The article "The RN first assi...

The article "The RN first assistant as OR concierge," is the basis for this ORN Journal independent thought The behavioral objectives and examination for this program were prepared by dint of Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN M BC education program professional, Center for Perioperative Education. Participants receive feedback forward incorrect answers. Each applicant who favorably completes this study will receive a certificate of completion. The deadline for submitting this reflection is July 31, 2007.

concluded the examination answer sheet and learner evaluation ground on pages 99-100 and mail with appropriate pay to

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You also may access this domestic circle Study via AORN Online at http://www.aorn.org/journal/homestudy/default.htm.

BEHAVIORAL OBJECTIVES

After reading and studying the article in succession the role of the RN first assistant (RNFA) as OR concierge, supply with nourishments will be able to

1 explain vexed questions encountered by the obstetrics and gynecology department at the facility described in this dwelling Study,

2. discuss options that facility members considered to disentangle these problems,

3 identify meanss used by the RNFA to interpret these problems, and

4 describe skills that an RNFA may posses that would deposit him or her in an ideal position to act as OR concierge.

Efficiency in health care is a paramount be of importance to as profit margins lessen and package constraints place harsh demands in succession surgical services departments. In addition, competition between hospitals for physicians and OR staff members has increased, and unhappy physicians and staff members are quick to incite to other facilities. Maintaining adequate OR staffing plains is becoming more difficult because of the nourish shortage, and a projected physician shortage in five to seven years will single aggravate the situation. (1) In this stressful environment, teamwork, which is "the backbone of perioperative patient care," (2 (p 372)) is smooth more vital to successful functioning.

DIAGNOSING THE PROBLEM

At Jersey Shore University Medical Center Neptune NJ the obstetrics and gynecology (OB/GYN) department plant itself plagued by physician complaints about delayed transactions inadequate or incorrect equipment, and question s with individuals assisting on entangled procedures. Perioperative staff members compiled lists of conducts in which problems occurred, and a review of these lists indicated that puzzles were widespread and not associated with a specific OR team or physician. a certain quantity of of the ongoing problems reported according to perioperative staff members included incorrectly scheduled measures physicians requesting instruments that were not in succession their preference cards, novel patient positioning requirements, and suits for a large variety of unfamiliar instruments.

resort to frequently lengthy and frustrating discussions were held during the month]y OB/GYN department meetings, further no appreciable improvement was noted. During this time, several physicians decided to perform their acts in other, smaller facilities where they perceived that fewer vexed questions occurred during surgery. Jersey Shore's tome of gynecology procedures remained stable because of the addition of of the present day surgeons, but individual physicians began to perform fewer deeds as they transferred procedures to other facilities. Additionally, gynecology case bulk in the attached same day surgery center (ie, surgicenter) was noted to be real low.

A decision was made to place a feed in charge of the gynecology service. This individual was instructed to fit with OB/GYN physicians frequently to address their bear upons Unfortunately, because of staffing limitations, this nourish at the breast also was responsible for urology and general surgery In addition, many riddles occurred during the evening and forward weekends when this nurse was not available; therefore, no improvement occurr and the succor overseeing gynecology services became frustrated and transferred to another hospital.

While these vexed questions were occurring in the OR and the surgicenter, a different locate of issues began to unfold in the obstetrical suite. Jersey Shore University Medical Center be of use tos as a regional referral center for high-risk obstetric operations As the complexity of patient conditions increased, more complicated and expanded surgical procedures were being performed in the labor and delivery (L&D) department, including hysterectomies, arterial ligations, and widened procedures involving the bladder or ureter Staff members in the L&D department had considerable expertise in assisting in cesarean sections (C-sections) unless were unprepared for more complicated transactions which usually were emergent and unscheduled.

Significant deficits were noted in instrument trays, particularly because they were not intended to be used for more extensive conducts Expense prohibited adding needed instruments to each tray, so separate instrument trays were created for more extensive acts Identifying these trays and ensuring that they were stocked fitly available, and easy to find and explain however, became a source of disquiet for L&D staff members and physicians. In addition, physician instrument and contribute preferences varied. A staff member was assigned to address these issues, nevertheless problems still were encountered in nearly each extensive procedure.