Preop nursing

[deleted875186]

The hospital I’m at has a pretty long preop nursing assessment. I feel most of the questions are redundant since I will ask many of he same. NPO status, meds taken, all the medical history of the patient, type of procedure. Then there are a set of ridiculous and irrelevant questions like did you use hibiclens, have you been out of the country, etc. I really don’t care how long the assessment is, except for the first case of the day, first case is at 730, and I’m standing next to the nurse at 7AM waiting for her to finish so I can consent, interview, place an IV, etc, with the surgery service waiting as well to talk to the patient.

So, curious how long other people preop nursing takes? I wish we could make the nursing assessment more lean and helpful, but I’m sure there would be tons of push back.

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[anbuitachi]

The hospital I’m at has a pretty long preop nursing assessment. I feel most of the questions are redundant since I will ask many of he same. NPO status, meds taken, all the medical history of the patient, type of procedure. Then there are a set of ridiculous and irrelevant questions like did you use hibiclens, have you been out of the country, etc. I really don’t care how long the assessment is, except for the first case of the day, first case is at 730, and I’m standing next to the nurse at 7AM waiting for her to finish so I can consent, interview, place an IV, etc, with the surgery service waiting as well to talk to the patient.

So, curious how long other people preop nursing takes? I wish we could make the nursing assessment more lean and helpful, but I’m sure there would be tons of push back.

Takes like 5 minutes here. They also ask those questions. It seems long when waiting but it's usually no longer than 5 min unless there are issues

 

[HomeSkool]

I get that you're frustrated about how long the nursing check-in takes, but much of what they're asking is very relevant. Bacteria can colonize into the first couple layers of epidermis, and the Hibiclens scrubs patients receive in surgery clinic help decolonize them and reduce surgical site infections. Those who've been out of the country could have been exposed to infectious diseases that may yet be in the incubation stage but still require cancellation of surgery. The best thing to do is to reduce redundancy by coordinating your efforts with those of the nurses. If they're asking NPO status, for example, that'll be clearly documented and you won't need to ask about it.

 

[Lecithin5]

Perhaps my biggest frustration working at a large hospital system. Ironically, nursing spends 20 to 30 minutes (yes, often that long!) assessing these patients, and then I have to rush my (more important) assessment because the OR is ready. And often the patient and nursing chit chat nonchalantly, killing time. The surgeon can cut in line and interrupt nursing assessment, but God forbid anesthesiology does the same. Ridiculous.

 

[deleted171991]

This idiocy is from the Joint-smoking Commission. Same almost everywhere.

As in asking 6 ft 300 lb males: "Do you feel safe at home?"

 

[deleted171991]

Perhaps my biggest frustration working at a large hospital system. Ironically, nursing spends 20 to 30 minutes (yes, often that long!) assessing these patients, and then I have to rush my (more important) assessment because the OR is ready. And often the patient and nursing chit chat nonchalantly, killing time. The surgeon can cut in line and interrupt nursing assessment, but God forbid anesthesiology does the same. Ridiculous.

Oh, wait! Are you suggesting that anesthesiologists don't get respect from nurses, patients and surgeons? Blasphemy! Burn him!

 

[Lecithin5]

Oh, wait! Are you suggesting that anesthesiologists don't get respect from nurses, patients and surgeons? Blasphemy! Burn him!

Nonetheless, still a frustration

 

[deleted59964]

Those who've been out of the country could have been exposed to infectious diseases that may yet be in the incubation stage but still require cancellation of surgery.

so people get their surgery canceled because they've been out of the country?

The best thing to do is to reduce redundancy by coordinating your efforts with those of the nurses. If they're asking NPO status, for example, that'll be clearly documented and you won't need to ask about it.

except the nurses at my shop will document whatever the patient tells them without any critical thought - yep nothing to eat since last night ... oh that thick shake doesn't count right.

 

[deleted171991]

so people get their surgery canceled because they've been out of the country?

I think the question is a relic from the time of the Ebola scare, a few years ago. Of course, in the beautiful tradition of stupid people bureaucracy, it's much easier to add something to the script than to remove it.

except the nurses at my shop will document whatever the patient tells them without any critical thought - yep nothing to eat since last night ... oh that thick shake doesn't count right.

Any American doctor worth her salt will double check all important information with the patient, such as NPO status.

