Stand your ground

Specialties Operating Room

Published

i just want to encourage all or circulators to stand your ground in that or suite! you know what is right and what is wrong! you have the authority to execute in your judgement, if a corner can be cut and how much it can be cut.

i am getting so tired of scrub technicians (whether certified, bonafide or calcified) who walk into an or and think they can 'decide' what to count, how to count and in some of the most outrageous very wide open chest and abdominal cases, if to count!

circulators...you are in control. but if you give control of that or over to a tech who has figured out they can intimidate you...you will some day find yourself explaining to the board of nursing why you let the tech call the shots! ( not to mention the judge)

i respect the heck out of my techs and i do not "pull rank" on them unless it is absolutely necessary. i have only ever had to do that two or three times in my career. i train new rn's in the or all the time. one of the very first things i drill into their heads is that everything that goes on in that room is the responsibility of the rn.

sometimes i get these hot shot techs who've been here, been there, been doin' it 30 years...well that's great. personally, i don't care if you were born into the world doing it and have the psychic ability to absolutely "know" where all your sponges and instruments are...you will still do a count as many times as i require which is equal to my satisfaction that we do have everything.

my techs have learned to appreciate and respect the way i run an or. it took them a while to realize that i have no 'pets'. i require all my techs to count the same way. i do not 'trust' sylvia cause she's been doin' it her way for 40 years.

i tell my techs...you can set up your field any way you want as long as it's integrity is maintained and does not potentially jeapordize my patient's well being should their break come up or they are going home before closing.

increasingly i am seeing rn's turning over the counting duties to 2 techs and the rn is out of the room. i saw 1 tech counting to the other tech and the tech's back was to him as he was putting new sheets on the or table...c'mon people...we are the ones who go to court if something goes wrong and we are idiots not to realize the awesome responsibility that we carry. surgeons are going to bellyache...they are taught to intimidate the inferior...it has never worked on me where ever intimidation has reared it's ugly head...we live in a sea of intimidation...we all had better learn ignore the whinings and whimperings of those around us. if we do what is best always for the patient...then we are in fact protecting everyone else's behind. surgeons are no exception!! they absolutely will perform a surgical scrub before they gown/glove and put their hands inside my patient. they will not be permitted to use blue/green or any other towel to put inside the body cavity unless it's a disecting aaa!!!! wishbone or backbone...which do we have?

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

Feel better?

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Yes, as a matter of fact I do. Thank you Marie. But I will feel even better when I see us stand together for the good of everyone concerned. And congrats to you for persuing your RN...and God bless you and keep you

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.
Yes, as a matter of fact I do. Thank you Marie. But I will feel even better when I see us stand together for the good of everyone concerned. And congrats to you for persuing your RN...and God bless you and keep you

To be honest, your original post sounded very 'us-vs.them'. I am no way excusing anyone poor attitude or poor technique (or poor-anything for that matter, and i'm well aware of who's responsible for it all), but the people (nurses or techs) who do a stellar job and go above and beyond, should not have the iron fist whacking them over the head, too.

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Specializes in Surgical.

I'm with ya sister! lol

Seriously, its MY liscense on the line. I don't ask the techs I work with to set up their equipment in "my" way... but I do insist that things be done properly - including counts.

Frustrates the hell out of a couple of docs... but I'm sorry, these things are done for a reason. So unless you are going to order standard post op xrays on every patient we are going to count before and after and inbetween as I see necessary.

I'm lucky that the techs I work with are very professional. I've even had them comment on travel RN's they felt were taking and/or trying to get them to take too many shortcuts.

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Yes, as a matter of fact I do. Thank you Marie. But I will feel even better when I see us stand together for the good of everyone concerned. And congrats to you for persuing your RN...and God bless you and keep you

Sounds to me like a "Battle of the EGOs" reaching a high point. I agree you need to stand up, if a decision isnt the best for a pt...but from reading your post....this is beyond "pt care" and more focussed around your own pride. Maybe its not the OR ,itself, that is malfunctioned...its you.

