Training Ob staff for C.Sections

[imenid37]

I am an Ob nurse, not an OR nurse, so please indulge me... I need an opnion/advice/experience re. training staff in a small facility (600 deliveries/yr.) to scrub and circulate for C/S. It has been proposed that we start doing our own sections. We have a fairly large staff (30 RN's and 5 LPN's) and about a 20% C/S rate. I work 3 12 hour nights/week and it is often 2-3 months between sections. We have lots of part-time and contingency staff who may not go for a section for an entire year. It just doesn't seem feasible for us to function safely doing the OR w/ so few cases and so many people to be oriented. It is not, according to the current proposal, an option to only orient some people because it would create a scheduling nightmare (ie. who can switch w/ who) to cover for C/S. Also what if a case became more than a routine section, for example if pt. hemmorhaged and needed hyster and we did not know how to handle this. Any thoughts please. OR is not in house 24/7, but must be called from home. Thanks in advance!

[webbiedebbie]

Hi...I trained in a hospital with 4 LDR's. As a staff nurse in L&D, we were trained also with circulating for C/S. If my pt needed a C, I would circulate. A staff person who was also trained in scrubbing would be called in to scrub and then go home after the C. We always had someone on call to scrub. I would then recover my pt. We added staff during the day if a section was scheduled. We also had the opportunity to learn to scrub.

In the hospital where I am working now (travel position), OR come in for the section. This was a problem one night when a STAT section was called and the OR didn't make it in right away. 3 nurses from the unit did the section with no experience ( 1 to scrub, 1 to circulate, and 1 for baby)...which left me responsible for 2 pt's in L&D, 8 pt's on PP, and 6 babies in Nsy!

In most of the hospitals that I have worked at, the staff is trained for C/Sections, especially on nights. At another that I worked at, OR only did the sceduled sections during the day.

[ceecel.dee, MSN, RN]

OR only at our hospital, where the floor nurses would not be able to ever spend enough time in the OR to feel comfortable functioning there, especially in a real emergency.

Sterile technique does not come naturally to all (or most) floor personnel.

[BRANDY LPN]

I learned to scrub at my old job, and at my current job we use OR. In a true emergency such as a hyst. the docs will know you dont have as much experience as an OR scub, and will probally just be grabbing stuff off your stand anyways. Also we always had hyst. set in the OR during the c/s and all you would need to do was open it onto your table. The doctors are going to ask you what instrument they want and all you really need to know is the names of the instruments if they dont ask remind them you dont normally do this and cant read their minds.

Sterile technique is something ALL nurses need to know anyways. OR or floor, you use it everytime you insert a foley ect. Also who sets up your delivery tables? That is sterile technique too. It is just applying stuff you already know in a bigger setting. I think any OB nurse in any setting should know the basics at least, in case of an emergency with no OR back up available in time to get there JMHO.

[ceecel.dee, MSN, RN]

It's actually pretty easy to see who is comfortable with/good at sterile technique, and who is new in the OR. Of course all nurses and even the docs should know sterile technique, but OR sterility and patient room or clinic room are just not looked at the same way. Doctors new to assisting in surgery often need to be told "You touched that table" or "the hand need to be kept above the waist...let me get you a new pair of gloves", or some such thing. That doesn't make them bad doctors...it's just about comfort zone and familiarity.

The delivery table can be set up perfectly, but the typical delivering doc is not maintaining a sterile table during a delivery.