or shortage
are we ever! in the hospitals i have worked in the past..you had to have a death to get into or...but here....we are sooooo short and none of the nurses from the floor are interested at all. I feel it is soooo much better than the floor. the manager and supervisor and educator were in rooms yesterday...how bad is yours?
thanks

Shortage
I'm our educator/relief charge & I've been in rooms for weeks now. The regular charge nurse is in a room lots of days. Our nurse manager has had to act as charge & our director has been working our prep area. We're sinking fast! Everyone has been working hours & hours of overtime just to keep it going, but we're all worn out.

If we don't get some help soon, we're going to lose more people. They have hired 6 inexperienced nurses plus 2 new grads--but they're months away from being any help to us. I'm afraid we're going to chase them all off before we can get them trained! We're trying to get travelers but not having much luck so far. We can't get it through to administration that we have to shut down rooms because we just can't do it anymore.

In 26 years, I've never seen anything like this! You're right, you used to have to wait for a death or retirement for a spot to open up in surgery! I don't know what the answer is.

what size or
just curious...what size or do you have....we have 6 rooms...this includes one urology room.....and 3 outpatient surgery rooms on another level. I have only been in or for 4 years and am wondering how other hospitals of similar size do certain things.
thanks

We have 8 rooms & a cysto room in the main OR, plus 2 cataract rooms in an adjacent building & 2 c-section rooms in our OB dept. We do probably 800 cases /month. I'm always interested in learning how other people do things too.

or
I feel we probably do about 3/4 of that. OB does their own sections...we just share anesthesia. How do you handle things like, call ins? working all night? specialties? do all rn's scrub? just curious...
here:
call ins are a problem and as far as call goes for the day..we have a list and whoever is at the top of the list has to take call...as long as they weren't on the night before or the next. it works better than drawing from a hat like we did for years.

we usually get to go home if we worked all night...it may be after lunches...but usually if we are still working when day shift comes in..they releive us and we go home. have to take pto for the day though. continue to have problems with people who worked one hr over or didn't work at all...wanting to go home at 1300..because they were "on call"...when you don't complain...you're the last one there...even though you worked until 2130.

we have specialties...but we are small enough to not always stay in our specialties....we feel we must be able to do "anything" as we have to on call...or in cases of illnesses, vacation etc ....and for the most part it works...okay....but i wonder...why hasn't this been ironed out...after all this time..

i have asked to learn to scrub for 3 years....i do when they need someone really bad...and just learn alittle here and there by drs and scrubs....wouldn't it be smart to have cross training as much as possible...
(i understand now...we are so short staffed it is not possible...but it has not always been this way)

do you have orderlies that really help....?? all ours do is come to room (if paged) clean....but put nothing away....do not anticipate needs...nor get room ready for next case....example...set up for upper extremety....get stirrups....i feel this is such a waste of time...they just go hold up a wall until they are paged again!!! i really strive for organization and efficiency....

i would love to hear how you handle these things and more..

thanks

We have to do c-sections. If it's an emergency, we do them on OB, if scheduled, we do them in the OR. That's a real sore spot with us! Poor OB staff just too short to learn to do their own! We have a very high c-section rate so they're really disruptive to our schedule.

Most of our call is voluntary. People sign up but if something isn't covered, we have a mandatory list. We recently put on a midnight shift, which has helped with the call situation. We were usually not able to let the call person go home even if they had worked all night. Right now we just have 3-11 call weekdays & 24 hr call on weekends. We break it up into 8 hr shifts, unless someone wants to take more. Our call pay is really good so a lot of people want it.

Our biggest problem right now is having to work over into 3-11. They let the docs schedule whatever & whenever they want. Lots of times at 3:00 we still have 5-6 rooms running. We have "star shifts" which is basically mandatory overtime. If you're a star, you most likely stay until 5pm (and we have 4 star shifts assigned per day). We have 2 regular 3-11 crews scheduled plus a charge nurse. Our 3-11 people tend to send the day shift people (who are stuck there) into the biggest rooms. They're theory is that they might have to work the full 8 hrs! Doesn't matter that we've already worked 8 & are working on 10!

Some of our RN's scrub, but not usually. Us older nurses can, but seldom do. We use ORT's all of the time.