 

[deleted59964]

I think the question is a relic from the time of the Ebola scare, a few years ago. Of course, in the beautiful tradition of stupid people bureaucracy, it's much easier to add something to the script than to remove it.

Any .. doctor worth her salt will double check all important information with the patient, such as NPO status.

fixed that for you

 

[deleted59964]

The hospital I’m at has a pretty long preop nursing assessment. I feel most of the questions are redundant since I will ask many of he same.

I really don’t care how long the assessment is, except for the first case of the day, first case is at 730, and I’m standing next to the nurse at 7AM waiting for her to finish so I can consent, interview, place an IV, etc, with the surgery service waiting as well to talk to the patient.

So, curious how long other people preop nursing takes? I wish we could make the nursing assessment more lean and helpful, but I’m sure there would be tons of push back.

same here - I feel your pain.

I think if you're prepared to put the effort in to change the form you might not get as much push back as you expect. Nurses love to complete checklists, they don't really care what's on them. You'll have to survive working with them in a committee to redesign the form as a quality activity though ... I prefer to go have coffee while they do the ridiculous check in

 

[MTGas2B]

You have to place all your IVs?


Sent from my iPhone using SDN mobile

 

[chocomorsel]

The hospital I’m at has a pretty long preop nursing assessment. I feel most of the questions are redundant since I will ask many of he same. NPO status, meds taken, all the medical history of the patient, type of procedure. Then there are a set of ridiculous and irrelevant questions like did you use hibiclens, have you been out of the country, etc. I really don’t care how long the assessment is, except for the first case of the day, first case is at 730, and I’m standing next to the nurse at 7AM waiting for her to finish so I can consent, interview, place an IV, etc, with the surgery service waiting as well to talk to the patient.

So, curious how long other people preop nursing takes? I wish we could make the nursing assessment more lean and helpful, but I’m sure there would be tons of push back.

They need to do it much earlier than you. Or bring the patient in earlier. Problem solved.
Also, you do your own IV? Yeah, that sucks and slows things down. That's a nursing thing in most places I would think.

 

[izzygoer]

Preops take me 5 mins or less 80 percent of the time. It’s another story when there is a language issue or a NH gomer with a hand written chart that dates back to the 80s.

 

[dchz]

Obv i concur with all the sentiments here.

I'm all about that circle jerk and dog on beaucracy. But if you want a constructive challenge: see if you can talk to the head of pre-op nursing to get something done. Remember, no one likes a big egoed resident, but you have legit bargaining chips. Show respect to those in leadership positions if you want things done in the real world. As a resident i'm worrying less about things i can't change and doing more direct things to try to affect things. Since we will be working in a environment with more pre-op nurses later on, I find it worthwhile to try to affect change.

 

[chocomorsel]

Oh, well if the OP is in residency, I can see why he has to start his/her own IV.

 

[deleted875186]

Thanks for the comments, sounds like it’s somewhat frustrating everywhere. Maybe I’ll knquire how difficult it would be to make changes.

It’s just especially frustrating to hear people waste time over stupid things. The other week, the preop nurse was going back and forth with a patient to make sure the surgeon was “bypassing his arteries, not fixing or replacing them”. I was standing there thinking, just write CABG on the form and move one.

 

[Urzuz]

...first case is at 730, and I’m standing next to the nurse at 7AM waiting for her to finish so I can consent, interview, place an IV, etc, with the surgery service waiting as well to talk to the patient.

Perhaps my biggest frustration working at a large hospital system. Ironically, nursing spends 20 to 30 minutes (yes, often that long!) assessing these patients, and then I have to rush my (more important) assessment because the OR is ready. And often the patient and nursing chit chat nonchalantly, killing time. The surgeon can cut in line and interrupt nursing assessment, but God forbid anesthesiology does the same. Ridiculous.

I pray that you both are residents. Our RNs always stop whatever they're doing the moment we arrive and let us finish our assessments, and will listen in and tick off whatever boxes they have that overlap with our assessment (NPO status, allergies, etc). In the event you are both residents, just know that it'll get better once you become an attending, as long as you join a practice where people respect what you do.

And despite how nonsensical some of the questions can be, sometimes the nurses do catch things that can help with the flow of the OR (the next patient isn't NPO, someone took their anticoagulation, the K is 7.6, etc). Frankly I don't care what they ask them as long as the cases aren't slowed down.

