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Interview – OR/Assistant Clinical Nurse Manager

“Molly Brown, RN” (aka “Unsinkable MB” – both are pen names) blogs at Blood, Guts, and Coffee.  She works in the Operating Room (OR) as an Assistant Clinical Nurse Manager.

Molly has been in her current position for over 6 years.  “My cousin who is an OR nurse peaked my interest in surgery while I was in nursing school.  During my leadership clinical, I observed a few surgeries.  The first one was a CABG (heart bypass surgery); it was love at first incision.  I started in the OR right out of school, moved up the ranks in my hospital system from Staff Nurse to Specialist (over one service), then was promoted to Assistant Clinical Nurse Manager (over 4 specialties).”

Molly starts her morning by doing rounds and helping her services get their day started.  She helps to open sterile instruments, gets supplies and equipment, assists with positioning patients and checks in with surgeons and staff.  Throughout the day she offers support when needed by troubleshooting issues with instrumentation, equipment, and supplies.  She also tends to anything that comes up with patients, staff, and physicians.  She provides lunch relief when short-staffed.  When she finally makes it to her desk, she works on various department and hospital initiatives, writes staff evaluations, tries to answer voice/email, and coordinates with vendors who might have to bring in instrumentation/equipment that has been requested by surgeons.

What frustrates you about your job?

No matter how hard I try, sometimes I just can’t make everyone happy.

What about your job makes you proud to be a nurse?

Although my direct patient care is a bit less than when I was a staff nurse, I am proud to know and to see that I can still make a difference in the quality of care by being a voice when decisions are being made at the administrative level.  Also, I’m proud that with my experience of working at Level I Trauma Center, I still have the critical skills of being a scrub nurse or circulating nurse when an emergency case comes in.

Do you feel you receive adequate support for your responsibilities?

My manager has been my mentor for quite a while.  She understands the challenges I face because she has been in my position before and has helped in my transition into this role.

What is something a nurse who does not work in your particular field might find surprising about your job?

In other departments, many nurses don’t consider surgical nursing “real nursing.” I suppose it’s because we don’t do what people typically think of as nursing – passing meds, taking vitals, etc.  Spend a day with us and you will find that we still have to perform assessments throughout our care, understand positioning (since we can’t turn patients in the middle of a long surgery), as well as maintain normothermia.  While we don’t pass meds, we utilize medications intra-operatively, which requires an understanding of contraindications as well as what to administer in case of toxicity.  Surgical nurses use their nursing knowledge to be a voice for the patient who is sedated and can’t speak for themselves.  Like our colleagues in other units, we perform the most important nursing skill — provide comfort at the bedside before patients “go to sleep” and again when they wake up from anesthesia.

Staff nurses are paid by the hour, plus call pay (when “on call”).  If they’re called in, then it’s time and a half (with or without differential, depending on what time).  I am an Assistant Clinical Nurse Manager – paid by the hour, but no over time (just straight time).  My official hours are 6:45AM to 3:30PM.  Because our department is undergoing a lot of change, I’ve been known to work a few 12 hour days here and there (self-imposed!).  Managers and Directors are salaried.

Molly says that for the most part she’s able to accomplish almost everything she needs to do in the time she has, but adds that surgical nurses tend to be perfectionists and she tends to stay over.  She further states that “teamwork is crucial in the surgery department and not just in the actual operating rooms.  For our unit to run smoothly, we need to work closely with the staff, surgeons, anesthesiologists, and other departments (Sterile Processing, Radiology, Pharmacy, ICU).”

As for extra training or certifications, Molly says that her hospital system provides frontline leadership training in the first six to seven months of the job as well as ongoing mentoring.  She also has a business degree and previous experience in Corporate America, which has proven to be an asset to her in her current position.

And lastly -

One of the biggest complaints given by hospital unit-based nurses is that they rarely have time to eat or go to the bathroom. Do you find that to be the case with your job as well?

Surprisingly, yes!  With all the troubleshooting that I do between operating rooms (supporting my team) and the meetings I have to attend, someone has to remind me to slow down and take care of myself.

 

Thanks to Molly for answering my questions about what nursing is like in the OR from the perspective of an assistant manager!

If you are or know of a nurse that works in a nontraditional setting and are interested in being interviewed, email me at codeblogrn@gmail.com.  My post about this project and a list of interviews done so far is linked here.

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When the patient is in no condition to lie for himself…

… then it is important that others lie for him.