Call ins are a HUGE problem for us! We have people who call in constantly, but get away with us. Our attendance policy allows 3 call ins in 6 mos. for a verbal warning, 3 more for a written, then 3 more for suspension. These people always time it out so they never get suspended. It's really irritating to those of us who actually show up on a daily basis. We just make do when someone calls in. So far we've been able to function, but we're so short now it's really getting ugly.

We have attendants. They basically transport patients to & from our prep area. Once in a while you can actually get one to help lift a patient! The RN & ORT turn the rooms over. We have housekeeping people who mop & take out trash, but we do the rest.

We also have teams, but we have to be able to function everyplace else too. We do everything but cardiac & neuro. Tons of ortho & GYN.

Does your hospital pay any more to be an OR nurse than anyplace else in the hospital? We've been pushing to get some sort of specialty pay thinking it make attract people to the OR. Naturally, administration isn't going for that. How about certification? Do you have many CNOR's? We used to have about 90% of our people certified, but none of the newer people will even bother with it.

or
i don't know if we offer more for or nurses...as it is grounds for termination to discuss salary. but i doubt it....there are probably new grads making as much as i do and i've been an nurse for 11 years. we have a holding area....who get pt's ready and make sure all is on the up and up for surgery. we go with anesthesia to holding..ask our questions...they push versed and we go...
another problem we have is between scrubs and circulators....we say we are a team...but are we really....some do nothing for the nurse...other nurses do nothing for the scrub...and so on....i am there to help everyone...but some things for me are a waste of time...and i am needed elsewhere to expidite the day...if i stay and mop.....then anesthesia...is mad because they are waiting for me in holding.. if i have time...i do mop....and open and spread...i work hard to anticipate needs of the scrubs so all they need do ...is just nod that yes...that is the suture they want or many times...not even ask....i just do it.
we too....do everything but brains and hearts...i specialize in urology and that takes up much of three days...most weeks. my second favorite is vascular....and i usually do this thurs and frid....as we are so short staffed....
we are often stuck in rooms...but for the most part....we are asked if we can stay...and if not....SOMEONE comes in....some will offer to stay if the board looks like that will be necessary...in these cases we get overtime to the first hour and then db time...this is the same of call back time...weekdays or weekends...(there is some shift differential there)
there are times...that no one asks...and no one gets you out...and you are stuck! but that is true of any nursing job. there are nurses that have never worked the floor or it's been years.....and i tell them it is the same way there. at least we get a decent lunch and can't have more than one patient at a time!!!
much of the reason we can't get people to work here.....is the reputation we have. it is of....frankly...*bitches* and just not being very nice to new people. that was very true when i started...and you do have to be thick skinned... i know these people now and know that they are very kind...i have told them...if they want help...you have got to be nicer to new people and even students.... we may get one new grad a year...and only two have stayed....nurses start with us and immediately transfer to holding area or recovery. we are getting better...it is not necessary to eat your young.

what does your midnight shift do? who does this consist of?

do you get good pay just to be on call or work?
our pay for oncall only is like an dollar an hour...we take about 1 day a week and a weekend (sat and sunday from 7am to 7am) about every 6 weeks...you can always get more if you want it...and most people will trade if necessary...but rarely give it away...unless someone..(like me) is in a financial pinch...and committing nursing suicide...(got about 32 hrs call back on a check not long ago.)

thanks for all your input.

You guys sound like us! The rest of the hospital avoids us like the plague because we're so mean! LOL! We usually get 2-3 new grads each year & it's been 10 years since anyone of them actually stayed. I just love spending months training someone only to have them move on for more money, better hours, etc.

We have a lot of RN/ORT issues too. Most of us do work as a team, but you always have the few who make everyones lives miserable. We have a few that it's hard to assign because they can't work with hardly any docs or staff.

I've mainly been ENT for about 10-11 years. Last year, they put me in my current position of education/competency/materials management/ whatever else they feel like having me do. All the while, I've still had my ENT Specialty Coordinator duties too. Now with this big shortage, I'm totally swamped. Plus, our regular charge nurse had surgery so I've been stuck doing charge now for the last few weeks.

When we work overtime on star shift, it's regular time til you hit 40 hrs. After that it's time & 1/2. Our call pay is figured really strange--some big payroll formula that none of us can figure out. For an 8 hr call shift where you're not called out, an RN makes about $125. If you get called out, it's automatic 4 hrs time & 1/2. We do offer the best call pay in our area.

