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

[Rose_Queen]

I've gotten a couple of PMs from members asking about a job as an OR nurse. In the interests of sharing those questions with anyone interested in a career as an OR nurse, I thought I'd start a thread for those questions to be posted. I'll check in regularly and answer the ones I can, and I'm sure the other regulars here in the OR forum will share their knowledge as well.

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

Edited to add: Tips for new operating room nurses

Edited again to add: Soooo, you're observing in the operating room (O.R.)...

Edited yet again to add: What do Operating Room Nurses Do?

(I just keep refinding older threads that are good resources)

[Rose_Queen, BSN, MSN, RN]

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.

Mavrick, I started this thread with the intent to guide nurses and students interested in a career in the OR. Nursing skills are just tasks- a trained monkey can indeed do them. It is the critical thinking behind those tasks that sets nurses apart. Your comment that basic nursing skills are not a major part only perpetuates specialty wars and that certain specialty nurses aren't real nurses. Outsiders don't really see the nursing care that goes on in the OR. Yes, I assess my patients. Yes, I pass medications. No, I don't titrate drips or do some of the other things other specialties do. But they also don't do a lot of what I do.

I will grant that you do have some issues at your workplace that need worked on; perhaps that can be another thread instead of a derailment of this one?

[Rose_Queen, BSN, MSN, RN]

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

Generally, a facility should have a delineated role for each person who responds to a code blue (or as it's called in my department, an anesthesia stat response as most of our "codes" are airway issues). We do have specified roles in our policy:

surgeon- continue operating or at least get to a point to stop if possible

surg tech- maintain sterile field, assist with compressions if chest is draped

pt care asst- compressions if not sterile

RN who comes from outside the room- document

anesthesia- meds, airway

On day shift, we get quite a few extra bodies, sometimes to the point we need to kick people out. Nights, sometimes we have to call PACU for help

Who pushes the code drugs?

Anesthesia's role is to manage the airway and give drugs. We always have at least 2 anesthesia providers during an anesthesia stat response. Usually all of them not physically in a room with a patient come running. Again, since most responses are actually airway issues, traditional code drugs aren't as common as anesthesia drugs such as paralytic agents, paralytic reversal agents, or other drugs that would be used during emergent airway issues.

[ruralgirl08]

Hi Maverick, I work both OR & PACU. During handover from OR to PACU. The OR nurse should know alot about their patient. As you would, when you hand your patient off to the Inpatient units or phase 2. Though as an OR nurse I would not be covering the detailed drug regime Anesthesia provided, I know what anaesthesia was used (blocks, general, local, ect.) any unusual occurances, difficult airways, ect. OR nurses mainly focus on the surgical experience, but we also assist anaesthesia during intubation/extubation, lines. It is NOT acceptable to not know your patient during handover to PACU.

[cocoa_puff]

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

I'm a second year nursing student, and I'm interested in becoming an OR nurse (specifically cardiac surgery). I have a one 12-hour clinical rotation in the OR this semester, and I really want to make a good impression on the nurse manager and let her know I'm interested (they do hire new grads).

Here are my questions:

1) How can I make a good impression? :) What would you look for in a student who wants to be an OR nurse?

2) I know training to be an OR nurse takes 6-9 months, is it possible to do an online RN-BSN program at that time?

3) I'm sure it depends on the hospital, but are weekends/holidays usually required as an OR nurse (not that it really matters to me, just curious!)

4) Is advanced education possible as an OR nurse? I would like to become a nurse practitioner and assist in surgery (like RNFA but as a NP?). Do they have positions like that available for NP?

Thank you! I'm sure I'll have more questions later!

[tnbutterfly - Mary, BSN]

This a great thread!! Very informative.

[Rose_Queen, BSN, MSN, RN]

1) How can I make a good impression? :) What would you look for in a student who wants to be an OR nurse?

Be attentive. Don't be that student that sits on a stool and stares into space or falls asleep (yes, that really happened).

Ask questions at appropriate times. When the nurse is counting, anesthesia is inducing or emerging, during the safety pause (universal protocol- good thing to look up), or any other time the nurse or other staff are doing something that requires attention are all examples of bad times to interrupt and ask a question. Go ahead and write them down so you don't forget and ask at a time when it's appropriate.

Be aware of your surroundings. If it's sterile, stay a minimum of 18 inches away. Yes, you'll see us get a bit closer at times, but you're an unknown and we just like that extra visible space.

Eat breakfast. It's important to help avoid fainting. And if you do start feeling faint, get your buns on the floor. We'll pick you up if need be, but it's better than you trying to leave the room and falling into something you shouldn't. It's not that uncommon for those who haven't set foot in the OR to feel faint, so don't be that embarrassed.

Check out this wonderful thread started by Marie, LPN, RN:

Soooo, you're observing in the Operating Room (O.R.)...

2) I know training to be an OR nurse takes 6-9 months, is it possible to do an online RN-BSN program at that time?

I would think a lot of this depends on the person and their ability to take on a lot. While on orientation, it is wise to spend some time at home preparing and researching. I don't think it would be as much time as a full credit course, but some time outside of work should be dedicated to work's homework. Some people can do it, and some will buckle under the stress. I would definitely not advise starting orientation and an RN-BSN program at the same time- any person starting a new job should give it their undivided attention for at least a brief time period (personal opinion).

3) I'm sure it depends on the hospital, but are weekends/holidays usually required as an OR nurse (not that it really matters to me, just curious!)

Yes and no. I don't routinely work on weekends in my specialty, but I am required to take call on every 4th weekend. Sometimes (like tomorrow, when the surgeon has scheduled a case that doesn't need done right this moment but can't wait until Monday), I do work during those weekends.

