this question was sent to a patient advocacy group in the us and pertains to the deliberate understaffing issue that i was fired for revealing. it is posted here under the general nursing forum rather than the or forum since the core problem, the toxic managerial practice of deliberate understaffing and the consequences for those who speak out, is one that we are all facing hospital wide.
how long is too long for a member of the sterile team to remain continuously scrubbed into surgery?
although the public might not understand that medical professionals including the surgeon must leave the or briefly during lengthy surgery, most conscientious practitioners realize that this is a normal safety measure necessary to combat fatigue. i am trying to get a consensus of feedback from those who routinely face this dilemma in the or as to what time frame is universally accepted as the maximum period that any member of the sterile team can be expected to safely function while scrubbed into surgery without a break. although i am now in the “nifa” training program to become a first surgical assist, even as a surgical technologist, performing the “scrub” role, i had to concentrate on anticipating the surgeons needs during a case. after how long would you consider that scrub role jeopardized by fatigue to the point where i might have lost concentration and focus on the operation?
while a surgeon can, and should, demand that the person assisting him is relieved, nurses and technicians fall under the control of or management which leaves us vulnerable to the vagaries of inappropriate or coverage as determined by the hospital. as a consequence of hospital “downsizing” to cut costs redundancy of personnel has been severely limited to the point where during the off-shifts especially at night and on weekends there’s no free staff to break people out of surgery for even a brief run to the bathroom! calling in call team people to provide relief breaks is considered an unnecessary expense, despite the fact that there is a clearly established link between fatigue and medical errors. the sterile team scrubbed into surgery are trapped without food or water until they are relieved; this also represents an unacceptable deprivation strain on the body. however there are no safeguards within the existing us employment laws or ocha standards to insure that critical hospital workers, including those in the or, are not left for hours of continuous, and dangerous, practice without a break. “breaks are at the discretion of the employer.”
i was left stranded at the field without relief for 8, 10 and on the worst occasion 12 hours straight. these situations impacted my ability to concentrate as my blood sugar plummeted; each time i reported becoming sick, dizzy and faint to the point of nearly passing out. when i complained that my condition in response to this hardship presented a danger to my patients i was targeted for removal and then fired. incidents where any member of the or team is forced to remain on task for that long should be documented in an “incident report,” as an extreme of this magnitude presents an unacceptable danger to the patient. the geneva convention strictly prohibits such inhumane treatment of working pows! how many normal human beings are expected to go for 12 hours without water, food or urination?
this is an interesting reprint from a document that those who work under similar unreasonable, torturous or downright inhumane circumstances in the us should take careful note of:
43.hours of work are interspersed with one or more eating and rest periods of not less than half an hour. continuous work may not exceed five hours. the rest period in jobs which span two meal times ranges between one and four hours (labour act in force, art. 58).
there is a lot of talk about medical errors right now, but far less mention of the toxic work environment that now encourages mistakes. this situation is getting steadily worse. while “at will” employment laws silence those who dare to speak out, lack of a humane break policy condones driving hospital staff until they drop: is there any wonder that errors are on the increase? little wonder that a sponge or an instrument is inadvertently left inside the patient when the scrub is almost comatose after a 12hour ordeal in surgery. all the cross checking and safeguards are irrelevant if the hospital staff are trying to function while so severely fatigued, hypovolemic or hypoglycemic that they are at the point of either falling asleep or passing out. when will the various safety advocacy groups in the us finally address this very real problem and insist on proper protective legislation? there have been advances recently with limiting the residents working hours and trying to stop mandated overtime for nurses, but much more emphasis must be placed on eliminating unnecessary fatigue among all of our medical staff.
no one is more important than the patient unconscious on the or table. for my very prestigious maryland hospital the “nursing shortage” was a convenient excuse to justify unconscionable managerial abuse that seriously endangered my patient in the or. doctors and nurses face severe discipline when mistakes occur, but why isn’t a negligent hospital policy that condones drastic staffing cut backs ever recognized as the real culprit? in some cases administration even offers financial bonuses to encourage self-serving managers to implement inadequate staff coverage. then they fail to hold a repeatedly abusive manager accountable when they drive dedicated staff until they drop. this managerial excess is focused purely on saving money not saving lives; we need proper safeguards in place to cub this negligent profiteering strategy before patients are harmed. plus when staff are courageous enough to come forward and expose a pattern of ongoing negligent practices they must be protected from retaliation and taken seriously by accreditation agencies who’s duty is to protect the public. no medical institution no matter how iconic, prestigious or powerful should be immune to rigorous scrutiny, as this lack of oversight encourages bending the rules, ignoring regulations and cost cutting that is harmful to safe patient care.
relentlessly abusive managers are a very valuable tool in facilitating staff downsizing without layoffs; i call this the spineless approach to cost cutting, but it makes our hospital working environment extremely dangerous for the patients. the current nursing crisis has come about through this dangerous downsizing and the creation of the toxic work environment that is driving nurses to leave their chosen profession because they refuse to take unnecessary risks. the us does not have a “nursing shortage” it has a “nursing exodus.” the us healthcare industry is still consistently expecting all of our medical professionals to take bigger risks by making do with unsafe staffing practices. this issue desperately needs to be addressed so please post comments,
kim.
ps: the issue of retaliation and unfair dismissal of whistleblowers has been further elaborated upon by myself and other affected nurses on another thread:
re: retaliation for voicing concern over unsafe practices.this thread was started by an icu nurse, but the problems i have seen discussed on this and other threads represent the growing concerns of many silenced patient advocate nurses. there are some valuable suggestions on exposing patient safety issues and combating retaliation on the above thread. i will be taking further action very soon by posting a petition calling for a compliance line investigation into my case. please visit this other thread to comment on the issue there too and consider the importance of making our voices heard, many thanks.
