Marie,
I am not an OR observer, but have been long ago when in nursing school.
Your information is so good ! Thanks so much for it. You always add a nice touch to this forum !:kiss
LPN 90
Thank you.
I'd hope this would become a sticky. I've seen so many students that had no idea what to do or where to go for their observation and their instructors didn't help. I thought this might give a little bit of a headstart on it.
(Which reminds me, i got another idea for another forum suggestion.)
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 suspicious 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 covered, 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 may be required to 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, or stand behind someone who's wearing lead.
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 one 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 everything is arranged. 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.
A quick way to insult and alienate OR staff (tech or nurse, doesn't matter) is asking if they are a "gopher".
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:
Let's see, a nurse that looks up, sees her pt.'s call light go off, goes back to cutting out coupons, but when i come out of that room after answering the light, she says "oh sorry i didn't see it". Yeah, right, i'd almost buy that but i saw you look up at it three times, then look up the hall to see if i were coming down the hall. (and yes, i realize that there are those that legitimately did not see the light going off).
The whole "who's a real nurse" arguement where the LPN, Diploma, ADN, BSN degrees are concerned. Find something better to get on a high horse about, please.
The "nurses eat their young" phrase. Man, i'm REALLY tired of hearing/reading that one!
"That's not my pt." when the pt. is crying from chest pains and has a HR of 164 bpm.
"I need to get my aide" when someone's pt. is dirty, and the aide is a floor float for 34 other pts. And they have no inention of helping the aide.
Nurses who think that that anyone (housekeepers, aides, LPNs, maintenance people) that is not up to their educational level is beneath their dignity, and treats them that way (thinking of one in particular now who does that).
Students who got into nursing for the sake of finding a doctor to marry.
The mixing meds thing has bothered me since i read it. I mean, what meds, what are the effects, compatabilities, etc.? I do not believe anyone should be mixing meds or messing with meds unless they have the knowledge of what they're mixing, drawing up, etc.
(And ideally, that person should always be a nurse.)
I have been a First Assist for 13 of the 17 years I have been scrubbing and NO I am not a RN. I make as much or sometimes more than the RNs in the room.
Money doesn't mean squat when it comes to pt. safety, and people being within their scope.
I can circulate circles around most of the RNs they grab off the street to fill some policy that states an RN must be in the room.
Grabbed off of the street Come ON!
The RNs come to me and ask what we need, I am usually the one to pull all equiptment the supplies, meds and mix then prior to the case because they give me some new grad fresh out of nursing school and expect me to be able to teach them.
If i were an RN, i would want another RN to teach/precept me. OF all people they would be able to train me according to my scope of RN practice.
I am a great teacher but I think you have to get your hands dirty to learn. Circulators: No sitting back reading a book or magazine after the case starts, you better be standing at my back table ready & willing to learn and LISTEN>>> Watch what's going on and be ready to anticipate the needs of the scrubber, myself and my surgeon
This reeks of self-entitlement.
No different than my job.
Yes it is. Check your state laws, and your facilities polies, you'll see the difference.
I have the experience in the OR and feel everone deserves to learn and if you are willing; keep asking, keep begging and if your free, ask a Tech to let you scrub in with them.
Experience is one thing, reality is another. You're not RN, no matter how many years you've done your job, and there are certain things in an OR that only an RN can do.
A patient shouldn't be in danger or die because they don't have properly trained staff in place.
Or staff that is doing things they should not be doing (like being a non-RN circulator)
One of the hardest things i still run into is listening to heart and lung sounds on someone with large breasts. In order to hear, of course i have to get underneath, but i have naturally ice cold hands (they turn right back to ice after washing them in hot water), and needless to say, not a good thing, because i can't hear anything crackles over "OOOOO YOUR HANDS ARE COOOOOOOOOOOOLD . The only solution i've come up with so far is putting towels in the blanket warmer, putting my hands in one on my way to a room, and use the warm towel to move the breast (better than a cold hand).
I'd hope this would become a sticky. I've seen so many students that had no idea what to do or where to go for their observation and their instructors didn't help. I thought this might give a little bit of a headstart on it.
(Which reminds me, i got another idea for another forum suggestion.)
A couple of tips and such to help:
Dress Code:
Sterility Rules:
Radiation Protection:
Misc. Rules:
If i think of anything else, i'll add it on this post.:hatparty:
I think it was missing the http part
http://abcnews.go.com/WNT/Health/story?id=1529546
That link's working, i just tested it.
Let's see, a nurse that looks up, sees her pt.'s call light go off, goes back to cutting out coupons, but when i come out of that room after answering the light, she says "oh sorry i didn't see it". Yeah, right, i'd almost buy that but i saw you look up at it three times, then look up the hall to see if i were coming down the hall. (and yes, i realize that there are those that legitimately did not see the light going off).
The whole "who's a real nurse" arguement where the LPN, Diploma, ADN, BSN degrees are concerned. Find something better to get on a high horse about, please.
The "nurses eat their young" phrase. Man, i'm REALLY tired of hearing/reading that one!
"That's not my pt." when the pt. is crying from chest pains and has a HR of 164 bpm.
"I need to get my aide" when someone's pt. is dirty, and the aide is a floor float for 34 other pts. And they have no inention of helping the aide.
Nurses who think that that anyone (housekeepers, aides, LPNs, maintenance people) that is not up to their educational level is beneath their dignity, and treats them that way (thinking of one in particular now who does that).
Students who got into nursing for the sake of finding a doctor to marry.
The mixing meds thing has bothered me since i read it. I mean, what meds, what are the effects, compatabilities, etc.? I do not believe anyone should be mixing meds or messing with meds unless they have the knowledge of what they're mixing, drawing up, etc.
(And ideally, that person should always be a nurse.)
Gum stuck in long blond (bleached) hair. The doctor wrote a recommendation on an order sheet to a cosmetologist.
One of the hardest things i still run into is listening to heart and lung sounds on someone with large breasts. In order to hear, of course i have to get underneath, but i have naturally ice cold hands (they turn right back to ice after washing them in hot water), and needless to say, not a good thing, because i can't hear anything crackles over "OOOOO YOUR HANDS ARE COOOOOOOOOOOOLD . The only solution i've come up with so far is putting towels in the blanket warmer, putting my hands in one on my way to a room, and use the warm towel to move the breast (better than a cold hand).
Gum stuck in long blond (bleached) hair. The doctor wrote a recommendation on an order sheet to a cosmetologist.