Question for the night shift OR nurses

ORoxyO · Apr 18, 2019

A lot of this will depend on how efficiently your OR runs during the day and how loosely they use the term emergency/ trauma.

First thing when you get there, you will be finishing cases that are still going from the day if there are any. Thats an easy one to figure. Next, you'll be available for emergencies overnight. Depending on your patient population and facility, it could be ortho (think x-fixes), fasciotomy , burr holes, appy, i&d, ectopics, transplants, gsw, stabbing. Anything that would go stat during the day. Now as I reread I see there will not be 24 hour service so forget that.

During my downtime, not operating, which is most time, first I walk around and clean up the rooms. Turn equipment off, throw away used tape, put supplies away etc. Then I check stock on cast carts, latex free carts, any special carts. Check crash carts. Empty return bins (unused supplies). Then set up rooms and pull cases for the next day. Afternoon shift starts on these things before I get there so it might be almost all done or not at all when I start. Just depends on how busy we were.

Some techs help me do everything and are wonderful. Sometimes we do it all together or split yhe work in half. Some do absolutely nothing... I choose to not get in fights over it and just do everything myself if i have to. Not the best strategy but its easier.

There is also a lot of tv watching, playing on my phone, resting.

Nights can be awesome to get away from drama but it can also be boring and leave your circulating skills stagnant. At least I get traumas where I am. Thats why I rotate to days. Not many people like rotating but I think it helps keep me fresh.

dRummiN_KS · Apr 18, 2019

Thanks for the help! Because we don't have 24 hour service, we utilize our call team, but by opening the 12 hour night position, my hospital can reconsider upgrading to a Trauma 2 facility. How do you choose when you call in the back-up team? How do you handle being overwhelmed?

ORNerd, BSN, RN · Apr 30, 2019

I used to work 3 12’s overnight at a level I trauma center. There were 6 of us all night; usually 3 nurses and 3 scrub techs. The shift started by finishing cases that were still going from the day. Some nights there would be add-on cases to go and we’d be busy all night. Lots of transplant, ortho, neuro, free flaps, etc. Emergencies would be craniotomies, lap appys, lap choles, ectopics, gsws, bring back free flaps, etc. We’d also test the autoclaves, pick cases for the next day, set up rooms, and put supplies away. And like the previous poster said, we’d also watch TV, play on our phones, read, and snack, haha. We tried to avoid using call teams unless we absolutely had to. If all 6 people were in a room and a trauma came in, the call team would have to come in.

ORoxyO · May 2, 2019

On 4/18/2019 at 11:51 AM, dRummiN_KS said:
Thanks for the help! Because we don't have 24 hour service, we utilize our call team, but by opening the 12 hour night position, my hospital can reconsider upgrading to a Trauma 2 facility. How do you choose when you call in the back-up team? How do you handle being overwhelmed?

How you use your call teams varies greatly in the facility. Some places will allow them to be called only for trauma or certain cases. Some have different call teams for different specialties. One place I worked at would routinely use their call team just to open another room for routine cases to appease doctors. Thats a tougher question than it should be!

As far as handling being overwhelmed. That will come with time. My biggest tip to new charge/weekend/ night nurses is to know your resources and how to get a hold. I have a night time phone list on the back of my badge. Sometimes in hectic situations I have random people helping such as an anesthesia tech or environmental person grabbing a piece of equipment for me. Review how to get blood and your rapid transfusion protocol now. I also check our dedicated trauma rooms as soon as I get on shift to make sure they are ready to go and have everything set. You can only do one case at a time and no more.

ORNerd, BSN, RN · May 5, 2019

On 4/18/2019 at 11:51 AM, dRummiN_KS said:
Thanks for the help! Because we don't have 24 hour service, we utilize our call team, but by opening the 12 hour night position, my hospital can reconsider upgrading to a Trauma 2 facility. How do you choose when you call in the back-up team? How do you handle being overwhelmed?

Like the previous poster said, utilization of the call team is going to depend on the facility. As far as feeling overwhelmed, that feeling will lessen as time goes on. It is generally accepted that it takes 1-2 years to feel competent as an OR nurse, more if you are working an off shift. Knowing your resources is extremely important. Knowing who to call, when, and for what, will be tremendously helpful. When I was new, I used down time to pick cases for the next day. That helped me learn and remember where items were; extremely important when you need to run for something during a trauma. I also checked the trauma rooms to make sure they were stocked and ready just in case. I was also fortunate to work with a group of very experienced nurses. They taught me so much about circulating and scrubbing a variety of trauma cases. I could go to them for anything. We also just worked really well together and helped each other out in each others cases.

Editorial Team / Admin · May 5, 2019

I'm in a level 2 trauma facility. We have one team staffed on night shift with 2 calls teams expected to be in the OR ready to accept a patient within 30 minutes of when they pick up their phone. We do not do specialty call- if it rolls in, you take care of it (except cardiac). Any time a case needs to go but isn't extreme life or death, the call team is called and must be on site before the patient goes into the OR. If it's a true life or death emergency, the in house team will get it started while the call team is en route. We must have a team available 24/7 for traumas, which is why the call team comes in as soon as a case is booked.

RN_amie_06 · Jun 13, 2019

On 4/18/2019 at 1:02 AM, dRummiN_KS said:
My question is: What do you do during the night? What kind of traumas are you doing? How do you pass time when there's no clinical work to be done? What is a typical night like? How do you manage the unit when the team is basically the nurse and your scrub tech? When do you feel the need to get the call-team in? What advice would you give a relatively new OR nurse working the night?
Some background, I transferred from Adult Med-Surg working 3 12-hour shifts, and since August 2018, I've been circulating, working the 8-hour Monday to Friday 0645-1515 gig. All of our circulators and scrub techs are well versed in Ortho, OB/GYN, Vascular, General surgery, Uro/Nephro, Robotics, Cardiac, Bariatrics, etc. Management has been very pleased and impressed at how quickly I've picked up circulating (I've even spent a few months learning how to scrub cases, also). This week, management offered me a 12-hour night position (1900-0730) working Tuesday, Wednesday, Thursday. I work at a trauma 3 hospital with no 24-hour OR service so this is the first time a staff nurse has been offered a night position, let a 12 hour position as wee normally use travelers to work the night shift.

Oh my gosh this sounds like my dream job! Sorry my post is no help, just wanted to throw that out there ?