O.R. orientation 6-9 mos. or 3 mos.?

[LAM2010, BSN]

Hi everyone -

I'm a new RN - graduated in December '09 and started as a circulator in March. It seems my bosses have given me just 4 months orientation instead of the 6 to 9 months they kept telling me it takes to learn the job. In fact they've only really given me 3 months - now I'm on a 30-day extension because I am not where I need to be at 3 months' time.

I'm not an extremely extroverted person, but I am normal - I'm not shy. I speak up when I need to, I don't get in everyone's business, I'm not bossy or arrogant or rude, I ask questions when I need to and I communicate well, I take responsibility and learn from mistakes, I am not afraid of snippy surgeons, etc. -- these were good things in my eval I got last week. I document, communicate well, I'm great with patients, assessments, etc. and I can rattle off the whole list of things I am supposed to do and check for as a circulator, from holding area to PACU report. I was told at about the 4-week mark I was doing great but needed to take the initiative to tell my preceptor to let me do things by myself (e.g. I am hooking up a scope camera while she goes over to hook up the bovie - I either should ask her to do that or tell her not to hook things up, let me do it all) - even though I "won't be on my own for at least 6 months". So after that I did that and they told me I was doing better and they were impressed.

But apparently I still didn't seem to come across as being the totally confident circulator I needed to be. Which is supposed to take at least 6 months, as they told me many times. But now all of a sudden it was only supposed to take 3 months, and they think I can do it so they've given me a 30-day extension on my "probationary period" (which all jobs have). In the week since they gave me my evaluation, they put me on some cases at the last minute by myself (because of staffing issues that came up). Even 2 ortho cases, which in my eval they said they don't expect me to be able to circulate myself yet.

So why did they make the big deal out of my capabilities last week, then the next week put me on cases by myself? Why did they feel they need this in writing? Every time they've told me "we want you to be at THIS level" - I've stepped up and done it, I've followed their guidance and direction, and I've made big improvements and my confidence grows more and more every day. I take their constructive criticisms well. (And on top of that I later realize I should have gotten paid a third of my sign-on bonus this paycheck!)

I am sure that they shouldn't be firing me in 30 days, but it makes me mad that they did this (it's in writing - I didn't argue). It just seems like something is behind it - like they have someone with perfect OR experience that they want to hire but can't because the budget won't allow it. Or they suspect some staff will be quitting or something. Or they want to hold off a month on paying me my money. But it took me a week to process this and I didn't have a week to think about it.

If I am just whining then tell me to shut up :) But it's a little dishonest of them. And I still feel like I let myself down, when maybe I shouldn't feel that way.

[GadgetRN71, ASN, RN]

I think they're just trying to push you a little bit..some places do this. Many times, staff forgets what it was like when they were new so things that may be obvious to them or no big deal are huge to a new person. When I trained, I was in a somewhat similar situation..but, I had been a tech in that same OR before, so there were people that didn't even think I should get an orientation..there was no acknowledgement that the role change was there and I needed some time to adapt. They had me taking charge when I had been a circulator 7 months. Scary.

Are you in a teaching hospital or in a community hospital? Sometimes the community hospitals can be tough, because they aren't in teaching mode often enough and the turnover of staff doesn't happen often. So, you have nurses and techs who have been there 30+ years and again, they forget what it was like to be new.

I wouldn't get hung up on the Ortho cases..they aren't that bad. Are there people available to help you out hen you take rooms on your own? Most places have you start circulating alone at about the 3-4 month mark-small cases usually. Good luck.:)

[RogueRN]

Do your preceptors fill out eval forms for you every day? If so, can you look at them and get feedback right away? Sometimes the feedback varies from preceptor to preceptor.

If I were you, I would keep notes and evaluate how good my preceptors are at teaching. Write down your observations and concerns about your day plus your learning needs. When management pulls you aside, at least you have something to back you up.

Good luck!!!!

[LAM2010, BSN]

Thanks. :) This is a community hospital. So the staffing situation you mentioned does exist.

And I haven't been given any other evaluations (daily, weekly, or otherwise) except this 30-day one. Taking the notes is a good idea, thanks. I have a few little notes on what I definitely need to work on, but it wasn't anything I was prepared to share.

My manager did say that they can't justify to HR keeping me on staff without giving me a 30-day extension, so it's like it is a favor. But I would have thought I'd have been scored according to my newness to the field, not compared to an experienced nurse.

