Nursing ridiculousness

[BeatriZZ]

Our ORs were recently audited by nursing/administrators and a mass anesthesia dept email was sent outlining their serious concerns about how we were compromising patient safety.
In addition to anesthesiologists bringing their personal bags into the OR (infection risk), and using their smartphones during cases (instead of monitoring the patient) and opening up the sterile laryngo blade packages to test if they actually work (more infection control) there was something I had never heard of:
Our bottles of hand sanitizer on our anesthesia carts present a risk of surgical field fire. We may no longer use our purell in our work area for risk of causing a blaze and burning our patients, if we havent already given them an infection and let them go into cardiac arrest while we text on our phones.
Has anyone ever anywhere read or heard about hand sanitizer causing a surgical field fire? Please share!

---

Members don't see this ad.

 

[Noyac]

Damn, what a malignant environment.

 

[Noyac]

A couple thoughts I had however,
-tell them that the phones and lap tops are needed for emergency apps and the occasional Up-to-date referencing in order to provide current standard of care treatment.
- phones are necessary for comunication with other anesthesia team members in order to run a more efficient ship without overly distracting means like calling into the room.
- actually see if you can start a fire with Purell (I bet you can) but demand an alternative since The Joint mandates that you clean your hands 250 times an hour.
- have them supply a Rubbermaid box to store you bag or pack in that can be wiped down btw cases.
- the laryngoscopes blade issue is just absurd but it came from the Joint. If the Joint is on a site visit then I will just crack the back of the wrapper open enough to attach the handle and check function while never removing the blade. Every other time I open the entire package.

All these points are to be used only if you like your job and wish to remain there.

 

[sbhfl]

First day or anti-anesthesia grudge?

 

[GravelRider]

We had clipboard warriors tell us something similar at my last job. They actually described the Purell bottles as being similar to a Molotov cocktail. Visions of actually throwing Molotov cocktails at these people started dancing in my head at that moment. The solution was to put these single-use hand wipes in the cart instead.

 

[nimbus]

We had clipboard warriors tell us something similar at my last job. They actually described the Purell bottles as being similar to a Molotov cocktail. Visions of actually throwing Molotov cocktails at these people started dancing in my head at that moment. The solution was to put these single-use hand wipes in the cart instead.

The hand wipes don’t pose a danger?

 

[deleted162650]

The hand wipes are what you stuff into the top of the Purell bottles to make Molotov cocktails.

 

[rakotomazoto]

That's the system you get when clip board carriers lord over the people who actually care for the patients. They have to continually create items for their problem list, or they will be out of a job. It's easy to watch someone else do their job and find fault, their perspective is not insightful. It's criticism for the sake of criticism. I have yet to hear of JCAHO doing much other than perpetuating the opioid crisis by promoting the misguided "pain as the 5th vital sign" effort. Our system is already complicated and complex enough without adding layers and layers of made-up rules, policies, and standards. It's like they decided to be referees over a game they have never played and to maintain their position, they change the rules slightly every season.

 

[Iso4ane]

Get the surgeons involved and pissed off.

‘Isn’t choloroprep supposed to dry for a MINIMUM of three minutes to reduce fire risk if they’re hairless, and by god we know the patients are COMPLETELY hairless so should we wait longer?’

 

[IMGASMD]

Get the surgeons involved and pissed off.

‘Isn’t choloroprep supposed to dry for a MINIMUM of three minutes to reduce fire risk if they’re hairless, and by god we know the patients are COMPLETELY hairless so should we wait longer?’

Suggest a timer for every OR and have nurses clock and document every single time. That’ll teach them.....

 

[nimbus]

Get the surgeons involved and pissed off.

‘Isn’t choloroprep supposed to dry for a MINIMUM of three minutes to reduce fire risk if they’re hairless, and by god we know the patients are COMPLETELY hairless so should we wait longer?’

Drying time is “up to 1 hour” if hair is present.

