SandraFenway

Hi, Asking for a friend. Friend has current a ADN, is working as an RN and also has a BA in Biology. Question: Are there bridge programs (preferably online) for working ADN RNs with non nursing bachelors that will take credits from that non nursing bachelors and apply them to the requirements for the BSN or MSN? Example: Biochem and Organic Chem series, Calculus, Physics, general ed... etc. Thanks!

Take care of the patient first. Set the computer on the back burner until that patient is completely monitored, induced and prepped. Do the time out and THEN, turn to the friggen computer. That's my number one advice to new grad circulators: get the case going first.

Has no one seen Myth Busters and the poppy seed muffins affecting the drug test? Well, it was no myth - poppy seeds will make you test positive for opiods. The first lesson I learned in Statistics was the high rate of false positives in drug testing, poppy seeds or not. Any sort of random testing is weak and sets the facility up for a lawsuit. It's foolish administrative overreach; begging for a skillful lawyer to show their client was shamed and unlawfully terminated for having a false positive, or for being on their legally prescribed prescription medication that their hospital had no right to violate their privacy about. There should be CAUSE to investigate employees, not random searches or testing, this is Management 101. Tell us the name of the corporation running your hospital so we can name and shame THEM for harrassing their nurses.

Sounds like a dream date for a contract effiency expert to add to his/her resume. The actuality of the process is a nightmare for the poor RN who is trying to give safe care. I mean, HONESTLY, how many phone calls will it take (from the hermetically sealed OR bubble) to ensure the safety checks are done correctly, the implants match the case, blah, blah.. PACU taking the pt with anesthesia is a nice taxi service though, we have done that with success.

[quote=NurseFrawg;9077502 Who and how do you chart this? How do you follow up with patients? Do you write an incident report for each case? What have you done to avoid breakdowns? 1. We chart preop and post op skin condition in the skin assessment portion of the operative charting. If there's a noteworthy change, I document who I spoke with in PACU, take pictures for the chart and file an incident report. I document that I showed the surgeon and anesthesiologist. 2. No, I don't follow. 3. If there is a significant issue, like what prompts me to take pictures, yes, definitely an incident report. Want to evaluate processes especially with positioning. We had a surgeon that was a fan of putting pt chest directly on a stack of bath blankets - until his pt had a serious shear incident that left her with open wounds. Writing it up encouraged immedilate change. Also, the write up alerts all services to watch over this patient - it's part of letting the facility rise to the occasion and make sure the patient come out whole. 4. No lift sheet under patient, pt directly on gel padded bolsters, large gel under lower body, padding hips, knees. Suspend forefeet with pillow under shins. There's more, but that's the gist. Directly on gel pads help distribute load, pts don't slip/shear on gel. Foam is very bad in regards to shear forces, I try not to use it for serious padding needs. Other nurses like duoderm dressings on bony areas. I'm less a fan, but you may want to try it. Pardon, if I may: breakdown on bony prominences shouldn't be happening at all. Boobs and chest tend to be the difficult areas because it's simply super tricky to avoid. Sometimes it cannot be avoided, but the soft tissue does seem to recover OK. But, if you're getting breakdown on the hip bones... That's preventable. Really evaluate what those practioners are doing in that room. Use gel pads, try duoderm ( put on pt in areas of concern).

The person bringing the pt to the OR will a nurse's aide. This process change has only been announced, not implemented. I have NO idea how short stay is going to know if OR is truly ready for the pt (implants, room set up, instrumentation,.. all the things you mentioned). Administration has not shared this. They simply announced it in in the weekly email huddle. No discussion, no explanation. If they are really going to do this and violate the WHO Implementation plan, then it's going to take a whole lotta phone calls and nail biting between the 2 departments. This is for everything from podiatry to open heart surgery, btw.

Hi, Allnurses, I found out that WHO has an Implementation Manual for the surgical safety checklist. You'll easily find the checklist itself, it's everywhere and is the basis for many facility's own version. Search now for WHO Implementation Manual pdf. The WHO Implementation Manual teaches safety concepts behind the checklist. WHO emphasizes that a single peri operative person performs the check off. It could be a anesthesia care provider, for example. It doesn't matter, what matters is PERI OPERATIVE and single person follows through the checklist with that patient. I think what has happened is that facilities scrambled to set up safety checklists, but didn't study the IMPLEMENTATION. There is a reason WHO emphasizes one single peri operative member perform the checklist: it's safer. "Safe Surgery Saves Lives" World Health Organization Implementation Manual of Surgical Safety Checklist We all have the WHO safety initiative to thank for prompting this safety push. It's unfortunate that one of the primary safety components has been de-emphasized in the rush to institute checklists. It's easy to copy paste a checklist, obviously less convenient to read the manual and implement them properly. I feel so fortunate, actually, that my facility implemented it correctly in the first place! Thank you, people of the committee that planned our checklist implementation - someone obviously did their homework. The Surgical Director who worked here at the time is long gone. I suspect it was her actions that gave us our proper implementation. That's right, no surprise, there is no "friend". It's me, it's my hospital. Recently an outside "efficiency expert" has come in and meets with the docs to Plot revenge on the nurses. It's called improving efficiency, but when they haven't any OR rank and file on their meetings, you know what it's really about. We get a one sentence bullet point email of this major change in our safety process (really) and we are supposed to Let it go. I'm sure this did not go to risk management, for example. The docs have no idea what we do, they just know we won't push their unmarked patient in the room, am I right people? We have a temporary surgical director, a temporary surgical manager and a contract "efficiency expert" that are tinkering with our Surgical Safety process. What could possibly go wrong? For any nurses that are not following the WHO recommendations of a single peri operative team member doing the checklist, can you see the dangers in your facilities process? Each element that changes hands increases error risk.

