What are your ideas?

[rotteufel]

Hi Everyone! I am new here, but I am looking for advice. I just took a job as a charge RN in a Same Day Surgery Clinic. The RNs in the clinic pre-op the patients, send them to the OR and then receive the patients back from the PACU for discharge. The unit does not work well as a team, hence why a charge RN was hired. The RNs were assigning themselves to OR rooms. This wasn't working. If a room only had 2 patients (perhaps long ortho cases) and another room had 6 cases (perhaps quick D&Cs), the RN w/ only 2 cases would just sit back and watch the RN w/ 6 cases work. In attempt to remedy this, I put a rotation in place. RN A admits patient 1, RN B admits pt 2, RN C admits pt 3. When pt 4 arrives, I go back and assign the next pt to RN A. As pts return from PACU, they get mixed into the rotation. So, as RN A admits pt 4, RN B receives Pt 1 back from PACU. (I hope this makes sense). Anyway, the RNs, whom I said don't work well together, get caught up in the numbers. RN A starts to complain that she has had 2 admits while RN B has had 1 admit and 1 discharge and that RN C has had only 1 patient. How do other SDS clinics work. I had been a charge nurse in another clinic like this and we never had a problem like this.

[cmo421]

Hi Everyone! I am new here. I am looking for advice from other nurses out there. I just took a job as a charge RN in a Same Day Surgery Clinic. The RNs in the clinic pre-op the pts, send them to the OR and then receive the pts back from the PACU for discharge. Teamwork is a foreign concept to these RNs. The RNs were assigning themselves to OR rooms, which wasn't working. If a OR1 had 2 patients (perhaps long ortho cases) and OR2 had 8 cases (perhaps quick D&Cs), the RN assigned OR1 would just sit back and watch the RN w/OR2 get frazzled as she tried to pre-op & discharge 8 cases, which were coming going at a faster pace. Furthermore, we have more OR rooms than we have RNs. Clearly not the best idea. In attempt to remedy this, I put a rotation in place. RN A admits pt1, RN B admits pt2, RN C admits pt3. When pt 4 arrives, I go back and assign the next pt to RN A. As pts return from PACU, they get mixed into the rotation. So, as RN A admits pt 4, RN B receives pt1 back from PACU. (I hope this makes sense). Anyway, the RNs, whom I said don't work well together, get caught up in the numbers. RN A starts to complain that she has had 2 admits while RN B has had 1 admit and 1 discharge and both complain that RN C has had only 1 patient. As the day goes on, the bickering gets worse. I tried assigning some RNs to admit and some to discharge, but there were problems again. There are no discharges first thing in the morning, but the discharge nurse felt that she shouldn't have to help with admissions because she's "the discharge nurse". Again, this resulted in people sitting around watching others work. Are there any other suggestions out there?

Sometimes one just has to wonder why people went into nursing. Maybe giving them my favorate reminder that this is a paying job, not volunteer, and if they can not come to some fair,reasonable, alternative to what you suggest, then the boss rules. Allowing employee imput can inprove moral and encourage team work, but sometimes people are so use to running the show, they can not adjust. Work assignments are never fair and totally equal, because stuff happens, but it always worrks out in the end. Once they see that management is willing and able to pitch in when things happen, they will turn around I hope! Good Luck!

[RN1989]

This is the way that it was done at an ASU that I worked in. The only time that we didn't do it this way was if they came out of the OR a little unstable - especially if we had to transfer them to inpatient hospital. Sounds like they are just accustomed to wanting to sit on their butts and need something to gripe about.

[rotteufel]

Thanks for your responses. I am definitely open to the staff's opinion, but we all know how nurses can tear apart the new person sometimes. I specifically asked the nurses for their input and the answer I got back was, "You're the boss." Not helpful. One of the complaints I got about the rotation routine was that the nurses don't know who their next patient is going to be until I tell them. My expectation is that they are all RNs and they are all capable of looking at the surgery schedule and assessing the situation. There definitely is a problem with people not wanting to work.