I Will Be On My Own Soon...SCARED

[IsseyM]

Hi everyone,

I will be on my own next week and i am really scared! I've been having nightmares for the past few weeks. I'm so stressed that my muscles are really tense. I've been getting alot of headaches. I get so nervous and stressed when the patient is brought into the room because so much is going on and i feel like i go blank. I feel like i can't prioritize, its like i get lost or something. I get nervous when my preceptors leave the room for whatever reason, when doctors pagers or cell phones go off, when i have to ask the doctors 2 or 3 times to repeat themselves because i couldn't understand them thru their masks....especially the soft spoken ones/mumblers. I am not feeling confident or assertive. I feel like i need more orientation but i don't think i'll be able to get it because some of the nurses have told my clinical educator that i will be fine on my own. The last class did not get extended orientation, they were put on their own as scheduled.

I would love to hear everyone share their experiences. What kind of feelings were you going through right before you were put on your own? How did you do the first day by yourself? Week? Month? Did you tell doctors before cases that you were new? Did any of you have thoughts of quitting? If so, why? Any suggestions or advice would be greatly appreciated

[chartleypj]

Issey,

I think it is natural to have some anxiety about anticipating new challenges. It is not clear from your post how long your orientation period is, or how much nursing experience you had prior to going to the OR, so I will respond as best I can.

Over 30 years ago, I was 'baptized by fire' in the OR; I had no real organized orientation plan, and surgeons were not nice. I was put on my own very early on without any clue as to what I was doing. It took me about one year to become comfortable with the basics, and about another 2-3 to become much more proficient in understanding all the intricacies of various surgical procedures. In addition to this, technology changes rapidly and so the learning continues. I have a broad base of knowledge regarding procedures commonly done many years ago as well as knowledge of the newer, endoscopic procedures done today. There were many days I wanted to leave and not return; it was stressfull and I felt stupid and useless. Like many things in life, there is a learning curve with perioperative nursing.

Having said this, I learned to prioritize by working with older OR nurses who based their practice on AORN standards and recommended practices while adhering to hospital guidelines. It helped tremendously to be paired with a very experienced surgical scrub tech for cases.

It helped tremendouly to understand what the surgeon was doing; anticipating what the surgical team needs BEFORE they need it is essential to facilitating a case. I bought "Alexander's Care of the Pateint in Surgery" as well as "Comprehensive Perioperative Nursing" by Gruendemann & Fernsebner to help with the learning. I joined AORN soon after going to the OR and I read the AORN journal every month.

Prioritizing is essential in the OR. to do this, I think about:

1) Pt safety and privacy - what do I need to do to provide a safe environment from the time I set up the room until I transfer to patient to PACU.

2) Collaboration - check with the surgeon and anesthesia about positioning if this is a concern, as well any extras he may need for the case.

3) Aseptic technique - how will I accomplish this before and during the procedure.

4) Anticipitation -knowing what the surgeon is planning to do along with his preferences (sutures/implants/cautery settings) will help you be ready. This will come in time, and preparing for you assigments by familiarizing yourself with procedures prior to doing them will help.

5) organization -after 30 years, and 4 different facilities, I still keep a notebook and jot down any information intergal to facilitating cases. In addition, keeping your room 'uncluttered' i.e., keep the floor clean so you don't trip over cords, trash, extra unnecessary furniture strew about. Line up drains, sutures,dressings, etc so they will be ready when your scrub asks for them.

6)Working knowlege of equipment - know what equipment you will use for a case, know how to troubleshoot it, and know who to ask for help in the event you have a problem with it intraoperatively.

As for the soft-spoken docs or the mumblers, I go right up behind them to ask a question or hear their response.

The scariest nurses and techs I ever worked with are those that think they know what they are doing - they did not know what they didn't know -if you get my drift. instead of asking, they charged forward, often making mistakes and aggravating the surgeon to no end. So, be open to suggestions, read up on procedures prior to circulating them, and ask if you don't know. Your confidence will come in time; you will become more assertive as you develop some proficiency in perioperative nursing.

Good luck,

Pj

[tessa_RN]

You will do great!!!!!!!!!At first it is scary being on your own but after a while you settle down..Eventually you will develop your own routine..I know when I first started out on my own I was scared..But if I ran into any problem I would call my charge nurse and ask her..I am very lucky to work with a great staff on 3-11, techs and nurses..They have always been very helpful to me..We help one another..Like a bovie pad for instance if I forget it the tech will remind me and I am greatfull for that and anesthesia is just wonderful too..You will do great and I have no doubt about that!!!!!! I remember the first room I circulated by myself on evening shift it was open heart I was quite comfortable there because that was the last rotation I had..Then the next day I had ortho and we were doing fractured hips and tibial plateaus on evening shift and if I needed any help I would ask my charge nurse because it is amazing how much you forget after leaving one rotation training....Dont be afraid to ask for help if you forget something..GOOD LUCK!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

[RNOTODAY, BSN, RN]

Issey, I could have written your post myself.....

but you dont want to know how I handled it...

be strong....

[lily_lover]

Hey Issey,

I can completely understand what you are going through. My orientation ended last Friday, and now I'm the charge nurse on night shift!!!! There are times when I'm nervous even with my preceptor around, and other times when I think "I can't WAIT to be on my own!" Just remember the basics-patient safety, positioning, prepping... and you should do fine. The surgeon preference cards we have are like GOLD, so utilize them. One other thing I've learned is that you shouldn't be afraid to ask the doctor questions. I've never had a surgeon snap at me for asking questions, and many times what they want to do/have for the case is different from what's printed on the card. I work night shift now, so I think the atmosphere is a little different. Just hang in there, and you'll get the hang of it. The OR is such a different place from the regular hospital, that being by yourself can be very intimidating and scary at first.

As a side note, I can relate to hating to hear the pagers go off.... the one and only time a doctor has lost it was after I answered a page for him. To make a long story short, he was yelling into the phone, and the person on the other end took him down a peg, so he turned around and yelled at me to save face. If I have no idea what the person wants or what the point of the call is, I'll just ask them "so what is it you want Dr. so-and-so to do?" As a circulator, being on the phone can take away from the case, so I try to be as brief as possible on the phone.

Good luck to you Issey, I'm sure you're going to be just fine.