Questions about OR for a nursing student

suzanne4, RN · Jun 9, 2005

I would try to shadow a nurse at a few different facilities. Each specialty is going to be different. Some will have more physical work, some will have less. Also, depending on what case is being done.

Example of an Open Heat case:

For the OH patients and the room, we are responsible for interviewing the patient, making sure that blood is available and in the room, helping anesthesia when intubating the patient, prepping the patient and inserting the foley. At some facilities, the Circulator is responsible for operating the defibrillator when and if it is needed. Sterile paddles are on the field, but you have control of the actual machine. Counting sponges, instruments, and needles before the case, during the case, and at the end of the case. Anticipating what the scrub is going to need before they need it.

You are there also as the advocate for the patient and are in charge of their safety. Making sure that fields stay sterile, no cross contamination occurs, etc. There is also quite a lot that goes into learning the names of all of the instruments, and what each case will involve. Specimens become the responsibility of the Circulate also.

Hope that this helps................and try reading some other threads on this topic here. It was discussed at length just a few months ago.

grimmy, RN · Jun 9, 2005

well, every ounce of my nursing skill and instincts are used - not all of the time, every moment, but when i'm needed, i have them. take yesterday, for example: i was circulating for a posterior laminotomy/decompression. procedure went well, we turned the man over, and he was ok. we extubated the patient and he did not take a breath...and did not take a breath...and his sats went down, and went down. they were having trouble ventilating...and his sats kept going down. so -in the meantime- i am at the bedside (as is appropriate when extubating) and i get the siderails down on the bed, and getting another et tube ready...the sats are now down in the 40's - i ask "do we need help??" finally, when the sat's go past 39, i ask again, and they say "yes!" i smack the button and the anesthesia teams pours in...we get the guy ventilated, his sats start to rise - it was a problem with the machines. but - i'm doing what the anesthesia team cannot do while they are attempting to ventilate, attempting to reintubate, etc. i'm pushing meds, i'm getting help, i'm making things run smoothly. i have never seen someone so purple-blue who is alive and well 30 minutes later.

that's a bad moment, but a good illustration of one set of skills. another set is the prevention of bedsores and pressure ulcers. positioning is a critical area of or nursing that is often overlooked and poorly understood. documentation, procuring implants, watching aseptic technique like a hawk, keeping the patient safe is my number one priority. from a distance, it may look like i'm not doing much, but my eyes are watching, and my ears are listening to everything. when things are going very smoothly, you could say that i did my job ahead of time.

as for the scrub role (which i must be able to do, too) i am also making sure that safety for the patient and the team is observed. there are tons of sharp, nasty objects on or about the field. i am assisting the surgeon(s) to focus on the task at hand, allowing the case to run smoothly and quickly. we want the incision to be open for the least amount of time as is possible. the basic defense of the body is open during surgery, and infection can easily result. i am keeping track of what is being used, and keeping things readily available. it can be calm, it can be hectic. pop a pulmonary artery, and things get hectic in a hurry! :uhoh3:

and...if you thought that was plenty, be able to do all of these things for any type of surgery: eyes, plastics, burns, pediatrics, cardiac, neuro, ortho, urology, gynecology, l&d, thoracic, ent, angio, vascular, transplant...and the list goes on. there are basic similarities between all specialties, but the finer points are endless. that is an incredible amount of knowledge (of which i have but touched the tip of the iceberg!) - it is a job i love. its not for everyone, and the differences between facilities can be like night and day. don't just take your shadowing experience from just one place and time. i think i was hooked the first time i was allowed to first assist, and i just couldn't get enough. i still can't get enough.

elkpark · Jun 9, 2005

I'm curious by what you mean by "the nurses didn't really DO anything" -- were they sitting around looking at magazines, or something? I have had limited experience in the OR, but I've never been involved in a case where the scrub and circulator weren't busy throughout the entire procedure ... I don't mean to sound like I'm criticizing you; I'm just sincerely curious. What did you expect to see the nurses doing? As the other posters have noted, nurses in the OR are active in every aspect of patient care and safety during any kind of procedure, from before the patient enters the room until s/he is handed off to PACU staff.

mcorrao77 · Jun 9, 2005

Thank you so much for your input!! I'm very interested in the OR. I find it fascinating, when I was there yesterday I couldn't get close enough too see what was going on.

I'm going to take all of your advice and shadow at several different facilities in the area and back home as well.

Thanks again!

mcorrao77 · Jun 9, 2005

I'm curious by what you mean by "the nurses didn't really DO anything" -- were they sitting around looking at magazines, or something? I have had limited experience in the OR, but I've never been involved in a case where the scrub and circulator weren't busy throughout the entire procedure ... I don't mean to sound like I'm criticizing you; I'm just sincerely curious. What did you expect to see the nurses doing? As the other posters have noted, nurses in the OR are active in every aspect of patient care and safety during any kind of procedure, from before the patient enters the room until s/he is handed off to PACU staff.

