Soooo, you're observing in the Operating Room (O.R.)... - page 3

A couple of tips and such to help: Dress Code: Give some serious thought into what attire you will wear into that dept. if you're allowed to wear something other than your clinical outfit on... Read More

  1. by   sunnyjohn
    Great post Marie.

    I can't tell you how many students have made me so nervous because they had no idea what was going on. I am going to print this out and give it to folks in charge so they can give it to all the studnets that come into the OR.
  2. by   crmson_lady
    Great post! I'm a senior nursing student and I can't tell you how many times these points were told to us. Our teachers told us many of these exact things before we went to our OR rotations. They wanted us to be thoroughly prepared for the experiences. Of course there were still the students who were clueless and were asked to leave the rooms.
  3. by   mandaleigh
    I am in the middle of clinicals and had my OR observation day today. It was more relaxed than I expected. The circulating nurses were awesome!! Available for questions during the surgeries and FRIENDLY!!!! The surgeons were relatively friendly, but I honestly didn't even expect them to acknowledge our presence. A few of the scrub nurses just acted like we weren't there which was okay with me. They didn't give a lot of 'dos and don'ts', basically we could stand anywhere that wasn't directly in the way, where we could see, and not contaminate. It was interesting BUT, I don't think that is the nursing for me. I really am better at the bedside nursing, dealing with the patient's everyday needs; physical and emotional. For those who love it, that's great!!
  4. by   tx2007
    Another thing I learned yesterday, when putting your lead up DO NOT fold it in half, this will weaken or break the lead and it wont be as effective. Place your lead UNFOLDED back where you got it and DO NOT drop them heavily either as this will cause weakening and breakage as well.
  5. by   mariedoreen
    I'm glad the OR teams I was with were so friendly. They were happy to have students with them and eager and interested to teach. In addition they were far more interested in giving direction and explanations than in giving threats about what would get us evicted. In fact no one ever told me I could be evicted. They simply told me what I needed to do to help them keep the patient safe. Very respectfully and very professionally. And that wasn't just one shift for one case for one day, it was multiple days, multiple people and multiple cases... from the surgeons to the CRNAs to the circulating RNs to the surgical techs... They were decent people who remembered what it was like to be a student in a foreign land, and they treated us like we were intelligent human beings who were more than welcome in their world for a few hours.
  6. by   sassy7cassy
    I know the lead topic was discussed long ago, but I am DREADING wearing leads after hearing my mom talk about how much pain they put her in after wearing them all day.
  7. by   Marie_LPN, RN
    Quote from sassy7cassy
    I know the lead topic was discussed long ago, but I am DREADING wearing leads after hearing my mom talk about how much pain they put her in after wearing them all day.
    If you're not scrubbed, then they don't have to be worn the whole time, just while x-rays are being taken.
  8. by   charebec65
    Lots of wonderful advice! I'm getting ready to do my official surgical rotation though I did have the privilege to see one previously. Even though I'd seen many surgeries on Discovery Health channel I was frankly afraid I my get queasy......but I didn't. It was a great experience. The surgical tech gave me a refresher on sterile technique in the OR and the doctors were great teachers.....anticipating questions before I could even ask (I was planning on waiting so as to not interrupt their concentration.
  9. by   PickMePlze
    Quote from Mave
    What smell? :uhoh21:
    I was thinking the same thing.
  10. by   nsgstudentinthe254
    I have observed a few times in surgery and I really enjoyed it. The smell can be harsh especially while they are cutting through the subQ fat. I do recommend eating before hand. i never got woozy, but they always tell us stories of students that faint. I hope nobody has an experience where they are not allowed to ask questions. That does not really foster a very good learning experience. everyone that I have had has been wonderful. The docs and nurses are always explaining what they are doing and they ask you questions to see if you understand. If it is a routine op like joint replacement they should be fairly comfortable with the procedure so they are able to let you know what is going on.
  11. by   MMARN
    Quote from Marie_LPN
    A couple of tips and such to help:

    Dress Code:
    • Change into OR scrubs first thing when you get there, AFTER letting the charge nurse know who are, what school you're with, and such. This includes a long sleeved jacket. It's cold in there, you'll need it.
    • WEAR YOUR NAMETAG. To us, you're a supicious looking stranger w/o your nametag. Cannot believe that this isn't a more enforced in schools to wear your tag.
    • Shoe covers are to be worn at all times when in the OR. Change them every time you go into another case.
    • Hats are to be worn at all times in the OR. All hair must be covers, and cover earrings as well. If observing in cases such as total joint replacements, spinal surgeries, or anything that's got a laminar flow air system that's running, you must wear a second head covering that is a full hat that ties around the bottom of your neck (nickname a "hood" by some of the staff). The first hat should be covered completely by this hood.
    • Masks are to be worn at all times when in the OR room. They must be form fitted to your face and both sets of string tied, no exceptions. Change mask each time you go to another case. It is also suggested that if you are allowed to stand close to the procedure, wear eye protection.
    • Isolation masks that are for MRSA and VRE protection (the yellow kind typically) are NOT approved for OR level filtration. Do NOT wear those in the OR.
    Sterility Rules:
    • The standard rule: if it's blue, don't touch it. Everything blue is sterile. Don't even reach over any sterile field for any reason (i've had this happen a couple of times, when a student pointed to something on the table and pointed OVER the field, and i wound up asking her to leave the room as a result, i could not risk a break in sterility. NO NO NO.) . If you have any questions about what is sterile, assume it IS sterile and treat it as such until you can ask about it.
    • Clear plastic in the OR is also sterile.
    Radiation Protection:
    • You need to wear lead aprons and thyroid shields when observing OR cases with X-ray. While wearing the lead aprons, never turn your back to the X-ray machine. If no lead is available for you (which is typical on heavy case days, step out of the room during the X-raying.
    Misc. Rules:
    • Eat a good breakfast that morning. I don't mean an energy bar, i mean eggs, sausage, OJ and toast.
    • Don't lock your knees while watching. Step around a little bit, even if you don't have much room to move.
    • If you feel weak, step out. If you're in a total joint room and aren't "allowed" to leave, at least sit down. And if you are allowed to leave a TJ room, chances are you can't come back in, because of infection control.
    • If the smell is overwhelming (and there's a high possibility of this), bring alcohol swabs with you. Poke on inside of your mask when needed. VapoRub inside of the mask has the same effect, but the alcohol swabs are everywhere.
    • Always ask the permission of the pt., nurse, and doctor before going in the room. Do not just assume that you're allowed. Pt. privacy is always respected, first and foremost. The circulator is the pt. advocate. Always check with the nurse before interacting with the pt.
    • Ask the pt.'s nurse, then the pt. before looking at the pt.'s chart. To do so w/o permission could get you in a position where you will be asked to leave the room, and quite possibly the unit, for privacy violate (seen it happen more than once).
    • When talking to the pt., try to talk to them in a lowered voice. Privacy, again.
    • Do not take offense if the doctors don't talk to you. They are concentrating on the situation at hand.
    • On the other hand, there are plenty that DO like to teach.
    • If you're taking notes on anything, refrain from using pt. name, or MR number. Identify your pt. as, for example "56 y.o M h/o yadayada. It's actually best if you leave ALL names off your paperwork.
    • I don't suggest asking anesthesia questions until AFTER the pt. is intubated, the tube is secured and connected to the circuit, the anesthesiologist isn't touching the pt., and/or they have sat down in their chair. And ask if it's OK to ask questions about what they did/are doing. Don't just assume it's ok to do.
    • Also, before asking the surgeon any case-related questions before, during, or after the case, ask them if it IS ok to ask questions.
    • Chances are, when you're in a room, you have NO idea where to stand to watch. We don't even know where you should stand till the pt. is draped and everythign is arrange. The safest bet is to stand up against the wall out of the way, and wait. Chances are, the circulator will point out a good place to stand.
    • OR staff will typically not talk to you during a case. We're trying to listen to what the surgeon says, and it's hard to hear a mumbling doctor when we're talking and listening to someone else.
    • Assume that anything laying on the floor is filthy and dirty. If you touch anything that might have touched the pt., go wash your hands with soap and water. If the nurse tells you to wash your hands, do it. They're telling you to do so for your own safety (ex. we dropped a sponge on the floor, student picked it up, i immediately told her to wash her hands in a quiet voice, then told her why).
    • Never forget HIPAA! You may be required to sign an agreement for privacy before you are allowed to observe.
    If i think of anything else, i'll add it on this post.:hatparty:

    ALL OF THESE THINGS ARE TRUE!!!
    I rotated to the OR last week for my clinical. The first thing you must do is change into scrubs (otherwise, they won't let you in), put on head gear (once again, RESTRICTED access for anyone w/o one), put on shoe covers, and whatever you do, as a room is being prepared, LEAVE THAT MASK ON!!
    It was a pretty great experience. I watched three cases: an ingunal (sp?) hernia repair, a circumsicion, and a lymph node dissection along with a masectomy (sp?). There IS an OR smell. I'm not quite sure what it is, but it's there. You have make sure you eat well, b/c if you don't, you'll get pretty dizzy with the things you see and the fact that you'll be standing for hours on end.

    In my experience, I didn't talk at all with the patient. They were pretty freaked out and barely listened to what the nurse and the anesthesiologist were telling them. When I first entered the room, I almost touched something blue and was almost chewed out by the surg tech. NEVER TOUCH ANYTHING BLUE. You will be asked to leave. Most of the time, all I did was try to flatten myself against the wall. I didn't want to get in the way of anyone. And, Marie LPN is right. The circulating nurse is your best friend. My nurse kept telling me where to stand in order for me to have a better look, and I did.

    The first two surgeons didn't even notice I was there. The third was my favorite. Before the surgery began, he saw me sitting on a stool and he went out of his way to meet me and introduce himself to me. Then, when he was pretty deep into the masectomy, he asked me if I could see anything from where I was sitting. I shook my head no, and he said, "Do you want to see something?" So, my pal, the circulating nurse, made me stand pretty close to the table (obviously w/o touching anything blue) and the surgeon moved out of the way in order for me to actually see. I will never forget him. He was pleasant and didn't make me feel inept or like a complete outsider.

    So, when you observe in the OR, make sure you actually follow what Marie LPN posted. It really does help.

    BTW, Marie LPN, I was thinking about your tips when I went to observe and I'm glad I didn't pass out, but when I felt a bit queasy, I did sit down. Thanks for the tips, doll!!!


    Mave.
  12. by   Marie_LPN, RN
    The smell is kind of a combination of disinfectant, betadine, blood, cauterized tissue, and/or abcess.
  13. by   smk1
    Quote from Marie_LPN
    The smell is kind of a combination of disinfectant, betadine, blood, cauterized tissue, and/or abcess.
    Marie, is it the kind of thing that you get used to?, Not just sense accommodation, but as the weeks pass do you find that the smell doesn't even bother you anymore even when you notice it? (kind of like he cadaver labs in A&P not making you sick after about the 4th or 5th week?)

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