When do you count ?

OR male nurse · Feb 9, 2008

correct but the "second circulator" may be a cst or cst, cfa as well as rn or crnfa. the main circulator (always rn) attends the patient and assists anesthesia while the second circulator gets counts and "feeds" the scrub whatever they may need. i hope your problem with the staff gets worked out.

thanks for the comments. it's not really a problem with the staff i'm hoping. this one time i did insist on counting first and she played a little hide the raytec game. i'm thinking it was an attention getter as to who rules the roost. our count policy states that the circulating rn must be the one to do the count. therefore someone else coming into the room can't do the instrument count for you. i have had the coodinator come into the room to help (once or twice) to do the count on the fly method. she helps anesthesia with the patient, while i counted and ran to get stuff that was forgotten. it was still busy and frustrating to be making noise while trying to put the patient to sleep.

thanks again

ewattsjt · Feb 10, 2008

I don’t think of it as being a matter of who rules the roost. Naturally the circulating nurse rules the roost. The hide the raytec was aimed at you but also a clear lack of patient advocacy.

OR male nurse · Feb 10, 2008

I don't think of it as being a matter of who rules the roost. Naturally the circulating nurse rules the roost.

You'd have to come and work here to understand. I'm the new guy and they are having fun at my expense and the safety of the patient. It's the Planet of the Apes here. The ST runs the department. If they don't want to do it, they aren't doing it. The ST's have been doing what they do for many years and it will be very hard to change their ways. Many of them have over 25 years in this place. They have a poor attitude even when labeling med cups for pouring the local into. I've already made an ST pour out a cup of local because she poured it herself into an unlabeled med cup with no second person to verify. When I did that, she rolled her eyes as if I was a jerk. I was told that I'm the only RN that actually makes them look at the label AND the expiration date before pouring. I'm a pretty easy going guy that wants to play by the basic rules of operating room decorum and safety. I've had a heated discussion with my boss as to how I'm glad the ST's are so flippant working under my nursing license. The RN is stuck in a bad spot at this hospital. I'm already looking at making a lateral move within the system or finding a job out of the network. I could write a book on how not to do things in the OR after working here.

gradyrn2b08 · Feb 24, 2008

We set up two small tables. One for laproscopic and one for open belly. Count open stuff ,cover with sterile drape and push aside. Start with Lap table, if you have to convert to open, empty mayo which should have stuff from laproscopic table only, clear surgical field of sponges have Circulator move out of room. Pull up open table. Works great and it takes about 3 minutes. I am not sure of your policy but it may help. Good Luck.

zerby1470 · Feb 24, 2008

I was told that I'm the only RN that actually makes them look at the label AND the expiration date before pouring.

God forbid that you expect that standard of care for your patients (sarcasm, here). It sounds like you are trying to put patient safety first, and if they are not able to see that, I would feel the need to leave there, as you have stated.

Count open stuff ,cover with sterile drape and push aside.

I would be unable to do this with a good sterile conscience. There is no way to aseptically remove the drape, and I believe it is also against AORN standards, but I don't have a direct link to that. Is that your hospitals policy, or just what has evolved over time?

gradyrn2b08 · Feb 24, 2008

Something I was taught by an older tech. Actually if you do not let the drape fall past the front or back side of the table and just roll it towards the side where the drape is past the edges, nothing gets contaminated. Does that make sense. also sometimes my nurse will get on oneside and myself on the other and use the end to pull the drape up and back!! Not sure of the policy, will have to check. I do know it makes counting easier and it keeps the trays seperated. Best of luck. I know the veteran nurses and techs can be horrible to the new kid in the house. Been there and got the t-shirt.

tnmtnman · Feb 24, 2008

gezzzz im lpn scrub but we count before pt enters room then once during and before closing and the rn circ is the boss but it is drilled into our heads our name is put onto that paper as to that we the count is right that type stuff i guess the bottom line is the pt care i belive and respect everyone here at our hosp being the newbie isnt fun and ya got to give it to get it at the same time ur the boss in the or and that needs to be understood i want to get my rn and be a circ anyways sounds like ur doing the right thing and best of luck

ShariDCST · Feb 25, 2008

just wondering how your hospital goes about the process of counting for your cases. where i work, it's total turmoil when it comes to counting. the scrub techs help the rn open up the case and then disappear while getting an extra 10 minutes play around time while the rn goes to pre-op to get the patient. once the rn and the patient enter the or, the tech scrubs in and then expects to count. i worked at another hospital prior to this one and it was much easier. the tech and rn opened up the case, the tech scrubbed in, the case was counted, and then the rn went for the patient. i'm having a hard time dealing with trying to count once the patient is in the room, you're expected to help anesthesia, etc, etc. and then count your case. is the place i'm working now just totally backwards, or do other hospitals out there count once the patient is in the room ?
need some input please.

i don't understand all the "head games," "power plays," "who rules the roost" and other forms of childrens' games that i've been reading between the original question and the replies that followed. this is not grade school pranks and high school nonsense - this is patient's lives, and it's all being played by people who are allegedly educated professionals.