 

[flightnurse2MD]

This idiocy is from the Joint-smoking Commission. Same almost everywhere.

As in asking 6 ft 300 lb males: "Do you feel safe at home?"

Or asking 85 year-old grandma Claire what sex she identifies herself as...

 

[Lecithin5]

I pray that you both are residents. Our RNs always stop whatever they're doing the moment we arrive and let us finish our assessments, and will listen in and tick off whatever boxes they have that overlap with our assessment (NPO status, allergies, etc). In the event you are both residents, just know that it'll get better once you become an attending, as long as you join a practice where people respect what you do.

And despite how nonsensical some of the questions can be, sometimes the nurses do catch things that can help with the flow of the OR (the next patient isn't NPO, someone took their anticoagulation, the K is 7.6, etc). Frankly I don't care what they ask them as long as the cases aren't slowed down.

No, I’m not a resident. Consider yourself lucky to be in such an environment. I would venture that the majority are not, and are not in a position to go on a crusade to change how things are done. That’s just the reality of the situation.

 

[Urzuz]

No, I’m not a resident. Consider yourself lucky to be in such an environment. I would venture that the majority are not, and are not in a position to go on a crusade to change how things are done. That’s just the reality of the situation.

Why don't you talk to the charge RN in your preop area about how, to increase OR efficiency, you need to do your preop assessment right when you arrive. Or, you could just assert dominance and cut them off mid-sentence...

 

[Psai]

You gotta do what you gotta do. OR being ready for the patient is more important for the patient than their preferred pronoun.

 

[deleted171991]

You gotta do what you gotta do. OR being ready for the patient is more important for the patient than their preferred pronoun.

Ouch, Dr. Peterson!

 

[dchz]

i prefer zer.

 

[2Fast2Des]

I've had a pre-op nurse ask me if I've ever started an IV when I came in to help get things going for the next patient. While I was getting ready she asked to speak with me to step out of the room. She asked if I knew how to do one and I told her in a joking manner, I'm a 4th year Anesthesia resident graduating in a few months, if I didn't know how to that would he a huge problem. She repeated her question and then asked if I was the attending, and that she doesn't feel comfortable I start an IV if I wasn't the attending or until she was finished asking her laundry list ?'s

I've had a secretary another time tell us that you're just Anesthesia, you don't dictate case flow when had to rearrange cases due to delays\npo status saying only surgeon has the authority (completely not true).

Unfortunately we are bred to be subservient to everyone so it's a culture that just always exist and we as personalities don't have the gall to stand up for ourselves like surgeons can

 

[Psai]

I've had a pre-op nurse ask me if I've ever started an IV when I came in to help get things going for the next patient. While I was getting ready she asked to speak with me to step out of the room. She asked if I knew how to do one and I told her in a joking manner, I'm a 4th year Anesthesia resident graduating in a few months, if I didn't know how to that would he a huge problem. She repeated her question and then asked if I was the attending, and that she doesn't feel comfortable I start an IV if I wasn't the attending or until she was finished asking her laundry list ?'s

I've had a secretary another time tell us that you're just Anesthesia, you don't dictate case flow when had to rearrange cases due to delays\npo status saying only surgeon has the authority (completely not true).

Unfortunately we are bred to be subservient to everyone so it's a culture that just always exist and we as personalities don't have the gall to stand up for ourselves like surgeons can

??? I've never had any of these problems

 

[jeesapeesa]

I've had a pre-op nurse ask me if I've ever started an IV when I came in to help get things going for the next patient. While I was getting ready she asked to speak with me to step out of the room. She asked if I knew how to do one and I told her in a joking manner, I'm a 4th year Anesthesia resident graduating in a few months, if I didn't know how to that would he a huge problem. She repeated her question and then asked if I was the attending, and that she doesn't feel comfortable I start an IV if I wasn't the attending or until she was finished asking her laundry list ?'s

I've had a secretary another time tell us that you're just Anesthesia, you don't dictate case flow when had to rearrange cases due to delays\npo status saying only surgeon has the authority (completely not true).

Unfortunately we are bred to be subservient to everyone so it's a culture that just always exist and we as personalities don't have the gall to stand up for ourselves like surgeons can

when i was a resident the nurses were more than happy to let me do the IV. nowadays they ask me to do an IV if they have any trouble getting one which is a very rare. i have never been delayed because of preop nursing. i usually don't interrupt when they have started their barrage of questions but if i get to the patient first they usually wait for me to finish.

