Over the past year we have received a few queries from our members through the info@BARNA site regarding the worrying trend of utilising the recovery room staff in other theatre duties.
Some nurses have been asked to re-train in scrub and/or in circulating duties to cover elective and emergency services.
Although we recognise multi-skilling as a way of managing staffing issues in theatres; the British Anaesthetic and Recovery Nurses Association (BARNA) view is that we need specialist nurses in all the theatre roles, which would negate the need for ‘skills transfers’ for all the staff members.
It is not beneficial in the long run to rotate staff continuously from one speciality to another; you are in danger of diluting the nursing skills; stress levels rise in your team and subsequently the sickness may increase.
We understand that this worries the nurses in the perianaesthesia speciality, as the most common question from our members is: ‘What can we do to prevent this?’
Maybe even our colleagues on the scrub side have the same views, as the old saying in theatres goes ‘the scrub nurse is only as good as their runner’.
We have received reports that the senior managers in some hospitals, who maintain they ‘know theatres well’ as they themselves previously worked there and then device irrational ideas on how to solve theatre staffing problems. They are damaging the very fabric of patient safety. Alas these managers were nurses themselves, so it is even more difficult to understand their management ethos.
As an example, the managers say that we train all our recovery staff to circulate in theatres and then when we ask who will care for the patients in recovery, they say that we ask the intensive care unit (ICU) nurses to come to recovery, seemingly forgetting who is nursing the ICU patients. This idea was maybe not said with seriousness, but never the less it is questionable to even consider such practices.
We are not saying that there is no room for nurses with good and long experience in more than one speciality, but to train recovery nurses for a short period of time and then ask them to circulate during night shifts for a major case is not best practice. We feel that continued training and support of specialist roles (anaesthetic/scrub/Post-anaesthesia Care Unit (PACU)) in Theatres is the most effective way of ensuring maintenance of quality.
As an Association, BARNA needs to ask what we can do for our members and non-members, when they are faced with a major change to their staffing and training.
The Association is at its most powerful, when we have the voice of a large number of members, alas this is not the current case for BARNA.
You may be aware that BARNA recently re-launched the Association. The website www.BARNA.co.uk is there to be marvelled at and is just one of the new features. The new website is constantly updated; hence, a regular visit is worthwhile.
You may have noticed more frequent communications from BARNA in your e-mail inbox and soon the new website will be the communication hub between BARNA and its members and non-members worldwide.
As the BARNA Chair Manda Dunne reported from Ljubljana, in Benjamin Franklin famous words ‘we need to hang together or we will hang separately’. This is exactly what any department needs to do to survive an irrational change regarding the principals of good patient care.
We in BARNA represent different theatre departments around the United Kingdom and have witnessed many odd, how ever well meaning, staffing re-arrangements.
Anaesthetic nurses have had to fight for their existence since 1980s and recovery nurses are now in the same situation.
We have always seen the best success in units where staff faces the issues together and who are able to reason and articulate, why any short-sighted staffing arrangements are potentially dangerous.
Refusal to negotiate rarely brings any good long-lasting results; however, there needs to be complete unity, which is not easy to achieve, as we have so many different nationalities that demonstrate a varied response to conflict.
We need to accept that the nurse who is used to standing on the barricade waving the revolutionary flag is abhorrent to many others who prefer a subtler approach to solving conflict. Nevertheless, the unity among the team needs to be found, before you have any chance of a success.
So what can we do, if we feel that the multi-specialisation of the staff will not provide the best care for our patients? Can we refuse, is the question that we are going to explore.
Understanding Karpan's drama triangle can be helpful in these situations, when you try to get unity working in your team. This type of situation is not that far removed from family triangle.
Persecutor: The management is authoritarian and rigid in their request, giving unmanageable time limits. They make you to believe that it is ‘all your fault and we are doomed’ if you do not accept the new protocol. They set strict limits and act like a critical parent.
Victim: That is your team, they feel oppressed, hopeless and powerless. Worried what the persecutor will do to you.
Rescuer: These employees in your team sound like they want to help and most of us think it is great to have them, but they often work for their own needs and do not produce the best results.
Remember that the managers can start to behave like victims and you easily start taking the rescuers role. You really do not want to do this!
So how to avoid staying in this ever changing triangle and break out of its confines?
The best way to deal with this type of situation is to ask for clear structures from management and negotiate clear time limits for training, mentoring and for the change.
Ask why is the change needed are there other ways to solve these staffing problems. Have other ideas been tried, what are the hurdles we need to remove. So now you already are moving towards problem solving and you stop being the victim.
We must never forget the rescuers, as they need help in staying within the team's objectives. They need to see the common good and not what they benefit from all this confusion. They need nurturing and need to discuss the issues they have in not following the team's goals.
So refusing is an option, but what you really want to do is to continue the dialogue with your managers. By asking for more time and starting to plan for the change, more problems will surface and more reasons there will be to continue with negotiations.
Your team is put under immense pressure, but carefully manoeuvring and remembering that as a team you have power and by buying time will you eventually come to a more reasonable solution.
Incident reporting is a powerful tool and needs to be continuous and ever present. By reporting critical incidents and near misses give a clear picture of the issues nurses face in their every day work.
You may have even failed in your standards of care, and this is to be remembered when management wants the staff skills mix to be changed. However, if you persistently have high standards in your unit you use that as your tool not make any dramatic changes.
Remember, BARNA is there to listen to your concerns; investigating and highlighting issues; propose solutions and give advice. We care for you so you can care for your patients. The Association is the Big Team!
