New OR nurse needs some advice

canesdukegirl, BSN, RN · May 26, 2012

Hey Smiggers,

You have gotten some EXCELLENT advice! It does take a while to learn the OR, and if you are beating yourself up about not knowing everything when you are only 2 months into the OR instead of running out the door screaming like a Banshee, then you are doing well!

First consider the transitions you have been through just in the last 9 months: you were a brand new nurse, you learned the basics on a med/surg floor, then applied for your passport to go to The United Rooms of Surgery. You had to learn a completely new language (Kerrison's? Bookwalter? What are Yasargil Clips anyway?), learn the intricacies of sterilization methods, learn how to maintain sterility, learn the hows/whys of multiple surgical procedures as well as learn the preferences and pet peeves of each surgeon. And that's just the tip of the iceberg. It can overwhelm the best of us!

I know what it feels like to experience pressure from management to become efficient before you are ready. I had an AWFUL preceptor when I first started in the OR. She was trying to become the OR's first nurse educator, and went about it completely wrong. There were a few of us that were new to the OR, and she had these 'proficiency' checklists that she gave to the circulator/scrub whom we were assigned to that day. They were to rate us on how well we did on each task and encouraged comments. Sounds pretty reasonable, huh? However, she didn't teach us ANYTHING before we went into the OR. The only teaching she did was to let us stay in the sterile core the first week and pick cases while she socialized with her buds. She left it up to the staff in the room to teach us what we needed to know, but the OR was terribly short staffed and the nurses/techs didn't always have time to teach us in an effective way. They were under the gun to get cases turned over, equipment in the room, charting done, etc. The staff didn't know that none of us had gotten any education/instruction/direction from her, so you can imagine how terrible our proficiency checklists were. Needless to say, she wasn't approved to be a nurse educator and was, in fact, fired.

The point of my long and drawn out story is that YOU shouldn't be short-changed in your learning because the OR is understaffed. It isn't fair to you and it isn't fair to the other staff members. The mindset of "see one, do one, teach one" is fine in clinicals, but it isn't appropriate in an OR setting. You really have to understand the rationale behind what you are being tasked with, and that takes time.

Keep a positive mindset and be easy on yourself. There is SO much to learn, and you will get it. Keep doing your homework, when you come home, read up on procedures that you did that day, keep a notebook, and make sure you are eating well. Play hard during your time off, because your mind needs a rest!

Keep coming back to us if you have questions or need pointers. We all want you to succeed!

Canes

ebear, BSN, RN · May 31, 2012

I had the same experience, Canes! It was a beeotch! :lol2:

RNJess10 · Jun 2, 2012

I'm right there with you! I have been on orientation at my hospital for 2 1/2 months, but we only have a 3 month orientation. At our hospital (it's a small hospital), they don't train circulators to be scrub nurses. It is a completely different world that nursing school doesn't even touch on. I think it will get better (for both of us!) as time goes on. Whenever I get down on myself, I look back at what I've learned in just these couple of months and how far I've come. Heavy expectations are always put on nurses no matter what type of nursing you do and regardless of how much experience you have. I was on med/surg for almost 2 years, and remember feeling the exact same way starting out. As long as you're still interested in learning and enjoying the operating room, I think the situation will improve. If you have an opportunity to go to central sterile, that will help you learn the instruments (I wish I had more time to spend there). If it's a slow day, maybe they'll let you open an instrument set so you know what's in there and what the instruments look like. Don't forget you're not alone, and no one expects you to know everything, so don't be afraid to ask. The only way to really learn is through practice, and mistakes are bound to happen...but each one is a learning experience and will help you improve the next time.

