Alaska State Hospital and Nursing Home Association | ASHNHA - … · 2020-01-22 · INTRODUCTION....
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INTRODUCTION
Transcript of Alaska State Hospital and Nursing Home Association | ASHNHA - … · 2020-01-22 · INTRODUCTION....
INTRODUCTION
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For some, you have all been expert nurses in the fields of nursing you have chosen to leave to pursue an education into perioperative nursing; you knew the culture, staff members, phone numbers, resources of your units. For some of you that are new graduates, this is all new to you. You have practiced nursing skills as the relate to floor nursing so … Now you are a novice in a brand new environment. your goal over the next 17 weeks is to understand and function in the perioperative culture. Videos:DVD OR Attire Traffic Patterns Principles of aseptic Technique Over the next two weeks this course will prepare you to feel comfortable when you walk into that strange environment. It will take a year before you feel competent every day when you go into work. By June you will have the basic skills to circulate a case. Goals are to Understand the language Develop competencies Understand the nursing process in the peri-operative environment.
Describe five domains of the Perioperative Nurse
Differentiate the roles and responsibilities of the Perioperative Nurse
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Perioperative equals admission to discharge. Perioperative services includes; Outpatient surgery, or OPS or Preop or the Surgical floor Intraop (Inpatient and outpatient) PACU Discharge Unit, Stage 2,
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5 domains of the perioperative nurse from staff nurse to future expert Your main focus is going to be as care provider, professional and researcher. Providing care to your patients, always acting in a professional manner, especially since all eyes will be on you. And you will be expected to research your assignments and look things up prior to the day of your clinicals, classes and labs. You will not be expected to take on the manager and educator role early in your experience as an official role but you do take on an “unofficial” role as manager and educator in your internship. You will learn the ways to manage your self and your team as the circulator is the one in charge of the rooms
Collect DataIdentify needsDevelop Plan of careCommunicate needs
Implement plan of CareCoordinate Activities of care
Evaluate CareCommunicate Information
PREOPERATIVE PHASE
INTRAOPERATIVE PHASE
POSTOPERATIVE PHASE
Assessment Nursing Diagnosis Outcome
Identification Planning Implementation Evaluation
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Just when you thought you’d be rid of that gosh darn Nursing process!! Guess What? It’s back. PREOPERATIVE PHASE Location of patient OP vs. IP Pre-op Nurse prepares patient OR nurse reviews this information H&P, site marking consent lab work report from nurse, hand off communication (Hand-off: SBAR, 4-P’s, sometimes written) MAKES PLAN – ASSESSMENT, IDENTIFICATION OF NURSING DIAGNOSIS COMMUNICATE INFORMATION NEXT SLIDE
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What is PNDS? Perioperative Nursing Data Set. Developed in 1993-1995 via a AORN task force. In 1999, ANA recognized the PNDS as a clinically relevant, empirically validated, standardized nursing language, specialized to the perioperative setting. This model provides the conceptual framework for the PNDS. It gives us a common language to build Perioperative Nursing Plan of Care. Based on 4 domains of Safety, Physiologic responses, Behavioral responses and the Health system with regards to the structural data elements,ie: CMS, SCIP, benchmarks, report cards, etc. In the middle, we assess patient needs, then determine desired patient outcomes, then identify our nursing diagnosis, which makes up the plan and then finally implement our planned nursing activities.
Perioperative Nursing Data Set, PNDSexamples
◦ Risk for positioning injury◦ Risk for infection◦ Risk for altered body temperature◦ Risk for injury from mechanical/thermal
sources
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PNDS = Perioperative Nursing Data Set from AORN, we’ll talk more about this coming up.
The patient is free from signs and symptoms of injury caused by extraneous objects
The patients is free of s/s of injury related to positioning
The patient is free of s/s of infection
The patient’s fluid, electrolyte, and acid-base balances are consistent with or improved from baseline levels
established preoperatively
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What kind of outcomes do we want for our patients? THE BEST OF COURSE!! for example…. Extraneous Objects, here are some of the nursing activities that we do to achieve the planned outcomes , they become 2nd nature to us and they will to you as well, in time Surgical Pause, TIMEOUT, Universal Protocol or safe surgery checklist: (site, side, procedure) new extended WHO Checklist Brief: pre procedure and De-brief: post procedure Thermal Sources=cautery, laser Mechanical Sources=positioning equipment Counts=risk for retained object Specimen Handling=risk for misdiagnosis Records Implants=risk for recall of implants Proper uses of Equip/Supplies=to prevent injury These are observable, measurable, and in response to the nursing interventions. Desired Outcomes determine the focus of the nursing interventions.