 

[btbam]

In the last month we've been told we have to switch to disposable handles, not blades, handles. Facial hair of any kind is out, we have to wear jackets, no more surgeons caps - only bouffants. If you wear your own scrub cap it has to be covered by a bouffant. I just can't believe this non-substantiated BS is real life.

 

[kidthor]

Drying time is “up to 1 hour” if hair is present.

And remember - you can't use (hair) clippers in the OR.

 

[deleted162650]

In a glorious turn of events, the bouffant mandate has been lifted after the release of the AORN statement retracting their previous statement. This includes the data that the disposable bouffants are the worst at containing particles when compared to all other forms of head cover.

 

[Ronin786]

Hot off the press:

Association between patient outcomes and accreditation in US hospitals: observational study

Conclusions US hospital accreditation by independent organizations is not associated with lower mortality, and is only slightly associated with reduced readmission rates for the 15 common medical conditions selected in this study. There was no evidence in this study to indicate that patients choosing a hospital accredited by The Joint Commission confer any healthcare benefits over choosing a hospital accredited by another independent accrediting organization.

Even more importantly:

It is also big business, since hospitals pay accreditors for the inspections. The Joint Commission charged an average of about $18,000 for an inspection in 2015. The group also charges participating hospitals an annual fee of up to $37,000.

Hospitals also spend millions on consultants who help them pass the accreditation process. A subsidiary of the Joint Commission provides for-hire consultants to hospitals that the parent organization inspects.

Study Challenges Hospitals’ Use of Accrediting Watchdogs

The clipboard warriors need to die.

 

[Cryc_to_the_point]

Why on earth are nurses given this power???

 

[IMGASMD]

Hot off the press:

Association between patient outcomes and accreditation in US hospitals: observational study



Even more importantly:



Study Challenges Hospitals’ Use of Accrediting Watchdogs

The clipboard warriors need to die.

If we were on reddit or any other platform that can push this to the front page, i would pay a few fivvers to get it there!

 

[HomeSkool]

Wow, your nurses are an order of magnitude more ridiculous than ours. Thank you for giving me perspective.

 

[urge]

A couple thoughts I had however,
-tell them that the phones and lap tops are needed for emergency apps and the occasional Up-to-date referencing in order to provide current standard of care treatment.
- phones are necessary for comunication with other anesthesia team members in order to run a more efficient ship without overly distracting means like calling into the room.
- actually see if you can start a fire with Purell (I bet you can) but demand an alternative since The Joint mandates that you clean your hands 250 times an hour.
- have them supply a Rubbermaid box to store you bag or pack in that can be wiped down btw cases.
- the laryngoscopes blade issue is just absurd but it came from the Joint. If the Joint is on a site visit then I will just crack the back of the wrapper open enough to attach the handle and check function while never removing the blade. Every other time I open the entire package.

All these points are to be used only if you like your job and wish to remain there.

Agree with all except with opening the laryngoscope wrapper to see if it works. I have yet to find one that doesn’t work. And guess what, if it doesn’t work reach over the drawer and open another one.

 

[Monty Python]

In the last month we've been told ... Facial hair of any kind is out.

Damn, we're all going to look like aliens without eyelashes or eyebrows. May the OR supervisor RN be the first.

 

[Psai]

The number of incredibly stupid and dangerous mandates increases on a weekly basis. I've had a few close calls with emergent cases where I'm making a set up from scratch because we aren't allowed to make anything in advance. Apparently we can't even open the monitors in advance because they will be unsterile?

The worst part is that even though we apparently don't have money for useful people like nps and doctors, we have an ever growing number of these *****s running around making rules that are actively detrimental to patient care.

 

[Vandalia]

Have you heard about the new virus? Incredibly infectious and deadly. Carried only by infection control nurses and other administrative types. Have to keep them at least 400 yards from every patient treatment area. Otherwise it is an infection control issue.

 

[gasmark]

I actually just did a CME and it was the first one that made me laugh out loud. It was a lecture from the 2017 ASA that basically debunked all of the "facts" AORN espouses. Worth a watch:

shop-detail - American Society of Anesthesiologists (ASA)

In a glorious turn of events, the bouffant mandate has been lifted after the release of the AORN statement retracting their previous statement. This includes the data that the disposable bouffants are the worst at containing particles when compared to all other forms of head cover.

