"I don't need a scrub nurse for this case"...

[ORgoodie]

Have you heard this line before? Surgeons are getting fed up with cancellations in their list and having their emergency cases delayed due to nursing staff shortages. We've started doing cases in which the circulating nurse opens everything on a sterile table and a resident will act as a "scrub nurse". Some cases include hernia repairs, ophthalmology cases, some plastic surgery cases, broken fingers... What are your thoughts on this?

[ChristineAdrianaRN, BSN, RN]

I would think that it would take longer for the resident to figure out how to set everything up! I guess those are very well trained residents. It seems to me, though, that the resident has enough to do on their own outside of the case that setting up for the surgery wouldn't be in anyone's best interest. But that's just speaking on my own situation. We've had surgeons have to wait for staff if they have an add-on and no one is available, but we've never had a bad enough shortage that it has come to this.

[nurseboudin]

As a surgical services nurse manager, I say ABSOLUTELY NOT! The scrub is responsible for adhering to specific standards as defined by their job description, not residents or other MDs. I will delay a case if I don't have staff. If this is a frequent occurrence, you may need to adjust your staffing targets.

[jeckrn, BSN, RN]

I agree with nurseboudin about not doing the case. If something goes wrong who is going to get blamed; you the nurse for allowing the resident to set something up wrong etc. The surgeon will be passing the buck and blame so fast your head would spin. If this surgeon can not wait for the proper staff, do you think he/she will own up to the fact that they did the case without a one. NO. Stand your ground and do not let residents open up. Know that is easier said then done but you need to do it and get the backing of your NM.

[LovedRN, BSN, RN]

Interesting. Isn't that against the law or rules? Becareful. Law sue is on its way.

[GadgetRN71, ASN, RN]

I had a doctor insist that he didn't need ANY staff to do a case. It would only take him 5 minutes, blah, blah, blah. That didn't happen, lol. You have to stand your ground because surgeons are like little kids, always testing their limits.

[canesdukegirl, BSN, RN]

It concerns me a great deal that emergency surgery is being delayed FOR WHATEVER REASON. If this is, in fact, occurring at your hospital, this suggests a lapse or a break down in the quality of services. That's a big fat hairy deal.

If you feel that you can, bring this up to your nurse manager. Pose the situation as a question, such as, "I was curious about the policy regarding emergency cases in the OR. I would like to understand better as to how we stage emergencies: should we hold a room, should we open another, etc." If you frame your question in such a way that your NM doesn't feel as if you are challenging the current policy, but are genuinely interested in either improving or educating others on the policy as it is, then s/he will be more likely to engage in a dialogue with you.

Perhaps this can be your avenue to improve quality indicators on your unit.

[Rose_Queen, BSN, MSN, RN]

Delaying true emergency surgeries is never a good thing. As a level 2 trauma center, we are required to have at least one circulator and one scrub person available at all times. We are staffed 24/7, although there is only one team in-house overnight. That means if something needs done, the call people are brought in.

We also have a "triage" scale for emergency/add-on cases- levels are emergent (requires surgical intervention within 1 hour), urgent (requires surgical intervention within 8 hours) or add-on (requires surgical intervention within 24 hours). Surgeons can always reassess their patients and upgrade the triage level (i.e. broken arm that at first was urgent, then patient lost sensation or has vascular issues and is now emergent).

This means as charge nurse, I can tell someone with a lap chole they've triaged as an add-on that even though they booked first, I need to get that little kid with the broken arm and vascular compromise in the OR first. The first surgeon can complain all he wants, but I've got the policy to back me up. If two surgeons booked cases with the same triage level but both say theirs needs to go first, then it's up to them to discuss who's first and who has to wait. Which usually ends up delaying things when we could have knocked out the case booked first by the time they make a decision.

In the event of some true catastrophe, like the mass casualty incident we had a few years ago, we will completely halt the scheduled cases that haven't already been started in order to free up staff should any of those patients need emergency surgery. Again, it's part of the policy. If your workplace is violating their policy for staffing levels, then perhaps the higher-ups need to be involved in remedying the situation.

[RNOTODAY, BSN, RN]

On 4/14/2012 at 2:51 PM, GadgetRN71 said:

I had a doctor insist that he didn't need ANY staff to do a case. It would only take him 5 minutes, blah, blah, blah. That didn't happen, lol. You have to stand your ground because surgeons are like little kids, always testing their limits.

If I were management, my response to this surgeon, would be the following:

“ Well it sounds like you don’t actually need a room AT ALL ; sounds like an office case to me”

Of course, I do realize I could say this only in my HEAD ?