Hi all-- thank you for reading this, if you are.
I am new to the OR, started the day after Memorial Day for a 6 month orientation. I came to the OR after 6 years of step-down/telemetry unit. Sometimes I miss working the floor... and then I think I must be crazy because I was really ready to leave it when I left it!
There are 6 full time OR nurses where I work. 2 of them are relatively new RN's with about 2 years experiences each. Another one is a seasoned pro with more than 20 years OR experience, but she only works weekends and has only been working at our facility for a little while longer than the 2 brand new nurses.
There is another nurse who has been at the hospital as long as I have been there. And then there is a PRN nurse, and a full time traveler.
And then there is me.
I don't know what to say about myself except that I think I was good as a floor nurse, or at least I became the best I was going to be. In 6 years, no one ever died on my watch, (some tried, but failed!) and I often got presents and cards from patients and their families. I loved my patients, and I almost always had a good rapport with them. I think for a floor nurse, those are the things you hope to acheive. But I always felt... well, My morale was often low, despite the gifts and accolades from patients.
So, I switched to the OR after trying it out for a few days, and really liking it.
The OR presented me with a challenge and an entirely new culture, and a whole new way of nursing that was refreshing. Plus, Morale seems to be good for OR nurses!
The few days I spent just checking it out made everyone think I'd be a good fit for this. It helped that I worked as TA for Anatomy classes in college.
And now, here I am, 7 weeks into training (well 6 actually because I was off for the week of the 4th for a family reunion) and there are days when I feel like a total idiot. And what is worse, is I think everyone else thinks I am one too!
Yesterday my charge nurse and the surgical services supervisor talked to me about how I am doing: they had heard some concerns from a couple of the nurses who have been precepting me. One was my sterile technique.
Ok, this is something I know I have to work on. I have some habits left over from 6 years of doing things a certain way... on the floor, if the corner of a foley box touches the patients leg, it's no big deal because the part that is going into the patients bladder, and my hand, are still sterile. After all, the floor "is not the OR." So yeah, things were more loose in that department. But now, starting a foley is hard. I could do them so easily before, and now, I have had to throw away so many boxes because... I'm an idiot who doesn't listen, apparently.
I swear that I am NOT an idiot, and I swear that I know I don't need a TPS for a hysterectomy, and I know how to work a jackson table and what the benefits of a Jackson table are (mostly C-arm ability, and also being able to flip a patient prone). I GET it. I do. after 7 weeks, I think I get more than I don't get.
In know how to open and give to the field while maintaining sterility. I know how to chart everything because it's the same charting system on the floor. I know how to order, and do a time out. I know when to do a time out, and I have a loud voice. I know that cautery always needs to be grounded and this includes the Malis, and I know what the malis is compared to a megadyne. I know how to hook up the foot pedal and what we use that for. I know about the H frame, the Wilson Frame, the Gel rolls, mastisol and cloth tape, about bucks traction and the gardner wells.... I know about scopes and insufflation and lights... someone quiz me! If I had to take a 7-weeks competency test, I know I would Ace it!
But then I get called in to talk to the charge nurse again today who basically tells me that the traveler who I got the benefit of being precepted by complained about me because I didn't take my jacket off when prepping a patient. She said I just "Don't listen". OK, well, yesterday when prepping a woman for hysterectomy, I DID take it off because I had to stand in between her lithotomy legs position and it's a small area and the jackets are kinda bulky.
But today, I guess I didn't even think about it. I prepped only one case, It was an anterior cervical spine fusion. I was wearing lead over my scrubs already. I also was wearing a size smaller jacket than normally. there wasnt anything dangling and the prep area was pretty small, just used about half a Chloroprep stick. She was cheerfully beside me while I prepped... what I was wearing wasn't on either of our minds, I know it wasn't.
Anyway. the travel nurse is a good nurse. She is really organized and I respect her work. I requested that she train me, if possible. I am dismayed that she didn't come to me with this feedback.
