orm_april-2024 - 9

Leadership
Most PACU nurses, she explains,
are asked to do both. " At my institution,
PACU staff handles both pre- and
postop. So in general, the nurse starts
the day by welcoming a patient in the
morning and prepping them for their procedure. "
The preparation stage includes
tasks like educating the patient about
the procedure, doing intake interviews,
recording vitals, setting up the IV, and
generally making sure they are safe and
ready for surgery.
" We like to say, 'I'll see you when
you wake up!' " says Seckner. While it
is probably reassuring for the patient to
hear that, she notes that nurses also
say that for themselves. It is not always
the case that they get the same patient
back from surgery that they helped prepare
pre-procedure, she explains, but
for the most part,
what they started.
they like finishing
That is when things begin changing.
For instance, while there are average
times surgical staff work with when calculating
how long a procedure should
take, sometimes cases run long. " Or
they go quicker, " Seckner says, both of
which change the order of how cases
come out, making it so that a nurse
gets assigned a patient in recovery
whom they did not see preoperatively.
" If you're available, you take the next
patient. One minute, you could be helping
send someone home after a simple
procedure. Then your next patient might
be a very critical case, maybe someone
who had a brain tumor, and that patient's
assessment is totally different. "
Neurological cases in particular can
be complex, she says, because there
are extra tests they have to perform to
make sure the patient is recovering as
they should after waking up.
Such scenarios are further exercises
in collaboration and show the importance
of good working relationships. " When
we signal that something is wrong, the
anesthesiologist or the surgeon trusts
our words, and they come check, " Seckner
says. " We have to be diligent about
communicating, and they have to be reliable
about answering the call. " But it all
starts with properly monitoring the patient
from the moment they wake up, she
stresses. " We can't miss any sign or hint
that something is not right. "
Stepping into leadership
After years of bedside nursing, the opportunity
to lead as a charge nurse presented
itself as a natural progression
for Seckner. Her deep understanding
of the department's operational challenges,
especially in patient safety and
nurse satisfaction, put her on the path
to leadership. She always paid attention
to important considerations, such as
preserving the 1:1 nurse-to-patient ratio
until certain criteria are met and the
nurse can take another patient.
" Checklists are important, " she
says. " In PACU, one of the first and
most important things we have to do
is check their bands. " That is a patient
safety consideration that is different
from floor nursing, she explains. " Usually
a patient is awake to confirm their
identity, but because we get patients
coming directly from the OR, they are
usually sedated and can't talk. So the
first item in our checklist is always to
check their band and confirm we have
the right patient in front of us. "
As a leader, Seckner makes sure
resources for the above-the right number
of staff and readily accessible materials-are
always planned for and available
in her department. And while she
has a knack for solving problems, it is
her ability to recognize issues others
have not yet identified that has made
her a successful leader.
" One pain point we had was patient
throughput, " she says. " Probably every
PACU wants to have more efficient patient
flow, but what's the root cause
of that inefficiency? " At her institution,
Seckner saw the root cause was a bottleneck
of patient throughput from PACU
to inpatient care, which she sought
to solve. " That got me a seat on the
table, and I was able to advocate for
change. " She was instrumental in establishing
criteria for which patients can
safely stay in PACU overnight and which
should be moved. Her leadership not
only improved the patient experience,
it also boosted the morale of staff who
were feeling frustrated and overworked.
" It was an administrative decision that
made a real difference in clinical practice
for the better, " she adds.
Proper delegation of duties is key to
a well-balanced team. Seckner explains
that as assistant director, she oversees
macro needs for the department and
must plan months and years ahead. But
she can do that because she has nurses
in charge of daily shifts and tasks. " I
oversee FTEs and budgets, but there's
also a strategic component. Why does
our patient volume look the way it does?
Are there certain procedures we should
be doing? What equipment can we bring
in to make our lives easier? These are
questions I'm always thinking about. "
And of course, she works closely
with other department leaders to maintain
patient care protocols and foster a
safe, efficient, and patient-centered environment.
" Working in PACU is rewarding
and exciting, " Seckner says. " Our
patients might not fully remember the
care we give them because of how out
of it they are right after surgery, but that
doesn't stop us from wanting to give
each patient the best experience. No
one wants to have surgery. We're here
to try and make the process as safe
and painless as we can. "
Seckner will present her work with
overnight stay criteria during the session,
" Capacity and throughput issues:
Making way for overnight stays, " at this
year's OR Manager Conference on October
28 in Las Vegas, Nevada. ORM
-Tarsilla Moura is senior editor of
OR Manager.
www.ormanager.com
OR Manager | April 2024
9
http://www.ormanager.com

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Table of Contents for the Digital Edition of orm_april-2024

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