Circulating nurses, surgical techs, and other team members who work in the OR will often be assigned to specific services, to cultivate a sufficient number of people with a high expertise level. —Anand K. Devaiah, MD
Explore This IssueJanuary 2021
“An example of this includes proactively training medical-surgical nurses in peritoneal dialysis, a form of dialysis not previously widely used at NYU, as a means of conserving hemodialysis machinery and staffing,” said Millman Glickberg. “Our staffing and facilities remain limber to approach any future COVID-19 challenges.”
Boston Medical Center does a significant amount of cross training of scrub techs and circulators in the OR. “That way we have flexibility and have less concern if one of the people who normally scrubs for cranial base is out, for example,” Dr. Devaiah said. However, like many other institutions, his department has been moving toward a more high-performance OR team model, where a very select group performs certain procedures to improve efficiency in the operating room.
“Circulating nurses, surgical techs, and other team members who work in the OR will often be assigned to specific services, and even specific procedures within specific services, to cultivate a sufficient number of people with a high expertise level,” said Dr. Devaiah. “This allows them to be more effective, efficient, and comfortable in the room, but means having a smaller number of people who would scrub for or circulate these cases. That can be a problem if enough people are out or cross-covering for others.”
This problem can be magnified during a pandemic in which there are staff shortages, as it puts stress on those filling in to cover cases they aren’t used to covering. While Dr. Devaiah said NYU hasn’t had to cancel surgeries due to staffing as far as he’s aware, it did require patience when working with those who didn’t circulate or scrub with their team regularly. “Thankfully, they would come in ready to learn. We would spend additional time making sure they knew what the instruments were so they became comfortable working on a case that they might not otherwise do,” he said.
Looking to the Future
Despite hazard pay for clinicians working overtime, adherence to unionized contract guidelines for nurses, and ramped up psychological services for healthcare workers at their workplaces, employee and faculty wellness during a pandemic can still be a major challenge. While office staff may not be asked to put in extra time, they might be multitasking and pushed to their limits. And the sheer volume of very sick patients can inevitably be overwhelming to those caring for them day after day.
“Sadly,” Dr. Pensak said, “there’s no easy answer, and all our leadership is encouraged to heighten their listening skills to anticipate and recognize when staff or colleagues are getting burned out.” (See “Wellness Rx: Embracing Optimism” on page 18 to learn more about the value of maintaining optimism during the pandemic.)
As the pandemic continues, as of this writing, Boston University School of Medicine physicians anticipate another surge but think it will be only half as bad as the first in terms of patients needing ICU beds. While the total number of cases in their state may look worse than before, Dr. Noordzij said those contracting the virus now are younger and tend to do better, with fewer requiring hospitalization and those who do less likely to end up in the ICU. “There are public health experts at BU that we’ve relied on to make these projections, and they’ve been quite accurate,” he said. “We hope they’ll be accurate again.”