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INTRAOPERATIVE Implement plan of care…Sounds so easy- this is why you are taking this course. Learn about: implants instrumentation equipment prepping sterilization How to present a knee implant to the sterile field without dropping it, story time How to set up an insufflator for laparoscopic procedure How to position a patient in prone position How to maintain a safe environment How to organize the OR environment How to give hand-offs intra-operatively! All the interventions that occur in the intra-op phase are related to the plan of care that was developed preoperatively.
Evaluate your care
Did you meet the outcomes
Communicate important information to the other health care providers
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POST-OPERATIVE 1. Most OR records have sections to document outcomes 2. Report to PACU RN and they will report to Floor RN. for example, a handoff communication could be in SBAR format.
Quality Assurance
Read Research
Problem Solver
Integrate research into practice
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The knowledge gained from research forms the basis of nursing practice and demonstrates a relationship between nursing interventions and patient outcomes. (Policies & Procedures and Journals) EBP – For example… some RITUALS have been Disproven because of research shoe covers cover gowns Using a scrub Brush to do surgical hand preparation Research is used to demonstrate the relationship between the nursing care provided and patient outcomes (Evidence Based Practice) Identifying clinical problems participating in collecting data for research studies reading research to determine how it might apply to practice sharing research with others participating on a research committee/QA committee/Local Practice Council for Magnet Hospitals using info gained from research to initiate change in the practice setting Interns as new learners will be expected to do their own research with regards to looking up procedures the night before and printing out preference cards
Orientation for new staff
Inservice training & continuing education
Perioperative Consortium
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You will - Teach patients and family members Orient patients to surgical environment Soon you will be educating the next class of interns and sharing/teaching them insights and tools to help them become successful Advance Role of the Educator is that of the Perioperative Educator Orientation for New Hires In-service training continuing education Perioperative consortium Advanced Practice Nurse/Clinical Specialist: DEFINE! APN is a term used by the ANA to designate RN’s who have acquired advanced specialized clinical knowledge in addition to having completed a master’s or doctorate degree. 4 such roles CRNA, CNM, NP & CNS. AORN Definition: Periop Advanced Practice Nurse Competency statement: “The periop advanced practice registered nurse (APN) is a clinical expert in the management of individual and groups of surgical pts. The APN anchors nursing practice to evidence based science to achieve pt-sensitive outcomes. Multidisciplinary collaboration to effect positive changes in surgical patient care is a hallmark of this specialized role. The APN consults, teaches, and role-models desirable behaviors and evaluates the results of nursing interventions on pts. The APN meets established criteria and manages resources to attain high-quality, cost-effective care. Productive collegial relationships, acute assessment of organizational culture, and exemplary leadership skills are essential for successful APN practice in the organization. The APN possesses a wealth of knowledge concerning applicable standards, guidelines and regulations and uses this knowledge to analyze, direct, and facilitate the preoperative, intraoperative and postoperative phases of superior surgical patient care. To function in the role, the APN must possess a master’s degree in nursing….”
“In order to be accountable, nurses act under a code of ethical conduct that is grounded in the moral principles of fidelity and respect for the dignity, worth and self determination of the patient. Nurses are accountable for judgments made and actions taken in the course of nursing practice, irrespective of health care organizations’ policies or providers’ directives.”
ANA Code of Ethics
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Pts trusting us, while they are asleep, to watch out for them, protect them, take care of them. A HUGE amount of trust! Nursing is the most trusted profession; don’t screw it up!
