New OR Nurse and feeling overwhelmed...

[astrn]

I am a nurse with 6 years of peds well baby experience and have recently been hired into the OR as a circulator. I have no hospital experience before this and have only worked in an office setting. I have good days and bad days in the past 4 weeks that I have been in the OR but I wanted to seek advice from other nurses or techs and ask them for their insight.

Every Wednesday that I have been in my current position I am assigned (with my preceptor) to a certain cst and one dr. we follow this one particular doctor all day, mostly plastics cases. He will typically ask an array of questions and name very detailed anatomy of whatever he is working on. He will wait about 20-30 minutes and then ask me to repeat whatever we went over previously. If you do not get the answer correct you get 3 choices (phone a friend, 50/50, or poll the audience). Last week we went over the anatomy of the face/lips. He asked me a question I did not know so I phoned a friend and picked his rnfa. she said she didn't know the answer either. after about 40 seconds she finally said the answer but told me rudely I should write everything down. The same tech instigates his behavior. Everyone sings her praises and our charge nurse came in the room today and told her "you make the world go round, not sure what we would do with out you." She also asks for things in a very stern way and half the time she says stuff really quick almost on purpose so i have to ask her to repeat it to make sure I get the right item.

every time i talk with her she is rude and harsh with me. my second week we were setting up a room and she started to put her gown on and i came up behind her and said can i help you with your gown, she replied its not going to tie itself is it? when i am learning how to properly prep the pt she is always standing there it seems like judging me. i understand it needs to be done correctly and i want to do a good job but it just seems like she is looking for a way to intimidate me. when i take a little longer she sighs a lot and it seems like there is always tension and awkwardness btwn us.

The same doctor gave me a hard time about following my preceptor to lunch last week after our relief came for our break. he asked where i was going as i was following my preceptor and she said quietly to me "he wants you to ask him permission to leave with me". he let me go after i asked him. our relief said one time when she was new he made her call the holding room and ask if his next pt had a hcg done and she was over 90 yo. he also made me call our nurse liason and ask for an otis elevator. little did i know that that is a brand of elevator our facility uses. she laughed and came back to the room later and they all had a laugh on my behalf.

most of the dr/nurses/techs have been good to work with. i am just having a hard time differentiating normal behavior on behalf of this particular tech or why she is having a problem with me. i am nice, come to work with a smile on my face everyday i have been there, avoiding being negative and have even tried to have conversation with her and she won't look at me or even reply to me half of the time i talk to her.

to make a long story short i have left the past 2 wednesdays feeling extremely overwhelmed and uncertain that I want to carry on with my training. has anyone experienced a similar situation? i feel like my preceptor and her are always laughing and joking so not sure my preceptor is a great unbiased opinion. my charge nurse is the same way. i know the OR is a tough place and i need to find my way but how do i deal with a hostile co-worker? i can see in her eyes how much she despises me every time she looks at me. should i confront her before going to my manager? i am afraid that if i do so she will spread the word to the rest of the staff and make things worse for me. am i just being paranoid?

[meriposa]

I started in OR boot camp back in Feb 2012 but came as a seasoned nurse with a background in L+D, medsurg and homecare. Everyone warned me that you had to have thick skin for the OR and treat the surgeons like they walk on water. I figured I would just get accustomed to the culture and with 10 years of exp under my belt I had high hopes for myself. Let's just say I cry at least 2-3 times per week (after work of course) and have to give myself a pep talk most days before I will even get out of the car. Each day I try to find witty comebacks, stand up for myself, try to remain non-emotional, get things done as fast and efficiently as possible and am prepared to be thrown under the bus by any team member I am working with. This is the norm and each day is like entering the battleground anew. I find it so unfortunate that this is my focus rather than giving excellent patient care and becoming an expert in my new setting.

I hope things improve for you. After going on a year in the OR, I have accepted that my environment will likely not change. I am stuck in a contract but will likely move on after I fulfill my time.

[astrn]

Thank you again for everyones advice and sharing personal experience. It seems like luck of the draw where you work if people have a good experience or not. It is too bad that others in the surgery setting don't become a team. It would seem to me that the more involved people were about teaching new hires the ropes instead of an enormous amount of time teasing and harassing things would get off to a quicker start. I find myself not trusting anyone and a few of the girls at work told me on friday I just need to learn to be a b*tch like them. I have my sisters wedding in the summer and they already told me it will be very hard for me to take anytime off work. Others who have more seniority always take July vacation so that leaves nothing for anyone else. What a crappy place to work.

[favoritemumsy]

I went to work in the OR straight out of nursing school and I agree with all of the others in saying that it does seem to be just the culture of the OR. I cried often the first few months and wondered if I was in the right place.( The only area of nursing I was ever interested in going to was surgery). A seasoned OR nurse told me to give it at least a year. I promise if you hang in there it will get better and in time you will feel confident and when you start giving it back to the ones giving you a hard time they will know to its time to move on to the next new person. I worked in that same OR for 14 years before leaving nursing to be a full time stay at home mom. Now 10 years later I am looking forward to taking a refresher course and going back. Although I am thinking of other areas of nursing this time around not because I didn't like the OR but want to experience another area maybe med-surg and gain some skills. Good Luck to you and hang in there!

