Anyone out there with advice why I should make a move from Primary care office to OR nursing?  Tell me a little about OR nursing if you would.  Thanks

I currently work in an OR and have for the last two years. I LOVE IT!!!

On the positive side: You generally only have one patient at a time. There is a doctor present at all times. Close relationship among the staff. Job is always changing with new techniques and equipment.  Makes you look at life and world in a whole new perspective due to your knowledge of what has happened to individuals.

On the negative side: You have call hours that you have to be available for the OR if needed. When staff position are not filled, you have to take more call. New staff can take up to 12 weeks to orient them. OR nurses tend to be very particular about how things are to be done. OR nursing is totally different than any other nursing you have ever done. There is blood present therefore higher risk than other areas of nursing for contact with Blood borne pathogens.

Overall, I enjoy it very much. It can be very hard and very easy depending on the case.

I worked in the O.R for over twenty years and always found it to be interesting. There is so much to learn, no two cases are ever the same. The work can be very hard, there is a lot of lifting the instrument trays are often very heavy. I enjoyed the changes in proceedures over the years.

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O.R. dynosur

Question:  In your O.R. experience of recent time do you witness the RNFA working without a general surgeon present in the O.R.

The reason I am asking is that we had a personal experience and I learned afterwards that the surgeon left the O.R. and the patient remained anesthestized for another 35 minutes. The only person in the O.R. to close was the RNFA.  From the description of the job detailed by the BRN, the RNFA is to work directly under the supervision of a surgeon.  What is your first hand experience?

I went to work at YNHH in the OR program.  At first I loved what I saw.  The learning was wonderful.  Unfortunately, not everyone wants to teach and a lot of the OR staff was very clicky.  We were warned during the entire program that the OR staff is not very friendly.  How true it was, comments were made to not make us feel very welcome.  I was glad I tried it but I was sorry it did not work out for me.  The strange thing was that our instructor a traveling nurse said all OR staff is like this and yet, I could not believe that as short as they were, that the staff continued to be obnoxious.

I have been a nurse for over 30 years starting in the OR and then moving about to pther areas but the OR keeps drawing me back.  There's something about the OR--now after a 10 year abscence, I have resolved that I will spend my remaining working years in the OR and not move about any longer.  You would think that after this long of a lapse that it would've been daunting to begin again but the OR is fundamental.  Yes, there may be new approaches and techniques but they can all be learned--the basis for the OR is always there.  You may hear that OR nursing is technical, non-patient care, etc...BUNK this is the time when the patient needs you the most--he/she is the most vulnerable and relies on you totally.  Don't think this is going to be an easy transition, it won't be--you'll have to learn ALOT, let alone learn to deal with the seasoned OR nurses, but it is worth it.  If you like things to be organized, patterned and a variety then you'll like the OR. Good Luck!!!  If you'd like to chat contact me @ ripeprunus@comcast.net    

re: OR nursing

   I've worked in several areas of nursing over the 30-some years since I graduated, including Intensive Care & Utilization.  I've been in the OR for the last 12 years & plan to stay here 'till the end. 

   Warning-it'll be @ least 5 years until you feel really comfortable.  There's alot to learn & a whole different way of doing things.  Yes, OR nurses can be difficult, but there's alot of responsibility & we don't tolerate carelessness.  If you're willing to learn & listen to what you're told, most of us are more than willing to teach & share what we know. 

   We don't have alot of time to get to know our patient, but he/she is our #1 priority & we're their front-line advocate.  We have to convey reassurance, confidence, & knowledge.

   Good luck-we need you. 

 

Since you have been in the O.R. for the last 12 years you have obviously seen many changes, both in technology and technique.  Question:  Is it legal for an RNFA to work independently without the direct supervision of a surgeon in the operating suite?  In other words, does a surgeon leave the O.R. and have the RNFA close without supervision?   Have you seen this occur?  I am most curious about what goes on with routine surgeries like hernia repairs.   Thanks.

Regarding an RNFA, I would check hospital policy & the person's scope of practice.  I have seen a surgeon leave the room briefly while the assistant closes, but he usually returns shortly. 

When you advise to check hospital policy are you saying that a hospital can override what the BRN mandates as acceptable job duties of an RNFA?

If you look at the guideline description of an assist it specifically states that they are to work under direct supervision of a surgeon. It further states what to do if the surgeon needs to leave for an emergencey, etc. Therefore, I interpret that to mean the assist is NOT to be working independently. My husband had surgery at a free standing surgi-center owned by Healthsouth Corp. and I uncovered from the medical record  anesthesia timeline and when the surgeon came out of surgery and spoke with me and his arrival to the PACU, that my husband remained on anesthesia for 35 minutes with no surgeon in the room and thus the patient had to be 'closed' by the assist (working alone). As it turned out the surgeon was in the room for a mere 15-18 minutes!  This was investigated by the BRN after filing a complaint.  They did NOTHING but read the medical file which documented none of this!  Who would document wrong-doing?   Comments please and what would you have done or said?