That's interesting, Rose Queen. How do preop and periop both do one check in? Computer? 2 papers? I did find a WHO document that specified that it is OR personnel that should be doing the safety checklist.

Hi, Can other circulators tell me who does the OR check in for your facility? Admitting RNs or operating room RNs? I'm talking about the first and second columns of AORN Comprehensive Surgical Checklist "Pre-procedure" and "Sign in". THANK YOU.

I knew I could count on you, Rose Queen. I'll try to access the AORN hand-off tool and see if it addresses this directly.

A surgical check in includes (not in order, not complete): checking the name, allergy and blood bands to the consent and H&P, check for tight rings and cut them off if the surgery warrants it (Admitting just tapes them), making sure the rep is in house and confirms that we have what we need on the vendor side, is the surgeon in house, checking the site marking to the consent, checking the H&P against the consent, verifying the consent with the patient, checking lab values, talking with anesth about their anesthetic plan, asking pt if they have any questions, introducing yourself to the family, does scrub have what they need, directing room arrangement. I disagree that asking name, procedure, surgeon and looking at the consent is normal. That is not a complete check in. My friend does NOT have the opportunity to do what she normally does. My friend doesn't even have the opportunity to do what the facility requires - admitting RNs will be falsely charting when they tick box that required implants/ instruments are available. Admitting RNs have no idea what surgery is about, what instrumentation is needed. It's a hope and a prayer way of doing the first safety check for surgery. (BTW, that pt you just interviewed in the room was pre-medicated). :-)

OR nurses may do all the things you say. It depends on where you work and your commitment level. There's no deeper assessment of the patient than putting your hands inside. Think about it.

Recently my friend's OR has started having the non OR nurses in admitting check in the patient for surgery. I mean check.in.the.patient. A non OR nurse will be looking at consent, ID, blood band, allergies, site marking: Universal Safety Checklist. The OR nurse simply receives the patient as its pushed through the door and pray it's the right pt for the right surgery. The OR nurses are specifically told to not interview their patient! My friend is going nuts thinking about this. It's hard enough to make sure everything is lined up for surgery, let alone have a patient you haven't checked in come through the doors. Implants, instrumentation... A non OR nurse doesn't know what we need. It's just a crazy, unsafe system. Obviously her hospital administrators have no idea what a surgical nurse does and the efforts we go through to see that patient safely through surgery. Yes, this is a physician led process (ya think?) but upper level nurse leaders are letting this go through. I don't think the OR director is permanent, he just doesn't care. What does YOUR Operating room do? What does Joint Commission say? AORN? Who should be checking in that patient for surgery? What about SBAR? Have you had close calls if your facility has non operating room RNs check in the patient? My friend is looking for another job, btw. She's not interested in playing games with safety.

The RN carries one of the licenses the surgical tech functions under. There are only a handful of states that require licensure of ORTs. Certification is very different from licensure. Licenses can be taken away if there is trouble with that professional. Certifications are merely a measure of training. RNs of course supervise ORTs, I carry the license, not the other way around. I have to tell the ORT and the surgeon to stop when there are scope of practice issues. In my state ORTs have very limited scope of practice and it's my job to enforce that as an agent of the facility. You cannot let ORTs override your license, no way, unless your willing to surrender it when things go tragic. (BTW, I'm a former ORT). I think many circulators are ignorant of what is going on during the surgery and prone to being directed by the tech. But, that is improper and a cop out, you'll be running around while they play torture the nurse. Why get your education if your going to not know what's going on under the lights? Like I said, I was an ORT before being a nurse. I'd MUCH rather scrub cases than circulate. i work hard as a circulator, not anyone can do it. I will say, though, when I'm acting as a nurse scrub and a less experienced nurse is circulating, I keep an eye on everything and do give direction to the circulator. Maybe that's how Aussies do it: the licensed nurse, whether scrub or circulator runs the nursing end. With all due respect, acerbia, I would never want a poorly educated tech positioning me or my family members. There's a reason we took those years of anatomy, physiology... It matters. Anyone can do anything, let the janitor hang the blood, but do you really think that's safe and appropriate?

In our facility, OR nurses are foley experts and some are excellent at IVs. BTW, pet peeve of mine: You'll still do nursing. You will be watching the monitors and listening to the suction and calling blood bank to see f they have units available- you'll know things are going South without anyone telling you. You will learn the art of safe pt positioning, a huge responsibility. You'll open supplies before anyone asks because you know what is needed. A good circulator is in tune with the room and anticipates every need, just like a good floor nurse evaluates each patient. I wouldn't say it's a butler, though, unless a butler knows how to charge paddles. It's too easy to not see what a good OR nurse is doing if she/he is doing it right. Hmm, Maybe we are like butlers... Nah, I'm kidding. Seriously, though, butlers? That's very short sighted, I don't agree with that statement. Oh, and OR nursing is extremely physical, you will find yourself on your hands and knees crawling around moving bovie pedals and the like. It's not for delicate flowers/ butlers. You will do whatever it takes to see your patient through the extemes of surgery. OR nurses tend to be matter of fact and brusque as they perform their duties. What else, ... I like what you say in your post and think you should seriously consider the OR especially if interactions with family frustrate you. It's very nice to be behind double doors sometimes!