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Use of Management Model Debated
A O R N JOURNAL
JUNE 1987, VOL. 45, NO 6
Letters to the Editor
Petroleum Products and Lasers Do Not Mix We have been using lasers in our OR for the past 1% years and are always delighted to see articles on this subject. The article, “Outpatient hemorrhoidectomy: Laser treatment and case results,” by A. T. Zadeh, MD, and Beverly Kirchner, RN, in the December 1986 issue of the Journal was very interesting, especially the description of the rectal packing. We have both been under the impression that the use of petroleum products must be avoided when there is a possibility of fire. In fact, lubricants in the eyes have been discouraged for the same reason. After reading the article, we did an experiment using petrolatum gauze and the neodymium yttrium aluminum garnert (Nd:YAG) laser at 50 watts. Although combustion was not achieved, we did note a definite increase in smoke. For safety reasons, we have chosen to forgo the lubricating factor and use wet sponges for our rectal packing. KATHYAGEE,RN WILMAWELLS,RN LASERSAFETY OFFICERS HILLCREST HOSPITAL MAYFIELDHEIGHTS.O H Author? response. A very important part was inadvertently left out of the article. In the section on intraoperative care, we discussed the scrub nurse making the rectal pack but failed to say when the rectal pack is inserted. Because of the extreme concern of both laser and patient safety, 1274
we do not use petroleum products during surgery. The rectal pack is inserted after the laser has been turned off and moved away from the field. The pack helps tamponade any minor oozing that might occur. It is removed in the postanesthesia care unit (PACU) 30 minutes after the surgery when the PACU nurse checks for bleeding. BEVERLY KIRCHNER, RN, CNOR DIRECTOR OF NURSES DALLAS SURGERY CENTER
Use of Management Model Debated I am appalled at and disappointed in the approach N. Farabaugh, RN, and R. Davidhizar, RN, took in their article, “Managers: Establishing a niche with former peers,” in the February issue of the Journal. This article is representative of the type of thinking that plagues and stifles the nursing profession. The article refers to traditional management models (Katz and Kahn) rather than more recent motivation and participation models (Maslow and Gordon). Communication is mentioned only in passing, and there are many references to the staff being subordinate to the manager. I do not agree that one has to give up relationships to assume a management position. Management positions in a professional environment should not require reassessing peers as subordinates. What it should indicate is one person’s willingness to accept more of the total responsibility of the job environment. In a professional environment, each person is personally accountable for their job and performance.
JUNE 1987, VOL. 45, NO 6
AORN JOURNAL
Subordination only appears in a traditional chain of command model of management. The participatory models recognize the individual as a professional peer whose contributions are valuable for the growth, continuity, and strength of the organizational structure. The tendency to confuse managerial ability with leadership ability in this article indicates a lack of comprehension of the difference in these two terms. A good manager is not necessarily a good leader. Is the authors’ definition of a good manager in terms of leadership or the ability to manage people, set routines, and get results? I suggest the authors give consideration to training new nursing managers in participatory management models. Managerial systems that inspire creativity give new managers the opportunity to be effective, produce results, and cultivate leadership. NORMAEASTERHARNACK,RN STAFF NURSE, SURGICAL SERVICES
ST JOSEPH’SHOSPITAL KIRKWOOD. MO
Waking Up In-Service Sessions Recently, I came up with an idea for an inservice session on the proposed recommended practices. Our OR has a 30-minute in-service session every Wednesday morning for the OR nurses. Some mornings, it is difficult to get them to concentrate. At one session, I asked them to assemble into groups of five. Each group then picked a folded piece of paper from a basket. O n each piece was a statement from the “Proposed recommended practices: Care of instruments, scopes, and powered surgical instruments” in the December 1986 issue of the AORN Journal. The groups were asked to answer three questions: How does their department comply with the recommended practice? What changes could be made in your department to comply with the recommended practice? Is the recommended practice easy to understand, and if not what would you do to make the statement more explanatory? After 10 minutes of discussion, a spokesman for 1276
each group summarized the discussion. What started as a group of sleepy lethargic people ended as an enthusiastic, talkative group. The staff truly enjoyed learning in this manner. GWENGRAHAM, RN, BSN, CNOR CLINICAL PRACTITIONER TEACHER
METHODIST HOSPITAL HOUSTON
Location of Ethylene Oxide Vents Questioned The article, “Pregnancy in the OR Part 11: Ensuring Fetal Health,” by Gayle Drinville-Shank, R N , in the March issue has a discussion of the safety precautions for using ethylene oxide (EO). According to the author, the exhaust duct must be at or below the door level of the equipment because EO is heavier than air. It is true that E O is heavier than air when both are at the Same temperature. But at the end of a sterilizing cycle, an EO sterilizer contains a warm (37.8 OC to 57.2 “C [lo0 OF to 135 O F ] ) mixture of air and sterilant that will rise when the door is opened and this mixture escapes into the cooler air of the work area. According to proposed recommendations for safe use of EO from the Association for the Advancement of Medical Instrumentation (AAMI), the exhaust hood should usually be located above the sterilizer door, but its exact placement should be determined by consulting with the sterilizer manufacturer.’ New sterilizers with built-in exhaust hoods generally have hoods above the door, but some sterilizers have hoods that extend down the sides of the door also. MICHAEL L. SCHNEIER VICE PRESIDENT
RESEARCH, DEVELOPMENT, A N D ENGINEERING CASTLECo ROCHESTER, NY Note 1. Good Hospital Practice: Ethylene Oxide GmVentilation Recommendations and Safe Use (Arlington, Va: Association for the Advancement of Medical Instrumentation, 1981) 2.3.