We've always had an ORT on midnights, but until recently the RN took it by call. They decided we need a 10 minute response time due to the c-sections, so now we have a midnight nurse. They do any emergency cases, finish pulling for the next days cases, check & see if all the supplies are there, get the rooms ready & open up for any big cases starting early.

We have a Prep Room & it's one huge HIPPA violation. We're trying to get things changed. It's just 1 big room with curtains you can pull. We have 5-6 patients there at any given time. There's no privacy at all plus you have family members in there listening & watching everything. We have a area adjacent to us that has individual cubicles that we want to convert to the prep area. Right now it's a short term recovery area for people having to stay 3-4 hrs post op.

Do you have a problem with surgeons behaviors? We have some who are absolutly crazy! We write them up day after day but administration won't do anything about them. They get a smack on the hand & told to be good boys! We have a couple we're actually afraid are going to hurt someone when they go off on these tirades.

I'm really enjoying our exchange here. It's great to know other people are going thru the same stuff.

or
we do sound alike! I am cleaning house and conning my kids into mopping the floor with laps and pretending it's fun.! :wink:

we get overtime (time and 1/2) with anything over 8 hours a day...reguardless of how many total hours in the pay period. that is nice...and our double time...is nowhere else in the hospital...but my very experienced co workers...fought hard for that many years ago...when they were soooo overworked. i'm not sure i understand your call back...i will just say i get around 40.00 per hour on db time...is yours comparible? we tossed about a night nurse...to do similar things..but our management has shot it down. i think it's a great idea...as long as they actually DO those things. not just sit.

is your prep area...a holding area like mine?? ours was a huge hippa violation also until it was recently remodled and now there is alittle privacy but still when a doctor blows up...it's there for ALL to see

yes...we have some doctors that are awful...and i just try to make sure they have nothing to get onto me about...just yesterday i was on call and we came in about 1030 to do a external fixation of an ankle..fairly new doctor..probably only worked with him 6 or 7 times... (i hardly ever do ortho...) (and fine with me) he said when i was prepping... " if you have to have gum....i better not hear it! understand!? " i said "okay" and kept on chewing.. I guess i had popped it in my mouth and he hates that...oh well!!!! there are many things i hate about him! i'll be damned if i am going to spit my gum out for him...when he asked me in that way!!!
I am very good at what i do...and i have an enourmous amount of respect for doctors...if they come in i get up for them to have a seat...i go out of my way to make things easier for them...and i will continue to do this until i have a reason not to...if he is sooooo bothered by that sort of thing....he better think of a better way to let people know about it.
why??? just because it's medicine and he's a doctor ...is it okay to talk to people like that??? would my dad...a banker...have talked to a teller like that...and got away with it?? hell no!!!!! but we get bloody instuments thrown at us....cussing....and not to mention god knows what said about us at the field when we can't hear it!!!!
thanks....i needed that little release i've never written a doctor up...but i sure would if necessary..

on the other hand

i love surgery because....we have FUN!!!! there are plenty of people to depend on when you have an emergency....my co workers are there for me....no matter what (at least most of them) if you need some medical advice...you have every specialty at your fingertips. ......i love my patients and their families....most of my surgeons are wonderful and respectful and great at what they do...I tell new grads..." you see those loops dr? is looking thru....imagine that you are doing it...you are suturing a vessel back together with hairlike suture and wouldn't you be annoyed if someone was just yacking....or talking on the phone instead of anticipating your needs.....moving the table..(even alittle) wouldn't you be alittle edgy if you knew...one wrong move and this person could die!!!! really think about it!!!!! not just how much paperwork you have to do...or what you're having for supper tonight...think!!!!! just put yourself in their shoes" now of course, they're not all going to reciprocate this...but it works for me.
thanks for the great stuff...keep it coming...

forgot
also...i forgot to reply about aorn or such...no one really is in that...we just started what's called clinical ladder and you gets points for how long you've been in nursing..etc...and you can get extra points for being a member of an organization etc...you can get up to a 7 % raise.,...

We have a call crew on 3-11 just for emergencies. There are 3 crews working until 7pm, then they go down to 2 crews until 11. They aren't supposed to use the call team for scheduled cases--not that they always abide by that rule. If you're on call, you just have to be within 20 min of the hospital. Except on Fri & Sat 11-7 when we have no midnight nurse working (then you sleep in house).