[sop832]

This type of behavior is why the saying is that "nurses eat their young." It INFURIATES me that this is seen as a normal part of the OR culture. You shouldn't need a thick skin to come to work each day. Go to the manager or team leader or who ever is next on the ladder. If that person blows you off, go up the chain. If I read correctly, you have to work with the same tech and nurse and surgeon every day?

No wonder you're miserable. You're being bullied, pure and simple. They think that they are big for belittling you, but authentic humans don't operate that way. Is there an employee assistance program there? They maybe can help you in strategies for dealing with difficult people. Just PLEASE don't let them make you think you have to be a ***** to get along.

[keep the faith]

Hi everyone. I am new to this site and have enjoyed reading a lot of the discussion on joining the OR nursing team. I too have recently made the move into the operating room after working 16 years as a registered nurse in an acute care setting. I was truly looking forward to the change in environment and the change of scheduling, switching from 12 hour shifts to 8 hr shifts.

But I too have to admit that the change has been overwhelming to say the least. I too like a previous writer have to continually give myself pep talks before and during each shift, and I have also cried many tears. Somedays my anxiety level is so high that I am unable to eat. To say that you need a thick skin to work in the OR is an understatement. I am naturally a people pleaser which I think helped me to be a good bedside nurse. This doesn't seem to be a favourable asset for inside the OR. My job is actually mainly PACU which I really enjoy because it is closer to bedside nursing. But I have to work a 2week rotation inside the OR every 6weeks or so which I do not enjoy. This makes it even more difficult to remember the techniques and procedures, plus the fact that every surgeon has his or her own way of doing things. I feel so torn all the time. My heart wants me to go back to my bedside nursing, but my husband wants me to stay with the 8 hr shifts because it is more " normal " for our family. I keep wondering if I will EVER feel like I belong there. I can't imagine having to continually feel like this for another 16+ years until I can retire. I guess I'll have to keep praying everyday for the strength and guidance to get through my shift without losing who I am completely. Thanks for listening and I wish you all the best in whatever area you move into.

[sugarik13]

I am a new grad who landed an OR position in a Level 1 trauma teaching hospital with 20+ ORs running at any given time.

I too am overwhelmed and having trouble adjusting to the attitudes I encounter from older, more seasoned members of my nursing "team." Some are downright vicious and there is, quite honestly, no reason for it. Period.

Yes, to be an OR nurse you need to have a "thick skin," but having a thick skin doesn't mean allowing yourself to be made to feel stupid, worthless, and inferior. EVERYONE was new to the OR at some point.

Nursing school does not prepare you to be an OR nurse so it is a totally unique perspective of nursing. It is actually more of a trade. The more experienced nurses don't realize that the training programs for new OR nurses now is quite different from how they learned.

Peri-op nurses used to do everything from checking in patients to set-up of instruments to scrubbing AND circulating to patient recovery. They did the same procedures over and over and over until it became second nature.

Hospitals today don't do 5 appendectomies back to back, or cholies, etc. In the same OR in one day I will circulate on a lap chole, followed by a mastectomy, then an adult circumcision, and finish with an irrigation & debridment. All much different types of procedures but you are expected to know how each set up is unique. It is unreasonable.

I can go through a general surgery rotation for 3 weeks and not see the same procedure more than 1-2 times. Every case is much different. I spend most of my day just figuring out where the supplies I need are, because they are scatted about. PLUS, I don't know exactly what I am looking for even looks like half the time!

Because I work in a Level 1 trauma hospital that also prides itself on being a "teaching" hospital, you basically get whomever they decide to stick you with for the day. Yes, it teaches you flexibility, but I am really tired of hearing from each nurse I am assigned to "You'll develop your own way of doing things eventually, but today you're in my room so you need to do it my way" even if I am the one charting under my license #.

I have a wonderful educator who tells me "I am showing you one way to do something, but there are many others. Find the way that works best for you and do it the same way each time." MUCH DIFFERENT way of teaching!

The problem with a teaching hospital is that management expects EVERYONE at any given time to teach a newbie. Some people don't WANT to teach. Others don't know HOW to teach. I believe preceptors should be volunteers who are trained and I know many hospitals do just that.

My other educator isn't the best teacher, but she always tells us how ****** the more seasoned nurses can be in the OR and to advocate for ourselves. If someone is speaking to us in a way that is not acceptable, we should come and tell her. Easier said than done!

The bottom line is (according to me), is yes, you need to put in your time, but you need to find a voice and not let yourself be abused. If you would not let yourself be treated in a certain way by your parent or spouse, you should not tolerate it from a co-worker, even one with more seniorty. One day they will want you to work a holiday for them, or switch a weekend with them at the last minute. Payback is a *****.

