Surgical Nursing in OZ

K+MgSO4, BSN · Mar 17, 2011

obs analgesia, obs, analgesia, emptying catheters (IDC) aspirating NG tubes, obs, analgesia, dressings, education about deep breathing & coughing, analgesia, mobilising pts despite them not wanting to, obs and analgesia!

Fast turnover of pts. Being able to deal with discharges and then a new admission 20 min later as ED snd bed manager is putting pressure on for movement. Frequent trips to recovery.

However VIC has pt ratios of 1:4 on an AM & PM shift. But limited HCAs. So you will be doing washes & bed making as well as everything else.

Discharge planning as most pt go home before they are fully recovered with services such as Hospital in the Home (HITH) or the Royal District Nursing Service (RDNS or Post Acute Care Unit (PACU).

What country are you coming from?

carolmaccas66, BSN, RN · Mar 17, 2011

Get your running shoes on! It's quite different from medical as you have to juggle many patients, have patients coming back from/to theatre, catheter bags to empty, a million obs to do - especially neuro obs - PCAs to check, juggling new patients just back from OT with uncontrallable pain, getting new patients to move - and all of the above.

Use a cheat sheet and write down all the patients and times, and get organised as soon as you get handover. It takes a while to get your time management down pat. Try not to get behind with post op obs, but if you do, just do them when you can, then start your obs on the next hour and take it from there.

I quite enjoy orthopaedics - it's interesting and the patients can't chase you down the corridor, but they ring the bell more often cos they can't get out bed!

Good luck juggling everything!

thegardenofpromise · Mar 18, 2011

obs analgesia, obs, analgesia, emptying catheters (IDC) aspirating NG tubes, obs, analgesia, dressings, education about deep breathing & coughing, analgesia, mobilising pts despite them not wanting to, obs and analgesia!
Fast turnover of pts. Being able to deal with discharges and then a new admission 20 min later as ED snd bed manager is putting pressure on for movement. Frequent trips to recovery.
However VIC has pt ratios of 1:4 on an AM & PM shift. But limited HCAs. So you will be doing washes & bed making as well as everything else.
Discharge planning as most pt go home before they are fully recovered with services such as Hospital in the Home (HITH) or the Royal District Nursing Service (RDNS or Post Acute Care Unit (PACU).
What country are you coming from?

I am from Canada, KMgSO4. Thanks a heap for your reply!

thegardenofpromise · Mar 18, 2011

Get your running shoes on! It's quite different from medical as you have to juggle many patients, have patients coming back from/to theatre, catheter bags to empty, a million obs to do - especially neuro obs - PCAs to check, juggling new patients just back from OT with uncontrallable pain, getting new patients to move - and all of the above.
Use a cheat sheet and write down all the patients and times, and get organised as soon as you get handover. It takes a while to get your time management down pat. Try not to get behind with post op obs, but if you do, just do them when you can, then start your obs on the next hour and take it from there.
I quite enjoy orthopaedics - it's interesting and the patients can't chase you down the corridor, but they ring the bell more often cos they can't get out bed!
Good luck juggling everything!

Ms Carol, do you think I need to review concepts about surgical nursing like wound dressings as well as anatomy and physiology? Will these be very "urgent" from your point of view?

carolmaccas66, BSN, RN · Mar 18, 2011

Ms Carol, do you think I need to review concepts about surgical nursing like wound dressings as well as anatomy and physiology? Will these be very "urgent" from your point of view?

Good question. I think reviewing any A&P is helpful. You need to look into getting a good surgical nursing book. I only have ones from 2007 so they probably still have relevant info, but try to get un updated one. You never know what has changed.

I suppose in surgical nursing it depends upon what area you work in as to what you review - surgical nursing covers a lot of different areas. For example, in orthopaedic nursing you need to be able to check wound drains, IDCs and know your outputs for these (IDCs should drain 30-50mls per hour). You need to be able to locate pulse points and be able to check these, if you can't find one, you need to use a Doppler machine to locate them. Also we use bladder scanners a lot with patients who aren't catheterised and who are post-op, very important you know how to do this correctly. You also need to recognise signs and symptoms of compartment syndrome, and what action you would take re this. It's also VERY important to look for gradients in patients post-op, what I mean is with blood pressure for example, if it keeps climbing high consistently, they may be developing an infection or becoming increasingly anxious - what would you do in this situation? A consistently low BP could also mean signs of internal bleeding. If patients become restless or say things like: 'I feel funny'; 'I just don't feel well' this raises a red flag with me - they usually end up coding or pass out.

You're always observing your patients closely post-op - that's our job, though the patients sometimes moan about being woken up during the night every hour to get obs done - but it's very important to closely observe people to pick up any problems ASAP.

You need to be able to think about WHY you are checking something and figure out what you would do if a patient became really unwell.

I would go into your local Angus & Robertson, or large chain book store, and see what surgical nursing books they have on offer, which will cover everything to do with surgery (ie: pre and post op care, reasoning, nursing diagnoses, wound care, drains, etc). A great book will cost a lot, but mine has been invaluble over the years.

