Questions Questions and More Questions

Marie_LPN, RN, LPN, RN · Oct 12, 2006

I have a small notebook and a small address book that i carry in my pocket. So far i have written down the names of doctors that i have been with during my orientation (more like observations). I also write whether they are ortho, neuro, peds, cysto, etc. I have also written the type and size of gloves they wear and what kind of preps they use. What other things could i add to my list that would help me be better prepared?

Gown size? We have one surgeon that technically fits in the Large size gown, but likes the bagginess of the XL, but most people wouldn't know this unless they've worked with him a few times. We also have another surgeon who needs the XL sized gown, but is in denial that he's gained weight, so he still wears a large. He's still covered but it's just a matter of time before it busts at the seams, and maybe then he'll realize he's out grown the large gown.

Also, what kinds of prep they prefer for what cases (betadine paint, scrub, DuraPrep, or Chlorprep)

Positioning? For shoulder cases we have surgeons that prefer the "beachchair positioner" (the bed attachments that are a pain in the rear to put on) and some that just want "beachchair position" (when the bed is flexed into a chair position.)

How about their routine pre-op antibiotic? The kind of tape they prefer? Local injections they like to use?

Also, for small talk's sake if you choose, their hobbies, children, wife, music, movies, etc.?

Depending on the case, do they sit or stand? Are they left-handed or right handed?

Music during the case?

I saw a case with a two year old that lasted 2 hours. I didn't see any warming units or warming blankets used on her. They only put on warm blankets from the warmer at the beginning. I was told that in peds. cases the main concern is heat loss. But i guess the child was fine because i didn't hear the anesthesiologist make comments about her temp. I was wondering, on all peds cases (except feverish kids), especially newborns and toddlers...are they supposed to have some kind of heating devices (warming blanket, IV solution warmer, heat lamps) and/or warm room?

We have it in the room, but rarely do we use it (Bair Hugger). The room temp is warmer for our pediatric cases, and warmed blankets are usually enough. For longer cases (like our dental restorations or complicated fractures which can last 3 or 4 hours), we may put a K-pad under the child (with a sheet over top of the K pad), a Tylenol suppository (if the MDA asks for it) and a rectal temp probe for monitoring during the case (if the MDA asks for it, if they don't, we ask if they want it).

We use warmed IV fluids for pts. of any age.

A resident walked into one of the rooms during surgery and he didn't have his mask on all the way, only his top part was tied and the bottom strings were hanging lose. This may sound like a stupid question but isn't that just wrong? Might as well not wear a mask at all right? I wanted to ask him if he could tie his mask but i'm not that brave or confident yet. I did mention it to the circulator and even he was hesitant to tell him about his mask. What would you do?

I've said "Sir, we have sterile packages open in the room can you please tie your mask?" but i stand next to him when i ask him that. Saying it across the room increases the odds of getting ignored. Have only had one person refused to do so, a resident who had the ego from hell, his response being "like i'm going to have some nurse telling me what little things to do on my case" (wasn't even his case), which i said "i would hope that for your surgery, you would have a nurse that is concerned about little things, because you would need it if your surgeon has the same attitude that you're displaying now."

Lastly, there have been a couple of times i had phone anxiety issues. Like times the circulator has left the room and the phone rings. (Actually i get nervous anytime the circulator leaves the room and leaves me by myself) Most of the time i can communicate clearly but there have been a few times i get tongue tied. I sounded like a complete moron the other day when a surgeon called the room to check on the other surgeon. I knew what i wanted to say but the words didn't come out of my mouth like they were supposed to. I felt myself getting very nervous because i was afraid this surgeon was going to yell at me for not making sense or taking to long to give him an answer. Sure enough the circulator came in to take the phone from me and i knew the surgeon was upset with me. The circulator had to explain who i was. I get nervous when i'm told to answer the doc's pagers or cell phones also. Do any of you get like this? What do you do or say?

The most common pager beeps we get are for pain or SOB. Make sure to get first and last name, and also the nurse's name, in case the call gets cut off. One of the first things our surgeons will ask for for SOB is for the vital signs, one of the first things our surgeons will ask for in relation to pain is when the last time it was that pain meds were given, and how much. So asking the nurse on the other end of the phone a few questions in relation to the problem will give you info that the surgeon's probably going to ask for when you say "This is 7 East calling about Mr. X, who's complaining that he feels like he's out of breath. The HOB is up 90 degrees, sat is 87% on RA."

Another thing is i don't know if i'm hard of hearing or if i haven't yet acquired this skill but i have a hard time distinguishing if the surgeon is talking to his assistant or scrub or if he's talking to the circulator. I've noticed circulators are all over whatever was communicated to them and i'm just like what in the world, what just happened, i didn't hear that, etc. Is this another skill that is learned after experience and time?