I do not know what you are referring to when you mention the 'BRN', nor does the RNFA I spoke with @ my hospital.  She told me our hospital policy states that the surgeon must remain within the department until the procedure is completed, therefore it is not unusual, nor against policy, for the assistant to close when the surgeon leaves the room.  After the surgeon left the room in your husband's case, most likely not all that time was  spent closing the incision.  We usually clean the prep solution from the surgical site, apply the dressing, plus wait awhile for the anesthesia provider to wake the patient from anesthesia before transferring the patient to the stretcher to go to PACU.  The surgical assistants I've worked with have all done an excellent job & are very conscientious about their responsibilities & are aware of their limitations, being careful not to overstep their boundries.  Most are certified & licensed & plan to stay that way.

Thank you for your thoughtful response.

The BRN is the Board of Registered Nursing (California) and the many pages that can be downloaded from the website actually details 'all duties and responsibilities' that the position of RNFA is allowed to do.  It clearly defines that the FA is to work under direct supervision of the surgeon. Whatever, it is spilled milk and all I can say is that we were so pissed off with the entire experience that the more we learned the madder we got.  The surgeon left the free standing surgery center in our case. The anesthesia record showed the patient taken off of anesthesia 35 minutes after the surgeon left the O.R. (that is when he spoke with me in a waiting room). The patient was moved to PACU 8 minutes after the anesthesia was dc'd. 

I surmised the eight minutes is the time in which the patient was 'cleaned-up' .

Who on the team is usually the one to remove the sterile drapes and clean the patients skin, dress the wound, and replace and tie the gown?  The other question I have is when a patient moves over to the table, what happens with the patients gown during all this procedure (prep and operation)?  How is the gown dry at the end of the operation when all this prepping is done on the table after the patient is 'out.'?

My husband had the same procedure done 18 years prior and I can tell you it was a very different experience. For one, the shave prep was done just prior to him going into the O.R. and a male did it. The surgeon was assisted with a male OB/GYN physician (no female FA).

Thanks for responding! I appreciate it.

 

I'll tell you about my experience working in an Ophthalmological Ambulatory Surgical Center OR. My eye surgeons own the center. We do 1200 cataract cases a year working 7 days a month. We also do lasik other days. I had 23 years experience working in ICU and 1 year in PACU before I moved here looking for a job with fewer holiday and weekends (this job has none and I work 6a-2p). I absolutely love it because of the camaraderie between the small staff and the surgeons, we are like family. The patients are always 'healthy' and very happy to have their procedure. The cases are repetative but the need for organization and ability to understand the unusual case keep things challenging. The trays are tiny so no heavy lifting. We are JCAHO accredited so our standards are above reproach. Nurses who work in Ambulatory Surgical Care (especially physician owned centers) need to be attentive to detail, quick, friendly and able to build safeguards into a system that moves very briskly. I wouldn't go back to the hospitals if you paid me a million bucks.

Our surgeon remains in the room until the wounds are closed, he fills out his post op orders,post op note, and could even dictate his operative procedure. They should always remain in the OR.

Dan,

What you state happens where you work is what my husband expected from his so-called surgeon. But...that was not the case. And, when confronted with it, they have denied it and it is not charted. Therefore, any complaints made to agencies that investigate actions such as this become worthless due to the fact that we learned that the investigation amounts to reading of the [falsified] medical record.  This is really a crock because they all know how to cover themselves and make a clean record.   As an RN, I found the entire experience appalling. Even the charting in PACU was fraudulent. From vitals q5 min to voiding prior to discharge! None of which occurred!   And the surgeon actually incorporated 2 pages of a H & P that was fraudulent. Claims to have done all sorts of things including a rectal! I was in the room and none of what he stated in the H & P did he do! As far as his dictated notes for the surgery (?) it was brief and was signed 5 days after the surgery took place.  This was truly a horrible experience.

It seems there is no ethics in the surgeon or this surgery center owned by Healthsouth Corporation. The sad thing is how is a patient to know any of this prior? Asking questions I don't think would have diverted any of this. He was lied to when he ask the medical director/anesthesiologist of ALL people! We wouldn't have stepped foot in this place or gone to this surgeon if we'd had a clue, that is for sure. The patient had complications and the surgeon actually refused to personally see him post-op. Instead, told him to come in and see a nurse. He rourtinely does not evaluate post-op.