Why won’t December end?

December is a time of high case volume in most US operating rooms. This is mostly because the high deductibles of some insurances have been reached and that means the rest of the year is on insurance’s dime.

It is also a time of high fat, high calorie partying which plays havoc on blood sugars. But that’s another story.

Mostly it is because the deductible has been reached.

This means that all six of our ORs have been running full tilt since the beginning of November.

To say nothing of December.

Having holidays in the middle of the mess does nothing to alleviate it.

It is now the end of January and our case volume hasn’t slowed down.

In the evenings it has even picked up.

When will December end?

Super fast turnover

You, the surgeon has been forced to wait because another surgeon has overstayed their case. You are definitely mad about this

Day shift charge, oh we’ll just do a superfast turnover as soon as that case leaves the room.

You, the inconvenienced surgeon are slightly mollified.

Day shift charge, who has circumvented a tantrum, breathes a sigh of relief.

Um, no. There is no such thing. The room is either clean or it is not.

Do not give the rampaging surgeon false hope about super fast turnover.

Why? This is a slippery slope.

  1. There is no such thing
  2. The surgeon will expect it every time from now until the end of time
  3. When the surgeon doesn’t get it every time from now until the end of time, there will be a threatening tantrum
  4. rinse, tantrum, repeat
  5. Please don’t set up evening shift this way, there is a reason our turnover times are so fast

Why are the evening shift turnover times so fast and without the benefit of a cleaning person.


Turnover should start way before the end of the case, before the patient leaves the room.

During the first case, thoughts should be had about what instruments/equipment is needed for the next case.

During the first case, the floor should be policed and all the trash picked up off of it.

During the first case, all extra stuff not needed for the second case, and has reached the end of its usefulness should be put back in the cabinets or taken out of the room.

After need for suction is over, the suction canister should be removed and solidifier introduced into the liquid, so that you don’t have to do that after.

All equipment that is no longer needed should be turned off and pushed away from the field.

As the patient is wheeled out, the bed should be stripped and the instruments taken out.

The circulator should give report to the PACU nurse.

The circulator should interview the next patient and return to the room to finish cleaning.

While the circulator is gone the scrub should take their instruments out and commence wiping all of the tables and OR bed.

The circulator should mop the floor while the scrub is taking a prep table and loading it with the next case instruments.

The circulator should make the bed, while the scrub is wheeling in the prep table and spreading the case.

New masks should be donned and the opening commence.

That is how evenings gets a 10 minute turnover.

Chores wait for no man

One of my favorite scrub techs has a saying she got from her dad, “Chores are very loyal, they wait.”

One of the things about evening shift is if we are not doing cases, we are working on chores. Chores that happen every day are bringing up the cases for the next day, picking instruments for the next day, stocking rooms and carts in the core, and preparing rooms for the next day after they have been terminally cleaned for the day.

Evenings can break down at any point in the night.

Some nights we can get the cases up and everything else on the chore list is completed.

Some nights we do the bare minimum.

Some nights I don’t get to eat lunch before everyone leaves for the night.

Some nights I get to do my paperwork and my e-mail.

It just is up to the luck of the draw.

But I would like to know how to motivate people to do any of the chore list before they leave for the night, say at 1700 or 1900. This is harder than it seems.

Recently, I heard someone say to leave the chores for evening shift, they’ve not much to do anyway.


It just so happened that after they left a doozy of a case came in and NOTHING on the chore list got done except for instruments. Any they complained that they didn’t have everything they needed. When they complained to me when I got in at 1430, I shrugged and said, “Maybe you should’ve done that before you left, instead of pawning it on us.” They weren’t very happy with that response.

I don’t care. My first responsibility is to the patient, not to day shift.

Who’s looking like the chore bitch now?

Audibly rolling my eyes

Every time the hospital rolls out a new endeavor that shoves their nurses into upheaval they don’t share the reason behind the new change. They just shove it down our throats.

I know lots of nurses in three states and let me tell you this is not just a “my” hospital problem.

Their new thingy is a prepping champion. Because all of a sudden there are new prepping guidelines. In all preps, betadine, chlorahexadine, chlorahexedine and alcohol. We’ve been doing it wrong, according to the company.

