PositiveVibesRN

Hi, has anyone ever heard / seen / had any experience with Deep Venous Arterialization procedure? Vascular procedure to save limb. Any information would be greatly appreciated. How often have you seen it and outcomes?

I developed Plantar Fasciitis my first year in the OR. Brutal. Nothing helped and I dealt with it for over a year... until I bought some Adidas Ultra Boost! I swear by them. Look up how their technology works. Great investment!

Los Angeles area Hospital - Standby was $6 hr, then $8 hr, then moving to $10 hr soon

Hi, I'm an experience OR RN who started off in the OR as a new grad in California - Los Angeles area. [Trying not to give my identity out to much] BUT YES, IT IS POSSIBLE! I know plenty in the LA, OC, and IE area who started as new grads or who was in a similar position like you. Right now there is a shortage in OR Nurses, nationally. Many hospitals are opening Peri-op 101 programs and management is looking into how to recruit more OR RNs. They are expanding their net. This is especially true in Southern California! LA, OC, IE. I've seen big hospitals like UCLA open up Peri-op programs [Santa Monica location], Community Hospitals offering sign-on bonus and their own training program [these are not advertise and just a few spots], Surgical centers hiring new grads even [these are not advertise and just a few spots]. A lot of the RNs I know who went into the OR as a new grad or with previous (NON med surg, ICU, or ER) RN experience was through word of mouth or they spoke to someone, honestly. The OR community here in Southern California is highly connected. Get talking to other RNs who have connections to ORs or call/visit HR departments or get in front of the hiring managers. (They have AORN meetings in LA, OC, and IE chapters). I wish I can go into more detail with my personal experience and all the other OR RNs i know but this forum is so public. Here is some advice/tips: Try every hospital and facility, honestly. You never know where opportunities lie. My position was not advertised so don't rely on Indeed or Internet job postings. Talk to those that are in the OR or visit HR departments and facilities. You'll get more insight. You need to WANT TO BE IN THE OR and let them know that. The Operating Room is a highly specialize department. It takes months and months of training and a lot of resources. Administration / Management / and Staff want to invest and train someone who will be there for the long haul and the OR is a hit or miss for people. * Show how determine you are to becoming an OR Nurse [Management wants you to be SURE you want to be in the OR] * Show them how your previous experience [2 years in Psych Nursing or any other experience] can transfer into the OR. You can reference back to your clinical or any pertinent experience. OR Nurses need to be detail oriented [You're multi-tasking, coordinating, supervising], great customer service [dealing with Surgical patients, Surgeons and Doctors], you need to be prudent and strong [Need to speak up if something isn't being done right], and a team player! [You're working along side many professions] * You're an open minded learner, quick learner, and love to learn [You are a forever student being in the OR.. learning new things everyday] The above may seem A LOT but honestly, If you're that determined to get into the OR and willing to do so, it is great practice to when you are finally in the OR. Get your foot in the door, do 2-3 years and you can write your ticket anywhere in California.. even the whole nation, to be honest. GOOD LUCK! - Being in Surgery and seeing everything I see.. nothing is impossible.

Hi, I work with Anesthesiologists and I would NEVER leave my Anesthesiologist during induction. The second the patient is brought to the room, the patient and the Anesthesiologist has my full attention. Everyone in the room understands this. No one can ask anything from me and everything and everyone else can wait.. including the Surgeon(s). Induction + intubation and extubation are the two most critical moments. From my experience, everyone in the room is aware and alert prior to induction. We have an Anesthesia Tech but still, even when we have support in the room (additional RNs) or even the Surgeon, everyone is aware, respectful of that moment and everyone is available for the Anesthesiologist. If there is anything but this type of atmosphere, I speak up as the Circulator. People are talking, I tell them to be quiet. The Nurse orientee is not paying attention, I signal for their attention and make them stand next to the OR Bed. The Surgeon is trying to do something to the patient (i.e. place a tourniquet, try to re-position the patient) or talking to the rep I tell him/her to stop. I've walked into other Nurses' OR rooms looking for something and notice they're about to induce and I stop what i'm doing and stand next to the OR Bed. I've had Surgeons walk in during induction and stop and stay to be available. (not like they know what to do though, lol.. just kidding.. but they stop and stay) Once the tube is in, End tidal C02 is confirmed and tube is secured, everyone can go back to normal activities. I've never seen it any different. If we're in a rush, at the very least, an RN will be standing to the right of the patient fully assisting the Anesthesiologist, while another RN does counts or mix meds but is ready to jump in when needed. You can have multiple individuals in the room assisting but staying yourself as an OR Nurse / Circulator to help assist is promoting Patient Safety and Patient Advocacy and that is an OR Nurse's #1 ROLE and #1 PRIORITY. Can you tell i'm very passionate about this topic? lol. That's my 2 cents.

