Circulating OR nurse frustration...vent

[gasman2014]

Graduating anes resident. Worked with graduating urology resident on Friday. Cases going great. He's operating fast, I'm anesthetizing fast. We made a goal before the first case to immolate PP as much as we could. 10-15 minute turnovers for me, he and his attending never left the operating suite......until.....the damn circulating OR nurse stretched the turnovers in a deliberate and progressive fashion (God forbid we actually FINISH the work in a timely manner). The first turnover hit 45 minutes (academics, she's known to be obstructive...shrugged my shoulders, got something to drink). The second turnover hit 1 hour (me and the uro resident both say something to our respective attendings...you guessed it, nothing happened).

The third turnover hit 1h 45m. At this point i'm extremely frustrated. I confronted her about it in the OR: "We're still counting." Scrub tech told me that was total BS. I then found her in the OR staff lounge loudly discussing something about how her son knows some actor in Hollywood. I suggest to her firmly that we need to get the case done. "We're still counting. I'm waiting on more stuff from sterile processing." Remember, scrub tech had already told me this was BS and she was ready. Oh, and the nurse in question hasn't received report from the preop nurse yet....so because of all the questions she has to ask (and her willingness to do so efficiently /sarcasm/) this will add another 20-30m before I can get the patient. I go and say something to her nurse manager. "Oh that's just so-and-so." I start seeing red. I walk to the preop area and she's FINALLY there, but now she's BS-ing with the preop nurses about her other son who knows some rapper in atlanta. I start to lose it. I notice my voice is beginning to raise as I start into her about piss-poor patient care, etc etc.

I stop and realize I have 8 clinical days left of residency before moving for fellowship, take a deep breath and just go sit with the uro resident, who is equally as pissed off as I am, and just wait. After the case (finally) went and we got the patient safely in the PACU, I left and had a nice high gravity brew.

/vent

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[jwk]

Graduating anes resident. Worked with graduating urology resident on Friday. Cases going great. He's operating fast, I'm anesthetizing fast. We made a goal before the first case to immolate PP as much as we could. 10-15 minute turnovers for me, he and his attending never left the operating suite......until.....the damn circulating OR nurse stretched the turnovers in a deliberate and progressive fashion (God forbid we actually FINISH the work in a timely manner). The first turnover hit 45 minutes (academics, she's known to be obstructive...shrugged my shoulders, got something to drink). The second turnover hit 1 hour (me and the uro resident both say something to our respective attendings...you guessed it, nothing happened).

The third turnover hit 1h 45m. At this point i'm extremely frustrated. I confronted her about it in the OR: "We're still counting." Scrub tech told me that was total BS. I then found her in the OR staff lounge loudly discussing something about how her son knows some actor in Hollywood. I suggest to her firmly that we need to get the case done. "We're still counting. I'm waiting on more stuff from sterile processing." Remember, scrub tech had already told me this was BS and she was ready. Oh, and the nurse in question hasn't received report from the preop nurse yet....so because of all the questions she has to ask (and her willingness to do so efficiently /sarcasm/) this will add another 20-30m before I can get the patient. I go and say something to her nurse manager. "Oh that's just so-and-so." I start seeing red. I walk to the preop area and she's FINALLY there, but now she's BS-ing with the preop nurses about her other son who knows some rapper in atlanta. I start to lose it. I notice my voice is beginning to raise as I start into her about piss-poor patient care, etc etc.

I stop and realize I have 8 clinical days left of residency before moving for fellowship, take a deep breath and just go sit with the uro resident, who is equally as pissed off as I am, and just wait. After the case (finally) went and we got the patient safely in the PACU, I left and had a nice high gravity brew.

/vent

IMHO - eight days left and you're worried about this?

Who cares? You're leaving. Move on.

 

[Psai]

Don't immolate pp, I need it to get away from this place.

Our circulating nurses are pros at going slow with turnover in an attempt to keep the addons from their rooms. Doesn't make much sense to me since they leave at 3 or 7 no matter what and it's the job they're paying to do. It's not exactly that arduous, especially compared to floor or icu nursing. Then when the addons finally get going, they end very late because of all the games the nurses played all day. It's miserable to go home late because someone else wanted to sit around playing candy crush instead of doing their job.

