OnCall4Life

In our area all ICU patients go directly to the OR unless they are not on any drips or vents. Anesthesia sees them in the ICU and makes the call from there. And when they are OK'd for the pre-op holding area an RN is right there with them until the Circulator can take over.

My motto is "nothing ventured, nothing gained!" I have heard pros and cons on the subject. You have to do what feels right for you. Having floor experience would be of benefit to you but it is not necessary for you to be in the OR. Good luck what ever you decide!!!

Hi Huck, While I understand where you are coming from aren't we really talking about apples and oranges here? Metal instruments can be taken apart and manually cleaned and processed. These items that are being sent for reprocessing have plastic and rubber parts that cannot be taken apart and manually cleaned. Our facility is very strict about how instruments are processed and sterilized too. We do reject instruments and instrument sets that are not up to our standards (closed clamps, etc). We don't mind telling the surgeon that something had to be sent back because it wasn't processed correctly. We have to inspect all instruments before they can be placed within our sterile field. We have pretty much solved that problem by placing our instruments on stringers that prevent clamps from closing. And by placing them in containers that prevent them from becoming damaged. I think in the long run the surgeons appreciate our adherence to high quality standards. But you have to agree the likelyhood of equipment failure goes higher each and every time it is reprocessed and reused. That goes without saying. But we can with an almost certainty say that a metal non-disposable instrument is more cost effective in the long run because 1) It can be kept and maintained for a longer period of time than a one-time reprocessed item. 2) The cost to process it at our facility using steam or Sterrad is cheaper. (we actually did research this) 3) We manually inspect these items before and after they are processed and can cull them before they are exposed to the patient. 4) We can decide if that re-processed item is up to our standards and not just take it for granted that whoever inspected it knew what they were doing. As we see the item in action we know what it can and cannot do. But the company that re-processes the item does not. Like you stated earlier even brand new products right out of the package can fail. That makes the liability fall on that company, not us. But if we use a re-processed item (with plastic or rubber parts) knowing that it's failure rate has increased then that makes us liable as well. I guess it is up to each facility to weigh the negatives and advantages of re-processed items and make their own decisions. This was just ours.

Wow Grimmy, sorry you had such a bad day. Kind of sounds like what happened to me on Friday also. Our 2 hour Thorocotomy turned out to be 7 hours. Plus the surgeon had a new partner with him that he was showing off to. So I feel your pain. I think we only went through 3 staplers but lots of refills!!! I think it is prettly lousy that your hospital put you in that kind of position. I agree you should go talk to someone. Unfortunately that happens a lot!! I'm not afraid to tell my supervisor that I don't know how to do a case and that they either get someone in there to scrub with me or I can go relieve someone else that can do the case. It seems that you guys need to get together and do some team nursing. Since you don't have a real OR supervisor maybe you can form teams like an Ortho team, a General team, a Chest team and whoever is in charge of that area can either help coach a team member or find help for that team member. I've seen this done in large OR departments. The head of the teams meet in the morning to organize and assign appropriate personnel to their rooms. Once your team leader says you are profecient in that area they switch you to another team to learn that area. And the surgeons like the idea of being involved in the teams also. It's just a thought. Maybe something similar could work until you get your permanent OR supervisor. Good luck!!

Wow glad to see Im not the only one!! I too have the blue picnic table cloths and my cats and dogs eat out of the blue plastic bowls. We used the Lap chole trays for out kids to use as place mats when the want to watch a movie in the den and eat popcorn! My husband likes the Pulse-a-vac's (the clean ones that either get dropped or contaminated on opening) to clean the screens on the windows or his lawn mowers off. What we do with left over drapes or clean supplies is give them to the local animal shelter. The wrappers off the trays are used as liners for cages and so on. Plus we save on the cost of disposal by doing that!!!

It's hard to get well trained circulators in the OR. There just aren't enough courses out there that spend time in the OR. So if you have a chance to be trained in Surgery, go for it!! Like was stated earlier it will seem very overwheliming at times but once you get the hang of it you will feel more comfortable. I started out as a scrub tech then got my RN, BSN. Scrubing will always be my first love but I enjoy circulating as well. It was a big change going from scrub to RN. I had to develop a whole different mind-set. A good preceptor really helps. Insist on one and ask around the OR to see who would be the best and ask for that person. I know that most OR's believe in see one, do one, teach one. Don't let them do that to you. Stay in one area until you feel comfortable then ask to go to the next area. But with your ER experience that should help you a lot. Several of our circulators were ER nurses. And they are good because they can move fast in a crisis. Just make sure that they stress sterile technique because as a circulator it is your job to keep an eye out for breaks in technique. Good luck!!!

