Ask an OR nurse (Questions about what we do or how to become one of us)

jdenni12 · Oct 1, 2015

How convenient I stumbled upon this post just as I was thinking of getting into OR! I'm a new nurse, with six months of tele experience and I'm seriously thinking of getting off my floor. I switch between wanting to do ER and OR. I know I really loved my opportunities to go into the OR whenever I did my clinical rotations. A few questions:

How to make yourself attractive to potential employers, when you have no OR experience?

What are the hours like?

How to best prepare yourself while on the job to learn the various instruments and such (we don't cover OR nursing in school-just the sterile aspect of it)

What would be considered an appropriate orientation time for a new nurse who has no OR experience?

Editorial Team / Admin · Oct 1, 2015

How to make yourself attractive to potential employers, when you have no OR experience?

I'll admit that this is kind of a difficult question. When I was hired, it was the tail end of the "you have a license? when can you start?" nursing shortage in my area. However, I do recommend (and this is general new grad/new specialty advice) that nurses seriously interested in working in a specialty join the professional organization. For OR nurses, that would be AORN (Association of periOperative Registered Nurses). Meeting attendance can lead to networking opportunities, getting your name out there, and demonstrating to those who do the hiring that you are truly interested.

What are the hours like?

This will vary by facility. Some facilities are not trauma centers and do not staff after certain hours. Some facilities are trauma centers and staff around the clock. My facility offers 8, 10, and 12 hour shifts. The bulk of the staff work day shift, a smaller number works second shift, a few work mid-shift (11a-7p), and a select few work nights. For cases that overrun or are added on during the later hours, we have call staff available to come in. Because we are required to have at least 1 scrub and 1 circulator available at all times for traumas and emergencies, staying late or having to come back in when on call is a routine occurrence.

As far as hours, there are some questions to ask at an interview:

1. Will you only work 1 shift or be expected to work some off shifts? My department's second shift staff is a mix of those who are permanent second shift and those who are rotated off of days for a set number of shifts per month.

2. What are the call expectations and policies? How much call is required in a set time period? Many facilities have a relatively short response time, such as 30 minutes from time of call to expected to be in the OR ready to accept a patient. For some of my coworkers, that has meant staying with a friend or in a hotel when on call because they live farther than 30 minutes away.

How to best prepare yourself while on the job to learn the various instruments and such (we don't cover OR nursing in school-just the sterile aspect of it)

Spend some time in the sterile processing department (SPD). Not so much in the decontamination area but in the set assembly area- this can help you not only learn names of instruments but also what instruments are in what sets. In fact, part of my orientation was a full week spent in SPD. If you work only in certain specialties, see if you can get a list of the most commonly used instruments, and look them up for what they are used for and other names they are called- some instruments go by more than one name. A Kocher clamp is the same instrument as an Oschner clamp. And that doesn't include surgeon pet names.

What would be considered an appropriate orientation time for a new nurse who has no OR experience?

A good OR orientation should last several months. Many facilities have 6-9 month orientation programs for those new to the OR. Can some get by on less orientation? Yes, but I don't think it's wise. My own orientation was 6 months one-on-one with another nurse followed by 3 months solo with a resource nurse available for 3 new nurses. Even when changing specialties, I had another 12 weeks of orientation.

guest769224 · Oct 1, 2015

So, what would you like to know about OR nursing?

What is the most difficult, challenging, or complicated thing that OR nurses have to deal with on a daily basis?

Do OR nurses have trouble switching specialties because of it being so specialized?

Why do so many OR nurses stay settled in the OR for their career? I assume this has to do with only ever having a single unconscious patient at any one time?

Editorial Team / Admin · Oct 1, 2015

What is the most difficult, challenging, or complicated thing that OR nurses have to deal with on a daily basis?

You'll probably hear every OR nurse say something a little bit different to answer this question. For me, it's probably the attitudes you'll encounter. While there are those with "strong" personalities in every area nursing and every job in general, it's been an anecdotal consensus that the OR attracts those who have such "strong" personalities. It can be the surgeons, the anesthesia providers, nurses, surgical techs, or anyone else who works in the OR.

Do OR nurses have trouble switching specialties because of it being so specialized?

I've never personally changed specialties from OR to anything else, although I've made changes as to what specialty team within the OR I'm working with. However, I have worked with other OR nurses who have successfully transitioned into other areas of nursing such as primary care, ICU, med/surg, hospice, and a few others. It's more likely to depend on the support offered in the new specialty.

Why do so many OR nurses stay settled in the OR for their career? I assume this has to do with only ever having a single unconscious patient at any one time?

One of the OR sayings is that you either love it and never leave or hate it and can't wait to escape. In fact, I work with at least two staff members who have been working in my OR since before I was born (and one since before my parents even met!).

Yes, it's nice that it's one patient at a time (and they aren't always asleep- there's always the possibility of cases done with local anesthesia or conscious sedation that don't involve anesthesia providers) and that families are only seen briefly. However, there's so much more that's great about the OR- good teamwork with your coworkers and just a general interest in the job itself.