 

[Man o War]

These exist in every place I’ve ever worked except surgery centers where surgeons own it.
Not worth it to argue with them, they just get passive aggressive and move even slower.

 

[Ronin786]

You've got 8 days left in residency. Burn the bridges.

 

[BobBarker]

Just let it go.

 

[dannyboy1]

You will see the same thing out in practice. Really should be no surprise as these people are shift workers and there seems to be no consequences for this type of behavior. Human nature is what it is

 

[San Marzano]

You gotta forget about this kinda stuff ASAP or else you’re only frustrating yourself. It’s pointless to try and speed something up that’s out of your control. And think about how much you cringe at a whiny surgeon whenever he or she is being loud about not getting things done his or her way... not a good look to portray. I’d much rather be the chill guy in the background who lets this **** slide and then leaves the hospital in due time to actually start enjoying the aspects of my life that I can control.

 

[Monty Python]

... The third turnover hit 1h 45m ... I go and say something to her nurse manager. "Oh that's just so-and-so."

I don't see how the person responsible for OR turnover metrics, efficiency, hired staff utilization, ROI, etc, can escape accountability for this. Is there no OR business manager (or similarly-termed person) in the picture?

 

[drmwvr]

We made a goal before the first case to immolate PP as much as we could.

...sounds like the circulator was immolating pp

 

[deleted171991]

If the surgeon couldn't fix it/didn't care, you won't either. Get your senioritis under control, bow your head. You are a nobody, and will stay a nobody for a very long time. The sooner you get used to it the happier you'll be.

 

[MoMoGesiologist]

One hour turnover for urology cases?! Are you sure? That seems extreme. Maybe these are the big urology cases like RCC with caval tumor resection... or maybe you're at the VA.

I've stopped trying to have fast turnovers. The nail in the coffin was when the last surgeon said "What took so long?" when I busted my butt trying to turn over quickly. Never again!

 

[Laryngophed]

Don't immolate pp, I need it to get away from this place.

Our circulating nurses are pros at going slow with turnover in an attempt to keep the addons from their rooms. Doesn't make much sense to me since they leave at 3 or 7 no matter what and it's the job they're paying to do. It's not exactly that arduous, especially compared to floor or icu nursing. Then when the addons finally get going, they end very late because of all the games the nurses played all day. It's miserable to go home late because someone else wanted to sit around playing candy crush instead of doing their job.

At 1400 every day, you can count on the turnover to double. Every single day. I call it, wait for it, wait for it... the 1400 slowdown. I once heard a circulator say "it don't make no sense for me to start this case (at 1415) 'cuz I leave at 1500." I nearly died on the spot. I couldn't and as a graduating resident continue to be unable to see the sense in it. Some of our circulators are excellent. Helpful, professional, efficient. We can have big cases turned over in 25-30ish minutes at an academic place. That isn't bad. But some know how to slow it to a grind.

You've got 8 days left in residency. Burn the bridges.

Shock and awe. Ballsy. I'd like to watch.

 

[Morzh]

immolate = to sacrifice by burning

emulate = trying to become as someone else is

Sorry to be the grammar Nazi... Maybe you meant immolate after all. Both could be appropriate

 

[deleted171991]

At 1400 every day, you can count on the turnover to double. Every single day. I call it, wait for it, wait for it... the 1400 slowdown. I once heard a circulator say "it don't make no sense for me to start this case (at 1415) 'cuz I leave at 1500." I nearly died on the spot. I couldn't and as a graduating resident continue to be unable to see the sense in it. Some of our circulators are excellent. Helpful, professional, efficient. We can have big cases turned over in 25-30ish minutes at an academic place. That isn't bad. But some know how to slow it to a grind.


Shock and awe. Ballsy. I'd like to watch.

They don't get paid more for working more/better. The fault lies with the managers. All humans respond to the right incentives.

 

[MirrorTodd]

They don't get paid more for working more/better. The fault lies with the managers. All humans respond to the right incentives.

I've always found drill sergeants to be effective motivators.

