I know that I did a series before of what it is like to be on call and called in. These are my personal preferences for call procedures.
Number 1- I do not want to surgeon’s message to go through the nursing supervisor. I would prefer that the surgeon call me directly.
There are reasons for this. The supervisor is busy, they are running the entire hospital. The supervisors, although most of them have been nurses for years, do not understand the operating room. Not that we are delicate flowers but everything about the OR is complicated. There are a lot of moving parts to a surgery.
To this end, I give the surgeons blanket permission to call my phone directly. This is my preference. This also cuts down on the number of calls that I have to make because I always call the surgeon for any special requests for the case or I might have a question for the surgeon and this allows me to give the surgeon a realistic time for incision. Or, at the very least, call the pager that I still have if they don’t want me to have their phone number.
This is where the two way call trust comes in. I trust surgeons not to abuse my phone number and, in return, I do not abuse the surgeon’s phone number. This is key.
Number 2- I will call the scrub tech myself.
Again, there are reasons for this but mostly so I know that the scrub tech is awake and activated to come in. I started this when the nursing supervisor would call the scrub tech and not get an answer and call me back when I was driving that they couldn’t get ahold of the scrub tech.
This led to a delay of the start of case because I would have to phone tree to get a scrub tech. I would call the original scrub tech on call and get no answer but I would leave a message. I would call again. This is a promise that I made to them that I try to get ahold of them at least twice before escalating to the phone tree.
The phone tree is where I call all the scrub techs for the department, searching for someone who would come in to scrub this case. I have had to do this multiple multiple times. This is a less frequent occurrence with the dedicated call shift though.
If, after I’ve exhausted the scrub tech list and didn’t get a person, I would start calling RNs. Ideally it would be someone who could scrub but not a necessity. I can always scrub a case myself.
Like magic this would always work but I had an avenue if it did not. And that would be calling the managers.
I try not to bother them at night.
Number 3- I will pick the case myself.
I am always the first person in. Regardless of where the scrub tech lives. I only live 5 minutes from the hospital with middle of the night traffic.
I love picking cases and will happily put on my favorite get stuff done song. I try to complete the pick before the song loops back. I can mostly beat the song these days. The song is Down with the Sickness by Disturbed and is four minutes and thirty seven seconds long.
Picking and preparing a room for surgery is going to be a separate post.
Number 4- Ideally, I will get the patient myself.
This can be complicated if the patient is in a unit bed and not the Emergency Department. If they are in a unit bed, they are most likely in a physical bed and that is harder to do alone. Sometimes I wait for the CRNA to help me with a unit patient, or, if the surgeon is there, I make them go with me. Or I will ask the supervisor for help. Or I will put in for transport but they are skeletons crewed at night.
Transport is always my last resort.
Number 5- I will prep the patient myself if possible.
If there is a PACU nurse there because of another patient I will let them do the prep but I prefer not to. I generally have a feel for the urgency of a middle of the night call case and can expedite prepping. Anyways, the OR patient prep is 9 screens total instead of 36 of the ACU nurse.
In a nutshell my prep questions are 1) who are you, name and date of birth, 2) what are we doing for you today (I don’t ask if they know the surgeon’s name, the answer is no because they’ve just met them and the patient is shell shocked by the events unfolding), 3) any allergies to medications, 4) when was the last time you ate or drank (yes, this means everything), 5) have you ever had a sleep apnea study, 6) do you have any metal anywhere like a total joint or screws, 7) do you have any contacts, dentures or hearing aids, 8) do you have any positioning limitations, 9) when was the last time you peed, and 10) do you have any questions.
I will hold on asking 2, 5, 6,7, 8, and 9 and instead listen when anesthesia asks them the same questions. Patients sometimes get grumpy at the same questions multiple times. I will warn the patient that they may hear some of the same question a lot. And then I tell the story of the time I was the last person that a patient talked to and they confessed to me, the 6th person, that they had lied and had had chocolate cake for breakfast.
This always gets a chuckle.
90% of the time there is a family member accompanying them and they will probably chime in.
Complicating factors or patient prep are dementia and inability to understand or sign consent, or interpreter needs. Both of these have their own challenges and therefore take longer.
Number 6- I will call PACU myself.
Timing when calling PACU is a must. Too soon and they are waiting for the surgery to end, and waiting. Too late and you are cooling your heels with the CRNA in PACU waiting for them and starting the recovery yourselves.
Getting the timing right is the most important thing and is the hardest thing to teach.
However, if I feel like I require a second set of hands I will call at least one of them in early. Some cases you just know are going to be busy and complicated and someone else would be so helpful.
These six things are my personal preferences, honed over thousands of call cases over 25 years. Other nurses will have different preferences and they can do what they want when they are on call. But this is the most efficient way that I have found.
