New OR RN Seeks Starting Point

Specialties Operating Room

Published

I have just landed my dream job as a circulating nurse in the OR at an urban Level 2 Trauma Center. I am in my third week of precepting/orientation in general surgery, but while on-call I will also respond to emergent cases, sometimes of different specialties (ortho/neuro, ENT, plastics, endo, trauma, etc).

I am going on my 7th year of being an RN, ADN. I gave 5 years to geriatrics, sub-acute care, dementia, rehab-to-home, Medicare, long-term care, and hospice. I gave 2 years to school nursing (ECE - 8th grade) and pediatric home health nursing. As a brand new nurse, I spent about 4 months on a cardiac step-down floor. Because I have spent so much time outside the hospital setting, I have lost some knowledge and skills that I want to re-establish.

I have watched a myriad of videos, read even more policies, and have tried to review a binder of information for this new position. Some things are sticking, others aren't, and I think I'm a bit overwhelmed by this very new and large body of knowledge. It's like the first semester of nursing school all over again and I have no idea where to start. I'm having a hard time figuring out where to focus first, so I am seeking any and all tips, information, practical knowledge, do's and don'ts that any of you may have to share with me.

Side note: I do get plenty of 1:1 time with my preceptor, clinical educators, nursing leads, and nurse manager. They always make themselves available to me for questions and/or concerns. I felt the need to mention that because this post is not due to a lack of guidance or education, but rather I am trying to get as much input as possible...the whole two minds are better than one type thing.

Thank you in advance!

-LJOHRrn

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Specializes in OR, Nursing Professional Development.

Guess what? You're perfectly normal! The OR is its own world, so while you have nursing experience, you don't have OR experience. You've got a steep learning curve, just like any new nurse or new to the specialty nurse. How long is your orientation? A solid OR orientation should be between 6-9 months for someone without experience- generally about half with a 1 on 1 preceptors orientation and the second half with resources available to you without conflicting duties (but not glued to your side) while you transition into being completely solo.

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Specializes in Surgery.

Something that helped me a great deal was this book!!! I would read over the procedure in Alexander's Guide, but it didn't always address my specific concerns as a circulator! You can actually download this book Kindle style to your phone and use it as a quick reference for positioning and prep!

It sounds like you are going through the normal growing pains of joining the OR staff!! Hang in there! It takes a while, but you'll find your sea legs!!

Pocket Guide to the Operating Room (Pocket Guide to Operating Room): 978

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Specializes in Operating Room, CNOR.

OR is so different from any other specialty, it will feel like starting over. Nothin but time... You will likely feel "new" for months and months. Possibly even a year. Steep learning curve for sure. I keep a notebook handy. I write surgeon preferences etc. I take pictures with my cell phone of room/bed/equipment setups for specific cases that I am unfamiliar with. 8 years later and I am still learning, especially because things are constantly evolving and changing in this field.

Learn to hone your "OR ear". Always keep an ear out toward the surgical field. At first this means you need to be standing there paying attention all the time. With time, you will be able to do charting, space out for a second, or hold a conversation and still immediately hear if the scrub or surgeon has asked for something. Super important that you are immediately available and they don't have to struggle to get the circulator's attention and ask 2 or 3 times for an item.

Take nothing personally. The OR is full of "strong" personalities who aren't necessarily skilled or give a damn about delivering feedback in a professional, courteous manner. Take the kernel of truth of what you need to learn and don't let the curt/abrupt/rude delivery throw you off too much. At the same time, learn to not take any ****. It's ok to tell surgeons and anyone else "Don't yell at me" or call someone out immediately if they are being a condescending bully. Learning verbal assertiveness will go a LONG long way in preserving your sanity. I swear surgeons and other OR peeps can smell fear and will take advantage. It's like sharks smelling blood. Not sure why the OR is like this, but it's been that way every place I have worked. So even if I am unsure, I do my best to present myself as strong, solid, grounded, and confident while still asking questions as needed.

Learn to graciously roll with mistakes. To this day I will still forget something stupid and basic. A simple "Sorry, guys!" when you forget to plug something in. You will make lots and lots of little mistakes but you won't be alone.

The cool thing about OR is you are NEVER alone. You have a whole team there if something goes down. There's always someone around to ask, support, etc.

Hope this helps!!

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Thank you for the reassurance. I also feel like a 6-9 month orientation would be right up my alley, but for whatever reason it's not feasible.

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I downloaded this several weeks ago and it has been very useful! Wish it covered more about skin preps. I still struggle with those.

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It sure did help! Had I taken this job sooner than I did, I would not have developed the thick skin needed to be successful in this arena. I have definitely leaned that if people yell, or are awful in pointing out your error, I don't take it personally. They have a lot more riding on their shoulders than I do as CRNAs, surgeons, etc.

I had a surgical tech tell me once, "everyone goes through a 'Yes, Doctor' phase, and then a 'Eff you, Doctor' phase."

I get what she was meaning, and I know right now I will be in the "Yes, Doctor" phase for a while. But finding my voice I think will take a lot longer. It's intimidating being around those with years of experience and education that surpasses mine. I have trouble speaking up when I feel professional boundaries have been crossed.

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WOW. reading the above comments are great! I am excited to start my new job as an OR nurse in August! I will be going through the residency program and I believe it is 8-10 weeks general orientation and another three months of specific units orientation within OR.

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I had a surgical tech tell me once, "everyone goes through a 'Yes, Doctor' phase, and then a 'Eff you, Doctor' phase."

I'm definitely in the "eff you, doctor" stageí ½í¸†. You will also get that way with some of your coworkers. The OR can be a beast but I can't imagine being anywhere else. Like others have said, there is a steep learning curve. I know you said it wasn't feasible to have a 6-9 month orientation but I would find out why.

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