Why is it when some staff members are done with their cases they just sit in the lounge and visit, while others go around and offer help? How does one change the work ethic of others? The staff members who sit in the lounge and visit are the first ones to complain about others not helping them. Back in the day nurses were trained to check in with the charge nurse when their assignments were finished, today it seems like they disappear. There is always work to be done in the operating room. Does anyone have any suggestions on how to motivate others?

A: I noticed that charge nurse rounding really helps with this. We used to have a jobs list that had to be done during any down time as well as proactively assigned staff to assist when their rooms were down. Also, we implemented hourly rounds through the lounges and other favorite hiding spots and if folks were lounging we would offer work or go home early option. That usually got everybody moving or off the clock at least. It also promoted changes in behavior so that people got the message very quickly that they would be rounded on routinely and lounging wasn’t going to be an option.

A:  What you allow is what will continue. Why are staff members allowed to sit in the break room? We have this issue as well but assign rooms/carts/areas for staff to maintain, clean and check out dates. Occasional downtime is OK! It allows the staff to decompress, socialize, etc. but shouldn’t be the normal routine. Let your staff know you are aware of who is abusing downtime, recognize the “worker bees” without calling out the “lounge lizards.” A little bit of peer pressure can go a long way!

A:  I once put a sign over our break room that said “herpetarium.” That was too far, just in case you’re wondering where some of the boundaries are. Some good did come out it in the end as it created an environment for discussion on this topic that “administration” had been unwilling or unable to deal with. There are other ways to deal with it that are less passive/aggressive but leaders need the tools, guidance, education and support to enact and follow through. Once it gets rolling it is a joy to be a member of.


Blood Consent

Should a blood consent be separate or included in the surgical consent? Some surgeons want it all in one consent and others want it separate. The majority of facilities have separate anesthesia consents. One facility had a separate consent for if they wanted their anesthesiologist to pray with them. If the blood consent is included in the surgical consent, is it true that it is the surgeon’s responsibility to inform the patient of the risks and benefits to receiving blood?

A: Our informed surgical consent includes a consent to receive blood products. The patient circles “Yes” or “No” and initials it. This could be a facility policy or even a state mandate in your area. I suggest following up with your quality department to find out what is expected.

A: Our facility has the blood and anesthesia consent in the surgical consent. It is a three-page informed consent form. In California it is the physician’s responsibility to give the patient information regarding risks and benefits of blood transfusion as per the Paul Gann’s Act. If for some reason the physician wasn’t able to provide the patient the information, the nursing staff has access to the informational pamphlets. They would hand them out to the patient to review and the patient would speak with the surgeon regarding their decision prior to entering the OR.

A: Blood is part of our surgical consent. We do have a separate anesthesia consent.


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