safe staffing in the O.R.

[lillynurse]

I work in the O.R. at an outpatient surgery center. I have a concern and have tried to find something in writing , such as a standard, but I have had no luck.

The situation: we have one surgery scheduled in the O.R. for the entire day and we have been given (besides anethesia, PACU..etc) one circulator and one scrub tech for the day. This leaves no one in the hall or in the O.R. department to assist if help is needed, such as retrieving a needed supply..etc. I feel that it is a safety issue when there is no one else available. There are other nurses close by in PACU and endoscopy (and some of them do often work in the O.R. but will not be schedule to that day).

On a normal O.R. day when we have multiple cases, there is always at least one other O.R. staff member available that is not circulating or scrubbing such as, a tech or the charge nurse (not assigned to a room).

I know in hospitals there is always someone around such as an orderly, nurses..etc. But is this considered a safe acceptable practice since its for one case?

I would love to hear from other surgery center nurses to know if this is acceptable.

[TakeTwoAspirin, MSN, RN, APRN]

What you are describing is fairly standard OP for a surgery center. So long as there is another nurse on site (PACU) and I have a good tech and anesthesiologist it doesn't concern me that there is nobody in the hallway. If I need something that I think is going to take more than a few seconds to retrieve I have no problem calling the PACU/Pre-op staff and having them run for something. Usually in a surgery center extended absences from the OR are limited because the facility is small and everything is quite handy. Again, given the limited size the surgeon's needs are usually better known before the case starts because there are fewer surgeons coming through and the teams are usually familiar with how everyone works and what they need.

Honestly, I have found that people are more willing to chip in and help out in a smaller team-oriented OR (even with minimal staffing levels) than I experienced in a 22 OR trauma center where people were sitting around drinking coffee for half of the day! I would literally have to beg for help sometimes. In a surgery center I find people more willing to do what it takes to get the cases turning and work as a more cohesive team, but that may just be my experience.

[SkipBeat]

Seems pretty typical to me. Usually there is only me and a tech scheduled in a room together for a case. Our surgery center has only 4 rooms and there may not be anyone in the hallway because staff are in a rooms doing cases. Running for something is not a big deal since you know ahead of time what the case is and any incidentals that may need to be handy. Also, I don't see why you couldn't just call out to the other department and ask on the phone for something. Although I think it's important to have the circulator in the room, I feel part of the reason you're there is to go get stuff because everyone else is scrubbed. It's an outpatient case, so pretty routine and you should be able to get prn's or extra supplies ahead of time.

I would only see a problem if you needed and actual "assistant," to maybe hold retractors or cameras and there wasn't anyone available who was trained to scrub and assist.

[lillynurse]

Thank you both for your responses. Since both of you feel this is typical for a surgery center, I feel much better about working with less staff on these occasions. Thank you for the peace of mind>