At least, that's what I'm telling myself. I wish you the best of luck and hope everything works out for you!

smiggers · Jun 3, 2012

Hi Guys and thanks so much for the support. It has been almost 3 months now and i am still not confident. I am doing a lot more and beginning to stand up to the doctors haha.. but i still don't feel confident setting up a room by myself. Once everything is in the room i can hook up everything and i can prep all the different cases, Actually after writing this I seem to know quite a bit that i never realized haha. I just get anxious they are gunna set me free when i'm not ready. I did 2 minor room cases (woo hoo nothing major but still) by myself with a doc who is not a fan of me bc i am new which went very well and although I was sweating buckets i had everything ready and new what he wanted when he asked.

i am still made to look like a fool on a daily bases but i learn from those mistakes bc there is no reall educator there and i am basically learning by watching and doing.

I don't love it yet but when i have a good day and i perform well i do feel really good.

I would like feedback from the nurses but i am not getting much right now I did get some on friday bc the nurse who was with me left me to do 3 pain cases which are easy too BUT it was my first time, everything went well thankgod..

Please give me any feedback you have as this blog is the only support I have. My husband doesn't get it he thinks i'm too hard on myself which is probally true but i still need someone to say you are where you should be for 3 months.

Thanks for letting me vent...

cpkRN · Jun 4, 2012

I have also been in the OR for 3 months and was hired as a new graduate. I still feel stupid and inadequate on a daily basis, but we (myself and the other new hires) have been told that it's normal to feel that way for a long time. Many say even 2 years! I'm normally very hard on myself but the OR is what I wanted, so I'm learning to give myself a pass on things. I keep a small notebook in my pocket and an constantly jotting down notes. I compile my notes on a bi-weekly basis into a more "formal" book that's organized by surgeon. It's been very helpful in remembering surgeon preferences and "quirks." I started with 5 other new hires and we're given time during the week to sit and talk about our experiences... We're all in the same boat! I'm certain that if you were joining us for these discussions, you'd fit right in.

Our OR educator "forced" us to keep journals. While it was a pain in the backside at first, I love looking back in it and seeing how far I've come since the beginning of March!

The best advice I was given is that every case is "BS" times 2: All you need to start is BOVIE, SUCTION, (kick) BUCKET, SALINE! I still run around like a chicken with my head cut off and freak out at least 3 times a week, but it will come in time. Take the time to reflect on what you're learning everyday, no matter how trivial it may seem.

My biggest deal is that I get so focused on what's needed for the procedure that little things like grabbing warm blankets go out of the window! At this point, I'm very comfortable in any laparoscopic procedure, some smaller general procedures, and some GYN. I still freak big time in ortho.

If the OR is where you want to be, make it work! That's the advice I give myself. I'm soaking up whatever I can, taking bits and pieces from how others do their job, and really working on not being hard on myself. Don't let frustrated surgeons get you down, show them you're strong and never take anything personal!

smiggers · Jun 4, 2012

Thanks for that reply. The thing is where i work they don't have a proper oreintation program for the OR. I have no feedback. But like you i write down every procedure i'm in and i make a copy of the preference card (scrratch out the pts name) and write down what went on and so forth then i have my pocker bible where i write the procedure and the doc's preferences. I haven't been in any ortho yet i am mostly in gyne and general, eyes a few times. General i would be ok with the bovie and such but with cases such as vascular , sports and even eyes i don't know all the equipment so when they ask for something i have no idea what it is.hahaha

I do wanna stay but when you get no feedback its hard to know if i'm doing good or not.

I'm very glad to hear you love and that things are going well for you.

How long is your orientation?

I did med surg for 7 months where i felt very confident so its hard for me not to have control hahaha

cpkRN · Jun 4, 2012

Orientation is technically 6 months. I was hired for a smaller facility but trained at the big "parent" hospital for the first 2.5 months. I've been at the small hospital full time for 2 weeks now and it's almost like starting over. I'm also someone who needs feedback whether positive or negative. While I was getting that feedback from the educator my first few months, there's no feedback where I am now. Do you at least have the support of your techs and fellow circulators? That's where I'm finding feedback if I ask for it. Some aren't good at giving it, but others are and I take it and run with it. I guess you could think of it as allowing the tiniest positive feedback to inflate my sense of pride in myself until something knocks me back down again. That's another BIG piece of advice I was given upon starting: you'll feel on top of the world one day and the next you'll feel like you're back to square one - that is totally normal and it will be the norm for quite some time!