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Specializes in OR.
Sounds to me like a "Battle of the EGOs" reaching a high point. I agree you need to stand up, if a decision isnt the best for a pt...but from reading your post....this is beyond "pt care" and more focussed around your own pride. Maybe its not the OR ,itself, that is malfunctioned...its you.
I didn't take the post as an ego thing..One thing I've learned as a new nurse and a new circulator is that the RN is held responsible for everything that goes on in that room. We had a nurse get reprimanded because the surgeon was swearing(not at anyone, just out of frustration), a student complained, and she got told that she is responsible for the "tone" of the room. The OP did say that not all techs disregard counts. There are some that try to take shortcuts or refuse to follow policy-just as there are plenty of nurses who don't follow standards properly. I could somewhat relate to this post because today, we had a doctor whose pt. had no H/P in the chart. He insisted he dictated one(which I doubt) and then scribbled at the top of a piece of paper "Patient has humerus fx" That's it. My preceptor and I had to dig in our heels and tell him that the patient doesn't go the room without an H/P. After much whining and pouting on his part, a proper H/P was obtained. I agree that the tone of the post was a little strong but I have to admit, I was sitting there reading it, shouting "Amen, sister!":wink2:
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Thanks for your comments...I apologize profusely if the tone was unpleasant. The 'tone' was my sheer frustration and disappointment at what I see my beloved OR becoming. In regard to any 'ego' comment...that is truly a misperception. And in my OR I would never even be remotely accused of that from those that know me. Here's my routine...I tell the techs..tell me when you're ready to count...(I know they have to build their nest and get comfy in it...so do I...lol) I do the same at the close...let me know when you are ready to count...I make NO power plays unless it comes to something that 'in my judgement' either conflicts with the well being of the patient or protocol. I can understand how some could be tempted to think of it in terms of ego...I deal with them frequently enough...and dismiss them just as easily. They can think what they want...I keep my eye on the ball and mostly am successful at avoiding the whole distraction. Ego should never cloud the judgement of anyone..however, we see it all the time. Ex: Just a few months ago, I had a tech that seemed to be dragging her feet on doing a closing count. I said.."hey just holla when you're ready to count". She never said anything, so I walked up to the backfield and said, you ready to count? She looked at me and said, I'm not counting anything, I know where all my stuff is". I was trying not to be confrontational with her. I shouldn't have to be. I really could not believe she said that to me. She was one of these techs that had been around for years and had a reputation for telling the RN what to do and bragging about it. She terrorized other techs. Get the picture? I didn't think she should brag but if the RN didn't know what to do then...yeah tell her. But I did know what I was doing. I looked at her and I said very calmly, "well, I don't know where your stuff is, would you mind showing me?" So much for my attempt at tact...she had the nerve to look at me and say, "if you want a count...do it yourself'!! Ooops...REAL WRONG thing to say to ME. It was simple...I was done...I just said...you have two choices...either you count to me, or I will relieve you of this room and replace you with someone who will follow protocal." That was the end of that...she counted to me and I guess she was satisfied I could not be bullied...but she still does it to others...that is why I want RN's to stand their ground when it comes to techs like this...they are like rebellious children and will teach newbies to be like this. No ego here...simple common sense of right and wrong...clear judgement with alot of obvious frustration. Sorry for the tone...though...God Bless

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Well, if you put it that way.....I'm WITH YA SISTA! :wink2:

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WOW! What a rant! I just hope you know that the techs do not work under your license. And the sole responsibility of what happens in the OR falls on the surgeon, not the nurse. Now, I haven't been in the OR long, but I do know that! If an ST is giving you problems and not doing their job properly report them. If they are certified or have been trained then they should know what to count and when and how to maintain their sterile field. Sounds like you have a problem with the ST's you work with and you should really let your supervisor know if they are not doing their job correctly...its not your license on the line, its the patients well being. A person like the one you described has no business being in the OR or anywhere else where they are responsible for a person!

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Specializes in OR.
WOW! What a rant! I just hope you know that the techs do not work under your license. And the sole responsibility of what happens in the OR falls on the surgeon, not the nurse. Now, I haven't been in the OR long, but I do know that! If an ST is giving you problems and not doing their job properly report them. If they are certified or have been trained then they should know what to count and when and how to maintain their sterile field. Sounds like you have a problem with the ST's you work with and you should really let your supervisor know if they are not doing their job correctly...its not your license on the line, its the patients well being. A person like the one you described has no business being in the OR or anywhere else where they are responsible for a person!
Not looking to start a battle, but you are mistaken. The surgeon does not have the sole responsibilty of the room. This is because a nurse is expected to act as a patient advocate and can be in deep trouble if he/she does not step in, if the doctor has made a mistake.(such as wrong site operated on, for example) I know what the job description says for techs also, because I was one for 5 years and the tech works under the supervision of the registered nurse and if there is no RN, then it's the surgeon. Not saying that techs are inferior, but when the poop hits the fan, they're really going to go after the licensed personnel in the room. It IS the nurses license on the line and until you've been there, you really can't know. Sorry if that sounds harsh but I had no idea until I was in those shoes. Just my 2 cents...
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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.
WOW! What a rant! I just hope you know that the techs do not work under your license. And the sole responsibility of what happens in the OR falls on the surgeon, not the nurse. Now, I haven't been in the OR long, but I do know that! If an ST is giving you problems and not doing their job properly report them. If they are certified or have been trained then they should know what to count and when and how to maintain their sterile field. Sounds like you have a problem with the ST's you work with and you should really let your supervisor know if they are not doing their job correctly...its not your license on the line, its the patients well being. A person like the one you described has no business being in the OR or anywhere else where they are responsible for a person!

Please double-check the facts. You will notice a few major errors in what you have just said.

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