Is it me?

[keepitreal]

I am looking for advice...Brand new nurse, Brand new in OR. I am not sure if it is me, or this is normal. I'll attempt to keep it short and sweet! I have been in training for 11 weeks. After one month of training I was counseled because I was not anticipating what instruments would be needed, I was not prioritizing, and I was allowing my preceptor to do things. I would let my preceptor do things if I had never seen that procedure before ie. prep, get supplies in middle of case. If I have never seen a procedure, I cannot anticipate the unknown I was NOT sitting there eating bon bons, I have no problem saying I dont feel comfortable, or let me watch this time and next time you watch me..... Different preceptor daily, weekly.After 2 months of training, perform independently. Anticipating and prioritizing. Got rave reviews from preceptors, matters little to educator, other than being told you are where you are supposed to be.

Second rotation: 2 days with one preceptor whom goes on vacation. Rest of week, and next week assigned various preceptors back in first specialty, whom say "call me in the lounge if you need something."

This week...assigned daily preceptor in new specialty, I have 2 days experience in this specialty. No formal education as to instruments used in this specialty, procedures....only training received is location of instruments and machines. Preceptor walks in and says you are doing this all by yourself, I will just get stuff if you need it. I explain that I have never seen this procedure, and this is my third day in this specialty. To which she responds that I should know by now and be able to do it. Then she begins yelling that I need to get the sutures...so I go to get the sutures. She show up 45 seconds later saying I should be in the room and I need to prioritize because I can get the sutures later in the case...okay.... Evidently she gets paid not to teach, but to demean people for 8 hours a day. She left to take her break, and things went smoothly, I sent 9 specimens, documented, lights, sutures...etc. I dont know at day three all the instruments, sutures used and etc... She returns to sit on a stool and stare at me for the next two hours, not saying anything, not doing anything.

Turns out she took a break to go tell my educator what a terrible job I did, how I cannot prioritize and I was getting the sutures when I should have been getting the patient, which she told me she was going to do.

For me, it was shear chaos, she was raising her voice telling me 40 things at one time. I am frustrated because I am really trying. When I am being thrown with different preceptors in different specialties, there is no consistency, each preceptor has different expectations, different schools of thought. So I was confronted by the educator whom told me that I should have been able to do this indepentently. I explained that I am still not very fast, I have never seen this surgery before and add to that someone whom is telling you to do 8 different things at the same time, it is impossible. Am I supposed to know everything by now?

I have never had a complaint from a surgeon, or resident. In fact I have received compliments from some of the most difficult to please. I never heard good job when I receive compliments from surgeons, or when I caught my preceptor handing off an expired implant, or when anesthesia was about to administer a med the patients was allergic to. Being a patient advocate doesnt really seem to matter here. But you see a case for the first time in your life, and you actually want your preceptor to help you the first time...Holy Makeral, you have commited a crime and they are going to let you know what a terrible nurse you are. There is alot of bullying going on here, intimidation, criticizing and threatening.I have had one great preceptor, she explained everything, then would wait and quiz you on it and again review if you missed something. She is what a preceptor is..a teacher.

I am frustrated because I really am trying. I was told that perhaps I should do what some other people do which is come into work early to set up the room, unpaid. I am usure if it is the hospital, me or the OR in general. Is their timeline of expectations correct?

[shodobe]

You know, some places are just the wrong places. It doesn't mean you aren't a good nurse and could be a great OR nurse. There are those who do feel threatened for whatever reason. I am not sure why your manager is taking the opinion of just one of your preceptors. A total review by all of the preceptors is necessary for a complete evaluation, unless you really have screwed up somewhere. It doesn't sound like it at all. Attitude is a trait that all OR nurses possess. If you give the opinion that you are comfortable with all negative opinions from people then they will back down somewhat. You have to remember that OR nurses are the best in the hospital, IMHO, and some really take that as the gospel. They want you to reflect that in their training and feel if that doesn't happen then they look bad. Maybe this preceptor just doesn't like you for some reason. Is she old, craggy with a wart on her nose? Are you perky, bubbly and cute? Sometimes there just isn't an answer.