This is the infamous story submission from Bongi, submitted to me a whopping 5 years ago. Bongi is a surgeon that blogs at other things amanzi, which is easily one of my favorite blogs.  Read on:

i was working in a private casualty unit to make extra money during my surgery training. (don’t tell the prof. it was strictly forbidden. one day i’ll post about the time i got caught.) it was some ridiculous hour. i was catching a nap when i was rudely awakened. the sister said an ambulance was expected to arrive in about 5 minutes with a possible epilepsy patient. i dragged myself out of bed. a medical case! absolutely wonderful. and at this time of the morning. just the thing to warm a budding surgeon’s heart.

i stumbled into resus just as the ambulance crew came casually strolling in with the patient. they told us they had been called to fetch the guy from work where his colleagues said he simply collapsed. they didn’t know why. something was wrong. he was restless. he was also pale. i felt his pulse. it was thready and fast. very fast. he had no drip up. being surgically minded, i thought that if i didn’t know better i would say he was bled out. fortunately the ambulance crew could tell me that his colleagues at work told them that he had been working in a dairy cold storage facility when he simply collapsed. i asked if there had been convulsions. they didn’t know. meanwhile one of the sisters was getting a blood pressure. 80 over 30 didn’t fit with epilepsy. a quick glucose test was normal. the only alternative was cardiogenic shock from myocardial infarction or some exotic dysrhythm. but once again, it didn’t fit. the patient was black. (white south africans have about the highest incident of ischaemic heart disease in the world, but south african blacks don’t have much of it at all.) then it happened. the patient, now gasping for every breath looked at me and said, “help me doctor! i’m dying!”

if you’ve been in medicine for a while you’ll know that most times, the reason a patient says he is about to die is because he is in fact about to die. i believed him. my blood went cold. it just didn’t fit. i wanted to tell him we’d do everything we could (although i still had no idea what i was capable of doing for him). in a reassuring way, i placed my hand on his chest. with every breath i could feel bones grinding against each other. i pulled my hand back in shock. he had broken ribs!!! epilepsy or cardiogenic shock or some heart problem does not cause broken ribs!! this was trauma! this was surgical! i jumped into action.

at that moment, the patient breathed one terminal gasp and promptly stopped breathing. for good measure his heart stopped beating too. nice bloody epilepsy, this, i thought. i delegated one sister to start cpr and another two to get iv access as i moved to the head to get airway control. the sister pumping the chest immediately stopped.

“everything is crunching under my hands” she said. what could be done? circulation is fairly important for survival, so i told her to continue. at this stage i was intubating. as i inserted the laryngoscope, fresh bright red blood came frothing directly out of his trachea. the trachea was also way over to the right. i shouted for someone to prepare an intercostal drain and slid the et tube in. the sister was fast. by the time i moved around to the left flank, the set was ready. i stabbed the blade into the chest. there was a gush of old dark blood. i shoved the tube quickly between the ribs into the pleural space. immediately one bottle filled with blood.

we consolidated. the patient was on a ventilator. two lines were running full tilt. with a touch of adrenalin, the heart started beating again (although i think the removal of the tension hemothorax also had a part in that). we got emergency blood going and got x-rays. we also called the thoracic surgeon.

the x-rays showed the worst disruption of the thoracic cavity i have ever seen, before and since. every rib on the left was broken and the fractured surfaces were about 5cm from each other. this basically meant there was a tear of the lung from top to bottom which was about 5cm deep. i gingerly reflected that that would explain the constant stream of blood draining from the intercostal drain.

as could be expected, the patient decompensated again. this time there was no bringing him back. when the thoracic surgeon arrived, the patient was already dead.

as usually happens, the story did come out. what the patient and his colleagues didn’t know was that the cold storage facility where they worked had closed circuit tv. this was probably to prevent night staff from stealing. or maybe to prevent them from racing around on a fork lift chasing each other. yes, dear readers, that is what they were doing when one of them lost control of the fork lift and drove into my patient, crushing him up against a pole. they figured they were in trouble already, so it seems they decided the depth didn’t really matter. if you are going to be in crap for messing with the machinery at night and for killing your colleague, then why not lie also to really confound any chances of the paramedics and the doctors to try to save his life. go figure.

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New Look! And Some Story Submissions

Recently, someone asked if they could use my logo on their brochure (neat!!).  I gave permission, then realized that maybe it would be nice to have a real logo.  I asked a dear friend of mine if she wanted to work on it and she agreed.