I'm used to excelling at any job I do within a few months' time, so this is all very strange to not feel like I have a clue. I tend to think that everyone around me is thinking about how dumb the new girl is. Even if that happens sometimes, I know that once I "get it," I'm going to be darn good at my job. That's what keeps me from getting too depressed. I'm sitting at home feeling a bit down because a group of surgeons decided to not let something silly I said slide and continued to rip on me about it all day. Oh well, they probably forgot about it the minute they left the hospital and I should too! I hate to be fodder for anyone's jokes but, ultimately it was just something that I was unaware of that was common knowledge to them. Now it's part of my knowledge too. All part of the process.

I've never been one to use positive affirmations to make myself feel better, but just reaffirming how far I've come (even though they're very small accomplishments in the big picture) keeps me going. Take a look at all of your lists you've made, I'm sure you'll see just how far you've come. It's the smallest of things, but just a few short months ago, I was freaked out by helping people put on space suits for ortho cases. I was afraid to budge around the sterile field. I stood in a corner totally freaking out at the beginning of an emergency case. I still find myself in the corner every so often, but it's baby steps. Fall down and get back up.

Ahhh... online therapy :-)

smiggers · Jun 4, 2012

Thanks so much for that. It is funny that we all feel the same way and that makes me feel better. I'm like you I like to be in control and run my own show. Today was a good day I didn't have any dumb moments so that was good.

Just when I think about doing it alone i start to freak out hahahaha.

Well I am taking one day at a time.

Thanks for the support.

Suziesmith · Jun 13, 2012

Smiggers - it will get easier! Hang in there!! I've been an OR nurse for over 8 years and I almost quit in my first year. I would go home crying every day I worked and I would dread going into work. It was so overwhelming and intense. I thought I was doing everything wrong. Luckily, one of the nurses on my shift took me under her wing and helped me out. She gave me the confidence i needed to just focus on the job and not the people in the department. Good luck!!

SandraCVRN · Jun 15, 2012

Don't be hard on yourself. You're still new and even years later you will do some bonehead things, so if you do them now it's just being new.

A year or 2 ago my scrub says I think I new some new irragation this is cooled down. So, you know what I did, I reached right over to the corner of the sterile field where the plastic pitcher was and felt the outside of it and said, yep it is cold. We both looked at each other and I proceded to pick up the pitched and get a new one and some warm saline.

So don't think you won't make mistakes or have a brain fart every now and then.

Good luck

canesdukegirl, BSN, RN · Jun 16, 2012

OP, don't let the docs know you are flustered. It's akin to a shark smelling blood in the water.

If you are uncertain about something, ask your tech. It the tech doesn't know, then make a call to your NM and ask.

I will never forget the time during the middle of the case when a neurosurgeon that asked me to get his "specials" basket that he uses for "every case, all the time". The tech clearly should have gotten this, but was testing me. I asked the tech where this basket lived, and she just looked at me and said, "Hmmm...I thought you should know that by now." The surgeon was getting irritated with me, let out a big sigh, and the tech was wearing a smirk. So I put on my big girl panties and said to the tech, "Sally, during the time out, you agreed that we had all of the instrumentation in the room. Obviously you did not ensure that Dr. X had the specials basket that he routinely uses. I thought that you would know to get that by now. If you can't tell me where they are, then you need to drop scrub, delay the case while you get it, and then perhaps we can finish the procedure." Both the surgeon and the tech looked at me in shock, the surgeon looked at Sally like she had three heads and dressed her down for not having his basket on the back table.

Never had a problem with either Sally or the surgeon again.