 

[DirtDocMD]

My hospital has scads of these folks running around. Never a lack of funding for paper jockeys. OTOH, the thought of paying a part-time patient transporter $60-$80 a day to work afternoons/evenings, and paying couple of folks to clean rooms on weekends, just seems to blow their mind.

 

[gasdoc77]

My hospital has scads of these folks running around. Never a lack of funding for paper jockeys. OTOH, the thought of paying a part-time patient transporter $60-$80 a day to work afternoons/evenings, and paying couple of folks to clean rooms on weekends, just seems to blow their mind.

We all know why admin hires these clipboard armies instead of people who deliver care: the former creates an additional buffer to allow plausible deniability in the event things go awry (like cheap insurance). The latter actually would be investing in something patient-centric instead of self-centric. The inmates are running the asylum nowadays and what they get away with is evil.

 

[Noyac]

Agree with all except with opening the laryngoscope wrapper to see if it works. I have yet to find one that doesn’t work. And guess what, if it doesn’t work reach over the drawer and open another one.

I agree that grabbing another one is a good option.
But for some reason our Stubbies (the short handles which are about 3”) have failed on me twice this week alone. For some reason the blade doesn’t actuate the lighting apparatus well. I even check it before using it and then it fails. Whatever, I have a backup.
So the point is, they fail.
I had an attending that loved to throw you curve balls. He pulled the batteries out of my handle on a pretty serious case. At least it was serious for me as a resident, a veteran with a huge beard and barrel chest with COPD. I induced him and tried mask him but that was poor at best. Grabbed the blade and my light didn’t work after I checked it like a good resident before interviewing the pt. For some reason the OR lights were already in and right over my head. So I grabbed the light and shined it into the mouth and intubated the pt. I got the highest marks from that attending he may have ever given.

 

[Moose A Moose]

Why on earth are nurses given this power???

Because physicians are too busy doing their real jobs while nurses get to go play and lobby.

 

[MirrorTodd]

I agree that grabbing another one is a good option.
But for some reason our Stubbies (the short handles which are about 3”) have failed on me twice this week alone. For some reason the blade doesn’t actuate the lighting apparatus well. I even check it before using it and then it fails. Whatever, I have a backup.
So the point is, they fail.
I had an attending that loved to throw you curve balls. He pulled the batteries out of my handle on a pretty serious case. At least it was serious for me as a resident, a veteran with a huge beard and barrel chest with COPD. I induced him and tried mask him but that was poor at best. Grabbed the blade and my light didn’t work after I checked it like a good resident before interviewing the pt. For some reason the OR lights were already in and right over my head. So I grabbed the light and shined it into the mouth and intubated the pt. I got the highest marks from that attending he may have ever given.

That's some pretty smooth thinking.

 

[deleted59964]

This thread - all of it - just killing myself laughing.

 

[deleted59964]

The inmates are running the asylum nowadays and what they get away with is evil.

This.

 

[woopedazz]

All the nurses that nobody can stand get funnelled into these positions by their colleagues of all people. Like, have some self-preservation and get rid of them some other way, don't give them power over all of us.

 

[Status Sciaticus]

at my program, the nurse run infection control is so dumb, they incorporated a policy that all scrubs must be covered with a white coat in the cafeteria to 'reduce infection risk.' If they only knew that white coats get washed way less than scrubs do....
Cant wear scrub caps even despite the new guidelines and retractions, because they're too butthurt to admit they were wrong...

 

[CopaceticOne]

Cant wear scrub caps even despite the new guidelines and retractions, because they're too butthurt to admit they were wrong...

But, but, but.... evidence based practice, studies show, guidelines state!

 

[jthedestroyr]

Suggest a timer for every OR and have nurses clock and document every single time. That’ll teach them.....

Now implemented at our children's hospital...... no joke.

 

[dannyboy1]

Whatever. They come for like 3 days out of the year. As soon as they leave it is back to business as usual.....