So what you see there at the top is the new logo!  I absolutely love it.  I think she did a fantastic job, and I wanted to give her credit here!  Her name is Meg Pike – this is her website, and this is her Facebook page.  Thanks Meg!!  It’s perfect!! (Don’t blame her for the colors – I picked them out.  Ha.)

I have a confession to make.  I have always welcomed story submissions (and I still do!), but I am not always very good about posting them.  To my great embarrassment, Bongi sent me one in 2007 that I held on to, but never posted.  Apparently in addition to being severely procrastinatory, I also hoard story submissions.  I emailed him to ask if he’d already posted it to his own blog; I’m assuming he did.  If he didn’t I’ll post it here.  (I promise!  Right away!  Fast fast!!)

I do have a submission from Jeanne from 2009.  She writes:

Have you ever leaped to the conclusion that a patient is a bit confused only to have him redeem his grasp of the situation by proving himself to be spot on?  Consider a 92 year old patient  who required assistance out of bed by myself and a nurse’s aid. He was your quintessential little old gentleman whose English pronunciation, as well as  sensibilities, had all the old world charm of European Italy. We also knew him to be vague, at times, with poor insight.

As we assisted him to the side of the bed for a transfer, he began to moan, “I’m a man, I’m a man.” We assumed that his consternations were related to his need to be assisted by women, and were strictly sociological in nature. We reassured him that, as a “man,” he was gaining strength with physical therapy, and that he was a “fine, strong man.”  Nonetheless, his protestations persisted, “I’m a man, I’m a man.”  We, in an effort to get the transfer accomplished, continued to reinforce to him  just what a fine man he was. Nonetheless, he continued wailing, “I’m a man, I’m a man.” Finally, I  got right down to eye level, hoping I could focus this gent back onto the task at hand. He looked me straight in the eye and proclaimed, “I’m a man. I’m a man. And I’m sitting on my goddam balls!!!”  Needless to say, this brought everyone down to earth in very short order,  and situation resolution was achieved.

 

Oh my.  Another story, this one from Alan RN, (also from 2009):

One of the times I felt I really helped a patient as a nurse occurred in the early ’80′s.  A male in his late 30′s had a motorcycle accident requiring a below knee amputation after post-op infections.  I worked with him in the ortho clinic over many months and learned he was a Vietnam veteran.  I was a Navy corpsman in the early 70′s but with no deployment to Vietnam, yet he still called me “doc” and we swapped military stories.

About a year later he returned after another motorcycle accident, now requiring another below knee amputation.  He was post-op on the ortho floor when I learned he was back. He was quickly earning the negative reputation among the nurses and physicians as a “biker”–throwing stuff, swearing, etc.  I talked with him and he confided in me that he was “going crazy” because of the child crying next door.  In short, the crying triggered what we now are learning more about–post traumatic stress syndrome and he was afraid to bring it up to the staff and not appear macho. Fortunately I had seen this in war vets while on active duty.  I spoke with the nursing staff and residents, and advised them to “back off” him and change his room.  Things went better for him after that and he calmed down enough to work with the staff through his admission.  These days with shorter length of stays it’s tough to learn enough about a patient–something to keep in mind if a patient is acting out, with more vets returning to civilian life now.

 

And finally, here is one from Linsey, RN (from 2010.  Hey, we’re getting there):

I hope that everyone reading this can congratulate me on my first ever blog experiences.  I am currently studying for my BSN and learning about blogs was a assignment of mine.  CodeBlog has stood out to me because it is unlike any other blog that I found and I will visit the blog regularly to see what interesting stories people are sharing. (Thanks Linsey!  Sorry it took me 2 years to give you your first blogging experience.)

I am a new nurse and have been at this career for three years.  I think that I will probably consider myself to be a new nurse until I hit the ten year mark because some days I am totally comfortable but some days I am totally lost.  There are nights I go home and can’t stop thinking about the events of the day… did I remember everything… will I get the infamous phone call from my manager that I messed up one of the fifty pages of paperwork I did that day.

Since I was a little girl playing with my tea-set I wanted to be a nurse.  Some kids change their career aspirations but all I ever wanted to be was a nurse.  In high school I almost lost my dream and fell into a downward destructive spiral… And then I buried my ten year old cousin and close friend.  That experience made me realize that I was wasting my life and I lost my bad friends, made some good friends and jumped right into school.

This experience and those of my family who have also had similar problems have made me the kind of nurse I am today.  I have learned to be patient with those around me whether they are staff or patients.  I have learned to accept all people for who they are rather than what society wants them to be.  Finally I have learned social skills that can’t be taught in a class but only learned through one’s life experiences.  Nursing has completed my life and soul.  It is wonderful to be in a profession that on most days, I am excited to go to work, I am excited to help people and gives me opportunity to realize how small my problems really are…That to me is the essence of nursing.

 

So there you have it.  Instead of being 5 (FIVE!) years behind on story submissions, I am now only 2 years behind.  Thanks for reading :)

 

 

 

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When the String is Cut

One of my colleagues recently died.

When I started at my current hospital, she was my main preceptor.  She was a stickler for getting things done correctly – no shortcuts.  When I would come across a patient or apparatus that I was unfamiliar with, all I wanted was for her to tell me what to do or show me how to operate it, but every time she insisted on having me look it up.

I came to appreciate the wisdom in that.

We worked together for several years.  She eventually went to a different department, I started working per diem, and we didn’t see each other much anymore.  But we’d run into each other here and there over the years.

She was very kind.  She wasn’t the type that was into gossip, but she did always want to know what was going on with you.

I saw her about a week before she died.  Everyone knew her time was short, including her.  Yet when you walked into the room, her face would light up and you’d get the impression that she was thinking, “Ah, just the person I was hoping to see.”  She handled the whole thing so much more gracefully than the rest of us.

I was thinking last night about how she simply isn’t in the world anymore.  And how weird that is.  I feel like we are all connected by invisible strings to the people we know, and when one string is cut, even the thinnest one, it throws you off balance.

I’m feeling a bit off-kilter for sure.

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Grand Rounds: Volume 8, No. 17

How’d we get to Volume 8 already?!  I think hosting this Grand Rounds finally ties me up with GruntDoc, who has hosted 7 times.  Grand Rounds is the weekly round-up of blog posts by medical bloggers.

Whereas in the past the host would post nearly every link they received, it appears that we are now moving towards more curated content.  I said in my previous post that I wasn’t going to institute a theme, but I was definitely more drawn to the personal-story type posts.  Thanks to everyone that submitted!

Ever been put in an awkward position?  How about if it was a position that you created yourself?  Bongi, who blogs at other things amanzi, describes a situation he found put himself in that he calls “buff and turf” – and it didn’t turn out very well for him.  He leaves it to our imagination to come up with what the other surgeon’s response was.

Working with children is hard.  Well, I think it’s hard.  I can relate to my own kids just fine, but finding common ground with a child you’ve just met and have only minutes to spend with is what I consider a unique talent.  The medical student that blogs at d.o.ctor used a classic technique to try to bond with her small scared patient.  Did it work?  Read on to find out.

What would you think if your nurse told you, “Buck up.  You’re going to feel terrible for a year?”  Would you believe it?  Jessie Gruman describes her insights as she worked her way through an entire year of feeling very “sick-ishly.”  I can tell you I found insight #3 somewhat surprising.  It’s something I simply wouldn’t have considered.

I shamelessly grabbed this next post from Twitter – Jordan, who blogs at In My Humble Opinion, wrote a touching post about mothers.  In Praise of Mothers wasn’t quite the post that I was expecting (and apparently the first commenter wasn’t expecting it either); it was even better.   And I’ve tried several times here to explain why, but I can’t.

And I shamelessly grabbed this one from Google Reader – Dr. V at 33 Charts shares his answer to the question, “How Often Should A Physician Blog?”  You could easily take the word “physician” out and apply the answer to any blogger.  I have been blogging for over 9 years now.  My posting frequency in the very beginning was about once a week.   Now it’s more like once a month.  He has some great insights that I found myself completely agreeing with.

What happens when you check up on a patient only to find that you’re the “last to know?”  In Duly Notified, Dr. Wes encounters an unsettling bit of difficulty when he opens the electronic chart of a long-time patient.

The next submission is an interesting read.  When someone suggests that you “build a coping system,” does your brain sort of shut off a little?   Yeah, yeah, coping.  Easy to suggest, a bit more difficult to implement.  But Will wrote a post that makes it seem doable.  He breaks it down into easy-to-digest sections and provides lots of suggestions.

Solitary Diner describes her “middle of the night chart review.”  Who amongst us medical professionals haven’t found ourselves in this position?  It’s a right of passage.  Welcome to the world of health care!

Medical Lessons brings up an interesting point – can cancer awareness initiatives go too far?  Where’s the line?  What if it seems silly to adults but might actually be helpful to children?  Should Barbie be bald in the name of cancer awareness?  (My take?  Sure, why not.)