in the time i've been on this forum. i've read about rns/nurses who think that the surgical techs are the scum of the earth, worth less than the dirt on the bottoms of their shoes, whom they abandon to do all the scut work and have the mindset that we are in some way infringing on sacred territory and are just some trash drug in off the street and taught how to hand someone a scalpel every now and then; techs who think they have the right to play "hide the sponge" from the rns and other unprofessional silliness because they're trying to make their circulator's day a hideous copy of hell on earth, who run and hide when there's work to be done instead of stepping up to the plate and doing their j o b, and think they rule anything at all outside of the sterile field, instead of behaving like the educated professionals we are supposed to be, people - and on and on and on. apparently there are also "jelly-fish" supervisors out there too who can't find a way to be supervisors and establish control and a good working environment over their own departments, letting the pettiness continue and flourish.

i'm confused here - where is the teamwork and the mutual concern for the benefit of the patient?? i'm afraid that's what i thought this was all about. but, there doesn't seem to be much of that going on - it sounds like there's a whole lot of "don't you dare disrespect me" going on, and everyone has lost sight of the real reason for doing what we do - the patient. and, no, i'm not some wide-eyed, fresh, innocent "newbie" who wants to change the world single-handedly. i've been doing this for a long time, and working in general even longer.

i interviewed for a job recently at a very small rural hospital where i was told outright during the interview by the or director that the staff, including the techs and the rns, were all a petty bunch of gossips, and went out of their way to make new people feel unwelcome and uncomfortable, and spent their time in their little "cliques" cutting people up and having them for lunch. of course. she did not "approve" and said it stopped when she was around - but geeeez-o-petes! :uhoh3: i just looked at her like she had turned green with purple spots. when i regained my composure, i apologized for wasting her time, because that certainly was not the atmosphere i would voluntarily choose to join, wished her a good day, and i left. it simply boggles the mind.

i have worked in places where or techs who have been there longer - and no offense to anyone who doesn't fall into this category - and they were always the military-trained, uncertified techs, who went out of their way to "set me up" or "throw me under the bus" during cases when i was new. i have been in one hospital with "ojt" techs who had been there for donkey's years who outright and outspokenly resented the certified techs, and i was not even allowed to have my professional credential "c.s.t." on my name badge because - and this came straight out of the or supervisor's mouth - "we don't want to make them feel bad because they can't take the test and be certified too." :bugeyes:

i have also worked in a very few places where there has been someone kind and knowledgeable who immediately took me under her wing - always a female - and made sure i was introduced around, found my way not only around the department and the hospital, but the local area as well, guided me in getting to know the procedures and routines, and just generally made my life a real pleasure there - one such individual has been my best friend for 9 years now. :bow:

and then there is always the "middle ground" that is neither hell or heaven - but some sort of limbo in between. but it always seems to come down to this - the folks who are insecure, in fear for their jobs, their positions and their place in the grand scheme of things and the petty little hierarchies that are allowed to flourish - and they let it come out in how they treat others by being defensive, and offensive and generally unpleasant all the way around. it doesn't matter if they are surgical techs, rns, housekeeping staff, unit secretaries or what have you - the goal gets lost in the egos. how did we lose the patient in all this hubbub? can we find them again? or is it all lost in personalities and egos?

by the way - where i was before, and any place else i can make this work, i set up the case before the patient is even in the room, have time to count with the circulator before she goes to get the patient, scrub out to help with getting the patient situated and assist the circulator with anything i can, while being in the room to guard the sterile field, scrub in when it's appropriate to gown and glove the staff, and do my case. clean up never "starts" - it's a constant process during the case. clutter on the back table is verboten and handled accordingly. there are always emergencies that don't allow for such coordination, but then we do the best we can to take care of the patient, stay safe and clean up the mess afterwards. the rn is in charge of the room, but then i am not just some toady who "does what she's told" either - i have training and experience and some latitude to act on my own when necessary and appropriate. and i would never take any fluid of any kind on my field without reading both the label and the expiration date first, and all are properly labeled once on the field. it's not a game - it's my j o b - and i take it seriously. i've had a nurse actually roll her eyes at me, turn away and throw the bottle in the red bin when i asked to read the label and the expiration date on a medication. if it's already poured on my field, and i can't get that information, off it goes. i don't play that, and the supervisor will know about it and take care of when i'm done. (the nurse responsible for that bit of unprofessional behavior was reprimanded immediately by the unit charge nurse and it never happened again.)

now, please don't think i have it "in" for nurses. or even other techs. as a whole, i love most of 'em. and i don't "have it in" for anyone in particular. but like everywhere else, there are always exceptions. and nurses are those with whom i have the most contact and direct professional relationships. there's nothing that makes my day better than a professional, attentive and knowledgeable circulating nurse who knows her job, does it well, and takes care of business during a case. and nothing worse than one who ignores me, makes me repeat myself three times when i need something, leaves her trash all over the room instead of throwing it away and spends her "down time" during the case leaning against the blanket warmer door and chatting with the anesthesiologist, leaving the room a complete shambles, and disappearing with the patient at the end of the case, never to be seen again. yes - that's happened too.

nothing in this world is perfect - and as long as human beings are involved, it never will be. but can't we try and make it as close to ideal as possible and support each other in the process?? is this always going to be an elusive, though desirable, goal that we will never find?

zerby1470 · Feb 26, 2008

Thank you Shari. It is far to easy to forget the patient in the silly power struggles on both sides of the coin. If we are not there for the patient, the team suffers. My job is no more or less important than the housekeeper that properly cleans the room, or the food service worker that provides the proper nutritional requirements to the post op patient to facilitate proper healing. We are all grown ups. If the patient is truly first, then the games should fall by the wayside in their care. I wish that some that I work with could remember that during the pedantic power plays from both sides of the sterile field.