Taking Time for a Time Out!

This is a great example of how the surgical team keeps a patient safe... It is practiced in operating rooms across the U.S. and is now being adopted by surgical teams in developing countries. Watch as this surgical "Time Out" is performed.

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Wait and See

Officially Ousted

It happened... I can't believe it, but it finally happened.

The crazy Dr. A can no longer perform surgery at MSTH.

It took one year of collecting information and building a case for Head Ortho Doc to finally rid our institution of a surgeon who was obviously a danger to our patients. My teammates and I found out yesterday. The information was confirmed by several other surgeons.

A collective sigh of relief was breathed.

But wait... Not so fast!

Just when we thought it was over, Nina, my team leader, warned that a lawsuit will most likely follow. I don't think he'll have a case because of the evidence stacked against him, but I'm sure he's gonna try... I guess it's wait and see for now.

* * * * *

Admini-Drama

In the meantime, it's the usual drama with the administration. Politics, politics, politics. We still need an OR Manager, but in the meantime, Nurse Educator Suzie has stepped in as Interim OR Manager. Personally, I don't think it's the right move for the OR, but it wasn't my call. Suzie, a friend of mine, came into her education role with ZERO experience. And now she's stepping in as Interim OR Manager? How does this make any sense?

When it comes to work, I'm all business. This isn't personal. I love my friend. I think she's a smart cookie, but she lacks experience not to mention vision. If she had a strong mentor to help give her direction, that would be entirely different. I am trying to be happy for her, but the business person in me is dreading what's ahead. My instincts tell me that if she wants this job, it's hers for the taking. She's developed a tightknit relationship with our Director who has the final say on hiring for that position. I don't want Suzie to fail... I want her to prove me wrong. That would be nice if it happened. OK, Suzie... You've got to step up, BIG TIME!!!

Before Suzie takes over as Interim OR Manager, an "Interim Nurse Educator" must be selected. The rumor mill has been churning since this was announced. Big surprise. There are several people vying for that position. To make things interesting, I decided to throw my hat into the ring. Why not shake things up a little? (Wink, wink)

So now it's wait and see. As far as I know, there haven't been any interviews scheduled. I'm hoping that the same thing that happened with the Interim OR Manager position will not happen with the Interim Nurse Educator position. I hope the decision will be made carefully and professionally, with experience and vision as the deciding factor, not friendship.

More wait and see...

It's not even the end of January and already 2009 has been interesting!!!

On Being an OR Nurse

This post in response to a comment made by Anonymous who wants to know "more about the job duties of an OR nurse." Basically, my whole blog has been about my experience as an OR nurse. Anonymous, it's tough to say which posts sum it up the best. I have my good days and bad days.

In a nutshell, there are two roles that OR nurses play: Scrub Nurse (sterile) and Circulating Nurse (non-sterile).

As a Scrub Nurse you would...

• Pull the necessary instrumentation for the case
• Set it up using sterile technique
• Select the appropriate instrumentation for every step of the procedure
• Pass the instrumentation to the surgeon
  

The level of difficulty varies by type of procedure. For example, repairing an umbilical hernia (general surgery) does not require the same amount of instrumentation as a total knee replacement surgery (orthopaedic surgery). In many hospitals, nurses are placed on a specific team - general surgery, neurosurgery, orthopaedic, ENT, etc. On this team, you will learn how to scrub for specific procedures. You will also be oriented to other services so that you can accomodate the needs of the department. Just because I'm an Ortho nurse, doesn't mean that's all I do. I cover traumas, vascular, neuro, gyne, and general surgery.

As a Circulating Nurse you would...

• Ensure that the proper equipment is in the room (e.g., bed, positioning aids, cautery machine, x-ray machine, etc.)
• Help the scrub open instrumentation utilizing sterile technique
• Prepare necessary medications for the case (e.g., reconstitution of antibiotics for irrigation, etc.)
• Conduct Pre-operative Interview
• Assist the anesthesiologist with hooking up monitors and assist if necessary during induction of anesthesia
• Assist surgeon/residents with proper positioning of patient ensuring patient safety (positioning is just as important in surgery as it is on the floor)
• "Prep" surgical site for procedure (using betadine or appropriate disinfecting agent)
• Record pertinent information on computer chart during procedure
• Provide additional supplies to surgical team
• Ensure that blood products are available necessary
• Handle surgical specimens (they are sent to pathology), cultures, etc.
• Answer pagers
• Coordinate cases for the day in your assigned room
• Be prepared for any emergencies (know where crash cart is, know your resources)

Much like other units, there are going to be good times and bad times. Sometimes you have to deal with a difficult surgeon. But sometimes you don't. You can develop wonderful professional relationships where people actually enjoy each other's company. Sometimes management isn't what it should be.


I chose OR nursing for certain reasons... It fits me. At least for now it does... Ultimately, you have to figure out whether or not you have the OR personality.


