OPERATING ROOM RN CIRCULATOR

Dear Dear Operating Room Patients,

I hope you “all” are well. I also hope that you all are staring to get a sense of my goals for this web site. My main intent for this site is to alert you about the many harmful variables in the operating room which could end up causing harm to you and / or to your loved ones
as well as to teach you how to perhaps minimize the “harmful variables.” I can only share my opinions and opinions of the experts. You all must help me to bring national attention to the issues because it is your voices to which the state and federal legislators must listen so that laws, and guidelines are changed! If the necessary changes are not made at state or federal levels, then the blood of many is on their hands.

I was never a negative person. Since I became a “medical misadventure,” a term someone referred to when they spoke about a medical error, I have become cynical and scared, cynical about my own personal post-op issues and scared for my family who might end up in an operating room. Things go on in the OR that one cannot imagine! Of course, there are some good results but the rest of the other results cause pain, suffering, and even death not to mention the financial aspect that will burden the patient and their families.

Most of us don’t even question “results.” We accept the pain and suffering and even death as normal things that could occur from our surgical procedures. You “accept” death as a RISK when you sign your consent! This is crazy!

Did you ever realize that when you take your car for a new transmission or new brakes, that you expect your car to be repaired but yet when we “hand over” our bodies to undergo a procedure, that there are no guarantees? There are no guarantees that you will have licensed or certified staff taking care of you!

There are no guarantees that you will even have a “registered nurse” in the operating room with you! Oh, one might interview you and say “hello” but that does not mean you will have an experienced RN with operating room training with you in the OR.

Dear God, even hairdressers are licensed. It is to be the responsibility of each state to protect their citizens and yet many states do not have any laws on the books at all, and then again, just because there are some laws, it does not mean that they are being followed!

The “verbiage” often used in regard to Operating Room RN “Circulator” presence in a hospital is “No language, CMS language, Weak / Inadequate, and Acceptable.” As far as the language for “mandating” that each OR patient has an OR RN Circulator in a hospital setting, it is my opinion that all the language is weak! The verbiage mandating an OR RN Circulator in ambulatory settings is basically zero!

The verbiage needs to be: There are needs to be a qualified Operating Room RN performing circulating duties for each patient for their entire “invasive procedure.” Canada has a post RN program just to teach / train RNs in the Operating Room Techniques. Just as “surgical residents” have to do an OR rotation if they want to become a surgeon so should every RN who wants to work in the operating room! This is not my idea or a new idea, in fact there used to be an OR rotation in nursing programs for all RNs years ago. When I was at one meeting I myself heard the phrase, “OR nurses are just trained monkeys!” Well folks, my reply to this nurse manager was, “the next time you have surgery, I would suggest that you better make sure you have a good trained monkey.” The OR RN Circulator is the “manager” of each room’s case: medications, blood, correct counting of sponges and instruments, making sure all safety measures are in place before the incision is made so the patient does not get a burn, nor bleeds to death because someone failed to notice that there was no blood ordered by the surgeon, or that a latex allergy is not noticed or that their patient history does not reflect that they are still on heparin and oops they are about ready to have a “spinal block” (and the list of safety issues goes on and on). It is your OR RN Circulator who is to be your “advocate” when you are shot up with drugs or are asleep during surgery and as a result are not able to speak up for yourself.

The safety list is tremendously long and tremendously important for each patient. I loved holding a patient’s hand when they were about to drift off to sleep BUT folks, that is NOT what OR nursing is about! Being “NICE” does not mean being “GOOD”. To be GOOD means that YOUR life is being valued! That YOUR life is worth hiring an OR RN Circulator so there is a licensed staff with you at all times.

The stupid stories out there that there is a SHORTAGE of nurses is a bunch of crap! Number one, studies show that many RN leave nursing ONE year after graduating! Why? That discussion is for another day, and I will address it! There is no shortage because hospitals have filled the “empty slots” intentionally over the years with unlicensed staff at lower costs! I will also address the UAP (unlicensed assistive personnel) issue later.

AHRQ (Agency for Healthcare research and Quality) in a July 2008 press release stated, that “Surgical Errors Cost Nearly 1.5 Billion Annually.” My opinion is that “one” of the most important
facets to the entire picture of “surgical errors” is the absence of an OR RN CIRCULATOR for each patient for the duration of the entire surgical procedure!

PLEASE read this CMS (Medicare / Medicaid) regulation very carefully! Also PLEASE think about the connotation of the word “SUPERVISION!”

“482.51(a)(3) Qualified registered nurses may perform circulating duties in the operating room. In accordance with applicable State laws and approved medical staff policies and procedures, LPNs and surgical technologists may assist in circulatory duties under the supervision of a qualified registered nurse who is immediately available to respond to emergencies.”

I say BULL!!!

1. What does the word “qualified” mean?
2. Some states do allow “LPNs and unlicensed” staff to circulate. Not very many “techs” are technologists (this title usually represents / denotes a two year associate degree) nor are all “certified.”
3. Some certification programs are a couple months, or one year. Many techs are “on the job trained.”
4. The word “supervision” might mean: in the room, in the hallway, in the next building or in the next country!

Dear patients, a licensed RN with training in the operating room arena has to be present at all time! One does not question the need for a RN in the ICU. Well, there should be no question that an OR RN is needed for each patient undergoing an invasive procedure, and being present for the entire case! Routine and emergent issues both need the expertise of an OR RN presence! It is only the RN that is allowed by state laws to: assess, to solve, to evaluate, and to coordinate patient care.

FYIs: From 2003 to 2006, there were over 238,337 preventable deaths according to Healthgrades. Also, LifeScience stated that MRSA killed 18,650 Americans in 2005. The list goes on and on, and I have many of those “lists!” Good grief!

Dear patients, after the national election, PLEASE call YOUR state and federal reps! States should not be allowed to dictate decisions based on “their special needs.” The decisions should be based on “patient safety.” Let us demand that every state law as well as CMS is clear and to the point: ONE OR RN CIRCULATOR ON EACH PATIENT’S CASE, FOR THEIR ENTIRE INVASIVE PROCEDURE!

Patients’ lives depend on it! Safety is the issue!

There are many issues to “solve” BUT it can be done IF all Operating Room managers were given the power and authority to make the necessary changes. CEOs need to demand that all QI / Risk reports be FORWARDED to Risk Management. If “numbers” don’t improve and I mean improve “honestly,” then some managers should be looking for another job!

Real change makes a difference. Up to now all the “numbers” of surgical mistakes show that people are “talking the talk but not walking the walk!”

God bless you all,
God bless our troops,
God bless the USA,
Helen French RN, BSN