 

[Iso4ane]

Perhaps my biggest frustration working at a large hospital system. Ironically, nursing spends 20 to 30 minutes (yes, often that long!) assessing these patients, and then I have to rush my (more important) assessment because the OR is ready. And often the patient and nursing chit chat nonchalantly, killing time. The surgeon can cut in line and interrupt nursing assessment, but God forbid anesthesiology does the same. Ridiculous.

Yeah, it even worse, when you're just standing there listening, and then the surgical attending (or even the resident) walks in, 'Oh here is the doctors, I'll let them talk to you."

If I had the temperament of some of our surgical colleagues, there would be a lot more holes in the wall and I would be written up for professionalism.

 

[chocomorsel]

No, I’m not a resident. Consider yourself lucky to be in such an environment. I would venture that the majority are not, and are not in a position to go on a crusade to change how things are done. That’s just the reality of the situation.

This sucks for you. The nurses need to start the IV.

 

[chocomorsel]

I've had a pre-op nurse ask me if I've ever started an IV when I came in to help get things going for the next patient. While I was getting ready she asked to speak with me to step out of the room. She asked if I knew how to do one and I told her in a joking manner, I'm a 4th year Anesthesia resident graduating in a few months, if I didn't know how to that would he a huge problem. She repeated her question and then asked if I was the attending, and that she doesn't feel comfortable I start an IV if I wasn't the attending or until she was finished asking her laundry list ?'s

I've had a secretary another time tell us that you're just Anesthesia, you don't dictate case flow when had to rearrange cases due to delays\npo status saying only surgeon has the authority (completely not true).

Unfortunately we are bred to be subservient to everyone so it's a culture that just always exist and we as personalities don't have the gall to stand up for ourselves like surgeons can

It all depends on the culture of the anesthesia group and or the region. Some groups have strong attendings and stick up for each other. Some lack the backbone to do that. Some areas, anesthesiologists are treated with equal respect by allied health. In my practice out West, I got treated well. In my little hospital in the NE as well. Just in the locums academic BS job I am doing now. Them bitches are evil and no one in the department stands up for you. One of the reasons I hate academics. Nurses can be so abusive.

Now Surgeons on the other hand can be hit or miss. When I was working mostly spines and heads, well imagine those surgical personalities. Once I left that and did mostly general, gyn, urology, ortho and pod, I was much happier. Much nicer surgeons. Only had a problem with a couple of Gen surgeons. They can tend to be jerky too.

 

[Urzuz]

I've had a pre-op nurse ask me if I've ever started an IV when I came in to help get things going for the next patient. While I was getting ready she asked to speak with me to step out of the room. She asked if I knew how to do one and I told her in a joking manner, I'm a 4th year Anesthesia resident graduating in a few months, if I didn't know how to that would he a huge problem. She repeated her question and then asked if I was the attending, and that she doesn't feel comfortable I start an IV if I wasn't the attending or until she was finished asking her laundry list ?'s

I've had a secretary another time tell us that you're just Anesthesia, you don't dictate case flow when had to rearrange cases due to delays\npo status saying only surgeon has the authority (completely not true).

Unfortunately we are bred to be subservient to everyone so it's a culture that just always exist and we as personalities don't have the gall to stand up for ourselves like surgeons can

You realize you are being "subservient" and people are treating you poorly -- why don't you stand up for yourself? I realize that while you're a resident that may be a bit tougher to do since you just want to keep your head down and get through, but nothing makes me cringe more than attendings relating stories similar to yours. I find it nothing short of pathetic that grown men who have studied for the better of their adult lives have to come to an online forum to vent since they don't feel comfortable putting subordinates in their place face to face.

 

[chocomorsel]

You realize you are being "subservient" and people are treating you poorly -- why don't you stand up for yourself? I realize that while you're a resident that may be a bit tougher to do since you just want to keep your head down and get through, but nothing makes me cringe more than attendings relating stories similar to yours. I find it nothing short of pathetic that grown men who have studied for the better of their adult lives have to come to an online forum to vent since they don't feel comfortable putting subordinates in their place face to face.

Grown men and women. You can put them in their place all day long, but if your department doesn't have your back, you become the problem. Women have more difficulty in these situations.