[Argo]

You need confidence. I know my new circulators have what it takes after a month. If you have been given 30 days extra then use it to build your confidence up. Tell them you want your own room, set it up before people do it for you. Have the confidence in yourself to read the preference cards and know you have the room how it is supposed to be and every supply that needs to be there on standby. I would always set up for all my tf cases at the beginning of the day just to ease turnovers they were never waiting on me. Just put extra stuff out of the way in the corner somewhere with a sheet on it.

I had one week of orientation and was on my own. 3 months later was the manager. I still circulate while running the board when we are short staffed. I did that for like a year before we got all the staff we needed.

[LAM2010, BSN]

i understand that now-experienced OR nurses had next to no orientation - no nurses did - i am reminded of that at least once a week. not sure why the AORN position on orientation time, then, but, whatever....it's only professionals and EBP.... good thing i haven't yet plunked down the $100+ for that membership, lol.

just wondering, though, being a new nurse on only a few days or weeks of orientation, how many times i would have walked between 2 sterile fields before someone told me or i read somewhere that that is incorrect - even though the surgeon's starting the incision, the grounding pad isn't clicked into the cautery machine all the way, and the tech hasn't pulled the back table up to the field yet. or the x-ray tech's got the c-arm draped and waiting for a cholangiogram, and i walk between it and the OR table - 2 sterile fields. which i am supposed to warn others about contaminating. but i've only been there since last Monday and i have no clue.

anyway, i meet with my manager this week to see where we're at. i had a week to think about all of this and i have written down what it's been like this week.

[BridgetJones]

I think it's unfortunate that they're having these kinds of conversations with you after only 3 months...I know that if my hospital had tried to make me come off orientation after 3/4 months I would have been sunk! I got 6 (and an extra week and a half) and I was still scared, but everybody tells that I'm doing well (I've been on my own about 2 months now). You sound really motivated and hard-working...I would say just keep doing what you're doing and plugging away! By the way, I'm pretty sure AORN recommends a 6-9 mo. orientation for new circulators.

[solneeshka, BSN, RN]

I would just sit down with my manager and ask what the deal is. Remind him or her of what your understanding was coming in and ask why that's no longer the case. Sometimes being straight up will get you good results.

[ramonmalino]

Wow. My hospital has us orient to the OR for 12 months if we've never been a circulator.

[LAM2010, BSN]

Tomorrow I am approaching the team lead to remind her that my 30 days was up today.

They've had me working cases without a preceptor for 3 1/2 weeks now - 2 days after that meeting. No one's initiated an official little meeting time or "review" session like they said they would... the place is a little crazy now with people quitting, etc. I've just been diving in and getting it done and learning from little blips where I didn't do something right or had to do something and had no idea how to do it and needed help, or I do it one way for one surgeon, but THIS surgeon doesn't like it that way - whatever. But I am gaining confidence, I am liking my work (most of the time!) and if I could just jump ahead in time to where I know everything (!), I know I'd absolutely LOVE this field. Maybe not my employer, but the OR world in general, LOL...

[LAM2010, BSN]

Soooo, to update..... after a few weeks of no one approaching me about my "re-evaluation" after that 30-day extension.... I finally got the eval and I passed with "flying colors". Nothing but praises about how well I've done, I rose to the challenge, they're very proud of me, are delighted to have me, etc. There were things I improved on that she said she didn't expect me to be able to do without help at this point. She had a different nurse evaluate me, too. So right now I'm good - they have seen that I can do the job, and now I can "relax".

At one point toward the end of that meeting, my manager said "I hated to have to do that". And I hate to say that I hated that that is what it took for me to jump in and take the initiative to run things without help from a preceptor. But I still don't know why they didn't just tell me and not do this whole paperwork thing. It took less than a week for me to turn around and get the confidence. Many improvements I made happened overnight (even surprised myself sometimes...).

I don't know if it has anything to do with the fact that our O.R. is basically a revolving door at the moment - I shouldn't even say revolving door... we're losing employees in droves (quitting) but don't have corporate's "blessing" to hire replacements.

Anyway...the other day one of the older more experienced nurses that I first pre-cepted with - who others think is "difficult" and picky and ornery (well, she is...she knows it...she just doesn't compromise when she thinks something's important)... told me that I have been doing a really good job, especially for a nurse who just graduated. She is not one to tell people that if she doesn't mean it. So I guess all's good. (She is not one of the nurses who evaluated me).

It was just a weird experience. But now I feel TONS more comfortable in this job :)

[sameasalways, ASN, RN]

Wow I am really happy for you! I am considering going into the OR and all of thse issues you bring up are of concern to me as well. I hope I can do as well as you if i get hired!