New To Cardiothoracic Surgery

Editorial Team / Admin · Mar 28, 2015

These are some of my standard tips that I give nurses new to the OR:

Things that I found helpful:

1. Knowing what cases I would be on for the following day. This allowed me to get copies of the preference cards so that I could look them over at home (yep, that's right, at home- homework doesn't end with graduation).

2. Breaking the learning into chunks. This day, focusing on setting up the room. That day, focusing on prepping and positioning. Some other day, focusing on documentation. Much easier to absorb and retain when not getting so overwhelmed by trying to do everything.

3. Keeping a small notebook handy to write down useful/important information. My notebook for my current position (that I have so well memorized that I don't actually carry it around with me anymore) has a list of important phone numbers such as blood bank, PACU, service line coordinators, charge anesthesiologist, and so on. It also has a cheat sheet for how to order blood products and intraop lab tests (a necessity when changing from paper to EMR). And then there is a section for each surgeon I work with where I can write down little idiosyncrasies: preferred radio stations and things like that that wouldn't appear on the preference cards.

4. Understanding that OR nursing is a whole other ball game- school has very little exposure (typically a single observation day) and it's extremely different than working on a med surg floor or any other type of unit. There's a common saying that it takes a year to begin to feel comfortable working in the OR. Don't expect yourself to get everything right off the bat- it's going to take time and there is a steep learning curve.

5. Along with #4, understand that there are going to be good days and bad days. The bad days might be those where your patient doesn't make it off the table or those where just when it felt everything was clicking, it all feels like your first day again. Even us experienced nurses have those kinds of day: new equipment is purchased, new procedures are developed, and we have to learn from point zero how use/do everything.

6. There are a lot of instruments and suture used in surgery. You may want to look into some books, websites, or apps that have images of instruments, what they are used for, and any alternative names. It can be confusing when someone asks you for a kocher clamp when everyone else calls it an oschner. (Yep, 2 names for the same instrument- and that doesn't include surgeon pet names.)

7. Understand that when someone goes off, it's almost always at the situation and not directed at a single person. Surgery is routine to us, but it can still go real bad real quick. It's not uncommon to see a surgeon suddenly start using some impolite language (we have a few that could make a sailor/truck driver blush). Now, throwing instruments and directing personal tirades at staff is not okay, and a good management team will support their staff and ensure corrective action.

Additionally, going straight onto the cardiothoracic team can be a little more difficult than starting in other specialties- in fact, as part of our orientation for nurses new to the OR who have joined the cardiothoracic team, we have them work in general vascular rooms for the first six weeks to learn the basics before we bring them back to the heart rooms. Granted, the variety of procedures done on the cardiothoracic team isn't quite as large as other specialties, but it is a lot to learn. Even after working in our main OR, circulating general/vascular, urology, some gynecology, neuro, ortho, plastics, and a few other things in between, I was still given a full 12 week orientation to the heart team. So basically, be prepared to do your homework, keep your ears open, and ask for feedback.

tiffcrn, ADN, BSN, MSN, RN, EMT-B · Apr 1, 2015

Thank you Rose,

They will be orientating me to all specialties before I go to hearts. I will also have a change of mind set due to being an ICU nurse for so long. I will be shifting from postoperative care of the cardiothoracic patient to perioperative. I love to read/study and find myself reviewing information often. I am looking forward to the change of pace. Thank you for the tips. I will be needing them!:)

Tiffany