[CheesePotato, BSN, RN]

The more experienced nurses don't realize that the training programs for new OR nurses now is quite different from how they learned. Peri-op nurses used to do everything from checking in patients to set-up of instruments to scrubbing AND circulating to patient recovery. They did the same procedures over and over and over until it became second nature.

.Actually, the way it used to be, and in some ORs it remains common practice: See one, do one, teach one. That's it. That's all the training you get. Not sayin', just sayin.

[sugarik13]

.See one, do one, teach one.

Heard that many times. It's a cop-out from someone who either doesn't know how to teach, or is a lousy teacher. I have found, BY FAR, the best nurses to learn from (and the ones with the best practice) are the true old-school peri-op nurses who learned by doing the same procedures over and over again. Hands down. They still are out there. I know because I worked with them while a nursing student on a medsurg peri-op rotation in a Level 1 trauma center. They were ALWAYS willing to stop, help, and explain.

And after all, in an area like the OR, where having good technique is essential for ensuring positive patient outcomes, isn't "see one, do one, teach one" a rather spiteful and irresponsible way to initiate the new nurses to your "team" regardless of whether it was how you were trained or not? Having vindictive nurses as teachers, forcing their newbies to go on scavenger hunts and wild goose chases for supplies they don't yet know, not answering their questions, all while prolonging the amount of time the patient is being left under anesthesia seems to go against the nursing ethic of non-maleficence.

[insa]

canesdukegirl, this is such a good perspective. I wish I could have gotten this advice when was orienting in the OR! There are definitely those who will intimidate, bully, or try to establish pecking order by finding fault with what you do. And just because somebody (surgeon, preceptor, manager, tech, whoever) tells you to do something one day today, doesn't mean somebody else won't scold you and tell you to do the polar opposite thing tomorrow.

None of the individual tasks in the OR are super-hard to learn. The hard thing seems to be learning the rythm and culture of the OR you're in. If you can show you're receptive in that way (think about how quickly you call time out, reply loud and clear to others who can't turn to look at you while they speak to you, hurry up and slow down at the right morments), you can learn to fit in. And you can remind yourself that the hazing (Otis elevator? Really?) and the condescension aren't good, aren't fair, and aren't something you can really do much about. Just resolve that you won't be that person when you're the veteran working with the newbie.

[springchick1, ADN, RN]

The OR is a tough place to work. I've been there for 5 years as a scrub tech and now I'm in school. As for the tech who is rude, some people just are, but you need to realize too that just because the tech isn't an RN doesn't mean she doesn't have a wealth of knowledge for you to learn from. For Kooky Korky to say that she is probably jealous because she isn't an RN is absurd and quite frankly, a little insulting. We are patient advocates just like the nurse is. She has every right to say something if you miss a spot prepping or contaminate something. Don't take it personally. If you let everything hurt your feelings you will never make it in the OR.

[Dove87]

I am also new to the OR and am also experiencing similar hazing and the unfortunate expected OR culture behavior. I knew going into this, that the OR would require me to have a thick skin, expect that not everyone is going to like you, and that it would be a completely different working environment than bedside nursing. However, I just feel that some people really take some kind of sick pleasure in watching you struggle and leading you astray purposly just to humiliate you. I just don't get why, never have I experiecned this kind of behavior - is it that they have such low self esteem that the only way to feel any satisfaction in life is to belittle and have some control over an inexperienced person? "Nurses eat their young" is at a whole new level in the OR....It's just been difficult when I come to work eager to learn, ask questions, and have a positive attitude that it is met with such hostility at times. It's been very hard to get used to as I am a people pleaser and love to help the team get the job done.

As a new OR nurse, I feel that when I step back to absorb what is going on or when I don't know how to best help the situation, it is seen as my being disinterested and slacking off. It's not the case though, I just lack the experience to know what to do in certain situations....Sometimes I feel like you're expected to know things that you have never seen before and be able to do it flawlessly. It's a hard working environment but I am not giving up.

I have tried to surround myself with the people in the OR who are supportive, understand that the transition is a steep learning curve, but these people are a select bunch. These are the days where I really feel my anxiety lessen, my preformance is improved and my confidence builds. God bless these nurses.

For the hazing nurses, yes, I understand that it takes a lot of time and patience to help new OR nurses become efficient and an asset to the OR, but it still does not give the right to create a toxic working environment. Instead of the hazing why not help me so that I can be helpful faster!

[kguill975, MSN, APRN, NP]

Every time I read these types of posts, it makes me sad. I think nursing and healthcare attracts some of the "weirdest" people, who don't have a single caring bone in their body. It should be a nurturing environment for EVERYBODY, and that includes patients, peers, students, and anyone else we encounter in the OR. Toxic OR environments are hard to break, and it requires management that is strong enough to lay down the law. It should never be tolerated, never.