This is an acquired skill. Sometimes you'll hear the doc say " i need a Chromic", and you know one hasn't been opened, and you'll pick up that one needs to be opened, and you're ready for it.

I had one surgeon get smartorificed with me when he griped that i wasn't listening to him (which i was, he was just mumbling). When he rolled his eyes and said loudly "Are you deaf or something?" i said "Matter of fact, i'm partially deaf in one ear (i really am) and people who mumble do not help that." Haven't had much to say to him since, and i noticed that most of the people that like him are also the kind that have a lips-on-butt relationship with him (which he thrives on), and the ones that don't, well, don't put up with his attitude (which he's not too wild about).

tessa_RN · Oct 13, 2006

The notebook is a great idea..Some of the things I write down are their little quirks..Like one surgeon likes a notecard with a name sticker on it for the end of the case..an ortho doctor likes a split sheet non-sterile to put on a patient before a procedure..those are the things I write down..What makes that one surgeon different than the others..plus the gown, glove, and prep...but the phone anxiety I know how you feel..I used to be the same way and have gotten out of it..especially training as evening shift charge...it comes with time...But if anyone has a mask on wrong or anything I am quick to tell them..At first it was awkward but you have to think of your patient..Goodluck with everything..its tuff starting out...

surginurse · Oct 18, 2006

Am I missing something? Doesn't your facility use preference cards of some type? Every OR I've worked in had some type of preference card system. All the "little differences" should be noted on the preference cards. If they stay in your notebook, or in someone's head, how is anyone else supposed to use this knowledge?

ortess1971 · Oct 18, 2006

Am I missing something? Doesn't your facility use preference cards of some type? Every OR I've worked in had some type of preference card system. All the "little differences" should be noted on the preference cards. If they stay in your notebook, or in someone's head, how is anyone else supposed to use this knowledge?

I believe that the OP is wishing to use this personal notebook in addition to preference cards, for her own learning process. The notebook is a great idea. I had one when I was a new tech and I have one now as a new nurse. Also, preference cards are not always correct. Easy enough for her to write the info in her book and change the card too. To the OP: Don't worry if you get teased or ridiculed for your little notebook. You know what you need to retain the information and I've had "seasoned" OR nurses take a look through mine when they're not confident with a case. Long Live The Notebook!!!:icon_hug:

Marie_LPN, RN, LPN, RN · Oct 18, 2006

Am I missing something? Doesn't your facility use preference cards of some type? Every OR I've worked in had some type of preference card system. All the "little differences" should be noted on the preference cards. If they stay in your notebook, or in someone's head, how is anyone else supposed to use this knowledge?

Sometimes the newest little difference haven't made it on the preference sheets yet.

And sometimes the little thngs aren't case-specific.

crackerjack · Nov 21, 2006

And sometimes the 'little things' are things that *can't* be put on the preference card....OMG he's such a PITA, never wants anything the same way twice, I've changed his pref card 10 times this month already and each time he's insistent that he's wanted it *this way* for years now, why can't I get this right....yada yada...we all have at least one of those.

There are also peculiarities of your anesthesia staff that come into play. We have an anesthesiologist whom I couldn't figure out what the heck I was doing wrong, had I offended this person, what?!? Well, come to find out, the person is extremely claustrophobic so getting within 5 or 6 feet of her made her edgy, snappy and such. Once someone shared that with me, I realized the last couple of times we'd worked together and she'd seemed snappy and I had been unable to figure out why, I had been standing *near* her....3 feet behind her picking up trash sorta 'near'. Now I am trying to remember to back off and let her have her space. I really thought she either didn't like me, for whatever reason, or that I'd unintentionally and unknowingly done something that offended her.

I got off track there, sorry. Long-winded example :)

staceyp413 · Nov 22, 2006

I also kept a notebook like you and I kept it when I first started in the OR, when I learned to scrub, when I took a charge position, and again when I took a new job as a Asst. Director/Charge in a new OR. We did have preference sheets at both facilities but I added more specific hints for myself in my book during and after the case.

I also kept some preferences for anesthesia, my scrub techs, as well as basic information for myself for vacations, meetings, etc. I think you are showing great dedication and initiative by doing this and your efforts should be applauded:chuckle

elcue · Nov 22, 2006

My little pocket notebook also includes important phone extensions. There's a page with a list of sales reps' names so I don't have to ask them over and over when documenting their presence in the OR.

I also have used the copy machine to shrink down the staff phone list, which I have attached inside my little book. When at home, if I need to reach a colleague for any reason, all the numbers are in my little book in the bag I carry to work.

My little book is my portable "brain". If I ever lost it, I'd be crippled! :banghead: