Ridiculous OR rules being enforced

[TheDude]

Wanted to hear from some of the other PA's out there and see if the rules that are being enforced are ridiculous or I am just getting my undies in a bind.

Recently, the OR where I am primarily at rolled out AORN guidelines that we will start to "strictly adhere to."  some of the guidelines make sense, some are lost the common-sense blackhole.

Here are some of the ones that just for some reason irk me;

ANY and ALL facial hair whether it is a 5 o'clock shadow or trimmed facial hair must be covered at all times when in or around the OR either using a beard cover and/or mask.  This included semi-restricted areas.

Sideburns must be covered at all times either a bouffant cap or hood.

Scrub jackets must be worn at all times when in or around the OR unless you are about to scrub in.

These are just a few of them.  Here is the kicker, I am a hospital employee as well as about 70% of the other surgeons.  We have a small # of PA's, one employed by a private group and another that's in the physicians group attached to the facility but a technical "employee."

They are quoting AORN guidelines and dogging the FACS about surgeons caps.  Now, if you're wondering, our infection rate is WAY WAY below the national average and we actually boast one of the lowest in the country, and we do it all here.  The nurses, a handful in particular are trying to flex their muscles and quoting AORN.  I've provided multiple studies to disprove their rules.  AORN cites four different studies ranging from 1973 to 2004, whereas multiple reputable organizations have disproved those studies on multiple avenues. 

I usually have a small 5 o'clock shadow and I keep my sideburns well kept and they are not down to the jaw, but they keep getting in my face about wearing a beard cover or bouffant cap or hood, which I will not as the bouffant gives me a headache and hood gets hot.  They won't address the surgeons, but they seem to ride me and a handful of other PA's about it.  It's to the point that a lot of the male scrub technicians and nurses are wanting to leave, and honestly, the stupidity of it all and not to mention the cost while we are on a budget crunch of buying cases and cases of hoods and beard covers is almost amusing.

Am I being an ass by pushing back, or should I just give in and follow the rules even though none of the other PA's or Surgeons are?  I feel they are wanting to treat us all like nurses and make us conform to nursing guidelines when yes, some do make sense, but about 90% don't.

END OF RANT....sorry 

 

[DizzyJ]

36 minutes ago, SOCM02-09 said:

Hey there! Just a PA-Student but I think when it comes to these 'silly' rules, it's likely out of good intentions. Granted, studies may show that facial hair is inconsequential, but guidelines are still guidelines and they are put in place for a reason. Just as with any science, we go with our best evidence at the time. While we all know it can change and get disproved, we have to follow the best knowledge we have or its simply ludicrous to assume we know better. I'd say it is indeed probably silly and annoying, but just do what's asked and attribute it to hopefully providing better care and better outcomes. IDK if that thought process helps the bureaucracy but sometimes you just have to let it go and focus on the task at hand. Best of luck! 

That's cute....wait until you become a PA and see how your thought process changes.  He is clearly stating that the AORN guidelines are not the best knowledge (last study cited 2004) nor proven to provide better care or better outcomes currently.  So, are you supporting the use of outdated guidelines because they have "good intentions"?

[south]

The OR is full of control freaks, probably the worst thing about it.  I have butted heads with snotty little empire queens on multiple occasions.

I have an overdeveloped sense of justice, so what gets me the most is the uneven application of these stupid rules.  I have MANY times been "warned at length" about something that the surgeon standing next to me has no intention of ever even considering doing differently.  A good example is when I was a student getting my ass chewed out for using a certain door to come in.  This was still in progress when my surgeon preceptor came in using the same door.  "You were saying?"

Good rant, I feel it.

[Kaepora]

The same thing is happening in my system.  Here's some fun reading on this issue:

http://skepticalscalpel.blogspot.com/2017/08/another-chapter-in-surgical-cap-wars.html

The AORN  has to try and justify their existence somehow, right?

[Guest JMPA]

it is pure sexual discrimination, feminization of medicine

[EMEDPA]

I would follow these rules only if the docs in the group did as well. otherwise, they can stuff it. direct them to the chief of surgery if they mention it. hopefully he has a beard or sideburns...

[dchampigny]

I'm still stuck figuring out how holding my hands too high in the OR contributed to me breaking sterile technique from back in PA school.

[MCHAD]

7 hours ago, JMPA said:

it is pure sexual discrimination, feminization of medicine

Not sure if serious or joking...funny either way!

[Guest ral]

23 hours ago, TheDude said:

 

.....Recently, the OR where I am primarily at rolled out AORN guidelines that we will start to "strictly adhere to."  .....

 

 

 

Tell them you are not a member of the Association of periOperative Registered Nurses.

End of story.  

 

( and before anyone gets their panties in a wad, I was an RN prior to becoming a PA)

[SedRate]

On 9/8/2017 at 6:20 AM, TheDude said:

Recently, the OR where I am primarily at rolled out AORN guidelines that we will start to "strictly adhere to."  some of the guidelines make sense, some are lost the common-sense blackhole.

They are quoting AORN guidelines and dogging the FACS about surgeons caps.   The nurses, a handful in particular are trying to flex their muscles and quoting AORN.  I've provided multiple studies to disprove their rules.  AORN cites four different studies ranging from 1973 to 2004, whereas multiple reputable organizations have disproved those studies on multiple avenues. 

