induction/emergence question from a nurse

[PeriOp]

I'm a new OR nurse.

I'm asking the question here cause what the hell, lets go straight to the source.

When I'm assisting you with induction or emergence, what do you want me to be focusing on. Do you want me to be looking at the monitor, looking at the vitals, ecg or are you focusing on that and you just want me to hold the mask, apply cricoid etc.

Also, I'm a baby OR nurse so I've yet to see any lets say intubation or extubation emergencies, do you have any tips on what you expect of me as a nurse to be doing in those times. That's probably hard to answer but I'll take any tips at all. I want to be a good OR nurse for anesthetists too

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[periopdoc]

Welcome, and thanks for the honest question.

For me, I just don't want you to be banging pans around or otherwise making a lot of noise while the patient is going to sleep or waking up. Just ask yourself what would you like to be experiencing when you are going to sleep at night or waking up in the morning and try to be considerate of the immense stress the patient is likely undergoing in this strange environment.

You are welcome to work quietly in the corner and if I need assistance, I will be more than happy to let you know exactly what I want you to do. Other anesthesiologists might not be so forthcoming so being close by, focusing on the anesthesiologist, and making it silently clear that you are available and willing to help in any way is great.

Whatever you do, don't tell me what is on my monitors. That is a sure way to p*** me off. I know what is there, I know if the SaO2 or the blood pressure is dropping and your telling me won't make the solution any less stressful for me.

If there is an emergency, just look at me to let me know you are there to help. I will be happy to direct you. Depending on the situation, I may ask you to call someone for help, get equipment etc. However, if you are in my room and there is an emergency on intubation/ extubation, in all likelihood the issue will be resolved before you are even aware of it.

- pod

 

[kmurp]

At our hospital, the circulating nurse is expected to be at the head of the table for induction to assist the anesthesiologist . The tasks required vary with the anesthesiologist and the case. You will learn these with time. In general, if the anesthesiologist requires something specific, he should tell you ahead of time. The critical thing is to be there, available and not distracted by any other tasks. Induction is a critical time. Our more experienced "lifer" RNs understand how badly things can go because they have seen it. They know that there are times when their assistance is critical and they do not allow themselves to get distracted during induction.
Good luck with your new career.

 

[anon-y-mouse]

Oh I can easily help with this one! Anesthesiologists, feel free to critique- this is just based on observation during my rotation.

When you're being asked to help, it's NOT for the monitors/vitals/ECG (because yes, the anesthesiologist is focused on that). generally, it's for things like holding the mask on the patient (lightly, if they're still awake!). your (much appreciated) role is like a third hand.

cricoid pressure: during a rapid sequence intubation, do NOT let go of the cricoid pressure until the person doing the intubation tells you to do so. it's key to confirm placement before you can let go. i've seen so many RSI cases where the nurse gets distracted by something and lets go of cricoid pressure so she can go write down the anesthesia start time or take care of some equally inane issue-- what's the point of cricoid pressure in that case?!

other things i've seen: when you sense that $hit is hitting the fan with establishing an airway (or placing lines or whatever), the fiberoptic is out, other fancy equipment is out, 3-4 people fighting a belligerent patient to put a tube down his nose, etc. etc., try not to talk (loudly) about your weekend with the scrub tech. people are trying to save the patient's life in the background.

use common sense when you're doing what you're doing. when you're padding a patient, don't lock all his joints in some uncomfortable extended position. just imagine yourself lying on that bed, what your body would naturally do. imagine if you were strapped into a table like that in the constrained position i see from nurses... for hours and hours... you're going to be pretty sore afterwards. this can cause a lot of problems when the patient wakes up. more padding isn't the answer! it's better use of it + positioning that will really help the patient.

oh, and don't yell out 'WHAT WAS THE ANESTHESIA START TIME?' at inappropriate moments. look around, see what's going on.

 

[Planktonmd]

The most important thing for a new OR nurse to understand is that Induction and intubation are routine and 100 % controlled events.
This is not what happens in the ER or the ICU, there is no drama and no need to get nervous.
Watching the monitors is the anesthesia provider's Job and even if they appear as if they are not watching they do know what these monitors are showing.
So, take a deep breath, keep quite, and just be available.