There are hospitals that hire new grads outside of residency programs.Residency programs are the most competitive, to be honest, because so many people apply for them. It's the obvious "new grad route" but don't rule out other options. There are many community hospitals that are willing to hire new grads. I've even heard / seen some bigger hospitals hiring new grads. Have your resume ready and speak to HR or find a way to meet the director or department manager. Be persistent and take the initiative. As a new grad, you need to get your foot in the door and gain your experience. Then, you can take that experience and be more marketable to bigger hospitals, if you choose to. Just start applying everywhere you desire to work and don't wait around for another cycle of residency programs. Just get in there and start applying and getting your feet wet with interviews. You never know where great opportunities lie. Then after a couple of years.. you can write your own ticket. My advice, have your resume ready and head over to some of the hospitals around South Bay / LA. Meet with HR, request a tour, get information, and introduce yourself. It shows you're motivated, dedicated, and willing to take the initiative. Plus, it can help you get a better understanding on where you want to work and doesn't hurt to network and put yourself out there. I got my first RN job as a new grad with no experience by signing up for a job fair to learn more about the hospital. The day before the event, HR director calls me to see if i'm interested in scheduling an interview with some directors. Completely unexpected! I said YES, i would love the opportunity but like to inform her that I am a new grad. She said one department / director is willing to train new grads.. got my interview.. and the rest was history. You never know where great opportunities lie =) Yes, try the common route.. the route where everyone goes.. but also try the road less travelled.. less competition and you'll stand out more. You just need to get your foot in the door and seize the opportunity. I always tell myself.. Knock on 100 doors.. all you need is for ONE to answer =) good luck!

Hi, I'm curious about this because I do many Ortho and Spine cases which include different approaches and see varying consent forms. First off, KUDOS to you! You're being a vigilant patient advocate and Nurse! Similar to what was stated above, you're protecting the integrity of that surgeon's practice, as well as your license, and most importantly patient safety and advocacy. I believe it is a valid question. Second, The "approach" of a procedure, like you said, can be a difference in patient positioning but also can have significant differences within the procedure, even if the final procedure / outcome is the same. For example: Ortho - Anterior Hip Replacement approach (Supine and use of Specialty Hana Table) Surgeon separates muscles to access site INSTEAD of cutting the muscle to access site like in a Posterior (Traditional, Lateral positioning) approach. That is why Anterior Approach is minimally invasive but both have the same final procedure / outcome Consent: I have always seen it as "Right or Left Hip Replacement" I rarely see the approach on the consent. Maybe once with a "Newer Surgeon" BUT in Spine cases: ALIF vs. DLIF / XLIF Surgeons DO specify approach "Anterior" Lumbar Interbody Fusion vs. "Direct Lateral" IF / "Xtreme Lateral" IF on the consent form Anterior-LIF : Risker due to the approach, especially L4-L5. Going through muscle and major vessels (Bifurcation of the great vessels) versus DLIF / XLIF (going through the side) less invasive due to cutting muscle to access site but both have the same final procedure / outcome I would think it's comparable to Laparoscopic vs. Open. Essentially it's the same procedure / outcome, example: removing a gallbladder but how the surgeon does it, Robotic vs. Laparoscopic vs. Open is significant. I believe everything that rn&run said is correct. Consent form should be specific and individualize but how often do we see that? As far as legal matters, direct it to your administration. From my humble experience, I've seen very detailed consent forms vs. vague consent forms (just depends on the Surgeon) but as an OR Nurse and Patient Advocate I feel like my main priority is, is that patient well informed. Though my consent reads "Right Hip Replacement" I will still ask the patient if everything been explain to them? I'll mention the anterior approach to see how well informed they are about the procedure. I also do Robotic Assisted (Mako) Hip Replacements and will also mention the Robot as well. I assess how informed they are and if they have any questions before proceeding. I don't answer any questions, because of course it's out of my scope of practice, but will get the Surgeon to do so. I also chart this in my charting. This was a good blog and reminder on inform consents Do You Understand “Informed Consent?” | Notes from the Nurses' Station This is a great question because I am curious too. I believe everyone in the OR has a different perspective due to each individual priority. I will ask my Surgical Director, Clinical Educator, Ortho and Spine Surgeons and get back to this thread. Also, Anterior Hip Approach vs. Posterior Hip Approach (traditional), is just that, an approach to how to do the HIP REPLACEMENT (both have final outcomes). There is no laterality other than RIGHT OR LEFT HIP. (agreeing with double-helix on that)

I COULD NOT HAVE SAID THIS BETTER MYSELF!!! AGREE WITH THIS A THOUSAND PERCENT!! I'm a new OR Nurse and this gives me hope, pride, and fuels my passion for the OR. I'm going to print your post and place it in our OR as a reminder. True responsibility and skill of OR Nurses.