My advice is to be honest with yourself about who you are and what kind of environment you thrive in. Then do your homework about the OR(s) you are thinking about joining. See if you can talk to some RNs in that department and go on a tour. Hopefully you'll get a better sense of which direction you should take.

Good luck!!!

Happy New Year

HAPPY 2009!!!

So it's been awhile since I blogged about the life and times of this OR nurse. Let's catch up...

The last two months of 2008 found me more stressed out than ever. The economy impacted life at MSTH like other hospitals across the nation. Slowly but surely agency nurses have been phased out. Every time someone's contract ends, we feel a great loss. After this month, they will all be gone much to our dismay. The OR, unlike the other units in this hospital, cannot afford to lose this help. The administration insists that it will be business as usual in surgery. They think that we will continue increasing the number of cases we do every month. I hate to break the news, but if they overtax the staff, we could see an exodus in 2009.

The scary Dr. A continues to operate at MSTH. Documentation is still being collected in the effort to oust him. I think the higher ups are really trying to make their case airtight. It's about time! Maybe this is the year they can finally get rid of him...

The OR manager position is still open. Supposedly there are some good candidates in the running. A few senior nurses tell me to go for it. Who me??? Really? Um, I don't think so. As much as I would like to help our OR change for the better, I honestly don't think that's the job for me. More work and more stress does not sound appealing to me at all!

What will my next step be? Lately, I've been seriously contemplating the direction of my career. At the end of this month, it will be two years that I've been at MSTH. I want to continue growing in my career, so I need to think about my goals for the next year or two. Nurse educator (which means more school)? Team leader? Leave the OR for something else like research? Travel as an OR nurse? I don't know... Hopefully, I'll find clarity in the next month or two.

Thinking...

So much for regularly scheduled blogging, huh???

The whirlwind that is Life took over for a little while, with my work as an operating room nurse taking up most of it. I wrote of that ever-elusive balance that I am trying to maintain. Some days have been better than others. Just when I think I finally have it all figured out --- BOOM! --- something happens and I'm back to square one.

At the end the day, I always ask myself if I like my job. Even after a bad day, the answer is YES! And then that's followed by "except for..."

Well, you know how that goes. There is no such thing as the "perfect job." As long as I continue to have a passion for what I do - which I do - then I need to stick with it until my gut tells me its time to move on.

There are a few things that make me start thinking of getting out of the OR, for example, strained relationships with certain surgeons, increased call requirements, and physical stress (lifting heavy trays, etc.). When these things start weighing on me, I remind myself of all the things I love about being an OR nurse, not to mention, how lucky I am to have a job in this shaky economy.

So for now I'm just going to deal with the ups and downs of being a surgical nurse...

As for blogging, I'm wondering if I need to keep writing about OR nursing. I have a tendency to just vent. I know there are more interesting things to tell you all about.

Any requests???

And now back to our regularly scheduled blogging...

Whoa... Has it really been that long since I blogged? My apologies...

After that last post, I was bound and determined to find balance. It occurred to me that I was becoming one of the people that I can't stand being around --- the Constant Complainers. At one point, I couldn't stand myself. I had to take a Time Out and regroup.

So here I am. I'm somewhat rested, my attitude has been adjusted, and I have come to terms with the realities of working in surgery at MSTH.

* * * * * *

And speaking of realities, yet another OR Manager bites the dust. Judy was fired last week. I saw this coming. Her lack of visibility, not meeting expectations/achieving goals, etc. was unacceptable and upper management cut her loose. Good. Now please hire someone who can actually DO something.

The problem is not just finding someone who is qualified and who can handle the job. Upper Management has to accept some of the blame for the situation that we're in. In my opinion, the person in this role is set up for failure. Upper Management wants someone to improve current conditions under very limited parameters. They want a Yes Person and not someone who can and will speak on behalf of the staff who are working their tails off to run the biggest income-generating unit of the hospital.

I don't know how much the absence of an OR Manager will affect us, seeing that Judy was hardly around. If anything, it has just given the gossip mongers of the OR something else to chew on.

* * * * * *

For past few months, agency and traveling nurses have provided some relief to our overworked staff. With the state of the economy and plans to build a new tower, the president of MSTH has decided that all units need to eliminate ALL contract workers.

Huh??? I don't think that's such a good idea...

For the past week, some really great agency/travel nurses have left the hallowed halls of our hospital. Sadly, this has brought the anxiety level way up in the OR once again. The gossip mongers keep stirring the pot and the poison is spreading.

Call requirements will increase again...
We're losing an overnight nurse so that means call will be mandatory staffing again...
People are going to quit...
The sky is going to fall...

Ugh. Shut up. We're lucky to have jobs when many Americans are losing theirs. It's time to sit tight, be thankful for what we have, and see what happens.