Ethics
Role Model
AORN membership
Certification
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Ethics= The study of values in human conduct Abortion DNR Making an ethical decision refers to determining what is the morally right thing to do in a given situation Trauma situation Counting and sterility vs. saving the patients life Role Model= Right now looking for a perioperative role model In the future you will be a role model AORN membership-highly recommended that all of you become members to this association Certification= Eligible in 2 years (CNOR)
Conscientiousness
Efficiency
Sensitivity
Open minded
Flexible/Adaptable
Supportive
Communicative Listens/Even tempered
Versatile
Analytic
Creative
Sense of Humor
Manual Dexterity
Stamina
Hygiene
Ethics
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Conscientiousness=no compromise Efficiency=time is not wasted, properly prepared Flexible‘/adaptable=able to cope with changes in routine listens/even tempered=professional, hostility and anger have no place in the OR Versatile=knowledgeable and can trouble shoot Analytic=knows the hows and whys of each task Sense of humor=can ease tension at appropriate times Hygiene=body odors can be offensive and cause discomfort
WHAT IS GOING ON BEHIND THIS DOOR?
OPERATING ROOM MYTHS REVEALED AND TRUTHS DISCOVERED!!
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We also know that there are myths and misconceptions about what the staff in the OR do… We also know that there are certain things that we do in the OR for a reason that may not make sense to someone who doesn’t work in the OR so we are going to discuss what we do and why we do it that way….
**the awareness that develops
from a knowledge base of the
importance of strict adherence
to principles of aseptic and
sterile techniques
*Remember, “ Do unto the patient as you would have others do unto you”
*Treat the patient as if they were a member of your own family
*Mary Louise Kohn- “the patient is the reason for our existence”
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This is the OR staffs mantra…. Because we have specialized knowledge about sterile technique and aseptic practices, we are aware of what constitutes a break in sterile technique. We are a team and we are looking out for each other If one of the team members observes a break in technique, then it is brought to the attention of the team and corrected. It is not a grey area, its black or white, it’s sterile or unsterile and there is no debating the issue
In OR area: Scrub top/bottom/warm
up jacket Surgical hat Shoes w/ booties No jewelry, watches No artificial nails, nail polish No clothing laundered
outside of facility No perfume
In OR w/ open sterile supplies or Surgery started: Same as above Mask Eye protection
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There is a strict dress code in the OR. Meant to provide protection to the patient and the staff Scrubs with a warm up jacket to prevent microbial shedding of skin, don’t have to have a nice wardrobe for work. Could wear our PJS to work if we wanted to. Surgical hat to prevent loose hair from falling out, we don’t have to get up early in the am to do our hair OR designated shoes or outside shoes with booties on Jewelry/watches harbor bacteria, can harm the pt, scratch them, etc. Artificial nails/ polish chipped harbors bacteria-I personally live for pedicures!! Clothing laundered outside of facility can also bring outside microbes, hats are laundered by our Laundry dept. Perfume can be nauseating to patients who are ill, have been NPO Mask prohibits droplet transmission. Eye protection prevents splashing of blood, body fluids, cleaning products Visitors to this area already wearing scrubs will need to change into our scrubs if they haven’t been wearing a long cover coat. They may be able to put on a “bunny suit” a white paper coverall with hat, mask and booties…
RN duties Morning report Goes to room and starts
getting 1st case ready Look at schedule and plan for
the day Retrieve medications Ensure any special order
items/equipment are located at start of day
Discuss w/Surgeon any requests/potential complications for the day
Scrub tech duties Morning report Looks at preference cards and
pulls all instruments for the day and ensures they have everything needed for their cases
Assist with opening 1st case supplies
Scrubs in for case and sets it up
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This is a photo of some of staff just before morning report
The room is prepared for the patient
OR table is prepared for proper positioning and equipment is placed on the table and in the room
Supplies and instruments are opened
Medications are retrieved to add to the surgical field
Items and supplies needed to prep patient are organized
Scrub tech sets up sterile field and counts items as indicated
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Once the 1st case of the day is complete, the team (RN float, scrub tech, PCA) removes all trash, linen, excess equipment, wipes down all surfaces of room, tables, bed, mayo stand, OR lights, mops floor, remakes bed, places garbage bags in receptacles, brings in necessary equipment and positioning devices, brings in OR pack and supplies from case card, instruments removed from cabinet and set around, see photo above. Supplies/instruments for the case is opened. Scrub tech scrubs in and set up case RN float counts with scrub tech, gives them medications if needed, and fluids to the field. Sets up prep stand for RN, ensures that all equipment is set up and ready to go before moving on the another room This process is happening in the room while the primary circulator has taken the prev. pt. to PACU and then is moving on to OPS to bring back the next pt.