[Heogog53]

I have often had adversarial relationships with the management in OR's. I'm not entirely certain why, but many staff I worked with told me that I somehow challenged management with my not PC mouth, my intelligence and my lack of understanding of why the "rules" had to be status quo....

But that's not what you are doing. You are trying to learn, trying to comply and yet, you are being bullied and told that you are a bad player......you need to find somewhere else to work.

Have you joined the local chapter of AORN? That might be a great way for you to network and find other places to go in the local area.

My OR is 33 rooms and we have a 6 month long program and then, once on your team, about another 6 months orientation. I understand the need for consistent preceptors; that's the same complaint everywhere I've ever been that has a program.

Trust me, it's not you, it's them. Something is pretty rotten about the systemically accepted use of bullying and threats. I suggest keeping anecdotal notes and copies of every bit of paperwork they give you or show you. You may actually have a legal basis for suing- or at least, talking to a labor lawyer about whether you have a case or not. I understand that you are reluctant to bring a lawyer into the picture, but if they decide to go after you maliciously, and fire you with bad references, you may need to do something to clear your name.

BTW- those kind of cases are taken if the lawyer thinks the case is strong enough, at no cost to you, just a settlement off the back, so if you have any hesitation due to money, don't worry about it...

Your reputation and license are the most important things in your work life.

Be careful and if possible, get out of Dodge....

[GadgetRN71, ASN, RN]

!! weeks is really just a drop in the bucket when you think about it, especially for someone new to the OR environment. In my hospital, the total newbies to the OR are pretty much still on the classroom portion of their training at 11 weeks. Yes, they go into rooms, but they are not running them alone. They spend some time in classroom and then maybe the second half of the day in rooms with a preceptor.

I had experience as a scrub tech and my orientation was still about 6 months. OP, I also think if you were doing THAT badly, they would have fired you by now. I think they are trying to break you, to be honest. Many were trained back in the day when it was acceptable to bully the new people. Guess what? It's not acceptable anymore..The feeling now is that bullying and intimidation make an unsafe envirinment for patients as well.

Stick this out long as you can, and then go to greener pastures. You owe these dimwits nothing.

[Scrubby]

There is nothing wrong with you at all. 11 weeks is not a realistic expectation, more like 11 months!

I would start looking for another hospital to work in. It sounds like this is an incredibly toxic environment where you are being deliberately sabotaged.

[OrthoBoi]

I feel your pain. I have been an intern myself, I know how hard not knowing, how to anticipate what is needed next. What i did if my preceptor is not receptive on my learning style, I utilize other resources ... try asking your Surgical Tech the sequence of the procedure. Prior to the surgery, set aside possible trays, sutures possibly needed. Take lots of notes. Be patient. You can try buying this book (helped me a lot to understand procedures) "pocket guide to the operating room" by maxine goldman 3rd edition ~ totally explains equipment needed for common procedures. In july it will be my 1st year in the OR, I don't know everything yet, everyday is a learning experience. Preceptors sometimes have high expectations for interns, they test your ability to think under pressure, they will see how well you conduct yourself in this arena, prove to them that you are a team player, a reliable RN ... and yes, try to see your ability on how to prioritize. 1st PATIENT needs ~ 2nd SURGEONs needs ~ 3rd the rest ... stick to the basics ... good luck . . . hang in there...

[ShariDCST]

this sounds like hell on earth - i can't blame you one bit for being frustrated, confused and angry. i think at this point, the next thing i would be signing would be a letter of resignation. and, as the others have mentioned - document document document - everything that happens on a daily basis. remember - if you don't document it, it didn't happen - that you learned in nursing school?? it still applies.

they obviously don't have - and don't care to have - a reasonable, established orientation plan and it's certainly not based on aorn guidelines! they don't even care to stick with the one they were "forced" to write! an outline is an outline - but it's also a roadmap to get you where you're supposed to end up. aorn has a specific program, designed carefully, combining classroom and clinical or time, to orient new rns to the ors - and it takes many months - 6 to 9 i hear - to get through - and then you're still a beginner!

