Shaking my head

[guest974915]

Hoping some fellow travel nurses can give some needed much needed advice or maybe just commiserate. I am currently on a CVOR/General Surgery travel assignment in a 200+ bed community hospital on the west coast. While this in a fairly progressive, affluent area, I find the facility is just about as close as you can get to being 'third world' medicine without actually leaving the US. The processes, systems, and accepted practices here are inefficient at best-i.e. paper charting, and downright scary and unsafe at worst. Additionally, the surgical equipment is dated and only marginally functional, the OR suites are what you would expect to find on a medical mission (no exaggeration), and there are supplies and instruments in every nook, cranny, cubby hole, cabinet, closet... There seems to be no rhyme or reason whatsoever to all of this disorder and before you say it, I am very accommodating and flexible (a must when traveling). How this place passes its Joint Commission or health department surveys though has to involve a bribe or payout and the crazy part-no one bats an eye or seems to notice. Anyhow, I'm growing tired of the travel nursing thing anyway and am seriously thinking of pulling the plug on this gig and going perm somewhere else. The idea of sticking it out another 8 weeks is beyond painful to me and I worry about my license. Where to start or what to do?

[NedRN]

OR nurse here, not getting what the issue is. Nothing wrong with paper charting, I wish all ORs still used it. Much more efficient than any electronic charting and it would be cheaper to pay to transcribe it to an e-chart than to have RNs do it. I'm only suggesting this for the OR, not other departments, although the ED is even slower than the OR in implementing EMR than OR for good reason.

Your description of the facility sounds spot on for one of the world's most prestigious hospitals, Johns Hopkins, and their main OR. I did an assignment there a dozen years ago. Black tile walls, numerous cubby holes, wedged into three separate buildings so walking around came with many changes of hallway width and height and architecture. I was truly astonished at how old all the equipment was. Easy enough to do CVOR there, but had the assignment been general OR, it would have been a nightmare trying to find stuff. UCSF about the same time was very similar but again, I was fine restricted to pedi CVOR. Both have since modernized. I've not been back to UCSF but worked a general assignment in a new detached (from the original John's Hopkins hospital) building that was well planned and built.

You've not actually identified anything that was unsafe at your facility. But even if it is unsafe, say for patients, that is a very long way from jeopardizing your license. If your license is in jeopardy, so is every staff member's license in jeopardy. Can't imagine such scenario. If your workplace is unsafe for you, you should bail. Document and report to OSHA and the state accrediting authority (they have far more power than JC).

[guest974915]

Ned, thank you for your response. I too have many years of OR experience in numerous hospitals throughout the country and though I can't reveal the specifics of the situation, suffice to say that there were no provisions (back-up plans) for a potentially dangerous situation that occurred outside of the OR. Could I be personally liable for a bad patient outcome in this instance-probably not. Do I want to be part to the same unacceptable practices in the future-a resounding no! At issue too, is finding needed supplies in an emergency-absolutely no rhyme or reason; bovie pencils next to cervical distraction pins next to aortic cannulae-huh? Need a Yankauer suction tip-they're right by the shoulder immobilizers and the internal paddles!

[NedRN]

Yup, silly. Done for the convenience of central restocking items with internal or external SKU numbers. Commonplace as you know. Again, not cost effective or efficient. Convenience for the lowest paid workers means more hours or longer surgeries for the highest paid staff, and frustrated medical staff who can do more procedures in their block at other hospitals. And of course slower emergency response.

[Argo]

"Anyhow, I'm growing tired of the travel nursing thing anyway and am seriously thinking of pulling the plug on this gig and going perm somewhere else."

I think this statement is the key of your entire post. Once you get to a certain point of burnout everything is an order of magnitude worse. Personally, I would stick it out and find permanent placement to start after the assignment and a couple weeks off.

[RN/WI, ADN, BSN, MSN, RN, APRN]

Hello! I only wish to go back to paper charting... I came in this way and had more time to spend with patients and my documentation described the patient and scenario way better. I could actually open one cover to a pt chart, ( binder). Figure out why the patient was there. History very easily and previous care. But enough of the past. Electronic charting works, ( when it does lol). It may take 10 minutes longer to scan my meds or more if the scanner is not working,( hoping not to red scan my pt in the eyes while messing around getting the wrist band scanned). Whatever it all works, although my wrists are sorer and hands with it the last 11 years of computer EMRs. I've been in some fancy buildings and not so fancy buildings. I do not care what the facility looks like. It is totally the people working their that make or break the assignment 😊 Give me friendly professional team oriented professionals any day over fancy facility items!

[Kooky Korky, BSN, RN]

Ned, thank you for your response. I too have many years of OR experience in numerous hospitals throughout the country and though I can't reveal the specifics of the situation, suffice to say that there were no provisions (back-up plans) for a potentially dangerous situation that occurred outside of the OR. Could I be personally liable for a bad patient outcome in this instance-probably not. Do I want to be part to the same unacceptable practices in the future-a resounding no! At issue too, is finding needed supplies in an emergency-absolutely no rhyme or reason; bovie pencils next to cervical distraction pins next to aortic cannulae-huh? Need a Yankauer suction tip-they're right by the shoulder immobilizers and the internal paddles!

It sounds like you now know where things are. I guess you learned by doing and didn't get much orientation.

I know you are trying to conceal things that should be concealed, but it's hard to know how to help you without some specifics.

Best wishes, whatever path you take.