Self-driven training

[ChristineAdrianaRN, BSN, RN]

Hey all!

I started my new job (circulating and scrubbing) July 11, but after a couple weeks of system/hospital/nursing/pediatric nursing specific orientations and CPR recert and tours and all that jazz, I actually really started in the OR the 25th. So I'm finishing up my second week of actually being in rooms.

I LOVE IT. I am so happy here so far.

My problem is my training. I know this isn't unheard of, but there isn't much of it going on. As a note, I am not a new nurse (worked for a year on a med/surg floor) but I am completely new to the OR. My educator told me point blank that she doesn't want me in Periop 101 because she heard from other new people that it doesn't help them much. So I asked what the alternative is, and she didn't really have one. I told her that I learn well with textbooks, taking notes, visuals, etc, and she said she has a book that she says she'll lend me, but she wants to pick out the chapters I need to read; however, she said that in the beginning and she still hasn't gone through it yet. I guess I'm going to have to keep on her about it because the book had some great drawings of instruments and whatnot and I think it would really help me.

She's has me scrubbing first because I told her that's what I need to focus on (I circulated a couple times and it doesn't seem all that difficult; it comes pretty naturally since I'm used to charting and whatnot). She went through sterile technique/scrubbing in and all that one-on-one with me, and, since she's starting me in ENT, went through T&A, BMT, and basic trays and explained all the instruments. That was really great and helped a ton when I actually went to do those surgeries.

Since then, she's just had me in the ENT room with no other formal training. I've got the T&A and BMT scrubbing down pat. I'm ready to move on. We've been getting several tympanoplasties and I didn't really feel like I was learning it just watching the scrub person do it. So I went to her personally and essentially got the idea that she really has no plan for me at all. I told her how helpful it was when she went through the other trays with me, and that I really want someone to sit down with me and go through all the instruments needed for a tympanoplasty. She kind of blew me off. Okay. So I told the nurse I was precepting with today how important it was to me to do this, and we ended up just making it a priority to really explain things to me step-by-step during the procedure and drill me on the instruments. It was helpful, albeit frustrating that I had to coordinate this training on my own without my educator's support.

So I'm figuring that I may just have to give up on getting formal training from my educator and figure out things on my own. It is what it is. I'm gonna do what I have to do, because I really want to learn this stuff.

My educator was talking about kind of bouncing me around to different services as needed, and I put my foot down on that. My orientation is a year. There should be no problem with keeping me in ENT until I am confident on scrubbing those surgeries on my own before moving me onto the next (which won't take that long if she would just work with me!). ...Right?

I forgot to do it today, but I plan on printing out some preference lists and instrument lists from the trays. The only issue with that is I need the visuals to go with the names.

I was thinking about taking photographs of the set-ups so not only do I have the visual of what the actual instruments look like, but where they physically go on the mayo and back-table. Is that overkill...?

Any other ideas or references you can think of that may be helpful?

I posted a little while ago about books I could learn from, and I was told to not worry about it because my educator will provide all my training. I know it SHOULDN'T be this way. I know I shouldn't have to learn on my own time and my own dime. And maybe some of you might think that I should be more adamant about getting formal training. But when I'm trying to coordinate with her, it feels like I'm talking to a brick wall sometimes (there is a bit of personality deficit with my educator that I won't get into detail, but this whole orientation problem starts with the fact that on the first day I met her, she told me she hates her job and she never wanted it in the first place....ahem.)

So there's where I am. I'm not deterred one bit by this. I am very excited to be here and motivated to learn. And I'm gonna do whatever needs to be done, even if it's sitting here in this coffeeshop trying to remember what the heck I saw today and transcribe it into notes. I *will* learn this!

Thanks in advance for your advice. :)

[PureLifeRN]

Hey all!

She's has me scrubbing first because I told her that's what I need to focus on (I circulated a couple times and it doesn't seem all that difficult; it comes pretty naturally since I'm used to charting and whatnot).

Was with you until I reached this point....circulating is extremely important and can be very challenging. Don't be so quick to concentrate on only scrubbing, circulators take charge of the room and have multiple layers of responsibilities. Just sayin....

[TakeTwoAspirin, MSN, RN, APRN]

Push for them to sign you up for the AORN's periOp 101 course, regardless of what this woman says. If she is unwilling or unable to train you then this course will help you learn what you need to know, both from a scrubbing and circulating perspective. If your facility won't sign you up, perhaps look into purchasing the course yourself. It's not cheap, but it is good and will give you a foundation to build on that is evidence based. Right now you run the risk of learning only "the way we've always done this" which is OK, but you need to know the EBP way first.

Buy yourself a copy of Alexander's Care of the Patient in Surgery and start reading, from cover to cover. You will need to know all of it, not just a chapter or two that someone else thinks is important for you.

I know some people will say you shouldn't be responsible for doing all this for yourself but you are responsible for your own license and if you continue to learn in the way you are I see problems looming down the line for you. If you can't change your employer, or motivate the educator, then you had better start looking our for yourself!

[ChristineAdrianaRN, BSN, RN]

Was with you until I reached this point....circulating is extremely important and can be very challenging. Don't be so quick to concentrate on only scrubbing, circulators take charge of the room and have multiple layers of responsibilities. Just sayin....