i keep saying this too - there is a reason it takes a minimum of two full years of prereqs, classroom, lab and clinical time for csts to become adequately educated in the basics - and then we are still beginners when we get our first jobs! it takes another full year - minumum - for us to begin to feel comfortable and somewhat confident in our role. there is so much to learn, and as we learn it, it changes! nursing school rarely introduces you to the or beyond some preliminaries, unless you're lucky enough to have attended a school which includes some or work in the curriculum. nursing schools haven't taught or nursing in decades. i have yet to meet an rn (who wasn't a cst first) who has any idea about the or. and we csts are usually the ones who teach the new rns their scrubbing skills - at least that's been my experience everywhere i've worked. and i've always done it with my eye on the fact that i remember being a "newbie" too. i've never had an issue with anyone i've taught to scrub. ever. experienced rns teach circulating skills - in a good facility with a responsible, knowlegeable, supportive clinical educator on staff who monitors your progress, and helps you - not shoots you down at every opportunity.

the bullying you describe could very well meet the criteria of a hostile work environment - it's also called "lateral violence" by some (see this article for more http://www.nursingworld.org/mods/mod440/lateralfull.htm) and if they fire you before you have completed their little trek through hell's fire and brimstone - it could be to your benefit to have your documentation to discuss with a lawyer, as someone else mentioned. even if it doesn't directly benefit you in the end, think of all the other unsuspecting rns who come along behiind you?

i wish you much luck - and a new job some place else! i'd love to know where this place is - it sort of sounds like one hospital i worked at for a while as a traveler - and they wondered why they couldn't get or keep permanent staff, which was why they had to hire travelers to begin with! my last day there - i told them exactly why they couldn't either keep staff - or convince me to extend my stay, which they pleaded with me to do! as a matter of fact, now that i think about it, the or director was a traveler too!! she came from an executive type traveling agency that only dealt with placing the "higher-ups" in temp positions. sad when you can't even get permanent management and have to go begging - and paying big bucks to - a travel agency to get your management.........

[ShariDCST]

here's some more information for you to look at - it sounds like they wrote this with your facility as an example!

http://www.minurses.org/news/mn2008/0506mn/0506mn_lateralviolence.pdf

heck - just google "lateral violence" - there's a ton of stuff on it - mostly directed at nurses in the workplace!

[shodobe]

I was taught to scrub by all RNs only because we never used Techs until 4 or 5 years ago. For the RN today a good Tech will be a bundle of info and someone to really listen to. I have always been an advocate of ALL RN staffs but in todays financials this not realistic thinking. Old, mean OR nurses are still there and it is a shame you can't just be left alone to learn your job and not hassled all the time. Good luck

[NabiRN, BSN, RN]

Well, it is not you. OR is a tough place for new nurses who do not have experience in the operating room. Many tough personalities in the operating room. I don't know why the operating room attracts these people. Perhaps others can put their 2 cents in.

If you educator does not have your interest in place, you need to work on your next plan. Unfortunately, it's tough to get a nursing job for new nurses now. Get at least a year under your belt and then leave this place. Learn what you can especially the latest technology (i.e. robot) and then say good-bye.

My hospital has 25 ORs and they are short of people sometimes. I remember getting assigned to a room or left in a room for various reasons after less than 2 months on the job. So your situation is not unusual. For a new nurse, it's probably better for you to start at a smaller facility where cases are less complex and the schedule does not change frequently. At larger facilites, the schedule changes all the time due to emergency surgeries and the norm is to expect the unexpected. You are in one room and next thing you are doing something else. On the other hand, you can learn a lot from larger hospitals and you will be more marketable in the future.

[cmermaid]

A good orientation should be at least 6 mos. I always told newbies that they would not start to feel comfortable until they had at least a year experience under their belt. I agree with another post - RUN AWAY!

[Marie_LPN, RN, LPN, RN]

The way we train people is to give them the same preceptor as often as possible throughout their training. We've seen that this helps in training because 1) the preceptors have years of experience, years of problem solving, etc. 2) it helps form a 'bond' with the trainee so that they feel comfortable asking questions, voicing concerns.