The circulator should be standing next to the patient when they go to sleep and when they wake up. How many times have you seen a teen/child go off to sleep and wake up struggeling on the table?? Usually we have 2 techs in the room and one can stand on one side and I will stand on the other. But your right about anesthesia waking up the patient too early. It's hard to get patients out of stirrups when they are bucking and wiggling around. I saw one nurse get kicked across the room by a 17 year old male. Of course they didn't know what they were doing. But that is what happens when anesthesia slams on the breaks for some. We too have safety straps that are kept on the patient at all times. Even around their arms on the armboards. They can twist their lower half but it's hard for them to fall. You could try calling for someone extra to come into the room to help stand by the patient before you undrape them.

I agree!!! I don't think that it is fair to use "used" items on patients. While I understand that some facilities are facing a financial crunch I think we need to keep reminding them that patient safety comes first! And a lawsuit would wipe out all of the savings that they think they have gained. Plus I would not want it used on me or my family. I think that facilities that use resterilized items need to do more research before they put into practice something that might be detrimental to their patients. Am I wishing in one hand....????

Hi we also had talked about doing that because the retractors are so expensive and there were some back-order issues. While the company that resterilizes it will guarantee its sterility we didn't feel it was worth the risk. We have a policy in place that states that one-time use items cannot be resterilized or reused. And I believe that the original guarantee of performance from the manufacturer becomes null if you send it to be resterilized. So if it breaks or causes pt harm you are on your own. Maybe you need to remind the powers that be about libility???

Hi Kimmie, Roux-en-y is a fairly common bowel procedure done for several reasons. It wasn't until recently that it has been publicized for weight loss surgery. The intestines are divided and repositioned to form a "Y". It can be reversed but is not done often.

Hi Shirley, I worked for an HCA facility for 7 years. One thing to keep in mind that it is a for profit corporation which means that the almighty dollar is the bottom line. Costs are kept to the minimum and that sometimes means that staffing is too. We would close off floors and lay off staff on a regular basis. But that may have just been the area that the hospital was located in. The pay scale was average and overtime was discouraged. We went through a lot of OR managers too. But that was just my experience. Anyway good luck in what ever you decide.

It's a shame that after all these years that there are still some neanderthals left in the world!! Keep your head high, you did the right thing. You were not hired to take verbal or physical abuse from anyone especially a Dr that seems to have an anger issue. He physically assaulted you and it does not matter if it is his word against yours, you were the abused and it is up to him to prove his innocence!!! Change the cart on him!!! Tell him that the only reason why you did not file a police report was not because you were afraid of him or the hospital but because you felt sorry for his family. Then I would get a restraining order against him. The hospital administration cannot retaliate against you without fear of you getting a lawyer and going to the press. It seems that bullies will back down when they think the newspaper may print an article about them!!! Are you unionized? Have you sought legal advice on this matter? I would. Don't let them run you off. If it gets to the point where you have to get a lawyer and go to court over this you may be helping a lot of other nurses that suffered the same abuse from this Dr. Your lawyer will be able to investigate and if the hospital has known about this Dr's anger problem then the hospital can get into hot water too. We had one orthopedic surgeon that grabbed a tech and shoved him in the OR room. The hospital administration wanted the tech to back down but he didn't and the hospital was forced to discipline the surgeon. So when push comes to shove the hospital will look out for themselves first!! Good luck!!

Hi Grimmy, don't feel so bad. I once had a spider drop down on my mayo during an Open Heart!! Talk about panic!!!

The Association of Operating Room Nurses guidelines say that it is best to work from clean to dirty. If you have to do the vag prep first then you must use a seperate prep and change gloves. You should change gloves before you put in the foley also. Just be careful and don't go back over your prepped area. A large majority of patients are getting an antibiotic before surgery anyway but you really should not let that prevent you from doing a good prep.