Outpatient Surgery
-Patients are “prepped” for surgery in this area
-pts come in 1 ½ hours before scheduled surgery time
-change into patient gown-all paperwork and chart is reviewed
-IV started-seen by Anesthesia/CRNA
-pre-op medications given if ordered-Labs/tests completed
-given a nerve block if indicated by surgery, Surgeon and Anesthesia MD
-seen by Surgeon, correct site marked if indicated
-H&P updated if needed-meet the RN circulator in this area
-each team member that meets the pt will identify the pt. with 2 identifiers
-patients will and do, start to get aggravated and irritated with having to
repeat all of the same questions-we tell them that it is for their safety
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Most patients come to the OR via OPS. Patients go home the same day, stay over 1 night or get admitted for an extended stay depending on the surgery complexity Some patients are already admitted to the hospital Usually patients preregister so that all paperwork, labs, tests are completed when the pts arrive RN circulator and anesthesia meet pts here
What we do…
Why we do it…
1. Patient is identified using 2 identifiers 2. Pt is asked to state what surgery they
are having and what Dr. is performing it 3. Pt is asked to show where the Dr. has
marked them if indicated 4. Pt is asked many questions related to
NPO status, contact lenses, glasses, jewelry, piercings, false, loose or capped teeth, metal implants in their body, any prosthesis, any problems with their mobility, etc.
5. RN explains what is going to happen to the pt in the room
1. *to ensure we have the correct pt for the correct surgery
2. *to ensure pt has given informed consent3.*to prevent wrong site surgery4. *pt is at risk for aspiration, corneal
damage, burns from cautery, risk for damage to teeth, risk for infection if jewelry, nail polish left on, risk for damage to fingers if rings left on, risk of nerve damage or injury if not positioned properly, if existing injury isn’t taken into consideration prior to positioning them
5. Surgery produces anxiety, it’s an unfamiliar environment, explanation of what to expect helps to relieve some anxiety
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1.There are many things the RN does for the pt.s safety that may not make sense to others Wrong site surgery is a real thing and we do not ever want that to occur. But it is possible… 2. & 3. We are very vigilant and almost obsessive about checking and rechecking name bands, consents, h&ps, etc. 4. 1 Anesthesiologist refers to it as “WE do this because you could die or be permanently injured” NPO status-risk for aspiration, pneumonia, death Contact lenses-risk for corneal damage, glasses, risk for breaking them during masking and induction Jewelry left on-risk for damage from burns, or swelling, infection Bras/underwear left on-pressure points, metal clasps in bra-potential for burns. Any surgery could turn into an emergency and we need quick access to patients chest/insert foley etc. Piercings-risk for burns from cautery. Electrocautery used to coagulate tissue, electric current, one way path, grounding pad, but could follow other means to return to console dentures/loose teeth-could be damaged, broken, chipped, knocked out and fall down into airway, obstruction-death Metal implants-risk for burns from grounding pad Mobility issues pre-op can become worse or damage can be permanent 5. Even pts who have had surgery before are anxious and some who have never had surgery are very anxious. We try to help alleviate any fears or concerns. This is the main contact with the pt. before they are induced under anesthesia, this is a short period of time to establish a relationship but it is also very important for the patient to help assess their fears and answer any questions. Once the pt. is asleep then the RN becomes the pt. advocate because the pt. can no longer speak for themselves
What we do… Why we do it… 1. Pt is introduced to the team and asked
to tell them what they are having done 2. Pt is assisted to the OR table, gown is
untied, safety strap placed across thighs, given warm blankets
3. Anesthesia places monitors on pt with assistance (or not) from RN
4. Pt will be given O2 via mask, medication to induce anesthesia given via IV
5. RN assists anesthesia and does not leave until pt. intubated, ET secure and their help is no longer needed
6. Pt is then positioned depending on surgery. Surgeon is in room at this point. All team members check position of pt
7. RN preps surgical site according to Surgeon preference and product indication
8. extensive “TIME OUT” completed before surgery starts
9. During surgery, RN is vigilant about sterile technique and observing sterile team members and protecting the pt from harm
1. *to prevent potential wrong site surgery2. *Assistance given, table is narrow, pt could
fall, safety strap applied*knots in gown not untied could cause pressure areas*OR room is cold, anesthesia causes decrease in body temp
3. *monitors tell anesthesia pt vital signs and how pt is reacting to surgery
4. *induction of anesthesia stops pt breathing and O2 sats rapidly decrease
5. *RN is needed to assist (cricoid pressure, pass the tube)
6. *Pt can be hurt during positioning, surgery, and transferring. All team members are conscious and aware of proper techniques and safety considerations*at least 4 team members needed to move a pt