I usually have a small 5 o'clock shadow and I keep my sideburns well kept and they are not down to the jaw, but they keep getting in my face about wearing a beard cover or bouffant cap or hood, which I will not as the bouffant gives me a headache and hood gets hot.  They won't address the surgeons, but they seem to ride me and a handful of other PA's about it.  It's to the point that a lot of the male scrub technicians and nurses are wanting to leave, and honestly, the stupidity of it all and not to mention the cost while we are on a budget crunch of buying cases and cases of hoods and beard covers is almost amusing.

Am I being an ass by pushing back, or should I just give in and follow the rules even though none of the other PA's or Surgeons are?  I feel they are wanting to treat us all like nurses and make us conform to nursing guidelines when yes, some do make sense, but about 90% don't.

 

That is silly.

 

So who is actually mandating these new changes? You mentioned "they," "the nurses," and "the OR." Are these OR staff members/nurses or directors? 

 

Are you a hospital employee? You could be implicated if you do not follow hospital policy, unfortunately. However, if you're a private practice employee, you could always use your surgeon as backup. Either way, it doesn't make a whole lot of sense if your surgeon continues wearing a cap while you're forced to cover every stand of hair. You could always argue that wearing the other garb negatively affects your work (e.g., headache, hot, etc) and you will not compromise patient care to adhere to rules that have been disproved by other studies.

[south]

5 hours ago, ral said:

Tell them you are not a member of the Association of periOperative Registered Nurses.

End of story.  

I like it, a lot, but OP seemed to indicate that this was a new policy, as in a rule where they work, or someone in charge's rules.  The source of it doesn't matter.

You could ask if that's a new policy and ask for a copy of it, and ask why physicians aren't subject to the rules, as if bacteria somehow does not cling to physician stubble and sideburns.

[SedRate]

I'll just leave this right here... http://gomerblog.com/2016/09/anatomy-of-surgical-caps/

[sk732]

I do OR assists on a PRN basis, I have my own OR caps I wear because I sweat - a buffoon, oops, bouffant,  hair net doesn't prevent sweat from rolling down my forehead into my face and into the operative field, nor does it keep stuff out of my eyes/eye pro.  I've never been talked to or at for my head wear nor about the fact I didn't shave when I got called in on short notice on a day off.

People that make silly rules should be people that actually do the work, not those that pretend to or may have done so sometime before they discovered penicillin.

SK 

[TheDude]

Thanks all for the replies and all.

Unfortunately, since I am a hospital employee I am bound to comply, but that does not mean I will.  I've provided the head shed with plenty of articles dispelling all that they are trying to accomplish, but am told practically that it doesn't matter.  I was actually walking by the desk and one of the nurses told me to cover my face (barely a 5 o'clock shadow), and at the same time a Surgeon walked by who has a significant beard, and they didn't bat an eye or address him. I made the comment that bacteria does not care who or where it comes from, and surgeons are not immune to it, her response, "he's a surgeon and your not."  

He butted in an lit her up, mostly on basis of her being an ass and trying to flex her nursing powers.

I've come to the conclusion that nurses and their organizations (AORN in particular) will do whatever they can to change rules and regulations to their benefit to show power over physicians and their associates.

[CAAdmission]

4 hours ago, TheDude said:

I've come to the conclusion that nurses and their organizations (AORN in particular) will do whatever they can to change rules and regulations to their benefit to show power over physicians and their associates.

Individual nurses are often great. Nursing ORGANIZATIONS are medicine's version of rectal cancer.

[nixietink]

I am not a hospital employee, and I think this helps me get away with a lot more on OR days than when I used to be a hospital employee.

One of the hospitals my SP and I do cases at are strict regarding wearing the dumb scrub jackets at all times rule, which makes absolutely zero sense to me.

Honestly, I'm a woman and haven't paid much attention to the facial hair issue, but most techs I come across just happen to be clean shaven and I've only seen other female PAs.

It's so ridiculous.

[True Anomaly]

This is not unlike mandating that there is no food or drink in patient care areas...while patients and family are able to bring in all manners of eats and drinks into a patient care area.  No logic behind it, yet most hospitals still adhere to this outmoded thinking

[TheDude]

So, in follow-up and after speaking with the surgery director (who actually agrees these are really idiotic rules, but has to abide by them due to the rules coming from the top down in a decent sized multi-state system), we are having a fake JACO survey and inspection next week.  We have been all told, including the physicians, that we will be penalized if not compliant.  I plan on doing what I can to essentially be "compliant" so that means I will look for small ways to skirt the law so to speak.

Many Physicians and PA's have provided more than enough evidence to dispel what JACO and CMS and the AORN are wanting to do.  

I'm still frustrated, but I will continue to push the fight for common sense, which isn't so common anymore.

[EMEDPA]

On 9/12/2017 at 7:33 AM, True Anomaly said:

This is not unlike mandating that there is no food or drink in patient care areas...while patients and family are able to bring in all manners of eats and drinks into a patient care area.  No logic behind it, yet most hospitals still adhere to this outmoded thinking

this is one reason I started working nights over a decade ago...night shift rules...no admins around means I eat and drink whatever I want whenever I want at work. no covered coffee mugs, etc total BS. my feeling is that if your car is never at the hospital at night or on the weekends then you Mr or Mrs administrator are just slowing the system down because we obviously don't need you to function....