The First Year Curve

SouthernizedRN, ASN, RN

I kept this in mind when I was on my year long search for a job that took me from my native California to 2,000 miles away in South Carolina. My instructors had told us to be willing to work ANYWHERE for two years. I had no encumbrances to keep in California. I had applied to every hospital in California to have only two interviews and no offers and so many rejection letters. I was a little fish in that metaphorically large pool of other graduates that did not have BSN's and 2 years of experience.

I expanded my search to other states such as Nebraska, Georgia, South Carolina, Virginia, and Arkansas. Other than Nebraska I had family (Aunt, cousins, and parents) in those states or surrounding states. I figured to be taken seriously by these hospitals I needed to have my licenses in those states, so I obtained licensure in Georgia and South Carolina along with my license in California. South Carolina is a compact state so I knew I could use it in other compact states until I got a license in that state if the opportunity arose. I was able to obtain my licenses by endorsement because I had just recently graduated and passed the NCLEX. This was extremely useful. I also made several (about 10 at last count) revisions of my resume until I was able to get it to a version that Nursing Directors would actually take seriously. Once I started to send this revised resume with all of my licensure and certifications I started receiving calls for interviews and movement up ladders into RN Residency and Versant Programs. I went on three interviews in less than a month and had three offers over two months. I finally accepted an offer into a Residency Program and directly into OR. A specialty that few get the privilege of starting straight out of school.

During my interview for this position the Charge Nurse and Shift Leader Nurses warned me that my first year would be difficult. That I might have times I just wanted to cry or maybe give up. Even with this in mind I still had no concept of just how steep my learning curve was until I started working. And yes, there were times I cried but I never ever thought of giving up.

Once a month for my first year I had to attend classes in the Nurse Residency program. I had the choice of attending these classes either during work hours or after work hours. If I missed three classes they could expel me from the program and I could lose my job. If I missed up to two classes they extended my time in the program as they had to be made up. Fortunately, as many times as I almost forgot I had a class that month, I never had to make any classes up and I graduated from the program on time. I believe this program was instrumental in helping me understand the first year nuances of being a nurse, but it was also so incredibly different from OR nursing. OR Circulator nursing is nothing like anything I experienced in nursing school clinicals. We were lucky to have one day in the OR plastered to the wall to avoid contaminating sterile fields. So not everything covered in the Residency classes really pertained to me in my position.

One of the qualities that interested my Charge Nurse about me was that I had as my choice precepted in the OR during nursing school. I did not do much during these times I precepted except try to stay out of the way, but I did get good at tying off the techs and doctors. I learned to appreciate Surgical Techs then because I thought of all that equipment they have to learn. What was it used for? How did they know just what to use? It was impressive. I learned a healthy respect for their skills in the OR. When I started though, it couldn't have been farther from the reality I thought I knew of the environment. No, I never thought the OR was like Grey's Anatomy. Like every other nurse everywhere I pick apart medical TV shows.

It was the most overwhelming year of my life. I had to learn so much that was just not in any book I read in nursing school. To circulate a room you have to be coordinated and graceful. Something I definitely am not. Kick buckets get in everyone's way and when you are going from one side of the room to the other they got in my way. So I tripped over a lot of kick buckets and only once did I contaminate a back table nearly falling. Fortunately, it was a small area and was covered by a sterile towel, but I was mortified. So was the tech. It was at the end of the procedure at closing so no equipment had been touched, just the table.

The circulating nurse also has a lot of documenting that needs to be done during the case. Documenting that needs to be done while running for extra sutures, another size laparoscopic scope, some dressing material, tissue slips for specimens, calling to send for the next patient, doing counts, calling family, calling x-ray, plugging in equipment...Ad Infinitum. The first year is just trying to learn how to do all of this and be able to find what you need in the sterile core. At times you wish you have the arms of Shiva to do it all.

The sterile core is animal of another color. This is where everything is stored sterile for use during surgery. This is an extremely overwhelming room because there is so much in there and when you are new you know absolutely nothing about it. The best way I learned the equipment in this room came from work pulling cases. When we are not working in rooms we go into the sterile core with a list of the surgical cases for the next day and with Doctor Preference Cards pull the equipment and supplies that will be used during the procedure. This was the easiest part of my job, but I still learn about equipment we have.

When you are not learning where equipment and supplies are you are either taking care of your patient before surgery in coordination with anesthesia or transferring them to PACU after. Finishing your documentation and moving on to the next case. During the year you are also supposed to be developing a routine. This is all the things you do before, during and after surgery such as assessing the patient, having equipment ready to be put in the room, getting medications needed, helping the patient to the OR table, assisting anesthesia with sedation of the patient, and counts. When all of this is put together well it becomes a well-coordinated ballet. This was all challenging, but this is nothing in comparison to other challenges that must be overcome.

In the OR you work with various other professionals such as Surgical Techs, Surgeons, Anesthesiologists and CRNA's. These people did not know me nor did I know them. We had to learn about each other and become comfortable with each other and what we could expect from each other. Often times this involved others with strong personalities. This sometimes can cause issues such as lack of trust and unwarranted gossip. Often times there was talk going on between others in OR about my abilities. I was aware of this talk. I did not address it with the individuals directly or with my Charge Nurse. I am not a confrontational person, but in this job at this place I had to learn to be. This means that you must be willing to speak up for yourself, because others might not. This talk behind my back became my biggest frustration. Not only was it affecting me personally it was affecting my relationships with the Surgeons. They refused almost to call me by name because they were listening to the talk at the table about my skills and my lack of confidence. There were surgeons who did not want me in their rooms because of this talk. This was very hard for me to accept. I tried so hard to develop my skills, to do the best every day and ignore the entire behind the back talk. I had to prove to these people that I could do the job and I was quite capable. The biggest thing I had to do was let go of all of the aggravation these others were causing me and go into my rooms with the confidence of a seasoned nurse. In other words show no fear. I spent more times than I like in my Charges Nurses office having sit downs about my abilities and I was sick and tired of what other people were communicating to her about my abilities. I had to change the way the say things. How I did some things and what they saw from me. I had to take ownership of myself and my rooms. On the anniversary of my year in OR my world change.

I had finally reached the apex of the curve. I am just starting to come over the top now. I have had many opportunities come my way because I made some changes, stood up for myself and my abilities. I own my rooms and my skills. People who used to talk behind my back are not left with much to say, I am still there. They were not able to run me off. Why? I had learned to love what I do and I was not going to let people who have nothing better to do than make others unhappy run me off. I am good at what I do and I improve every day. I love my patients and what I do to care for them. I am also not the new nurse on the block. I am surprised everyday when a Doctor uses my name, because they either did not use it at all or they would ask someone else in the room. They know me, they know who I am and I can be trusted.

I know that when another new nurse has the opportunity, fresh from school, to work in OR I want to take them under my wing. Guide them through this process, because it should never be this difficult. I want to show them the best ways I learned my position. I learned from some great nurses. Some of what they have taught me has been paramount in critical cases. When a Doctor thanks me for good work I thank the nurse who taught me that skill. No one should have to deal with gossip and mean spirited talk, but it's a culture that still persists. No one should have to deal with mean spirited people to learn a job. I never forgot what my instructors had said about "Nurses eat their young." It's not only nurses it's Techs, CNA's, and Surgeons. There were many who did not think I would last. I did. I am still here and I am not planning on going anywhere. I learned to stand tall, show confidence, and own my skills.

The First Year Curve

About SouthernizedRN, ASN, RN

More Like This