7. *RN aware of prepping principles and what prep is OK to use on the body (iodine can burn, ETOH based preps need to dry), jewelry removed, name band not on operative limb
8. *TIME OUT process is to prevent wrong site surgery, make sure all team members are ready for the case
9. *RN is in charge of the room, sets the tone. *has a 3rd ear listening to what is going on at the field*anticipates the needs of the team*checks position of pt after OR table is moved
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& 2. Introduce pt to team members so scrub tech can hear what the pt says they are having done. To help put them at ease and for the scrub tech to ensure that they are set up for the correct surgery 3, 4, 5. Some anesthesia providers are high maintenance, others are low. You learn who wants your help and who is OK to do their own thing RN presence very important during induction, RN needed to stand by and assist. Cricoid pressure is used to prevent stomach contents from entering airway during intubation, pts with GERD, not NPO 6. We put patients in many positions and all can lead to injury, even supine. Put their legs in the air-lithotomy On their side-lateral Face down-prone 1 leg in traction-fracture table All team members are involved in positioning. All are responsible and check pt that limbs, etc are padded 7. Area being operated on need to be prepped to remove microorganisms, to assist with preventing infection Piercings need to be removed if they are going to be in the operative field, due to risk for burns and risk for infection. Jewelry harbors bacteria Same with nail polish. It harbors bacteria and can interfere with pulse ox reading Rings on operative limbs need to be removed…the whole arm or leg is prepped completely so if they are not removed, the finger/toe will swell and constrict circulation Name band on wrong wrist occurs a lot… 8. Safe surgery time out…has many steps, all for pt safety. Briefing, time out, debriefing 9. RN has many responsibilities during surgery….observing, listening, assisting, checking the patient, documenting.. Some cases are very fast some are longer….
What we do…
Why we do it…
1. RN secures dressing, drains, tubes
2. Scrub tech wipes prep/blood off pt
3. Team members move pt back to supine if needed
4. Pt redressed, covered up, warm blankets given
5. Pt transferred to stretcher/bed
6. RN stays at head of bed to assist anesthesia with extubation
1. *to prevent the dressing, drain, tube falling off/out
2.*prep left on pt can be irritating, burn, body fluids can be disturbing to pt
3. *pt needs to be put back in supine position, legs lowered together and slowly if in lithotomy
4. *hypothermia is a result from anesthesia, can delay healing
5. 4 team members needed to safely move pt. goes to PACU on stretcher/bed
6.*pt emerging from anesthesia can be restless, unpredictable, harm themselves, have airway issues
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Don’t secure drains/tubes to pt gown, they could be pulled out if gown removed, etc. 2. Pts don’t want to see blood on their skin after surgery, under the dressing and on the sides of the patient … Iodine preps if left on can burn and be extremely itchy (dan shoulder surgery) only betadine used on mucous membranes, vaginal prep, scrub has soap in it, etc. Chlorhexidine w/ alcohol (Chloraprep) is hard to come off and meant to stay on to provide prolonged anti microbial action
PACU-Post Anesthesia Care Unit•Pts come to PACU after General/Spinal
anesthesia
•If local w/ sedation can go directly to Stage 2
•Pts usually spend 1-2 hours in PACU
•RN from OR/Anesthesia provider gives report
•Pt is placed on monitors and observed
•Pain/nausea medications given
•Anesthesia provides the orders for the pt while they are in PACU
•RN completes OR record
•RN reports back to room to assist with next set up OR carries on to OPS to pick
up next patient
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Pts come into PACU via stretcher or their own bed if a more complex surgery, total joint, ACL, large bowel resection, 2. Can go directly to stage 2 if OPS and only had moderate sedation w/ local 3. Anesthesia directs the pt care while they are in PACU. If pt. condition deteriorates, then Anesthesia Dr. is called Anesthesia gives main report with regards to health history, medications given, vital sign trends, what surgery was done, blood loss and fluids given OR RN add on to this report and gives info related to dressings, drains, tubes, Foley, local medications, etc. Pt is observed for potential complications. It can occur, pts have issues with bleeding post op, and have to come back to surgery urgently RN completes OR record and then depending on staff availability can carry on to get the next patient to promote efficiency or returns to the room to help turnover then goes to get the next patient. It is our plan to have enough staff available to allow RN to carry on from PACU to OPS…
EQUIPMENT AND ROOM SET UPS Positioning devices-equipment to
hold heads, arms, legs, knees, place patients prone, lateral, lithotomy
Not just 1 kind but many, mcconnellheadrest, mayfield headrest, strykerknee holder, blue knee holder, mcconnel arm holder, peg board, bean bag, etc…….