I didn't mean to make it sound like I was invalidating the importance of circulating. Of course it's an extremely important role. I should add that there is apparently no need for circulators in this department, but they are short on people to scrub. A lot of the nurses have requested that they only circulate, so I feel like it is important to solidify my skills in scrubbing early on because of the need and because I think it will take longer for me to learn how to scrub than it will take me to learn to circulate, basing off of what I know my own experience and personal strengths and weaknesses are. I don't intend on brushing off learning how to circulate. I circulated today, and I gave it just as much reverence and focus on learning how to do as I do the scrub role.

[canesdukegirl, BSN, RN]

I could have written your post when I first started in the OR. My 'orientation' was awful. There was no real nurse educator, but a staff member that was allowed to run roughshod over all of the new orientees. Her idea of teaching new staff was to assign each of us to a nurse, give the nurse a performance evaluation sheet to fill out at the end of the day (mind you, we had absolutely no training, but were expected to perform the duties on the evaluation sheet), and then leave the room to go play with her friends. The nurses that we were assigned to were resentful of the fact that they had to teach, and they let us know it. I was thrown into cases after the first week to do them ON MY OWN, with the rationale of 'see one, do one, teach one'. I had PACU and Med/Surg experience...that's it. The staff at this particular hospital were not willing to help out, and were very jaded. I hated it. The morale totally sucked, and I felt that my license was in jeopardy because I was expected to care for patients in a setting that I was completely unfamiliar with. The acting NM had no idea what she was doing, and the OR itself had gone through 3 different NMs in a span of one year. I left that hell hole after 3 months and was immediately hired at another OR. The NM that interviewed me knew about the horrid conditions of my former OR and totally understood why I left. She even high fived me!

I digress.

This is what I did:

I went to the local community college and looked at their clearance texts for surgery. I bought 4 books for maybe 10 bucks a piece. These books were invaluable to me, and I was able to pour over them at my own pace. I was very motivated, just like you are, and didn't mind doing this learning on my own.

Then I got a small palm-sized notebook and divided it into services. Under each service, I further divided into each surgeon. Then I subdivided that into each procedure. I took this notebook with me everyday and made notes right after the case so that I wouldn't forget. Sometimes you will have a preceptor that also carries a notebook with them, and most of the time are delighted to have you copy their notes into your notebook. SCORE!

For each procedure I listed instrumentation, supplies, suture, dressings, positioning requirements and medications needed. Then I added preferences such as "only likes LP gowns, doesn't like music, call for the next pt when the specimen comes out, likes bovie and suction at the foot", etc. I also listed their MD ID#, pager # and glove size on the face of their particular divider.

Sounds like you want to take the bull by the horns and not depend on a slacker educator...good for you. When the surgeon is yelling at you for not knowing what something is, you aren't very well going to say, "Well my educator didn't give me the book I need to learn what instrument you are talking about!" You will just look like a bumbling fool, and the surgeon couldn't care less about what sort of orientation you received...and truthfully, s/he shouldn't have to. His/her focus is getting the surgery done and the patient off the table. The surgeons SHOULD be able to rely on the OR staff to know their jobs. I don't fault them in the least for this very reasonable expectation.

Which leads me back to the crux of your issue: our educators need to step it up. They should be a whole lot more visible. If the job is too much for them, then the job needs to be split up so that each orientee is assigned one "nurse mentor". I have seen this at many hospitals. The nurse mentor is the person who supports you, talks through issues with you, gives you 'tips and tricks', tells you what to avoid, what to be proactive about, and gives you pep talks when you feel like giving up after a long, hard, confusing day.

I admire you for taking on the task of learning on your own. I know that you can do it. I did it, and I am the consummate airhead.

Please don't hesitate to PM me if you need additional help/resources in which to learn. I would be glad to help.

[4_Sq]

There is nothing like a good post grad course in OR to start you off on the right track.. you want to learn excellent habits, technique from the beginning.

Get yourself a copy of the AORN standards & review them.. It is nice to have a formal training & from that you can guide your practice.

I would insist on some sort of plan if at all possible.

There are many good websites where you can learn some of the surgical techniques etc.. you should check this out as well.

All the best, hope you love your new career.

[ChristineAdrianaRN, BSN, RN]

canesdukegirl, I'm so glad you replied to this post. You always have such great advice. I went into my first day with my Handy Dandy Notebook thanks to advice of yours I had seen before. I take all those notes at work and scribble them down and then type them up into something legible when I get home. =] Yesterday I was stressing because they wanted me to scrub into this big case and I was like "waaah I can't take my notebook!" so the circulator suggested I open a sterile pen and take notes on the back of my sterile gloves paper. Hehe, it worked just fine!

BOXRLUVR, do you know of any of these specific websites?

Thanks everyone!

[4_Sq]

Specific sites I know related to Ortho are Synthes, Sythes , and from there you can look at a number of surgical techniques.

I mainly go by the companies whose equipment I work with and some more examples of those might be Zimmer,

Smith & Nephew, Stryker & so on.

You simply need to create sign on with username & password & presto.

Spine is another interesting place to go. Look up synthes skeletal simulations, & work through those once you are doing ortho.

Then for good measure start looking @ what is available for resources in CV & Neurosurgery..

The opportunities for learning are endless.

Good luck in your search.