OR newbie needs advice

[sugarik13]

I am new to the OR. I have taken initiative and asked to put in foleys on my patients when I am circulating if they are ordered. Usually the nurse I am circulating with (a different one each time as I don't have a set preceptor) hovers over me, questioning things the whole time. The questions are insignificant and have nothing whatsoever to do with the actual foley insertion, they just question why I am not doing it the exact step by step way THEY do it. They nit-pick where I put the lube and how I soak my cotton balls with betadine, to the point where they get annoyed and ask "why do you do that" or "who showed you how to do that?" More often than not they are questioning things that have been shown to me by nurses I worked with on different days.

Some have even gotten impatient (when I am doing nothing wrong) and put on gloves and try to take over. That just ends up with extra hands in my way, an increased chance of contamination, and me doing it how THEY say. I can understand if they see me violating aseptic principles, or if I can't find the right hole, or if I am about to contaminate something. Putting in a foley is a skill we all learned in nursing school. I have done it independently MANY times as a medsurg/capstone student with my preceptor watching and saying my technique was good.

I have no problem doing things the way the regular nurse in the room likes them done, but I get annoyed when they don't let me insert the foley in the way that I am comfortable, and try to get me to do it their way. It seems foolish to question me over things such as soaking cotton balls vs. dipping and lube staying in syringe vs. being squirted into the tray. I wouldn't mind them saying "I have found it works better if..." or "maybe next time you should try this..." As long as the foley gets inserted properly using aseptic technique, isn't that the most important thing?

Now instead of having my own way, I find myself doing it the way whichever nurse I am working with does it which is usually awkward. Concentrating on doing it THEIR exact way usually makes me forget something, and then they are quick to point out that I forgot a step. I wouldn't have if I had just been allowed to do it from start to finish myself. It also takes me longer because I spend time trying to remember their exact sequence so I don't get berated.

The bottom line is...everyone has a method, and I'm trying to develop my own, but I know what works for me and what doesn't. How can I advocate for my autonomy in foley insertion without stepping on their toes and having them take over?

[springchick1, ADN, RN]

I work in the OR. I am scrub tech and I do A LOT of precepting. The nurse I work with also precepts a lot of people. Yes, everyone has a method and yes, your method may not necessarily be wrong (there is more than one way to skin a cat), but the best advice I can give you is do it the way the person training wants it done. You will take something from each person and come up with your own way of doing things but the preceptor has a system and a routine. Also, you don't learn sterile technique in nursing school. You learn to put on sterile gloves and how to open a sterile package but in the OR, there is so much more to it than that! Good luck to you:)

[Ilovethe80s]

Good grief, I can understand your frustration. It really doesn't matter if the Betadine is soaked in the cotton or you dip. It is hard to try to remember how each person does things & the OR can be a tough environment. A lot of nurses are used to being the only circulator in their room and doing things their way, so they can be type A....I'm like that at times, too. I know, it can be a pain dealing with having a different person teach you each time, but please hang in there. I think if you do it textbook, you can't go wrong. Is there any chance you may be assigned a more permanent preceptor? We have a couple preceptors where I work & the newbies tend to stay with them for a while & then they let them work other nurses. Seems to work much better that way.

[sugarik13]

Also, you don't learn sterile technique in nursing school. You learn to put on sterile gloves and how to open a sterile package but in the OR, there is so much more to it than that!

Not trying to be mean, but please don't to tell me what I learned in nursing school, since you were not there with me. I did learn sterile technique in nursing school. And I learned how to use sterile technique to put in a foley, suction a patient, and change dressings. I also took a course in perioperative nursing at the ambulatory surgical center of my nursing school's affiliate hospital where I had education and experience in sterile technique, scrubbing, and circulating. AND I did my senior rotation in the perioperative unit. And I have a Bachelor's Degree in Nursing. I think it makes me qualified enough to put in a foley catheter without being made to feel like an idiot.

[limaRN, BSN, RN]

Just go by the textbook! Then if anyone questions you on your technique just say I used blah blah reference and can back up your technique with evidence. I use the AACN policy procedures manual in ICU for my reference. Just because "we do it that way" or "we've always done it that way" doesn't necessarily mean that's the way it should be done. It sounds like your coworkers a just being a little picky.

[KyleRoth]

I'm in your exact same situation: new to the OR, being critiqued on my foley insertion. the "sterile technique" in the OR is definitely different than it is in med/surg. All I have been able to do is grin and bear it until my orientation period is over in May.

My advise to you, from experience, is to just make sure your sterile technique is perfect, have everything set up where it needs to be before you start, and be sure of yourself when it's time to perform.