Special OR tables-able to X ray through
Video towers-laparoscopic surgery, take pictures/video/hi def
Special cautery machines-urology/gyne
Ultrasounds Lasers-holmium, CO2, KTP/YAG,
green light, etc……. Consoles for power sources-Stryker
command, styker TPS The equipment that you use in the
OR is dependant on what Surgical service it is, the surgery you are doing and the surgeon’s preferences
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Upper photo is basic ENT set up with microscope and white cart with some consoles on it. Light source, special ENT cautery Don’t let this photo intimidate you. Not all of this equipment is used at the same time. Usually up to 4-5 different towers/consoles are used at a time with up to 3-4 different positioning devices needed at the same time. Most cases, start with basic OR table, pts have SCD compression stockings, Kpad and Bair hugger…. Example, one of the most complex = Total Laparoscopic Hysterectomy (removal of uterus laparoscopically) tower, slave, enseal, wolff kleppinger, morcellator, PALS stirrups, shoulder restraints, arm sleds = 9 Least complex = inguinal hernia repair= 0 Lower photo is one view of our main equipment room. Shown are some video towers, tables, IV poles
Circulator-RN Scrub tech-Certified or on the job trained, RN Anesthesiologist-MD,
working on their own or supervising CRNAs
CRNA-certified registered nurse anesthetist, operates under the direction of Anesthesia MD, RN with specialized training
Surgeon-MD/DO with special training, General, Gyne, Plastics, ENT, Vascular, Urology, Orthopedics, Podiatry, Dental,Opthomology
Assistant-another surgeon, Physician Assistant (PA), Nurse Practitioner, Medical student, another OR team member
Unit Assistants/OR aide-team member, assists with turnovers, picks up patients, assists with stocking rooms of supplies
Manager/Director-oversees administrative duties
OPS staff-prep the patients PACU staff-recover the
patients SPD staff-sterile processing
department, decontaminate, wash, sterilize OR and hospital items
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Circulator is always an RN Scrub tech can be an RN, only a few RNs were trained to scrub in their programs. We have some staff who were scrub techs 1st and then went to nursing school to become RNs Anesthesiologist=my favorite Drs, work with them for your entire shift most times, you get to know them and they get to know you and you gain their trust because they really do need your help. CRNA can do almost the same as the DR but operate under their direction surgeons= no open heart or neuro but we are getting a new Dr. neurosurgeon to do back/neck surgery Assistants=mostly other PA or NP, we get med students from WWHAMI program-we have to watch them very closely Students- nursing students, paramedic students, job shadows, OR aides-orderlies assist with turnovers and gather needed equipment, fetch patients from the floors, run the OR schedule, SPD staff=very important to the smooth running of the OR. All items are cleaned, decontaminated, sterilized in the dept. next door to ours. They assist to turnover needed sets that we have limited # of to ensure the surgeries are not delayed We can sometimes have a large number of people in them…due to size of our OR rooms, we sometimes have to limit how many can be scrubbed in at the field or even just observing.
