Staff Ratios Cardiac Surgery Operating Room

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  1. # RN cardiac circulators: # Cardiac Scrubs in a non-academic setting?

    • 52
      2 RN Cardiac circulators: 1 Cardiac Scrub
    • 8
      1 RN Cardiac circulator: 1 Cardiac Scrub
    • 7
      1 RN Cardiac circulator: 2 Cardiac Scrubs
    • 23
      2 RN Cardiac circulators: 2 Cardiac Scrubs
    • 2
      Other

14 members have participated

I have a question/ informal survey request regarding open heart staffing in a community hospital. I work in a hospital that has one open heart room/ one heart surgeon. We currently have 2 RNs/ 1 scrub tech per case. There is 1 anesthesia tech on day shift who serves the entire 5 room OR.

Our new surgeon is keen on reducing the staff to 1 RN/ 1 scrub. But, we don't have the ancillary staff like an academic center that is dripping with personnel and residents. If everything is going well, I can see the possibility of doing the case with 1 RN circulating- but what if all H breaks loose? Sometimes there is NO one to run for blood or help out. And, then there are the turnovers... remember, I said we have ONE open heart room.

So, I'm really worried about this. My question is: what are other hospitals doing in terms of staffing ratios in the heart room? Can anyone point me to an article or source that can give stats on cardiac OR staffing ratios in a community hospital? Thank you very much.

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Specializes in OR, Nursing Professional Development.

Our cardiac rooms are staffed with one circulator and two scrubs. One scrub has the table and the second scrub functions as a second assistant. We also always have a PA and a surgeon. No residents or medical students as we are a non-academic general community hospital. We are responsible for doing our own turnovers, with 40 minutes scheduled between wheels out to wheels in. One of the surgeons I work with who came from another facility worked with one circulator and one scrub. Pleasant surprise to him that we provide two scrubs, and there was never any effort to change the staffing pattern.

To be honest, with only one heart room and one heart surgeon, I'm surprised you even have dedicated cardiac staff. The other hospital across town from us has the same setup. Everyone rotates through all specialties, including cardiac. There is no dedicated "cardiac team".

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Hi, our team isn't dedicated to only hearts; we do all areas. Sorry if you got that impression from my post. Thank you for the info!

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I have some questions: Are your 2 scrubs RNs or 2 OR techs or a combo 1 RN/1 tech? How are the roles divided: pt check in, opening, set up, counting, anesth assist, line insertion, foley, prep, etc... The second RN in our facility REALLY comes into play at turnovers and getting the case going due to the multiple roles. If you have at least 1 scrub who is an RN, then do they jump into circulating roles to get the case going? Thank you so much.

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Specializes in OR, Nursing Professional Development.

The person at the table is, so far, always an ST, although we have one RN interested in learning. The second assistant is either an RN or an ST, just depending on the number of cases, who's on call, and who's off that day. We have anesthesia techs assigned solely to a single heart room- so if all 3 of our rooms are running, we have 3 anesthesia techs who are assigned to us and nowhere else. They assist with induction and line insertion. The second assistant is responsible for opening for the ST. The circulator is responsible for patient check in. Counts and foley must be done by an RN, so depending on whether the second assistant is an RN or ST, the circulator may have to do both or if an RN second assistant, circulator will do one while the second assistant does the other. Our preps take two people, so it's always circulator and second assistant. We also have patient care assistants in our OR who are responsible for helping with turnovers. Also, if we have any available extra staff, they jump in to help as well. Because we are such a heavy case load of cardiac cases (around 600/year), we have a dedicated team of 13 (1 vacant position at the moment, so it's really 12 right now), and we work really well together with turnover and getting cases started. Unless people are off or attending required educational events, there's usually at least 1 extra set of hands in the morning to help get started.

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What I'm hearing is 3 people are key in your facility's heart room and if 2 of them are RNs it helps with getting all the tasks done quickly due to the broad scope of practice an RN brings to the team. Is that a correct summary?

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Specializes in OR, Nursing Professional Development.
SandraFenway said:
Is that a correct summary?

Pretty much.

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Hi Rose_Queen, I really appreciate you taking the time to provide all this information. Thank you again.

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In the room at a community hospital setting we have 1 circulating nurse, 1 first scrub, 1 second scrub the 2nd scrub can break to help the circulator if all he** breaks lose. We also have 1 nurse tech (2 rooms)

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Hi, thank you for the information, Hear_

I have another question for AllNurses.com members: How many people are on call (circulators and scrubs) during the weekends/ off hours for the heart room? Do you have anesthesia tech coverage on call/ available all hours also? Surgical aides?

When we have a crash emergency heart, there are only the 3 team members (2 RNs and 1 ORT) to respond. We do not have 24 hr anesthesia tech or surgical aide coverage.

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Specializes in OR, Nursing Professional Development.
SandraFenway said:
I have another question for AllNurses.com members: How many people are on call (circulators and scrubs) during the weekends/ off hours for the heart room? Do you have anesthesia tech coverage on call/ available all hours also? Surgical aides?

As a trauma center, we have 24 hour in house coverage for anesthesia tech as well as another on call who comes in if there is a heart. One aide in house on second shift, one on call during 3rd; both cover cardiac and main OR. On call aide rarely comes in- if we do a heart on 3rd, the night shift staff cover that role unless they're busy with traumas/emergencies.

As far as cardiac staff, we have a full team- 1 circulator, 1 second assistant, 1 scrub, as well as the PA.

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I'm feeling really vindicated in my perceptions that the surgeon/ management wanting to cut our heart team members, is well - I cannot say what I'm really thinking. I shall default to the polite and still accurate "unsafe".

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