne precautions too! I used the Kaplan book and the Lippincott Q&A. I went through the Kaplan book from beginning to end. But, as for the Lippincott book, I would read all of the rationales then go back and take the test. I know that seems kind of backwards, but I feel like it really reinforced a lot of the info for me. And, when I missed a few questions after reading all of the rationales, those are the questions I would really focus on and try to get a better understanding (obviously if I got them wrong even after reading the rationales, then I definitely needed work in that area). It took me 2 solid weeks to get through the entire Lippincott book and it was ~900 pages long, so start early! Good luck to everyone who is getting ready to take it, just breathe slow, try to relax, and get it!!