Myths….. Truths.… We sit /stand all day Surgeons yell and get mad You never get to do anything
interesting or scrub in for cases You use one set of instruments
for all of the surgeries There are no 12 hours shifts The staff in the OR are “clicky” OR nurses are mean and they
yell at you You never get breaks You have no patient contact You are nothing but a
“gopher” (go for this, go forthat)
You are only sitting when you are charting, everything is going smoothly
Surgeons respect you and appreciate what you do, if they are upset, it’s usually not directed at you…
Our work is interesting and we do train RNs to scrub…
There are over 100 different instrument sets that we use, in addition to separate instruments, supplies and equipment
We have 8, 10 and 12 hour shifts We have to work together as a team, we
don’t get out of our dept. much… OR nurses are “watchdogs”, so if they
observe a break in sterility, they will tell you
Our work is physical, fast paced, no floats to our area, breaks are important
You have a short time to establish a relationship, then you become the pt. advocate
If you prepared for your cases, then you should not have to do any running, if you do need to “go for” an item, you do it urgently
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Sit on our butts all day or stand all day-even when you are sitting, you are on guard and not really relaxing…. It is a different atmosphere in the OR, the surgeons rely on you to get them what they need and they do appreciate you if you are making an effort. Some cases get stressful and they do get frustrated and may get loud or yell, not very often In my opinion what I do is very interesting if you think about new technology, some of the bigger cases, total joints, ACL reconstruction, latest ones are the total laparoscopic hysterectomies, even a minor procedure is interesting and takes preparation and knowledge of it to best prepare for it. We do as part of our new training program, teach the RN basic scrubbing principles As you will soon see in the next slide we have an over abundant amount of equipment, instruments, supplies, We have 7-3:30, 7-5:30 and 7-7:30 shifts, our main shift is 7-3:30 but we have staff with preferences of 12 hour shifts and that’s what we try to give them if possible, we don’t have a set schedule. It is based on the call sign up as the staff sign up for their own call. The OR is a very specialized place to work and every team member has their own duties and responsibilities. All members have to know their job and be able to work together to achieve the best outcome for the pt. There is a great deal of trust involved in working in the OR. I need to trust my team that they know what to do and there is no cutting corners here…we really do not get out of our department, except for lunch, short, only 30 mins. We stay in our department because we need to be available to return to our room in case of an emergency….so it may seem that we keep to ourselves but its because we have to…we have a nice lounge with comfy couches as seen above We are a friendly group with positive attitudes and a teamwork approach to our jobs…we are on constant guard so if we see an error or mistake we will bring it to the team’s attention. In some instances of visitors to our area. (lab, med students) with not a lot of sterile technique knowledge and are not aware that they have made a mistake, then we may have to be more vocal to get their attention To us, we try very hard to give breaks. The float pool can not come to our area when staff call in sick, we work short or call in staff who may be on their day off. We know what it is like to work short staffed and so we do our best to help each other Patient contact is limited yes and for a short time, some staff enjoy that, but you have a short time to establish a relationship with that pt. then they are drifted into unconsciousness and then cannot speak for themselves and this to me is a very important responsibility Yes you have to do some fetching of items or supplies. If you take pride in your job, try to be as prepared as possible for you cases, then you should have as much ready as possible so that the amount of running you have to do is limited. Time is precious and surgeons are impatient , so when you do have to go for an item, you move your butt but don’t run, that alarms your co-workers
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Presentation Notes
suture cart. Color coded and we have hundreds of suture to choose from and each one has different purposes. Absorbed by body, not absorbed, different needle types, cutting vs. taper, etc. Top right and bottom right are some carts in our center core that have sterile supplies, and instruments, the instruments are in blue wrappers. We have close to 20 different carts in our center core and then have them distributed to other areas and rooms also Middle picture is our employee of the month for October. We vote each month and announce it at our monthly staff meeting We have a sunshine club where we recognize staff’s birthdays for the month. We get them a card and a balloon on their actual birthday and then have a cake on the 3rd Thursday for them We have BUNKO, showers, etc. Lower left picture is more of the equipment room, again don’t be intimidated Picture of the 2 staff scrubbed in setting up, you can see that they both are smiling by looking at their eyes. In the OR when we are working in a room, we are completely covered up. Hat, mask, eye protection but you can still see and be able to tell how your team member is feeling that day by the expression in their eyes and the tone of their voice. With experience, you can “read” your Dr. or scrub tech. You can tell if they are starting the day in a bad mood. You can tell during a surgery if things aren’t going well by the tone and volume of their voice. If you are charting your case and listening with your 3rd ear and you all of a sudden hear your Dr. raise his voice or the volume of the conversation goes up, I stop, get up and go closer to the field to look and listen to what is going on…. I can hear the tone of the O2 sat monitor go down I can hear when the suction of fluid increases
Presenter
Presentation Notes
There are many domains of the Perioperative nurse. They are incorporated into your role every day There are many opportunities for growth in the peri-operative environment It is ever changing and there is always something new to learn. With the results of emerging technology and research, your job will always be in demand Welcome to this new world! Congratulations!!