I figure docs have to earn respect. I'll bend over backwards to help the ones who treat me good. Some, I wouldn't spit on if they were on fire! I can deal with a little bad behavior if they're a good surgeon. What I hate are the quacks who are also jerks! I keep hoping one of them will throw something & hit me! You better believe I wouldn't be working anymore! There's one guy I threatend to call the police on if he gave me any problems! He was having a fit when I came on one Sun. 3-11 & had the whole day shift crew in tears. I had the administrater on call alerted & was ready for a fight. The jerk was a perfect gentleman to me all evening! I was mad cause I'd gotten all worked up for nothing!

I really enjoy surgery too. I can't even imagine working a floor! Overall, we have the best schedule in the hospital. And I love having 1 patient at a time. I could do ENT in my sleep, but I'm kind of rusty in some areas. I HATE ortho! I've never liked it from the day I hit surgery.

We have a pretty good bunch of people in our OR, just a few bad seeds. There are several of us who started there together many moons ago. We're the "old farts" that everyone comes to for help. I feel like a lot of us--including several of the docs--have grown up together. We're really a family (dysfunctional most days, but still family). We fight & bicker a lot, but everyone pulls together when any of us has a problem.

We did get work today that a traveler has accepted a position with us. The only bad thing is he's coming from Australia & won't be ther for 4-5 weeks! We're hoping a guy in Tennessee accepts our offer also.

Do you guys have a problem with incorrect instrument trays, misplaced equipment, stuff like that? Our Central Supply processes our trays. We have TERRIBLE problems with stuff being wrong or missing. They also put our trays away in our storage area & never get them in the right place. We've looked at several tracking systems, but they're so costly we can't get approval for one. We also have a problem with our own staff misplacing equipment. No one seems to be able to put anything back where it belongs. We waste a lot of time everyday just trying to track stuff down.

Actually...no we don't have much trouble with that. The sterile supply girls are great..but do occassionaly forget an indicator or forget an instrument in a set or add an extra...but for the most part are great. we have trouble with administration deciding we don't need something and taking it out of inventory without asking the people that ACTUALLY use it!

as far as equipment like stools, stirrups, machines...etc....there are people who don't put them where they belong..but you can usually find them in the last room they worked in. of course no one says anything to them unless we do it ourselves.

do you help anesthesia? do they go with you to get patients?

how many people on call at a time? here we have one circulator and two scrubs..if it is just a one scrub case, like a cysto...only one comes in.

who can count ? we only allow RN's....no LPN's.

how do you transfer patients? we use rollers.

do you have suture and gloves and plenty of supplies in all the rooms?
we only have a few things....like a few syringes, blades, gowns, preps, med drapes....hypos...tubing...etc and the rest of the spanken new cabinets are empty...(have to reduce our inventory)

i have heard that in england they don't use masks unless they are scrubbed in. i would love that!

can you wear cloth hats? we cannot...wish we could.

i guess i've badgered you enough with questions for now.
thanks
bs

We have a few good CS people, but most of them are so underpaid they could care less. We has a person who washes instruments, then they're taken downstairs to the main CS & processed. When we send something to the workroom, it's like sending it to the Twilight Zone! It may or may not come back.

We recently got a new storage room--which is great. Except...it's too far away from the room! We call it the South 40. We're finally starting to get supplies organized.

The RN moves the patients back to the OR with a CRNA. We also move them into recovery together.

We don't have any LPN's. We've had them in the past as scrubs. It has to be an RN counting with a tech.

We have 1 RN & 1 ORT on call. We sue PA's to assist so there's always one of them on call.

Yes, we use rollers too. We nicknamed ours Fred years ago, lol. We have the little short ones & mounted 1 in each room. We used to have to run up & down the halls looking for Fred whenever we needed to move.

Since we got the new supply rooms, people tend to keep too much stock in the rooms. We've made par levels & tried to organize, but it doesn't last long. People don't want to run to the South 40 to get things or put them away, so there's way too much junk in all the rooms.

We can wear cloth hats & our own warm up jackets. Do you all have to wear lab coats when you go out of the OR? We did for years, but they stopped it. I still feel uncomfortable outside without one.

Our biggest problem with administration is they tell all the docs they can have stuff, without ever checking to see if we need it or anybody else wants it. We recently had a laser turn up one doc asked for! No one had any idea about it, but a VP had told the guy he'd get it. He also got another one an ultrasound machine! It turned out several other docs wanted the US machine--but no one really wanted the one we got! It was a mess, sending it back, getting another one. We have one orthopod who's constantly going over our directors head & getting stuff. He had a $500,000 navigational system brought in for trial recently! None of the other orthopods want it plus we already had a different version of it for ENT!