* * * * * *

As for me, I'm definitely making sure to put ME first. I'll do my part and take call when I have to. I'm NOT signing up for extra slots. And I'm not going to overdo it and volunteer for things that I have no time for like the staff newsletter.

On a personal note, I've decided to be pickier about social engagements that I attend. For example, I got invited to a baby shower for the son and daughter-in-law of one of my mom's friends. Do ever talk to him or his wife? Nope. I'll send a gift... I have to put myself first and NOT feel bad about this. Unless I'm working, my weekends have to be for me. Because I'm worth it.

Desperately Seeking Sanity

Excuse me while I vent --- just once more time...

* * * * *

When you can't brush off the snide remarks, the passive aggressiveness, the mean gossip, and the overall negativity of your environment, what does that mean?

Does it mean that you need to just get over yourself and deal with it? Does it mean that you have to shrug your shoulders and accept that this is your fate? Does it mean that you need to put on a happy face despite everything?

Hmmm... I don't think so. I've done all that for a long time already; it just doesn't work anymore. Usually the happy-go-lucky one, it seems that I have been internalizing my frustration, allowing it to fester and grow.

The realization of my state of mind came today when I was working with a high maintenance surgeon, whose goal was to degrade every person in the room from the nurses to the anesthesiologist to his own physician assistant. By 11:00AM today I had finally reached my limit... (Obviously, it didn't take long!) I was ready to burst.

My attempts to control what came out of my mouth were, for the most part, successful. But I was just not myself. My friends tried to snap me out of it. I was grateful for their concern, but all the unsolicited advice, feeble attempts at humor, and hugs were not cutting it.

"Just let it go..."
"Everything is going to be OK. Here... Let me give you hug."
"Go home and you'll feel better tomorrow."

This just made me more crazy. I know my friends meant well, but I just wanted to be left alone to focus on my job - the charting, hanging bags of saline for the arthroscopy procedure, or whatever needed to be done.

Sometimes people just don't understand that the best thing they can do for you when you're mad or upset is to give you some SPACE. I tried to explain that to them, but it didn't seem to sink in. They were either frightened for me or they were frustrated. Either way, I had no energy to worry about what they thought. I just needed to get through my day.

I was never so happy when change of shift rolled around...

* * * * *

Today was payday. I was curious about how much overtime I worked this past pay period. Perhaps it was the reason for my current state of mind... Basically it was the equivalent of working every day for two weeks. Sad but true.

* * * * *

Balance. Time for myself. Yes, I am trying to do this. A few weeks ago I started taking dance lessons one night a week. I have been committed myself to this and avoid call when possible. Another outlet is time with friends. This isn't so easy because our schedules often conflict. Then there's exercise; I am working on establishing an exercise routine. I started scheduling massages every other week. Don't forget blogging and reading blogs. And somewhere in between all this, I find time to sleep.

Change of Shift at Nurse Ratched's Place

Change of Shift is here... Grab a cup of coffee and kick up your feet, head over to Nurse Ratched's Place for some reading, cause it's Pulp Fiction Week!

Burning Out

Air is sucked out ever so slowly... You don't even notice it until you see the flame begin to flicker. Then it begins to dim.

It's the flame of energy and passion I have for my job as an operating room nurse at this Level I Trauma Center. I am trying my hardest not to completely lose it. The last two months have been very mentally, emotionally, and physically draining.

I can feel my attitude changing. It's awful... I know I'm just tired. The amount of overtime I have earned is ridiculous. I'm not one of those people who wear my overtime hours like a badge of honor. You know those types who have to tell everyone about how much they've been working so they can look like heroes.

Please. I am not a martyr. I just do what management asks me like any other working stiff. But what they're telling me with these call requirements, faster "turnaround" expectations, and earlier starts for my specialty is that I need to forego having a life outside of work.

Sigh.

The situation in the OR at MSTH seems like it's getting worse. People are tired and looking for answers. We are all trying to hold each other up. Even the most positive people on staff are having a hard time finding something good to say.

It has been two months since new OR manager started. We've listened to her at staff meetings. She has terrific ideas, but there is one major problem: she is missing in action most days.

Where the heck is she??? Corporate meetings? Perhaps a few here and there. Calling in sick? Yes --- and quite frequently.

She has great suggestions for our operating room, but what she lacks is VISIBILITY. I have also heard from other staff members that she can be somewhat harsh almost to the point of inappropriate.

Will things ever get better?

I used to fantasize that perhaps in the next couple of years I can take a leave of absence and head to Europe as a travel nurse. Now I seriously contemplate making that March 2009.

At some point, I'm not sure when exactly, I will be forced to make a choice. It will probably be a change of environment before it will be type of nursing. I love the operating room. I love what I do. I just can't do it this way...

I'm going to hang on for as long as I can because I love my team, team leader, and my friends at work. I love what I do at MSTH. However, if I can't find a way to cut down on my overtime hours, then I choose ME - my health and sanity - over everything else.