Here are a couple quickies:  Insure Blog covers the situation of an autistic young man when a program his family has come to depend on is restructured – leaving them out.  Behaviorism and Mental Health explores a different perspective when addressing the problem of increased violence in California’s state psychiatric hospitals.

I hope you’ve enjoyed reading these posts I’ve selected for this Grand Rounds.  The calendar tells me that Volume 8, No. 18 will be held at USA Today (!), written by Dr. Val Jones.  Send submissions to val.jones at getbetterhealth dot com.  As always, thanks to Nick at Blogborygmi and Dr. Val at Get Better Health for keeping the whole thing going!

 

 

 

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Grand Rounds

Dr. V at 33charts is hosting Grand Rounds this week!  Go read his carefully curated links.  I liked what he said at the end about each host essentially bringing their own flavor to the ‘Rounds.  (paraphrasing there!)  There have been a few warbles here and there about how it should be hosted, but I’ve always thought that each blogger should do what feels right for them.

Having said that, codeblog will be hosting Grand Rounds next week.  It’ll be my 7th time hosting and I’m excited.  Mostly excited because now someone will tie up GruntDoc‘s 7-time-hoster record :-)  But!  Also excited to read what you send my way.   I have never requested that submissions conform to a certain theme, and I’m not going to officially request it now, either.  All submissions will be considered, but my favorites are the personal stories and anecdotes from the world of health care.  My past entries for Grand Rounds have been silly & gimmick-y, but I have a feeling that I’ll employ a simpler format this time around.

E-mail me at codeblogrn at gmail to submit; please put “grand rounds” as the subject.  I’d appreciate if you could get them to me by Monday afternoon at the latest.  Thanks!

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Happy New Year!

Happy New Year!!!

At the end of December, codeblog turned 9 years old.  It amazes me that I’ve been doing this for that long.  I was so excited when I was asked questions for the Reader’s Digest article “50 Things Your Nurse Won’t Tell You.”  My comments appeared in print, and in the online version here and here.

For that last link, the quote was this:

“If you ask me if your biopsy results have come back yet, I may say no even if they have, because the doctor is really the best person to tell you. He can answer all your questions.”

This blog took issue with that comment:

“And still another nurse admits that the nurse might falsely say that biopsy results are not back, “because the doctor is really the best person to tell you. He can answer all your questions.” The physician may be the best person to tell you about some things, but he–or she–can’t necessarily “answer all your questions”; nurses are more expert about a number of aspects of patient care. “

I stand by my comment.  If your biopsy results come back with a specific form of cancer that I know nothing about, I’m not going to march into your room and say, “Hey!  You have cancer!  Unfortunately I have no idea what they will do to treat it, if it even can be treated, or what your prognosis is.  And no, I also have no idea when your physician will be in to discuss these things with you.”

There have definitely been times in my life that I have just wanted to know.  But I think those times have been fairly straightforward.  I would have probably paid good money for someone, anyone, to call me with my betaHCG results when I was having symptoms of a miscarriage, but instead I had to wait for the doctor to call.  No one else would tell me.  But I had already done hours and hours of reading about what those numbers would mean and felt fairly prepared to interpret them on my own.  Every minute I had to wait was agony.

I think things would be different if I had no idea what to do with the results.  I would most likely be okay waiting a few extra hours for some results if I could get them from the doctor who could then answer my questions rather than have someone less knowledgeable report them.

Then again, maybe there’s something to be said for getting results and having a chance to do my own research so that I would have a chance to let the information sink in and be able to come up with appropriate questions.  I guess it’s a grey area.

Anyway, I was completely tickled to be in Reader’s Digest.  My grandmother read a LOT and I spent a lot of time with her when I was younger.  I also started reading a lot, and she had many books around.  When I went through all the books, I asked her what I could read next and she found a box of old Reader’s Digests for me to go through.

I (metaphorically) devoured them.  I remember one had a story about the Titanic and what happened hour-by-hour.  I read that probably 5 or 10 times.  Every issue had several interesting things to read.  She renewed her subscription and I was so excited when an issue would arrive.

I think she would be so proud that my name was in RD.  I wish she were here so I could show her.

 

 

 

 

 

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  • profileI am Gina. I have been a nurse for 15 years, first in med/surg, then CVICU, inpatient dialysis, CCU and now hospice. This blog is about my experiences as a nurse, and the experiences of others in the healthcare system - patients, nurses, doctors, paramedics. We all have stories!

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