I work with Surgeons all the time and some can be notorious for their negative / sarcastic remarks about staff. There's 2 ways to respond in my opinion.. What "TheCommuter" suggested.. In a playful but call them out on their behavior type of way.. or pull them to the side and let them know their comment/behavior is not appreciated and UNACCEPTABLE. (Especially since it was said in front of a patient) You need to let it be known that you overheard it and that it is not acceptable. People act this way because they get away with it. Any respectable professional that is worthy of being respected will respect your efforts and intentions. I remind myself this when face with these type of challenges.

I understand your situation. I work at a hospital where I only circulate and get zero to minimal scrub experience. They promised scrub training down the road, when i first got hired but due to staffing issues, as well, circulating has been the priority. I personally feel there are other ways, even better ways to get that training / education. Entering a Surgical Tech Program is going to cost you TIME AND MONEY. That time spent on a Surgical Tech Program can be spent on getting your Master's or even RNFA. I doubt going to a surgical tech program will give you that much of an upper hand too. Don't get me wrong, having that scrub experience is VERY VALUABLE but I would focus on gaining the experience at work or apply for a hospital that will give you that scrub training. We have Student Surgical Techs in our hospital and they say they just learn the basics ( Major Tray, Minor Tray, Sterility but nothing specialize) and learn so much more once they get to our hospital and do their clinicals (which is their last semester). There are so much more trays and instruments than what you learn in a ST Program and nothing beats that experience when you're actually in an OR. You really do learn more ON THE JOB. There are other ways to learn and take advantage while you're in the OR as a circulator as well. At work, I take the time to familiarize myself with the instruments of each case. During the case, I try to pay attention to the field to learn the process and routine and which instruments are being used. (Why they would use that instrument versus another and for what?) Any questions I have, I talk to my Scrub personnel and learn more about the instruments and about the case. Doing this will also benefit in our circulating role as well. I also watch my Scrub personnel.. how they set up their Mayo stand for the case, how they organize their instruments, which trays we use, how they handle / put together instruments, how they work with the Surgeon. You can learn a lot by observing. On slow days, you can pick cases, open up the case with your Scrub, Scrub in on a case to observe, or spend a day in SPD. Even when I have a free hour where I am support or waiting on a case, I go to the Instrument room and look at the instruments. Any questions I have, I always have a go to senior co-worker or the service coordinator. If there are not much slow days, talk to your Charge Nurse or Director about setting up time for you to learn. I try to take initiative when it comes to my education and training because i think.. I have nothing to lose. The least I can do is try and ask my supervisors for the training / support / resources. If those resources are very minimal, then I try to squeeze every learning opportunity at work. We're getting paid while we are doing it anyways and it's specific to the cases you work. Mind you, I'm still a New Grad RN and a New OR Nurse with 1 year experience. I'm sure there are other ways / better advice BUT this is what I have learned from my humble experience.

Oh wait, "package of 4 pins" There should be a package sticker that represents all 4 pins in that package, therefore charge once as a unit. If not, always clarify with your REP. Usually they have a charge sheet as well and you can clarify and compare.

Hi, I do spine and ortho cases in which In and Outs are common. I'll share what I do. Charge sheet and Implant sheet are two separate documentation. So for instance if I have 3 screws and 1 was an in and out, I would charge 3 screws but document the 2 that was actually implanted in the Implant log but charge for 3 screws. I would pay attention during the case and listen to the measurements and what's being discussed with the REP and Surgeon. If I didn't catch it, I would ask the Rep. I always confirm with the rep which were implanted and which are charges only. I always document each Implant individually. (Eg. Instrumentation from the rep's tray). If it comes in a package.. there should be an Implant sticker for the whole package. Keep track of what was actually implanted and document only that in the Implant log. Some reps are great about specifying. In our hospital, we charge in and outs. Usually if it touches the patient we can charge. If we drop an instrument, instrument was compromised during implantation process or if the situation is the hospital staff's fault, we don't. Certain grayish situations I run it by the front desk. Hope this helps