We try to streamline to cut costs, but administration always caves in. We use both Auto Suture & Ethicon staplers because they won't make them go to 1 kind. We have thousands of $'s in staple inventory! It's ridiculous. I didn't realize how much money we had tied up in stuff til I started over seeing some of the materials management.

How do you all do your scheduling? We schedule thru our front desk & it's chaos! We normally have 2 unit clerks at the desk, but the charge nurse ends up having to do a lot of scheduling. It's all computerized, but is fairly time consuming to do. I think we should have a schedule clerk, seperate from the front desk. A couple of the docs have case info faxed in from their offices which makes it great. You have a paper in front of you to schedule from. Plus, if it's scheduled wrong, you have that paper to look at to see if the office or we screwed up.

Happy Easter!

there are two secretaries...that have been there Forever! and they schedule everything via the computer...I don't think we have much trouble with it that i know of....but i just do the cases that are scheduled....who am i to say...they can or can't.... for the most part...they are scheduled accurately with an average amount of time the last similar case took...in for the proposed amount of time for the case...some days it works...sometimes not.
i guess we're lucky to have our supplies, etc...so close to us...
i think it's a great idea to hand the rollers....i will bring it up. do you swap for doctors to accomidate...if enough crew?
bs

What do you mean swap for doctors? Do you mean move cases around from room to room? We do that a lot. Anything to move the schedule around. I hate it when I'm in a room, but understand it has to be done to keep things moving.

Do you all have Block Scheduling--a doc has assigned hours that he can do anything he wants in? It works pretty well for us with a few exceptions. Our biggest problem with that is administration lets docs have block time who hardly ever come there. Blocks release at certain periods before the date, but it still ties up rooms you know won't be used.

yes, instead of same crew, same room...we flip/flop either just room or anesthesia and/or crew...so the turn over time is less....the anesthesia say there is a stipulation in their contract that they wont do this...and we do it only occassionally...i don't know whey just occassionally...rarely have enough crew to run five rooms...!!! i feel if we start doing it for one doctor...why not all of them...?
yes they have blocks...i don't understand it competely...they must establish that they can have to load to get a block and they must release it in a certain amount of time...and etc...etc....since...i'm always in a room..i know very little about this.

does your manager really know what happens in the or? what about supervisor?
thanks
bs

We're constantly flip flopping rooms. We usually just move the cases--not the crew. If a room finishes or has down time, we'll run another case in it. Our anesthesia people hate moving to other rooms, but they'll do it.

We're supposed to be running 9 rooms 2 days/week & 11 rooms3 days/wk. Lately, we've been closing down 2-3 rooms every day due to staffing problems.

Our manager & director have never had much of a clue as to what actually goes on in the back. Since we've been so short--they've had a rude awakening! They've actually been having to help out. Lots of days our manager runs the schedule and our director has been helping out in our Prep Room.

We've got 5 new RN's we're starting to train (no OR experience). Plus in June we'll get 5 new grads. Hopefully, some of them will hang around past their orientation! I don't feel like we're able to train anyone very well right now because we're so short handed. Our regular charge nurse is due back to work Tues from having surgery, so I'll be out of that position (THANK GOD!). I hope to really get started trying to train the new people next week.

I have worked in many areas in nursing (Med/Surg, ICU, ER, OR) and I will have to admit that in ways I found many people in the OR are unwilling to help orient new nurses. As nurses we can be our own worst enemies. Instead of working together we tend to help only or inner circle of friends treating newcomers and others as outsiders. Yes, I know helping to train and orient a new person can be tiring, frustrating, and mentally exhausting but you have to think back to when you were a graduate nurse or a RN new to the OR. It is surprising how many people will say if they were treated badly when they first started off in the OR or another speciality and that they treat the new employees the same way they were treated. When will we ever learn, stop working against each other and start working together to make a better work environment for all.

I agree we can be our own worst enemies. I try to keep new people away from certain staff members & docs as long as I can. We have a couple people who've run off several people. Problem is, there's been numerous complaints about these people & administration never does anything.

For the most part, we are like family & it is hard to get people to feel like they belong. We do get tired of training new people, especially when you doubt they're gonna stay long. I wish the nursing schools would offer more perioperative classes. That would give people more of an idea what the OR is really like before they invest anytime trying to learn it after graduation.