I was getting sometimes every nurse as a preceptor all in one day. It was crazy making because they all said different things, no one knew what I new, and they all treated me like I was a complete moron with instructions on how to take a patient to the bathroom, when I needed to don gloves, and things like that. Or how to transfer a patient from gurney to bed...stuff every CNA knows.
Sorry-- I am just frustrated with no one to turn to. I have invested a lot of hope and energy into this new venture. And instead of feeling welcomed, I feel like I am being chased out.
I don't want the new-ish nurses to train me-- one of them is very nervous when I am in the room with him, and it makes me nervous that he is nervous. The other one is very nice, but doesn't totally have his game together. The gal who has been at the hospital there as long as me is often busy with cases that aren't good for a newby to participate in (robotic or otherwise), and she kinda acts like she resents the extra work having to teach me. There isn't anyone warm and willing, who is competent. The traveler is actually the best nurse we have, and so I asked if I could just stick with her.
She said today that she didn't want to be training me becasue she doesn't know the hospital's particularities and policies, etc. This is a good point. But then she went and told the charge nurse that I don't listen!
I don't get it. I asked her after lunch if I had done something wrong becasue she was mad at me for not being there to position the patient. I had gone to lunch after getting the room ready and interviewing the patient (she was at lunch while I finished up the previous case and took it to the PACU). My lunch was not long and I returned to the room I had prepped after eating, as I was instructed to do so by the charge.
She said "You just missed the most important part. It's the positioning that you need to do." I didn't know what to tell her. I guess I wasn't supposed to take a lunch then. Obviously.
And she had no idea that I had actually done that positioning before... a few times. Granted, I can always learn more, but... how can I communicate to her that #1 the charge told me what to do, so that is what I did. and #2, maybe it isn't a super huge deal that I missed the positioning since I had, technically, helped with it 2 times before? I would love to have been there for it. But... I also get told to LISTEN and I show that I can listen by doing what I am told to do, which at that time was "go to lunch". Lucky me, I can't win.
Look, I care about my training here. In just 19 more weeks, if I pass (in the eyes of my coworkers/preceptors), I will be on my own. Yet, I have NO measuring stick to tell me how well I am doing. No checklist, and no one single preceptor who actually gives a dang and knows I'm not a flibbetygiblet! Or who knows that I have already been taught XYZ, but might still have questions.
I feel like I"m drowning and no one is throwing me a rope. I don't give up easily, and I ASKED for this experience because I wanted a challenge. Buy my challenge thus far hasn't been with medical know how or actually running a room. It has been with convincing my preceptors that I'm not a moron!
O, and then, I made a joke. Lots of joking going on in the OR at my hospital. It wasn't a good joke, and it wasn't one, in retrospect that I should have made. But I am trying to fit in and learn this culture.... Lots of crass talk, lots of sad fun-poking about crazy people or fat people. Hey! At least my joke wasn't one of those. They are just as valid human beings in my mind as diplomats are.
So, my question is-- how do I deal with this? I feel like I've talked to my charge nurse about it, and she basically has no advice. Just that they will continue to watch me and make sure I'm getting it.
But how can I prove myself when no one trusts me to do a thing without barking out orders at me?
They say "If you have any questions, just ask!" So I do and they look at me like I'm dumb. Or they say "After you get the patient on the table, stay there by their side to help intubate" but then they snap at me and accuse me of not listening because I didn't get the SCD's, which are on the boom, hooked up before the patient was under.... and then I get the lecture about how SCD's need to be on BEFORE sedation occurs...I know this, but they just said not to leave the patient's side to help with intubation! And they were there with me setting up the room. They knew where the SCD machine was, and it wasn't a problem. Some of my preceptors hook them up afterwards.
I feel like I can't win. I feel like a brand new nurse all over again... remember that? Coming home, crying at least once a week? Wondering what we had gotten ourselves into? Wondering if we should just quit?
Anyway, thanks for listening. I ranted a lot. I really do'nt have anyone I can talk to about this, and I don't remember what I did as a new nurse to survive it. It seems to me like I just kept showing up and after a while, the tension went away.
Hope you all are having a grand day!