 

[Urzuz]

Grown men and women. You can put them in their place all day long, but if your department doesn't have your back, you become the problem. Women have more difficulty in these situations.

Maybe I am just in a way different sort of a practice, but what does your department have anything to do with your personal interactions with someone who demeans you? Maybe you are misunderstanding what I am saying, but I am talking about growing a spine and standing up for yourself if others are treating you poorly. That doesn't mean getting red in the face and screaming at the top of your lungs, it means taking them aside, pointing out where they went wrong, and then asking them to never do XYZ ever again.

Just like in life, if you act like a doormat you will get treated like a doormat.

 

[deleted171991]

Grown men and women. You can put them in their place all day long, but if your department doesn't have your back, you become the problem. Women have more difficulty in these situations.

Agree. It's a group thing or nothing. If you're the only one sticking up for the specialty, soon you will be seen like a problem. Life is not fair.

 

[deleted171991]

Maybe I am just in a way different sort of a practice, but what does your department have anything to do with your personal interactions with someone who demeans you? Maybe you are misunderstanding what I am saying, but I am talking about growing a spine and standing up for yourself if others are treating you poorly. That doesn't mean getting red in the face and screaming at the top of your lungs, it means taking them aside, pointing out where they went wrong, and then asking them to never do XYZ ever again.

Just like in life, if you act like a doormat you will get treated like a doormat.

Urzuz, I don't argue with stupid people. It usually doesn't lead to anything constructive. You can't truly educate an IQ of 85-100; you can just "train" them ("do this, don't do that"), and that should be done by their bosses. Who should be told by my boss that they need to train their people.

 

[Urzuz]

Urzuz, I don't argue with stupid people. It usually doesn't lead to anything constructive. You can't truly educate an IQ of 85-100; you can just "train" them ("do this, don't do that"), and that should be done by their bosses. Who should be told by my boss that they need to train their people.

Agree 100%. But I don't advocate arguing with anyone. Tell them exactly what your issue is and how they can correct is. It's as simple as that. Most people will be responsive if you're able to articulate exactly what your problem is, as long as it isn't some frivolous nonsense. That isn't even a doctor-nurse thing...just human beings in general. All I am saying is, don't let yourselves get trampled on. If you just bend over and take it, people will continue to do it (the "one guy" that gets made fun of in a group setting always).

 

[chocomorsel]

Maybe I am just in a way different sort of a practice, but what does your department have anything to do with your personal interactions with someone who demeans you? Maybe you are misunderstanding what I am saying, but I am talking about growing a spine and standing up for yourself if others are treating you poorly. That doesn't mean getting red in the face and screaming at the top of your lungs, it means taking them aside, pointing out where they went wrong, and then asking them to never do XYZ ever again.

Just like in life, if you act like a doormat you will get treated like a doormat.

I have done exactly that. And spoke to that persons superior. Nothing happened to the nurse because she said I talked to her poorly first which is a lie because the OR nurse apologized to me on her behalf and asked me why I didn’t snatch her face off.

She was educated on “professionalism”. When another nurse yelled and me and tried to order me around and I told her not to talk to me that way, then it turned into an argument because she wouldn’t stop, nothing happened to her. However, this is happening in my locums academic gig and reminds me a lot of residency. Other attendings deal with that **** too, but my time is limited thankfully. The people in charge don’t give a **** and half of them don’t get a long. So many unhappy people. Can’t keep anyone full time.

Not saying all academic depts are like that, but plenty of **** that happens in academics I bet don’t happen in the real world. At least that’s been my experience. Never had problems with RNs in PP. Just CRNAs sometimes.

If you aren’t a woman, you can’t understand how much more **** we have to deal with.. If you are, more power.

 

[chocomorsel]

Agree 100%. But I don't advocate arguing with anyone. Tell them exactly what your issue is and how they can correct is. It's as simple as that. Most people will be responsive if you're able to articulate exactly what your problem is, as long as it isn't some frivolous nonsense. That isn't even a doctor-nurse thing...just human beings in general. All I am saying is, don't let yourselves get trampled on. If you just bend over and take it, people will continue to do it (the "one guy" that gets made fun of in a group setting always).

It’s not as simple as that. Your working environment seems to work like it should. There are many other working environments that don’t. That can be toxic. Lucky you haven’t experienced it.

I imagine some people in the current White House never experienced some of the **** they are experiencing now.