JUNE 1987, VOL. 45, NO 6
Letters to the Editor
Petroleum Products and Lasers Do Not Mix We have been using lasers in our OR for the past 1% years and are always delighted to see articles on this subject. The article, “Outpatient hemorrhoidectomy: Laser treatment and case results,” by A. T. Zadeh, MD, and Beverly Kirchner, RN, in the December 1986 issue of the Journal was very interesting, especially the description of the rectal packing. We have both been under the impression that the use of petroleum products must be avoided when there is a possibility of fire. In fact, lubricants in the eyes have been discouraged for the same reason. After reading the article, we did an experiment using petrolatum gauze and the neodymium yttrium aluminum garnert (Nd:YAG) laser at 50 watts. Although combustion was not achieved, we did note a definite increase in smoke. For safety reasons, we have chosen to forgo the lubricating factor and use wet sponges for our rectal packing. KATHYAGEE,RN WILMAWELLS,RN LASERSAFETY OFFICERS HILLCREST HOSPITAL MAYFIELDHEIGHTS.O H Author? response. A very important part was inadvertently left out of the article. In the section on intraoperative care, we discussed the scrub nurse making the rectal pack but failed to say when the rectal pack is inserted. Because of the extreme concern of both laser and patient safety, 1274
we do not use petroleum products during surgery. The rectal pack is inserted after the laser has been turned off and moved away from the field. The pack helps tamponade any minor oozing that might occur. It is removed in the postanesthesia care unit (PACU) 30 minutes after the surgery when the PACU nurse checks for bleeding. BEVERLY KIRCHNER, RN, CNOR DIRECTOR OF NURSES DALLAS SURGERY CENTER
Use of Management Model Debated I am appalled at and disappointed in the approach N. Farabaugh, RN, and R. Davidhizar, RN, took in their article, “Managers: Establishing a niche with former peers,” in the February issue of the Journal. This article is representative of the type of thinking that plagues and stifles the nursing profession. The article refers to traditional management models (Katz and Kahn) rather than more recent motivation and participation models (Maslow and Gordon). Communication is mentioned only in passing, and there are many references to the staff being subordinate to the manager. I do not agree that one has to give up relationships to assume a management position. Management positions in a professional environment should not require reassessing peers as subordinates. What it should indicate is one person’s willingness to accept more of the total responsibility of the job environment. In a professional environment, each person is personally accountable for their job and performance.
JUNE 1987, VOL. 45, NO 6
AORN JOURNAL
Subordination only appears in a traditional chain of command model of management. The participatory models recognize the individual as a professional peer whose contributions are valuable for the growth, continuity, and strength of the organizational structure. The tendency to confuse managerial ability with leadership ability in this article indicates a lack of comprehension of the difference in these two terms. A good manager is not necessarily a good leader. Is the authors’ definition of a good manager in terms of leadership or the ability to manage people, set routines, and get results? I suggest the authors give consideration to training new nursing managers in participatory management models. Managerial systems that inspire creativity give new managers the opportunity to be effective, produce results, and cultivate leadership. NORMAEASTERHARNACK,RN STAFF NURSE, SURGICAL SERVICES
ST JOSEPH’SHOSPITAL KIRKWOOD. MO
Waking Up In-Service Sessions Recently, I came up with an idea for an inservice session on the proposed recommended practices. Our OR has a 30-minute in-service session every Wednesday morning for the OR nurses. Some mornings, it is difficult to get them to concentrate. At one session, I asked them to assemble into groups of five. Each group then picked a folded piece of paper from a basket. O n each piece was a statement from the “Proposed recommended practices: Care of instruments, scopes, and powered surgical instruments” in the December 1986 issue of the AORN Journal. The groups were asked to answer three questions: How does their department comply with the recommended practice? What changes could be made in your department to comply with the recommended practice? Is the recommended practice easy to understand, and if not what would you do to make the statement more explanatory? After 10 minutes of discussion, a spokesman for 1276
each group summarized the discussion. What started as a group of sleepy lethargic people ended as an enthusiastic, talkative group. The staff truly enjoyed learning in this manner. GWENGRAHAM, RN, BSN, CNOR CLINICAL PRACTITIONER TEACHER
METHODIST HOSPITAL HOUSTON
Location of Ethylene Oxide Vents Questioned The article, “Pregnancy in the OR Part 11: Ensuring Fetal Health,” by Gayle Drinville-Shank, R N , in the March issue has a discussion of the safety precautions for using ethylene oxide (EO). According to the author, the exhaust duct must be at or below the door level of the equipment because EO is heavier than air. It is true that E O is heavier than air when both are at the Same temperature. But at the end of a sterilizing cycle, an EO sterilizer contains a warm (37.8 OC to 57.2 “C [lo0 OF to 135 O F ] ) mixture of air and sterilant that will rise when the door is opened and this mixture escapes into the cooler air of the work area. According to proposed recommendations for safe use of EO from the Association for the Advancement of Medical Instrumentation (AAMI), the exhaust hood should usually be located above the sterilizer door, but its exact placement should be determined by consulting with the sterilizer manufacturer.’ New sterilizers with built-in exhaust hoods generally have hoods above the door, but some sterilizers have hoods that extend down the sides of the door also. MICHAEL L. SCHNEIER VICE PRESIDENT
RESEARCH, DEVELOPMENT, A N D ENGINEERING CASTLECo ROCHESTER, NY Note 1. Good Hospital Practice: Ethylene Oxide GmVentilation Recommendations and Safe Use (Arlington, Va: Association for the Advancement of Medical Instrumentation, 1981) 2.3.