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Posted: Feb 25, 2008 01:03 AM
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An old OR nurse once told me that any good OR nurse always carries scissors in his/her pocket. While I make use of my scissors daily, there are other factors that are vital to being a great OR nurse.
One of the first things that any aspiring OR nurse needs to do is find a good pair of shoes...for me, I'm always on the hunt for the "perfect" shoe. This has led to me having a nursing shoe museum in my locker. I open it and nine times out of ten, I'm greeted with an avalanche of footwear.
Currently, I have two pairs of Danskos, two pairs of Crocs(one with holes, one without) a pair of Nursemates and a pair of Red Cross shoes. I try to rotate them and wear all of them except for one pair of Danskos, which sit in my locker and make me feel guilty every time I look at them. There went $100 down the drain! At least my scrubs are provided by the hospital, so I have a little bit of leeway with my shoe sickness. The shoes are important because in the OR, I spend the majority of the day on my feet. I also have to run for items that the surgeon decides he or she needs all of a sudden. I'm seriously considering asking the makers of Heelies(sneakers that have roller skate wheels on the bottom) to make a nursing shoe.
This running amuck in the OR is probably the aspect of the job that most people equate with being an OR nurse. While it's a huge part, it's not the most important part. The most vital part of OR nursing is being a patient advocate. I have to admit, I tend to get peeved when those outside the OR state that OR nurses don't have to like patients because "the patients are unconscious anyway". Even worse, they think we don't do any patient care. Nothing could be further from the truth. Having surgery tends to bring out the most vulnerable aspects of a patient's personality. We have to gain our patient's trust in a short span of time(about 10 minutes) and I've had to use all those "theraputic communication techniques" that you learn about in nursing school. Sometimes they backfire though! One time, as a squeaky new OR nurse, I had a patient who was seriously depressed and had anxiety issues.
The holding room nurses said she had been very weepy on and off in the time she had been there. I introduce myself and I ask her all the usual questions(allergies, NPO status, any previous surgery?) and we seem to be getting along nicely. She even smiled once or twice. I was trying to keep her distracted since she was anxious, so I start asking her "get to know you" type questions. Everything was going fine until I asked her if she had any pets at home. She bursts out crying and told me that her cat "Snowy" recently got hit by a car. I mean, she was practically in hysterics. One minute, I think I'm doing a pretty good job and was proud of myself, the next, I'm running to get her tissues and assuring her that if animals do go to heaven, Snowy is most certainly there. Sheesh, took me a while to live THAT one down.
In my hospital, we do an ID of the patient with anesthesia and the attending and this process is not up for negotiation. Most of the doctors are good about this, but I've had to stand my ground with a couple to make sure this gets done. I help anesthesia intubate the patient and I try to provide emotional support for the patient while they're going to sleep(although since the Snowy incident, I leave pet questions out of my repertoire!). I then help position the patient, and this is important, since you can cause damage to a patient if they're not positioned properly. Often, the surgeon wants the patient to have a Foley , so I put that in-I had a great dread of female Foleys for a good month or two. I've since learned that the OR light can be your best friend when trying to find that elusive female urethra and also not to be shy about asking someone to don gloves and help "retract" the lady parts.
I put a grounding pad on the patient(for the electrocautery) and I make sure they have a safety strap securing them to the bed. In my OR the residents prep, and sometimes they'll take the belt off or it will shift. This means that I have to pay attention and fix the belt if need be. The patient is then draped by the doctor and scrub. I plug things in and make sure the scrub has everything he or she needs to get started.
I pride myself on not starting my charting until everything at the field is settled. We have computerized charting and while I am computer savvy for the most part, I swear these systems were made by someone who never stepped foot into an OR. Documentation is important, yes, but my ultimate priority is that patient. I admit, more than a few times I've been saying some very naughty words under my breath while charting and fantasized about committing bodily harm against the person who thought of bringing computerized charting into our OR. Then again, I'd probably end up having to take care of them, so why bother!
I was a scrub tech for a few years so I'm one of those nurses that "lurks" outside of the field. I do this for a couple of reasons. First of all, I feel that it's my job to keep track of what's going on and second, I'm nosy and feel left out sometimes.
I think the techs like it because they don't have to flag me down frantically if they need something and most surgeons like to teach and show what they can do. I can also make sure sterility is maintained-most of the time, it's usually the light handles that get contaminated by a tall resident/surgeon who hits it with his/her head. When I have tall docs in my room, I bring an extra set of light handles in.
I give medications to the tech, call the blood bank for blood, check the blood with the anesthesiologist/CRNA, and answer pagers if the doctor is on call. I hate those freakin' pagers with a passion and have had to restrain myself from flushing them down the nearest hopper. I hear that some places make physicians leave them at the desk and can only dream of such a marvelous place!
The counts that we do to make sure no suture, sponges, or instruments are left in the patient are one of the most crucial things we do for that patient. We do three counts for the most part...one before incision is made, one at closing and a final count when we're on skin. I work in Ortho, so we don't count instruments. I've had to butt heads with doctors who were being difficult when told of an incorrect count (ie. they keep closing). Most times, the item is found in the folds of drapes or on the floor, but on a few occasions, it's been in the patient. I have to say, the majority of the surgeons are grateful if you've kept them from leaving something inside the patient.
After the procedure, we move the patient back on to the stretcher, and the anesthesiologist/CRNA and myself take the patient to PACU. I give report and tell the PACU nurse anything unusual that happened, if any meds were given and how much, mention drains and dressings.
I know in my above description, it sounds unlike a lot of nursing jobs out there, and can seem very technical, but everything we do is for that patient. If these things are done poorly or not at all, it can severly impact the patient's recovery and in some cases, survival. An OR nurse can't be afraid to disagree with the surgeon or anesthesia if policies aren't being followed. I've taken to saying that if I don't butt heads with someone at least once a shift, then I'm not doing my job right.
It seems to me that a good OR nurse has to assume many roles and be at various times, a psychologist, a computer specialist, a mechanic, a gopher, and an advocate. You have to have compassion, curiousity, a good set of eyes and ears, and stamina. A strong stomach doesn't hurt either. Some people have asked me if they need previous experience to be successful in the OR, either med/surg or some other specialty.
I don't think so-to me, the OR environment is one in which enthusiasm and a willingness to learn will take you far. Those things, and a good pair of shoes.
Would you like to comment?
I have no intention, what so ever, on going into the Med-Surg field. I feel like my heart belongs in the OR. My main goal is becoming a first assisting RN. Do you have any thoughts on that? Have you had any experiences with them? 