I totally agree with you. From what the other posters wrote, they are very active in patient care. I just didn't see that at the hospital I was in. It seemed to me the nurses were more interested in what was going on in their personal lives than what was happening in the OR at the present moment. The circulating nurse even left serveral times during the procedure. When the scrub nurse asked the circ. nurse for something, sometimes it took a little before the circ. nurse got it to her. It just didn't seem organized and planned ahead. I know you can't plan for everything that might happen in the OR, but to me the nurses weren't too involved with the whole process and justed wanted to know the color of the dress a nurse's daughter is wearing to her prom and things like that. I never heard them mention the patient at all expect when I asked a question. That's why I posted here and wanted to know what other OR nurses did, because I knew that's not only what an OR nurses does.

#1rnstudent · Jul 5, 2005

Hi everybody

I'm halfway through my program. I've wanted to be a perioperative nurse since before I started nursing school. Where I am, perioperative nursing is a post RN specialization. I know that most schools don't take new grads into the specialization programs, but I am aware of at least 3 that do. My question is, should I apply to the perioperative programs that take new grads as soon as I have graduated and passed the registration exam, or would I have a better chance of applying to hospitals and then trying to get into the specialty? The programs I am looking at are full-time and last about 4 months. I've spent time shadowing in various ORs and it feels so comfortable in there - I just LOVE it! :yelclap:

OBRNinTN · Jul 7, 2005

I totally agree with you. From what the other posters wrote, they are very active in patient care. I just didn't see that at the hospital I was in. It seemed to me the nurses were more interested in what was going on in their personal lives than what was happening in the OR at the present moment. The circulating nurse even left serveral times during the procedure. When the scrub nurse asked the circ. nurse for something, sometimes it took a little before the circ. nurse got it to her. It just didn't seem organized and planned ahead. I know you can't plan for everything that might happen in the OR, but to me the nurses weren't too involved with the whole process and justed wanted to know the color of the dress a nurse's daughter is wearing to her prom and things like that. I never heard them mention the patient at all expect when I asked a question. That's why I posted here and wanted to know what other OR nurses did, because I knew that's not only what an OR nurses does.

I understand what you are saying. I know you weren't being judgemental, just curious. As a fellow nursing student, I was tremendously excited about my OR rotation. I love OR nursing. But, my first case was a little disappointing as well. The circulator in the room I was in talked about a lot of inappropriate things, even about the unconcious patient, and set a bad tone for me...it really freaked me out. Now...the other cases I observed were absolutely nothing like the first. Very professional and educational. So I say, give it another try. It's fascinating, and the OR nurses do a tremendous job. As a matter of fact, I liked it so much that during my summer externship (I didn't get the OR), I have arranged to go down and "observe" for a few days. I have noticed during school to not make up my mind about something until I've given it a second or closer look. I think asking these questions of other OR nurses is a great idea, otherwise...how would we know?

mcorrao77 · Jul 7, 2005

I understand what you are saying. I know you weren't being judgemental, just curious. As a fellow nursing student, I was tremendously excited about my OR rotation. I love OR nursing. But, my first case was a little disappointing as well. The circulator in the room I was in talked about a lot of inappropriate things, even about the unconcious patient, and set a bad tone for me...it really freaked me out. Now...the other cases I observed were absolutely nothing like the first. Very professional and educational. So I say, give it another try. It's fascinating, and the OR nurses do a tremendous job. As a matter of fact, I liked it so much that during my summer externship (I didn't get the OR), I have arranged to go down and "observe" for a few days. I have noticed during school to not make up my mind about something until I've given it a second or closer look. I think asking these questions of other OR nurses is a great idea, otherwise...how would we know?

Thanks for understanding caffeinatedstudent. I actually got my last rotation for my senior clinicals in the OR. Hopefully, it will give me a better understanding of the whole process. I graduate Aug. 12 and counting... Good luck with your nursing classes! :)

Jimmedda · Jul 13, 2005

When I was an OR tech at an Army hospital the nurses were very busy. Try to look into Military Nursing. Maybe it will be different

Marie_LPN, RN, LPN, RN · Jul 13, 2005

The circulating nurse even left serveral times during the procedure.

Left for what is the question?

Our fluid warmers are kept outside of the room.

Certain specialty sutures are kept out of the room.

ortess1971 · Oct 7, 2005

I totally agree with you. From what the other posters wrote, they are very active in patient care. I just didn't see that at the hospital I was in. It seemed to me the nurses were more interested in what was going on in their personal lives than what was happening in the OR at the present moment. The circulating nurse even left serveral times during the procedure. When the scrub nurse asked the circ. nurse for something, sometimes it took a little before the circ. nurse got it to her. It just didn't seem organized and planned ahead. I know you can't plan for everything that might happen in the OR, but to me the nurses weren't too involved with the whole process and justed wanted to know the color of the dress a nurse's daughter is wearing to her prom and things like that. I never heard them mention the patient at all expect when I asked a question. That's why I posted here and wanted to know what other OR nurses did, because I knew that's not only what an OR nurses does.

The thing about the OR is that the situation can change very quickly so it may have looked like they weren't prepared. Circulators do have to leave sometimes. I find too that many students hear negative things about OR nursing from their instructors and I think this colors their view of the OR to a degree. Like I said, your critical thinking skills are important because anything can happen.