 

[Dejavu]

Also know that your help is greatly appreciated even if the given anesthesiologist might be too busy to say so at the time.

 

[Jeff05]

you definitely do not need to watch the monitors. we have everything under control.

 

[PeriOp]

Sweet. Thank you guys )

Especially about the intubation and extubation being a controlled event.
I'll make eye contact to let you guys know I'm available and especially when things do go bad. oh and not let you know the patient is desatting and going hypotensive

 

[DreamMachine]

Sweet. Thank you guys )

Especially about the intubation and extubation being a controlled event.
I'll make eye contact to let you guys know I'm available and especially when things do go bad. oh and not let you know the patient is desatting and going hypotensive

...and don't call us "anesthesia."

 

[drmwvr]

The most important thing for a new OR nurse to understand is that Induction and intubation are routine and 100 % controlled events.
This is not what happens in the ER or the ICU, there is no drama and no need to get nervous.
Watching the monitors is the anesthesia provider's Job and even if they appear as if they are not watching they do know what these monitors are showing.
So, take a deep breath, keep quite, and just be available.

ahhhhhhhhhh

 

[maceo]

whatever you do dont act cocky. dont think you know more than me cuz you dont. you are there to help ME. I will tell you what i want you to do if i want you to do something. hold cricoid hold the mask, hold his arm out while i start this line... hold the swan, get a warm bottle of saline please. thats how to be a good circulating nurse. very few circulating nurses know what their role is. many think that its all about them.. while its all about the patient and assisting the anesthesiologist and the surgeon do their job. not the other way around. It truly is a pleasure when a circulating nurse understands that. usually its the little filipinas who can do the job of 3 american nurses blindfolded that understand their role . If you have any issues can i assist you in anything?is a great start and will win you points...

 

[dillpickles]

whatever you do dont act cocky. dont think you know more than me cuz you dont. you are there to help ME. I will tell you what i want you to do if i want you to do something. hold cricoid hold the mask, hold his arm out while i start this line... hold the swan, get a warm bottle of saline please. thats how to be a good circulating nurse. very few circulating nurses know what their role is. many think that its all about them.. while its all about the patient and assisting the anesthesiologist and the surgeon do their job. not the other way around. It truly is a pleasure when a circulating nurse understands that. usually its the little filipinas who can do the job of 3 american nurses blindfolded that understand their role . If you have any issues can i assist you in anything?is a great start and will win you points...

To maceo: While I understand where you're coming from, these words come off as really cocky, IMHO. I think they are inappropriate words for a new nurse who is coming to us with a genuine interest in how to help, how to be a team player.

To the OP: Congratulations on your new job. Thank you for finding this forum and "coming to the source" so to speak for tips about what matters to anesthesiologists from the OR nursing team. I respect that. This attitude and initiative will serve you well in your working environment.

The thing I appreciate most from OR nurses is when, in both their demeanor and words, they communicate that they are ready, able & happy to help if we need it.

Functioning adults will communicate what they want - for example if the anesthesiologist wants cricoid, s/he will tell you. Malfunctioning adults will not communicate what they want and get mad that the other person is not doing what they want. I'm sure you've seen that in other jobs and you'll see it in the OR too.

Good luck and thanks for the question.

 

[Consigliere]

whatever you do dont act cocky. dont think you know more than me cuz you dont. you are there to help ME. I will tell you what i want you to do if i want you to do something. hold cricoid hold the mask, hold his arm out while i start this line... hold the swan, get a warm bottle of saline please. thats how to be a good circulating nurse. very few circulating nurses know what their role is. many think that its all about them.. while its all about the patient and assisting the anesthesiologist and the surgeon do their job. not the other way around. It truly is a pleasure when a circulating nurse understands that. usually its the little filipinas who can do the job of 3 american nurses blindfolded that understand their role . If you have any issues can i assist you in anything?is a great start and will win you points...