Q: Staff Favoritism

Often charge nurses start to favor certain staff. This usually happens when the surgeons start to make requests. This is a lose/lose situation. The staff is unable to learn the surgeon’s idiosyncrasies, and it only reinforces negative behavior. Instead of asking to have an assignment changed, the inexperienced staff member doesn’t usually ask because they don’t want to work with the surgeon either. It gets even worse when the favored staff do not get along with the inexperienced staff. If so, they could do the cases together. This would teach as well as decrease the level of anxiety of the surgeon and the new staff. Any suggestions on how to improve this situation?

A: I see this happening at my institution. One of the troubles with this is that we require all of our staff to be on call. If they are not or have not worked with a surgeon for a while and do not know the case it is not fair to the person taking call. I would like to know of ways to change this as well.

A: As the Clinical Educator, I had all nurses and surgical techs complete an “Employee Experience Survey” to determine a basic level of expertise in all service lines. The staff can choose from “independent,” “needs assistance”, or “no experience.”

Completion of the survey was met with mixed reactions. Some staff were eager to learn a new specialty and overburdened, expert staff were excited that colleagues who “hide” behind the façade of “I can’t do that lineup, because I haven’t done gyne in a long time” would be assigned to different service lines. Those who were hiding weren’t excited at all, as they had to ’fess up to their level of expertise and move out of their comfort zone.

We started training for all our staff to become “expert generalists” in January 2014!

A: It’s a universal problem, if you are not big enough to have a team for this and a team for that. We do the preceptor and new tech/ nurse, that is tied to the career ladder. The issue is teamwork and the culture in the OR is a difficult one. In my 30 years in the OR, I try to empathize with the patient and that is why we are here.

I don’t know if this helps, but I wanted to share that this is not just your situation, but exists everywhere.

Q: Endo clips – Permanent or not?

During upper GIs oftentimes resolution clips are used. There is usually one clip per device. Is this considered an implant? It is temporary, and falls off by itself. Lap Chole clips are permanent. Hulkaclips are permanent. Mesh is permanent. Port-a-caths are not permanent. Urology stents are not permanent. What is the answer regarding the Endo Clips?

A: Not implants.
A: We don’t consider these permanent.

Q: Immediate use sterilization practices

I was visiting a facility and the sterile processing technician stated that they do “non-wrapped prevac cycles” for many of their instruments and stated that this is not considered “flashing.” Is this considered Immediate-Use Sterilization?

A: Same thing.

A: Immediate-Use Sterilization is defined as the shortest time possible between a sterilized item’s removal from the sterilizer and the aseptic transfer to the sterile field. This is not to be used for future use and not held from one case to another. The use of Immediate-Use Sterilization should be kept to a minimum. Implants and implanted devices are never to be sterilized in this manner. At our facility, we only use this when an item is out of service with no replacement. The surgeon is aware, and an occurrence report is generated.

A: Immediate-Use Steam Sterilization is still considered to be used only for emergent or “have to” situations. This practice should be limited and should not be for the lack of instrumentation on a routine basis. We have worked very hard to reduce our rates and are now hitting below 5 percent.

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