ICU to OR, any advice? - page 2

I have been working in a community hospital ICU and have an interview this week for a position as an OR nurse in a level 1 trauma center. I'm very excited and would really like to make the transition. :yeah: I'm hoping there... Read More

  1. 6
    Good Day--

    First of all, congratulations on getting the job. I know that orientation can feel like...well...forever, but trust me, it is worth it.

    I know this is long winded and I....I am so sorry.

    A typical day, huh? Well, I don't know if this is what you had in mind....forgive my rambling, but I'll describe for you not just a typical day, but today, in fact, at my level one trauma center of employ.

    My day starts out with the typical eye rubbing and strings of profanity that generally accompany the incredibly rude blaring of my various alarm clocks. My alarms feel as if they are rebelling and going off early today as I stumbled into bed late last night after being called in for an open tib/fib fracture and blown apart ulna/radius. But such a thing is a lucky injury when one decides to do battle with a mini van. Blasted vans have this horrible tendency of winning.

    I digress.

    Fill in normal morning routine information here -->XXX .....aaaaaaand here -->XXX.

    The elevator deposits me safely by the surgery locker rooms and after donning my armor of periwinkle and my bouffant helmet, I brandish my pager and dart out to see what there is lurking on the scrolling board. Scarcely escaping the locker room, I find myself being summoned down to the charge desk by He Who Shall Not Be Named, AKA, the charge nurse.

    And so it begins.

    As a member of the trauma team, it would seem that my day begins early as I am dispatched to assist in a Level I coming up hot from ER. It is 0630 and I find myself working on an individual who decided that the train on the tracks wasn't really moving, so heck, why not cross? The tally: Crani, pelvis, belly, and two blown apart femurs, arms pretty much unscathed (how in the hell that happened....I'll never know). Partridge in a pear tree unavailable for comment. Typical organized chaos of too many alpha male surgeons all trying to mark their territory, the mandatory emergent placement of a couple chest tubes, a crash cart and what feels like endless amounts of blood product later, and we're finally underway. Blah blah blah, drain to the head, ex fix to the pelvis and femurs, irrigate irrigate irrigate, spleen removed and we are sashaying up the ICU. Job well done, snow cones for everyone.

    It is only 1039.

    So I get to provide lunch relief by scrubbing out a few scrubbers, which, frankly, I adore as it gives me face time with my docs.

    So here's the story: yeah, surgeons expect a lot of nurses, but here's a couple tips in order to be well received:

    1. If you don't know....say you will find out and do so. Docs respect follow through.
    2. Don't patronize them. Don't suck up either. They can smell bull$%#@ a mile away and it irritates them beyond reason.
    3. Until you have been in the OR a while, keep your head down, your focus keen and your mouth shut. What this translates to is this: A knowledgeable, practiced nurse can watch the monitors, track the case and talk. A blabbermouth who knows nothing and is not paying attention earns no friends and fast. If your scrubbers and fellow nurses don't respect you, your surgeon picks up on it and is a lot less likely to trust you.
    4. Repeat back. It lets them know you heard them and are going to complete whatever it was they demanded/asked for. Very helpful in Level I such as the one above due to the chaos of so many docs/nurses in one room. It's just good communication.
    5. Saying hello never hurt anyone.
    6. Eye contact is good.
    7. Get to the bloody point! If you have a question, ask it direct and concise. Don't ramble. And try to cut out as much fluff from your info as possible. They don't care that the patient enjoys the smell of a freshly opened can of sardines. What does the patient NEED?

    Yeah. As I was saying. Lunches, scrubbed in, chatting with docs. They are funny and strange little creatures. I learned a few great knock knock jokes while performing a breast biopsy. But that shall have to keep for another time and place.


    AAAAaaaaaah. Finally able to sit down and have a cup of coffee. Wait. Never mind. Heart patient from this morning is bleeding like stink. Yay for crashing bring back hearts. Coffee abandoned.

    Pour and cut. Nothing quite like literally dumping betadine on a chest and tucking arms while under the drapes to get the adrenaline running. It's a beautiful thing when hearts go well. But man when they go's worse than a close up of Willie Nelson's plastic surgery. Crashing onto pump. Aorta dissecting. Boat loads of product, placement of a balloon pump, and one pair of shredded pants later (yes, my pants exploded.....don't ask how), and things have finally simmered to a point where I can go back to my abandoned coffee and leave the room nurses to it.