Hope this helps a bit.

thegardenofpromise · Mar 18, 2011

Good question. I think reviewing any A&P is helpful. You need to look into getting a good surgical nursing book. I only have ones from 2007 so they probably still have relevant info, but try to get un updated one. You never know what has changed.
I suppose in surgical nursing it depends upon what area you work in as to what you review - surgical nursing covers a lot of different areas. For example, in orthopaedic nursing you need to be able to check wound drains, IDCs and know your outputs for these (IDCs should drain 30-50mls per hour). You need to be able to locate pulse points and be able to check these, if you can't find one, you need to use a Doppler machine to locate them. Also we use bladder scanners a lot with patients who aren't catheterised and who are post-op, very important you know how to do this correctly. You also need to recognise signs and symptoms of compartment syndrome, and what action you would take re this. It's also VERY important to look for gradients in patients post-op, what I mean is with blood pressure for example, if it keeps climbing high consistently, they may be developing an infection or becoming increasingly anxious - what would you do in this situation? A consistently low BP could also mean signs of internal bleeding. If patients become restless or say things like: 'I feel funny'; 'I just don't feel well' this raises a red flag with me - they usually end up coding or pass out.
You're always observing your patients closely post-op - that's our job, though the patients sometimes moan about being woken up during the night every hour to get obs done - but it's very important to closely observe people to pick up any problems ASAP.
You need to be able to think about WHY you are checking something and figure out what you would do if a patient became really unwell.
I would go into your local Angus & Robertson, or large chain book store, and see what surgical nursing books they have on offer, which will cover everything to do with surgery (ie: pre and post op care, reasoning, nursing diagnoses, wound care, drains, etc). A great book will cost a lot, but mine has been invaluble over the years.
Hope this helps a bit.

Not just a bit, but your post has provided a wealth of information. Thank you so much, Carol! Your reply to my query is very much appreciated! I'm sure I can improve as a surgical nurse with the facts that you have provided! :yeah:

carolmaccas66, BSN, RN · Mar 19, 2011

Not just a bit, but your post has provided a wealth of information. Thank you so much, Carol! Your reply to my query is very much appreciated! I'm sure I can improve as a surgical nurse with the facts that you have provided!

You are most welcome. Any other questions, please ask. I have only been a RN for a little over 2 years now, but have worked in very busy, very large, public, teaching hospitals in my 26th year now, (also as a Nurses Aide), so I think I must know something!

talaxandra · Mar 23, 2011

I'm a medical nurse all the way, though we get a smattering of surgical patients - although the priorities are a little different, the biggest difference for me with surgery is having to deal with surgeons instead of physicians!

It might be because our surgical patients tend to be either outliers or medical patients with surgical input, but I find it next to impossible to get them reviewed quickly, get new IV/med orders etc. I'm sure they're better on their home units, though!

K+MgSO4, BSN · Mar 23, 2011

Yeah I have the opposite problem, surgical with medical outliers. Can never get a physician up to do a fluid assessment or talk to family. Surgeons are in theatre most of the time so I ring their mobile rather than page with urgent issues. Currently got 2 demented medical pts who fall out of bed constantly! Think I can get them reviewed?

thegardenofpromise · Mar 24, 2011

@ Talaxandra, K+MgSO4 and Carol or to any good soul

How are handovers usually done in a surgical unit, knowing that the pace in the area is very rapid? Is it done individually or could it be possible that the RNs and ENs report directly to their respective TL's and the team leader in turn, does all the handover to the succeeding shift? How long does it usually take to do handovers and what is the ratio of a surgical nurse to patients in both private and public sectors, not just in VIC but also other states like NSW?

Thanks in advance to all of you!

carolmaccas66, BSN, RN · Mar 24, 2011

Western Australia - ratio of patients is usually 6:1 private & public, but you can have all post op patients between 2 nurses, ratio 12:2 or 13:2. South Australia ratio is about 5:1 or 6:1 in private and public hospitals in my experience.

Handover is usually done on tape, only the relevant details are handed over. The patients' name, room number, initial diagnosis etc is already on the handover sheet you will be given before you start your shift. ONLY handover details such as patient status, pain control initiated (patient may be on a PCA), state other pain meds ordered such as Oxycodone and dosage, IDC in place and rate it's draining at, observations being done, ie: any neurological obs and if they are abnormal, could have hypertension after surgery and what actions taken. Also state how many hours post op and if any other problems, say with breathing. Also state if patient has other medical problems, ie: diabetic, asthmatic.

Some hospitals get the nighshift staff to listen to the pm staff's taped handover, and the pm staff note any changes for the night staff on a handover sheet with patient name, room number, diagnosis and briefly the problems/changes encountered. This saves time doing another handover on tape and I thought it was a very good idea.

I don't state if deep breathing and coughing was done because we had pre-prepared care plans printed up we could tick off for this and when all our checks were done. We could also add codes for different things, ie: if patient's dressing was unusually soiled, dressing was changed, what time, etc, so I didn't hand that over but you can if you want.

The facility and shift coordinator/CN will give you an idea re handover protocol, but make it short, sharp and sweet. DON'T do long handovers that take up to an hour to listen to! You won't have time on a surgical ward to listen to them all, with patients coming from recovery and going to theatre.

Also when many of your patients have gone to theatre, and the rooms are empty, use this time to get the rooms prepared b4 hand, ie: get iced water jugs and glasses, check all equipment working such as suction and O2, rooms clean and tidy. Get your medical notes done when quiet as well.

Can think of a million other things, but it's getting late here down under, so I will have my cup of Milo and be off to bed soon!

Keep those questions coming!