The surgical process has been the root of many discussions amongst the leadership and staff meetings on my unit. There are many days when we have three or four scheduled cases which ultimately turn into six to seven cases being done on any given day. This causes chaos amongst the staff and physicians and leaves the charge nurse in the middle trying to referee, organize and and bring order to the mass confusion. At the start of the day we usually allow staff to choose their assignments, on some days the charge nurse will delegate or request certain nurses to please take the OR/PACU assignment to help facilitate a presumed busy OR schedule. We start out with usually a two person OR/PACU team, on some days if staffing permits I (as thecharge nurse) will assign a third person to the OR/PACU team to help with the flow of admissions, preps and recoveries. This flows great until a STAT c/s is called or some other sort of unscheduled case, whether it be a rescue cerclage, D&C, D&E or vaginal repair. This throws off the schedule, also when anesthesia is ready to take lunch. This will cause a 30min or 1 hr lag in the schedule. I have my nurses to relieve each other for breaks and lunches so that we can keep the OR running and moving the patients along as sceduled. The OB physicians love this however anesthesia is not happy, and they do not have coverage during the designated lunch time, so they must break themselves unless it is an emergency. The back and forth with anesthesia and the physicians and the constant delays with OR cases, along with patient complaints that their c/s procedure was delayed and didn’t go on time , this their family members were waiting in the waiting room, have caught the attention of the manager. So, as of March 11, in our leadership meeting we are going to try her suggestion and do away with our OR/PACU team assignment and have 1 nurse follow the patient throughout their phases of care in labor and delivery, hopefully continuity of care and personalization of care will help soothe over any ill feelings that the patient may have. Also, we are to explain to patients that the OR will break at a designate time for 30 minutes. Also communicate with patients about the timeline. We are on the fence about an electronic status board, like our OSDU and other surgical sites within the hospital, I, myself are for the electronic status board, because it will be placed in the PACU and one in he family waiting room. Each patient will be given a random number, which will be their identifier and the patient and the family member will be cognizant of where they stand on the status bard instead of questioning staff. All of the Unit Coordinators feel that this is a great idea, we are in staffing 90% of the time, therefore we interact with patients and families and also see. How frustrated staff and physicians are with the unknown status of cases. “It is critical that managers not view change as a threat.” (Marquis & Huston p. 197) The manger doesn’t quite understand where we are coming from, she just receives multiple complaints staff, physicians and patients. “It is important that managers or change agents identify and appropriate change theory or model to provide a framework for implementing, managing and evaluating change.“ (Mitchell, G, 2012) We have asked for feedback from staff and physicians from the first trial, which is 1 patient and 1 nurse througrout the surgical process, this is my managers choice, we decided to attempt her suggestion first for a peroid of 1 month. then we will survey the staff and see which way woks better for the team, so that we can work thru the kinks to have a more proficient, productive and efficient surgical process, with the number of staff that we have. “Whenever possible, all those who may be affected by the change should be involved in planning for that change.” (Marquis & Huston, p.197)
Some have suggested that we have a separate group of staff available for STAT cases, or have a second OB Tech on call if the need arises to run two ORs at the same time, or increase the daily staff so that their are more nurses on duty to assist with the surgical cases and step in to scrub if need be, since some of our nurses have been trained to scrub. These are all possibilities that the leadership team have collected are have ready to present tp management at our next leadership meeting next month. This is all just recently coming to the table and full circle again and we are reassigning it and giving this issue our utmost attention. Many heath care organizations are undergoing changes that are directed at restructuring, employee retention and quality improvement. (Marquis & Huston, p. 187) I believe that this issue and change that we are experiencing is directed at all of these such topics.
Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management – UK, 20(1), 32–37. doi: 10.7748/nm2013.04.20.1.32.e1013
Retrieved from the Walden Library databases.
APA format, 2 references, discussion reply please