It has been over a year since I started working at LTC and things have definitely changed for the better. The leadership team has managed to build some trust and implement various initiatives. But we still have a lot of work to do.
What is glaringly apparent is that the staff, despite being nice people, need a lot of work when it comes to being prepared for procedures. Needless to say, this thought keeps me up night!
Preparation for a surgical procedure can vary from being very simple to a complex set up. Either way, it all starts the same way. The surgical tech or scrub nurse, along with the circulating nurse, looks at the surgeon's preference card, discusses any special needs with the surgeon, and sets up the case from there.
The scrub tech or scrub nurse will make sure that all instrumentation and sterile supplies are opened. He or she will scrub in and set up the case. Meanwhile, the circulating nurse will make sure that all the right equipment is available - bed, positioning equipment, cautery, suction, etc. Medications are pulled and prepared. The patient's chart is double-checked and an assessment is done in the pre-operative area by the circulating nurse, anesthesiologist, and surgeon.
Ideally, before the patient is brought to the room, the scrub tech/nurse and the circulator should have everything ready for the case. At LTC, it seems that this does not always happen. In fact, it seems like some of our surgical teams are always scrambling at the last minute. It's so nerve-wrecking!
At morning report, in staff meeting presentations, during rounds, we have tried to impart on the staff how important it is to be prepared. "Do the right thing," we say.
Maybe they are confused on what that means...
It is difficult for me to comprehend because, as I look back on my training, it was strongly impressed on me as a new operating room nurse that I am the patient's advocate. The people in my care have put their TRUST in me that I will give them the best care possible while they are under anesthesia. This is a BIG DEAL. Trust is something I do not take lightly.
So now I'm trying desperately to figure out how to get through to our scrub techs and nurses.
How do you make healthcare professionals realize the important role they play in someone's care?
I wish I had an answer...
It's basically the law of the least physical effort. Getting the OR completely ready before bringing the patient into the room means no socializing, downloading coffee, etc between cases. Not only that, but what are the incentives for staff to be ready? Around many OR's the nurses and techs feel that any time they save in turnover of the ORs will be wasted by someone else, surgeons, anesthesia, residents, housekeeping etc. Success in this area requires a team effort, and the nurses and techs are usually the only ones focused on team goals as opposed to individual goals (surgeons, anesthesia). My experience is that an institution cannot turn this around until it hits bottom, and then it requires a joint effort.
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