I’m not sure if this is a thing. Or the company that brings us betadine kits were jealous of the mandatory three minute dry time for the chlorahexadine and alcohol.

This was a 45 minute waste of my time. And the company paid for “experts” to fly in and awkwardly “teach” us how to prep.

It was all that I could do to stop the rolling of my eyes being audible.

If there is new evidence please bring it to us. We’re college educated, we’re smart. Don’t tell me there must be a change. Show me why there needs to be a change.

Or the rolling of my eyes will become audible.

For the want of a complainer

I’ve been the scheduler for the OR for about five years now. And the OR has decided to blow up the fucking call schedule.

Because, as near as I can tell, three people complained they were getting too many calls on certain days or nights. And my night tech went home at 2130 on two of those evenings and sometimes (often) I needed to call in the evening call tech to cover.

Instead of asking me about it, or seeking my opinion, or doing some basic research and data collection, they decided to throw the baby out with the bathwater and chuck the whole thing.

Instead of 2 calls, one evening 1700-2300 and one night 2300-0700, there will only be 1900-0700 and the two pools of call taking people will be combined.

On paper this looks amazing, less call evenings or nights per week for the complainers.

But there are a few holes that no one is interested in hearing about.

  1. I use the evening call a fair amount, at least once or twice a week and now I will have no bridge person in case the schedule requires it because some surgeon is running over late.
  2. If I or the evening tech becomes ill or injured and can’t work there is no bridge person to cover from 1700-1900.
  3. I am taken out of the call rotation because there will be no one to cover from 1900-2300. This directly impacts my bottom line. Their answer is that people will be dying to give me their call. This is not untrue.
  4. If the evening tech is on call from 2300-0700, there is no one on back up from 1900-2300, goes back to point 2.
  5. No one likes this change, we’ve lost 2 nurses because of it.

But, sure if it stops the complaining that the two bosses have to deal with, no problem. It just is the problem of all the non complainers who will have to take unfamiliar call shifts and sometimes work until dawn.

No problem, as long as there is less complaining.

Sometimes I feel like Cassandra from the Greek myths who was cursed to only tell the truth but no one ever believed her.

The post holiday hangover

For weeks my coworkers and I have been consoling each other with “Maybe it’ll get easier when December is over.”

How quickly we forgot.

Once the glitz/fun/parties whirl of the December is over, the schedule craziness still  hangs over us like miasma after bad seafood.

There will be no lightening of the schedule until the flu season starts to lift.

At least, that is how it has been in the past three years.

And although the year is still very young (nine days old), it looks to repeat the pattern of heavy patients, heavy case loads, heavy call shifts.

But without the fun of the holidays.

Joy to the OR,

That was a close one

I am the scheduler for my OR.

Shocking, I know. Extra work, where do I sign up?

The first two weeks of this current schedule started with the week of Christmas and the second week was that of New Year’s.

The current schedule wasn’t due to be completed/published until December 10th. It was decided to complete the first two weeks early so that staff could plan their holidays. I finished the first two weeks before Thanksgiving and published them.

I then worked like an idiot because Christmas/December in the OR is anything  but merry.

I did complete and publish the rest of the schedule by December 10th. This means the last 4 weeks of the schedule was complete with all calls, weekend and otherwise, and days off by December 10th.

It being December I didn’t look at the schedule again until Thursday, January 3.

Whereupon I discovered that the last four weeks of the nurse weekend call days were missing.

Well, fuck.

The schedule had been published, I can’t go back and re-add the call days in for the RNs.

But I have a worksheet that I make myself with the calls planned out.

Some of the nurses copped to the fact that they were scheduled on certain days and they were rescheduled.

Some of them did not. I refrained from shouting liar, liar pants on fire.

I, of course, will bat clean up and take any calls not spoken for. Maybe 4 out of the 12.

But, when I discovered that the program had eaten all the nurse calls from January 5-February 2, I was mad, sure I would have to cover all 12 of the weekend call days by myself.

And my husband would be mad at me.

And my cats would be mad at me.

4-6 out of 12 isn’t so bad.

And you bet I e-mailed the staffing program’s inbox and told them of the hiccup. My OR may not be the only one affected.