When you're precepting in a few years, remember to be more helpful than critical. lol

[fracturenurse]

This is just awful. No wonder why new nurses aren't going to the OR. Who gives a crap about how you soak your cotton balls in betadine? Why does it matter, the only thing that matters is that everything remains sterile. I've been in the OR for 15 years and have my CNOR certification. I am so sorry this is happening to you. Just keep counting down your days until you are on your own. OR nurses tend to eat their own.

[kd7hfw]

My best advice is to ask your preceptor if there is anything they do that they feel strongly about. This helps them feel like you are willing to learn and will most likely get them to back off a little. Putting in a foley can seem like a small thing, but when it comes to infection all circulators should be overly cautious. I do a significant amount of training in our OR, and I feel that the hardest students are those that come in thinking they know everything already. Look at each new preceptor and situation as a chance to see things from a different point of view. Good luck!

[cherston1]

These are all excellent comments, however, I've been in this situation and yes the O.R. tends to eat their young. Maybe that is why I'm thinking of leaving. The best thing you can do is request from the manager that you be given a regular preceptor. Two at the most. It is counter productive to have a new preceptor every day while you are trying to learn.

Secondly, most O.R nurses will agree that AORN standards are the GOLD standard of nursing practice. So I would get a current copy of their standards (which should be available in your department) and memorize how to insert a foly according to AORN. Then when someone questions you about what you are doing, you can state that you are doing it according to AORN. But also be open to suggestions. Sometimes asking someone to show you how they do it helps tell them you are willing to listen. Sometimes too what is happening is not a put down of your technique, but instead they might be trying to see how "open" you are to suggestions or how well you do under pressure. You might also ask the preceptor of the day to watch your sterile technique to make sure it is correct, sometimes that tells the nurse that you are aware of how important it is to keep things sterile. Hopefully after they watch you several times and realize you know what you're doing they will leave you alone. But having one preceptor would also help. :)

[sugarik13]

Thanks for the comments.

I am not sure how to go about advocating for myself and asking for a regular preceptor, which I think would be good for me. I don't know how it would be received because I have asked for things before from my educator who decides my daily schedule and been turned down (ex. getting to see a particular procedure, getting to work with a certain person I learn well from, etc). I'm not sure if it is to put me in my place. I am really trying to see the big picture and figure out the method to her madness.

In my hospital orientees spend about 3 weeks in each service rotation (GU, GYN, general, ortho, neuro, etc.). It's unknown until I come in whether I am scrubbing or circulating, or if I am even in the service I am supposed to be in. For example, I am in the middle of my GU rotation (my first service) and have just started to feel comfortable with the procedures and equipment, but was put in GYN for the day and felt like a fish out of water. I was made to feel like an idiot when I didn't know where to find some things I have never seen or used before.

Just frustrating.

[OR-RN<3]

I'm so sorry you're going through this, I have totally been there. OR nurses in particular are total control freaks. I would urge you to talk to your educator again to get several consistent and supportive preceptors that teach you well and ones that you feel comfortable with. It is so important to have this.

If that is not an option, I would ask these abrasive preceptors if you are contaminating anything when you do it your way (the answer we all know is most likely no). I think it would be in your best interest to pull these nurses aside (one on one) and tell them how you feel. There are always several ways to do something and just because it is different, does not mean it is wrong. You may be surprised by the results you get. I know it can be scary confronting someone, especially when you're new but it is obviously getting in the way of your learning.

Some people just aren't meant to precept, and I have definitely experienced the worst like you have. Luckily I was able to choose my preceptors and I really hope you can too so you get a good learning experience. Good luck

[suckulator]

I finished my orientation about a year ago. It was the hardest thing I have ever done but has been the most rewarding. I urge you to just keep plugging along. You will never know everything and will learn and see new things every day. I learned more in the first six months than I have in my entire life even though I often felt like an idiot and wanted to quit often. If there are any other orientees you should use each other for support and hints on services completed. During downtime, have someone show you a few things pertaining to your current service (location of equip., supplies, trays). If there is no one around go into the sterile supply area and just look around. Eventually you will have it memorized. Seems impossible I know. I hated GU also! Usually short cases and no time to chart and the rooms get very cluttered and wet! Hang in there I promise it will get better. Unfortunately there is no book to study from, each facility is so different. The only way to learn is to struggle through. Wait until you scrub/circulate your first case and everything goes perfectly and surgeons ask for you to be in their rooms and are bummed when you aren't. There is no feeling like it! I feel very privileged to be an important part of the team. The things that we get to do and see are amazing. Think about it, it's a world very few people get to see, like another planet! You will get very close to your team members also.