 

[Arch Guillotti]

Here is my suggestion:

last day of residency was ,without a doubt, one of the best days of my life... I was on call, 3am get a call from burn unit to emergently intubate a big guy that had been 50% burned upper torso with smoke inhalation. Half a stick of stp and 100 o' sux-- all edema. I told myself i wasn't goin' out like this. Just rammed a 7.5 where i thought it should be and it slid in. Bs bilateral and pcxr was solid. O2 sats golden and rt lady all happy. No procedure note, no charge sheet. Beeper left at or board when no one was lookin'. Slid out hospital at 0645 with no goodby's, thank you's or gonna miss you's. Got to the apt. And loaded up u-haul with 100% va disability, 100% ss disability uncle( vietnam, agent orange, ptsd--you know the bogus gig). Letter and keys in an envelope dropped in the apt. Night box. No change or forwarding of address with post office, no cares about apt. Or electric deposits. Zippy done evaporated! Roll on out at 1700 with floorboard boom box playin' "comfortably numb", and a bottle of chilled wild turkey in the ice chest. Uncle drivin' and on outskirts of town we light up a big fat doober. I told him not to shut off the old biitch until we were home. Ole hunter thompson didn't have a thing on us that night... Regards, ---zip

 

[MirrorTodd]

Here is my suggestion:

This is what I was gonna suggest...

 

[Ggoodman]

As an or manager who bust his ass to get things done I would be so far up this nurses rear you could hear me singing. That’s said I have told many a doctor when we are running 20 rooms I cant be everywhere at once, help me help you. I agree you shouldn’t have to but my CTS rushed the spit out of a team by helping them. When I was not an Anm and in ARNP school I was on the cardio and Neuro teams. My docs bought me lunch we had team building at the local bar the paid the bill. The translated to close dedicated teams. Do this and your teams will know what your going to do before you do it and will bust their ass for you. Ie 15 min turnovers for multi level fusions. There is another dr I can not stand, he has alienated himself to the point no one wants to work with him so he gets all the newb’s his turn overs are long and I make a point to avoid him.

Point here is how you play with others and take care of your people impacts the service you receive. The hospital system is indiscriminate of great vs terrible nurses scubs and support staff.

My 2 cents

 

[anbuitachi]

As an or manager who bust his ass to get things done I would be so far up this nurses rear you could hear me singing. That’s said I have told many a doctor when we are running 20 rooms I cant be everywhere at once, help me help you. I agree you shouldn’t have to but my CTS rushed the spit out of a team by helping them. When I was not an Anm and in ARNP school I was on the cardio and Neuro teams. My docs bought me lunch we had team building at the local bar the paid the bill. The translated to close dedicated teams. Do this and your teams will know what your going to do before you do it and will bust their ass for you. Ie 15 min turnovers for multi level fusions. There is another dr I can not stand, he has alienated himself to the point no one wants to work with him so he gets all the newb’s his turn overs are long and I make a point to avoid him.

Point here is how you play with others and take care of your people impacts the service you receive. The hospital system is indiscriminate of great vs terrible nurses scubs and support staff.

My 2 cents

I think this is highly variable. definitely important to build good relationships with your team. but at same time, being all buddy with them may not speed things up. They may think you are chill and take their time, or just do things the same way but just be nicer to you.

Though being in academic, i personally dont even want 15 min turnovers in big cases like multi fusions, cause the nurse will always write down anesthesia delay since being the anesthesiology resident means i'm pretty much alone.
The surgeon just waits for a team of techs/nurses to set up the room for him. The resident/attending surgeon dont got to do anything but tell them what they need. meanwhile the anesthesiology resident has to drop off the patient in PACU, give signout, put in orders/note. (10 minutes right there, often more if PACU nurse is slow). Then we have to go set up the room (assuming anes tech turned over your workstation in the 10 min you were gone), set up vent workspace. 2 IV, arterial line, draw up drugs. Then talk to patient, look them up if needed, before wheeling them in. No way this takes <15 min in academic institution.

 

[Ronin786]

I think this is highly variable. definitely important to build good relationships with your team. but at same time, being all buddy with them may not speed things up. They may think you are chill and take their time, or just do things the same way but just be nicer to you.