 

[IMGASMD]

Now implemented at our children's hospital...... no joke.

That’s scary. I was just mocking the whole process not believing that there would be someone crazy enough to try to implement this kind of big brother tactic.
Sorry for you and anyone who has to endure that nonsense.

 

[dpmd]

Get the surgeons involved and pissed off.

‘Isn’t choloroprep supposed to dry for a MINIMUM of three minutes to reduce fire risk if they’re hairless, and by god we know the patients are COMPLETELY hairless so should we wait longer?’

You joke but one of the hospitals I work at does have a timer and forces a wait time before draping (though on weekends or at night I offer to use no cautery on the skin in exchange for not waiting those three minutes)

 

[jthedestroyr]

You joke but one of the hospitals I work at does have a timer and forces a wait time before draping (though on weekends or at night I offer to use no cautery on the skin in exchange for not waiting those three minutes)

We aren't at the same hospital are we?? I know at first surgeons thought it was a joke, but once prep hits, timers start. No surgeons laughing after.

It can be urgent, nurses will try to get doctors written up if the 3min rule is broken none the less. You can imagine physician retention is at all time highs across the board at this place.

 

[dpmd]

We aren't at the same hospital are we?? I know at first surgeons thought it was a joke, but once prep hits, timers start. No surgeons laughing after.

It can be urgent, nurses will try to get doctors written up if the 3min rule is broken none the less. You can imagine physician retention is at all time highs across the board at this place.

Luckily everyone likes me so I haven't been written up for ignoring it. But I don't ignore it all the time so maybe that factors in.

 

[dpmd]

Also they have had or fires at this hospital (not many and not with much damage but still) so I can understand the principal.

 

[drmwvr]

The hand wipes are what you stuff into the top of the Purell bottles to make Molotov cocktails.

Do you have an agent?

 

[nimbus]

Luckily everyone likes me so I haven't been written up for ignoring it. But I don't ignore it all the time so maybe that factors in.

So true. If you are well liked, you can basically get away with anything. If you are not well liked, you will be written up for nothing.

 

[dpmd]

So true. If you are well liked, you can basically get away with anything. If you are not well liked, you will be written up for nothing.

Yup. Though I don't go out of my way to be well liked, just happens to be in my nature to be relaxed and flexible so compared to other surgeons I am pretty different.

 

[Psai]

at my program, the nurse run infection control is so dumb, they incorporated a policy that all scrubs must be covered with a white coat in the cafeteria to 'reduce infection risk.' If they only knew that white coats get washed way less than scrubs do....
Cant wear scrub caps even despite the new guidelines and retractions, because they're too butthurt to admit they were wrong...

Can you link the retraction? I can't find it for some reason.

 

[dpmd]

Can you link the retraction? I can't find it fit some reason.

I too would be interested. As chief of surgery I tried to fight the cap fight due to some of my surgeons asking me to and got stonewalled with aorn recommendations as the bible despite what ACS had to say about it.

 

[jwk]

Can you link the retraction? I can't find it for some reason.

Surgical Attire Joint Statement Released; ASA Expects Continued Stakeholder Engagement - American Society of Anesthesiologists (ASA)

 

[Gas you down]

Has anyone else heard the bs about the empty syringe for inflating the ett? If you have one out, it has to be labeled “air”

 

[Psai]

Has anyone else heard the bs about the empty syringe for inflating the ett? If you have one out, it has to be labeled “air”

This one is so absurd I don't even know what to say. What next, labeling syringes as "10 cc syringe"? Idiotic.

Then again, they're trying to tell us to label LR bags with labels where they want you to write "lactated ringers" with the time and date. I generally don't waste my time doing stupid things though.

 

[Twiggidy]

Has anyone else heard the bs about the empty syringe for inflating the ett? If you have one out, it has to be labeled “air”

 

[deleted162650]

Has anyone else heard the bs about the empty syringe for inflating the ett? If you have one out, it has to be labeled “air”

In that case I would start labeling it “Go F*ck Yourself”