Mavrick, BSN, RN · Oct 1, 2015

I work in the PACU and get patients delivered to me from the OR with a report something like, "I just relieved the nurse, I don't know anything about this patient". Do OR nurses not have to know anything about their patients or am I just a lazy PACU nurse that is not willing to look all that stuff up myself in the 0.3 seconds I have before the patient is now in my care?

OK, there is a little sarcasm in with a perfectly good question. I have never worked in the OR and though I may be a competent PACU nurse I would not begin to think my nursing skills translate to OR nursing. When I have been recruited and helped on occasion I was perfectly content to be the trained monkey that opens packages and hands stuff to the scrub tech. It does seem that basic nursing skills are not a major part of what they need to be successful. This is my observation.

Editorial Team / Admin · Oct 1, 2015

I work in the PACU and get patients delivered to me from the OR with a report something like, "I just relieved the nurse, I don't know anything about this patient". Do OR nurses not have to know anything about their patients or am I just a lazy PACU nurse that is not willing to look all that stuff up myself in the 0.3 seconds I have before the patient is now in my care?

Not the best practice. I may not get a full report on how the patient was preop unless there's something important (such as patient has a phobia of having anything over their face- go with nasal cannula or blow by if you can) but to say I don't know anything about this patient is unacceptable. We have SBAR report forms that travel with the patient throughout their surgical experience (preop to OR to PACU) that should make a report between OR nurses easy. Now, we do have key points- allergies, procedure, antibiotics, dressings, drains, things like that. I'm not much concerned that the patient had a hernia repair 30 years ago unless it affects the current surgery.

My report to PACU consists of:

Surgeon and procedure

Allergies

Antibiotics

Dressings

Drains

Any local anesthesia injected

Any special instructions (chest tube to -20 suction for example)

My facility does have patients assigned as soon as we call into PACU that we've finished surgery. That gives the nurse about 5-10 minutes to get into the EMR (depending on just how quickly the patient wakes up) and get the pertinent history. We do have a summary screen that gives the bulk of the information that we also verbally report.

guest769224 · Oct 1, 2015

Is OR nursing ever boring?

Mavrick, BSN, RN · Oct 1, 2015

I really appreciate starting with a "Who and What". In my PACU we get assigned a number as in "You get the next one, and you get the second one etc" I have no idea which patient I get until they roll into my bay and it's a scramble to get 'em hooked up to the monitor.

It wouldn't work to say "that's unacceptable" when I get the dismissive "not my problem" attitude as they run off to turn over the room. Probably more the culture of the OR where I work but it just leaves a bad image of the OR nurse as a glorified go-fer.

Please forgive the use of that term but I do hear it and wish it weren't said. I follow your posts so I know you are not that type but there are a fair number of practicing OR nurses that leave that impression.

Editorial Team / Admin · Oct 1, 2015

I really appreciate starting with a "Who and What". In my PACU we get assigned a number as in "You get the next one, and you get the second one etc" I have no idea which patient I get until they roll into my bay and it's a scramble to get 'em hooked up to the monitor.

That sounds like a not so great setup. I do like that in my facility the nurses at least know who and what.

It wouldn't work to say "that's unacceptable" when I get the dismissive "not my problem" attitude as they run off to turn over the room. Probably more the culture of the OR where I work but it just leaves a bad image of the OR nurse as a glorified go-fer.

Agree that it sounds like the culture where you are. And sadly, there are many who view us OR nurses as a glorified go-fer.

Please forgive the use of that term but I do hear it and wish it weren't said. I follow your posts so I know you are not that type but there are a fair number of practicing OR nurses that leave that impression.

Sometimes we are our own worst enemies.

Editorial Team / Admin · Oct 1, 2015

Is OR nursing ever boring?

Just like with any job, there are crazy busy days and crazy slow days. Last year on Christmas Eve, I sat in my empty cardiac OR twiddling my thumbs. I had to be there as a member of the call team (everyone else took low census and stayed home) but we had no cases to keep me entertained, I had already finished all of the mandatory annual online learning modules, the rooms were stocked and outdates checked, and there truly was nothing else to do. Not a frequent occurrence, but not unheard of.

During some of the longer cases (and working in cardiac, I do get some long cases), I've surfed the local newspaper's webpage, checked my work email, copied the crossword puzzle out of the newspaper and worked on it when I've completed everything I can to stock my room, documentation up to date, the scrubs have everything they need, and there's just nothing else to do but sit and stare.

Then again, I also have those crazy days where I'm working with our fastest surgeon (door to door on a multi-graft CABG can be as little as 3 hours) where we finish, turn over the room, lather rinse repeat. Or we might have some small cases that sneak into our schedule like sternal wire removals. Or, we might see the brown stuff hit the oscillating blades.

I've actually been in a room with a patient ready to start surgery where we have to abort so the surgeon can run into another room where a surgeon or interventional cardiologist perfed the heart and we have to do an emergency repair. Or we get an aortic dissection or trauma where we scramble to get a scheduled patient where we haven't made an incision to PACU on a vent and reset before the emergency patient codes and dies. I've actually had an emergency patient on a litter outside the OR as they were rolling out with the cancelled patient. As soon as the mop whisked out the door, I was pushing the patient in.

guest769224 · Oct 1, 2015

What are the OR nurses specific duties during a code blue?

Who pushes the code drugs?