Though being in academic, i personally dont even want 15 min turnovers in big cases like multi fusions, cause the nurse will always write down anesthesia delay since being the anesthesiology resident means i'm pretty much alone.
The surgeon just waits for a team of techs/nurses to set up the room for him. The resident/attending surgeon dont got to do anything but tell them what they need. meanwhile the anesthesiology resident has to drop off the patient in PACU, give signout, put in orders/note. (10 minutes right there, often more if PACU nurse is slow). Then we have to go set up the room (assuming anes tech turned over your workstation in the 10 min you were gone), set up vent workspace. 2 IV, arterial line, draw up drugs. Then talk to patient, look them up if needed, before wheeling them in. No way this takes <15 min in academic institution.

There's no reason not to do that before you leave the room with the last patient (JCAHO be damned). As a resident I rarely stepped foot into the OR between cases until I was bringing back the next patient. With 40 minute turnovers, I had at least 20-30 minutes to myself in between cases. And if they ever needed 15 minute turnovers, it made no difference to me.

 

[anbuitachi]

There's no reason not to do that before you leave the room with the last patient (JCAHO be damned). As a resident I rarely stepped foot into the OR between cases until I was bringing back the next patient. With 40 minute turnovers, I had at least 20-30 minutes to myself in between cases. And if they ever needed 15 minute turnovers, it made no difference to me.

Thats another part of being a resident. It depends on the attending, some let us do a dry setup and keep it in the corner, others dont. Especially after the last JCAHO visit, our institution has gotten more strict in many areas.
And some patients have no information on EMR if they are coming from home. Their information is in their paper chart which you wont be able to see until you are in holding with the patient. Same with talking to the patient. If everything goes smoothly pre op can be quick, but it can easily take longer than expected for many reasons (anxious patient, lots of questions, medically complicated, etc)

It also relates to what i mentioned in another thread. a lot of what we do is hard to defend in court if something does happen. We are technically breaking the rules (despite many of those rules being really stupid) by doing stuff like setting up for another patient in the middle of a case. Yea it is prevalent in the real world but breaking rules just so the nurse doesn't mark you as the reason for case delay is annoying.

 

[Psai]

Ask your attending to see he next patient when they come in. Talk to them, place iv, get consent and write note while your attending sits the room for a bit. If you do that and make a dry setup, all you need to do is drop your patient off and finish your setup.

 

[IMGASMD]

breaking rules just so the nurse doesn't mark you as the reason for case delay is annoying.

Totally agree. Another great example of how the f-ing rules make no sense; and no clinical basis. Let’s just shave some time from our end and stick it to the anesthesia time.

I don’t set up anymore. My chairman/associate chair/PD do not set up, when other attending ask me how come. The answer is, not allowed.

 

[Psai]

when the rules don't make sense, are counterproductive to patient care and not supported by any evidence, they should be ignored.

 

[nimbus]

There’s a rule against setting up for subsequent cases?

 

[deleted171991]

There’s a rule against setting up for subsequent cases?

Yes. Because the previous patient is in the room, you cannot open any single use equipment (infection risk).

 

[powermd]

I never cease to be amazed at the failure of leadership found so routinely in hospitals.

 

[vector2]

Yes. Because the previous patient is in the room, you cannot open any single use equipment (infection risk).

One day when there were two staggered hearts in flipped rooms, I brought in the perfectly sealed dirty TEE from the first case at the end of the second case to put back in the case cart to get processed. The second patients chest had already been closed, bandages on, just waiting for transpo. Judging from the RN's reaction, one would've thought I strolled into the OR mid-pump and took a fresh steaming Hot Carl right on the LIMA graft.

 

[anbuitachi]

One day when there were two staggered hearts in flipped rooms, I brought in the perfectly sealed dirty TEE from the first case at the end of the second case to put back in the case cart to get processed. The second patients chest had already been closed, bandages on, just waiting for transpo. Judging from the RN's reaction, one would've thought I strolled into the OR mid-pump and took a fresh steaming Hot Carl right on the LIMA graft.

If there's an infection you know who they'll be blaming

 

[powermd]

 

[dchz]

One day when there were two staggered hearts in flipped rooms, I brought in the perfectly sealed dirty TEE from the first case at the end of the second case to put back in the case cart to get processed. The second patients chest had already been closed, bandages on, just waiting for transpo. Judging from the RN's reaction, one would've thought I strolled into the OR mid-pump and took a fresh steaming Hot Carl right on the LIMA graft.

We had an anes tech that was named carl, he put Hot in front of his name with a sticker. took people like a year to catch on... LOL