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SRNA looking for advice

Posted

Specializes in ER, Trauma ICU, CVICU. Has 5 years experience.

Hello! I am an SRNA and while I am totally comfortable in the ICU, I am very new to the culture of the O.R. I just started clinicals and am trying to learn the ins and outs.

I have so much respect for O.R. nurses and what you do, but I can't help but feel that there is sometimes tension between anesthesia and the nursing staff. This confuses me because we are all nurses, with a common background and a common goal..we are in it together...for the patient.

I am looking for advice and pearls of what I can do to not peeve off the circulators, and how I can create a culture of mutual respect. Please let me know what you like, dislike, and feel free to share any funny stories about silly things anesthesia has done to drive you crazy!

Thanks in advance!

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 15 years experience.

Keep in mind that if you are just starting your clinical portion of the program, you are an unknown. It takes time to earn the trust of others, especially if you are brand new to the OR environment. Learn what you can about the environment, expectations of various staff members, and other tips to surviving in the OR environment. While geared more for students completing an observation day, the post "Sooo you're observing in the OR" in the FAQ section of the OR forum may give you some other hints.

TakeTwoAspirin, MSN, RN, APRN

Specializes in Peri-op/Sub-Acute ANP.

Usually, the circulating nurse is busiest at the beginning and end of the cases. Be mindful of this. Make sure that you have everything you need to receive the patient and intubate them without overly bugging the circulator when she is attempting to count, position, pour meds, get sutures the surgeon just said he wanted, etc. Make sure you are in the room ready to receive the patient when they get there - nothing bothers circulators more than having to chase around the OR team to get to the room while she is attempting to transfer the patient etc. If you are going to need anything special in PACU for the patient, don't wait until the nurse and tech are doing their final count to ask for those needs to be fulfilled. Plan ahead and let the circulator know once the room has settled. If you know anything about the patient that you feel the circulator might not know that is important to patient safety, discuss with the nurse before taking the patient back to the room - nobody likes surprised like, oh did you know they have Hep C, B, HIV, TB, etc? Communicate with the team and be respectful of them and they will respond in kind. Good luck.

Foggy14

Specializes in OR. Has 7 years experience.

I agree with Asprin that a lot of it boils down to respecting our time. The anesthesia provider in my room can really make my day miserable with poor time management and requests that cut into the time I have to get the room ready. You'll be fine if you just think ahead and plan accordingly. If you know you're going to need more Decadron or antibiotics for the next case or you need local for a caudal block, grab it out of the Pyxis between cases or at least let me know about it during a slow time in the case. If the surgeon is using C-arm, find your own lead before the case starts instead of waiting until right before they start shooting x-ray to ask me to get you some. Come back to the room and put it away after you drop the patient off in PACU, instead of leaving it on your chair for me to put away (this will get you big, big points). Have your induction agents drawn up and your blades ready to go before the patient comes in the room. This sounds obvious, but you wouldn't believe how many times I've had to make small talk or sing Frozen songs with the patients to distract them while my anesthesia person fishes around for a Miller 2 ("uh, can you call somebody to bring me one?") and draws up their roc and propofol. Be considerate of turnover time needed after a big messy case or before a two-surgeon combo case that requires more time to set up. Other bonus point items to consider: coiling up monitoring lines instead of leaving them tangled on the floor, getting your own sterile gloves and art line supplies, and helping me position and get the bair hugger on the patient so I can start prepping. Really, I don't expect you to be perfect (and I'm certainly not perfect either), and I honestly don't mind grabbing some calcium or albumin for you during a long case. As long as you are aware of what's going on around you and pitching in where you can, we can be friends. :-)

Remember too, as another poster said, that it does take some time to "break into" the OR setting. We're not being mean, we are probably just trying to see who you are and how to integrate you. Showing that you can pull your weight and engaging others about mutual interests or hobbies is good here, complaining about your call and student loans is not.

It sounds like you are starting off with a good attitude toward being a part of an OR team and that will serve you well. I personally value the relationships I have with anesthesia providers, and many of them have helped make me the nurse I am today. I give the above tips not to sound cranky, but to give you some practical ways to make my life easier and show that you respect me and value my time. There's really not a secret to getting along with the OR nurses; just show them respect and you will get it back. Good luck and best wishes!

scrubulator

Has 1 years experience.

As everyone has stated (and what I will repeat because it is important)-be mindful of our time. It drives me nuts when anesthesia asks for every little thing- "can you pick this medication up from me", "can you call my attending and let them know we are going to wake up " (yet the patient only has 1 twitch) "can you clean this for me". Now I know some things are important such as blood and blood gases but if you can plan ahead, do it! I not only have to take care of my scrub/surgical service, I have to watch the med students/visitors, coordinate with other professionals and plan for my next case.

Also, a lot of times when my patient transfers from the cart to the OR table I see garbage on their bed (bloody gauzes, hypo/needle caps, empty syringes) that anesthesia used to start an IV line. Even when they put in an A-line in the room they leave the garbage on the patient/ OR table. It completely drives me nuts-so please clean up after yourself.

Lastly, know your anesthesia basics. The other day I had an SRNA ask me how to complete the type and screen paperwork. Now I know this probably varies per hospital, but this is something I have never done. i have no clue, this is something you (as anesthesia) should know. This also reminds me of a time when a anesthesia resident asked if I could perform a blood draw on our patients because he didnt know how too. haha. Embarrassing, so know your basics.

Not to leave you on a sour note, most CRNA/SRNA that I have worked with are pretty good. I actually prefer working with them than anesthesia residents. In my eyes, and I am sure others can agree, you are one of us-a nurse. You are already good in our book, just dont ruin that.

sweetdreame, BSN, RN

Specializes in ER, Trauma ICU, CVICU. Has 5 years experience.

Wow! Thank you all so much for your advice! It really amazes me that some people expect you to clean up after them...that's crazy! I have had a few days in the O.R. now and I have to say that the circulators have been SO nice and friendly. They definitely made my nerves slightly better. You guys rock! Thanks again!!!