    And....and then it happened. That sound. That sound can only mean one thing. Sure as shootin', my page squeals to life, heralding the arrival of the chopper and some poor torn up soul needing skill, attention, magic and a prayer.

    I go with HWSNBK (charge nurse) down to the trauma bay to receive the patient with the ER trauma staff. It doesn't look good. Someone stood on the wrong side of a shotgun.

    I would love to say that something could be done....but not this time. We can only do so much and it's a pity when modern medicine proves futile.


    I wander back up the locker room and shed my scrubs and disappointments, reminding myself to leave them with the evidence of a rough day in the laundry hamper.

    Sure, there are days that are not quite like this, but I dare say they are becoming fewer and further between. The patient population is showing up for care at a later point....almost when nothing can be done and the cases are more critical. Then there is the trauma aspect.

    But I wouldn't trade it for the world.

    You, as an ICU nurse, have the leg up of seeing the patients after they are done with the OR side of things and not all OR nurses have such an experience. Your bedside skills of managing drips, etc, will not go to waste. You are probably already pretty bold as you have experience, and as far as not taking things personally, you are an ICU nurse--I would hope such a point is behind you.

    I'm sure you will do well. Trust in the instincts you have developed and absorb as much as you possibly can. Ask intelligent questions and embrace the private, little known world that exists behind the double doors.

    As far as specialties...if you are given the choice, the main advice I can provide is for you to follow your passion. If you don't like hearts, for whatever reason, no matter how cool they seem.....for pity's sake, don't join the heart team. You have to be willing to be woken in the dead of the night and rush through snow, snakes, high water and Twinkie shortages to get to the case in under 30 min. Therefore, love what you do so when you do get called in, it's all good--you are right where you want to be.

    Remember, you can always change teams and cross train in other areas. I started out as, I go where I am needed: hearts, neuro, etc.

    Welcome, my friend, to the dark side
    Last edit by CheesePotato on Jan 11, '12 : Reason: Inexcusable idiocy.
    RUBY2623RN, theothers, SuperSteff, and 3 others like this.

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  2. 0
    What an amazing reply. I'm contemplating OR too eventually after getting some general experience. Decisions decisions for integrated practicum.
  3. 0
    Hi everyone! I have been a nurse for about 6 years now (Floor nursing and CVICU) and I am about to transfer into the OR. I just started NP school and my ultimate goal is to get some OR experience while I'm in school (about 2-3 years) and eventually work with a surgical team as a Nurse Practitioner. I would love work as a first assist and possibly work in CVOR where the NP or PA get to do EVH and other surgical duties. They currently have this position available where I work and I have spoken with one of the P.A.'s, and he told me that I should get some OR experience since the NP program does not really offer the surgical training, like the PA program does. The job position is for a NP/PA-CVOR.

    Finally my question... Have any of you OR nurses seen many NP's work in the OR as a first assist with a surgical group? I have seen many jobs available throughout the country but I have not met many NP's doing this. I know it can be done- but I wanted to know if there are any experiences you can all tell me about.

    Thank you so much,

  4. 1
    Have not seen NP's doing this lately. I have seen some advance practice nurses (not sure about the NP status) who did some assisting in the OR, but mostly were used to see patients, make rounds and take out sutures, dressing changes, evaluations etc. I hope more doctors see the value in hiring NP's over PA's but the recent increase in the number of NP's is changing the game somewhat. It will be interesting to see how things pan out. To me when you spend that much on your education and licensure etc, you best get paid. Doctor's are kind of cheap when it comes to salaries. So negotiate well my friend. Good luck.
    LJames13 likes this.
  5. 0
    Thanks for the reply... I know what you mean about the salary. When talking to the PA he said that was their #1 problem, their salaries. He said they kept losing people after the 2 year mark because at that point they were better trained and could get paid way more somewhere else. I think it depends on your state and hospital as well, unfortunately.
    Hopefully we will start to see more nurses in this role- I think we will be the complete package! because we have the bedside plus the degree and then the skills in the OR!!

    Thanks again,
  6. 0
    Dear Cheese,

    Thank you for making me LOL at 0600 after a short night of tossing and turning, envisioning myself as the NKOTB in our OR. I haven't started yet, but just yesterday, accepted a position in our OR and will be working in open heart. I've been a floor nurse for four years and I'm THRILLED to be going to dark side...actually I believe I'm coming FROM the dark side, but that's another story.

    I will take your advice to heart..i especially like #3 and will do my best to stay humble yet go getting all at the same time. sigh. Here we go again..little fish, big pond..but that's the fun of it in my opinion


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