However, our non-cardiac OR folks work every third weekend. It's a combination of 3 shifts, which is a mix of working and covering a block of call (8 hours).

Depending on the trauma status of the hospital and its staffing model, you may find yourself only covering call for emergencies on the weekends you are assigned, you may work shifts on a weekend, or if it's an outpatient center you may not have any responsibility to cover weekends at all.

4) Is advanced education possible as an OR nurse? I would like to become a nurse practitioner and assist in surgery (like RNFA but as a NP?). Do they have positions like that available for NP?

This will depend on both the facility and the surgeon groups who operate. We have a few groups who employ NPs or PAs who assist in surgery. Others, the surgeons fly solo and we provide a second scrub who helps do things like hold retractors and suction (these duties are generally spelled out by facility policy- they are expressly prohibited from using the electrocautery, firing intestinal or lung staplers, or suturing). We did recently begin hiring RNFAs and CFAs for certain cases like robotics- only a surgeon, PA, or first assistant may change out the instruments on the robotic arms. They are also utilized in other cases if available for surgeons who don't have their own NP or PA to assist. As a non-teaching facility, we do not have residents involved at all.

Thank you! I'm sure I'll have more questions later!

Ask away when you think of them!

[cocoa_puff]

Rose_Queen, thank you so much! I can't wait to experience the OR! I have a few more questions:

1) Are new OR nurses generally trained to circulate and scrub?

2) Do OR nurses ever get pulled to the floor (med-surg, for example) when there are no surgical cases or if staffing is low in the other units?

3) How is the mobility in OR nursing...can an OR nurse easily transition from a hospital OR setting to an outpatient surgery setting (or vice-versa)?

Thank you again! :)

[Rose_Queen, BSN, MSN, RN]

Rose_Queen, thank you so much! I can't wait to experience the OR! I have a few more questions:

1) Are new OR nurses generally trained to circulate and scrub?

Depends on the facility. A facility that hires mostly nurses will likely teach them to scrub. A facility that relies heavily on surgical techs will probably be less likely to do so. My facility does not train nurses to scrub. There are some who were surgical techs prior to nursing school who fill in when we need extra scrubs, and some of the nurses on the cardiac team will scrub as a second assistant.

2) Do OR nurses ever get pulled to the floor (med-surg, for example) when there are no surgical cases or if staffing is low in the other units?

Not sure how it is in all facilities, but in mine the OR is a closed unit. We don't float out and nurses from other units don't float to us. Can be kind of a double edged sword as there are some days we are rather short staffed and the charge nurse is attempting to run the schedule while simultaneously circulating in a room. On the other hand, if we have a low case load, people either volunteer for a low census day or are instructed not to come in (involuntary low census day) even if other departments need help.

3) How is the mobility in OR nursing...can an OR nurse easily transition from a hospital OR setting to an outpatient surgery setting (or vice-versa)?

Thank you again! :)

I've never done it personally, but we have had many nurses leave us when some of the surgeon groups opened their own same day surgery centers. I've also seen nurses leave and go to other specialties.

And you're quite welcome!

[springchick1, ADN, RN]

1) Are new OR nurses generally trained to circulate and scrub?

At my facility, you are trained to circulate first. After you have circulated for at least a year on your own, then they will start training you to scrub.

[Rose_Queen, BSN, MSN, RN]

At my facility, you are trained to circulate first. After you have circulated for at least a year on your own, then they will start training you to scrub.

And this demonstrates how facilities can be very different and why it is a good idea to get that kind of information in an interview- remember, they are interviewing you, but you are also interviewing them. Prepare a list of questions ahead of time and have them written so that you don't forget what you wanted to ask.

[MereSanity]

I love the OR...been there for 8 years now. Call us trained monkeys but the trick is to think three steps ahead of the surgeon and scrub (helps to know how to scrub too). Also, know what all the equipment and instruments are, what they do, how they work, how to troubleshoot, etc. Also, training for the OR is the longest of any specialty (pretty good (and necessary) for a trained monkey). There are also a ton of guidelines, standards, and regulations that the good (CNOR certified) OR nurse knows back and forth. My job is to advocate for the patient during their most vulnerable time (unconscious and alone). I am in charge of the room (think of it like a manager) and have a hundred responsibilities as the manager of the room. Sure the doctor is the doctor but I'm in charge of the room (no ego trips here, we are all there for the patients best interest). My surgeons depend on me and know I can get the job done...there are hundreds of room and equipment set ups for every type of surgery (and every surgeon has different preferences so multiple that by over 100), and a good OR nurse knows them all. I am ACLS and PALS certified so I can push meds during a code (I've had surgeons leave during a code and anesthesia can be so busy that they can't run a code...it's all me). The OR is NOT for everyone. You need thick skin and the ability to work under pressure and with every type of personality. I call report to PACU and could give them their life story but they don't need that, so I give them the basics. I am also trying to do 80 other things at the same time (count, open dressings, call waiting room, move patient, chart, specimens, clean up, etc, etc, etc...just forget it if it's a quick case). I don't know if PACU realizes that sometimes or even has a clue what we do back there. And sometimes I just don't have much info to give (healthy 20 year old, lap appy....fluid, dressings...what else is there to tell if it was a straightforward case?). You love it or you hate it. It's highly specialized and under appreciated. I do know that if you think all an OR nurse can do is be a "go-fer" you haven't got a clue. We need ALL specialties! Why so much bitterness between them? I DO NOT want to work the floor, the ER, ICU, PACU (etc). My highly ADD mind would implode. You work your area, I'll work mine! Vive la difference!

MereSanity BSN, RN, CNOR

[LadyLamp]

Oops, moving my question to separate thread because I think I may be too off-topic. Thank you for this thread, though---I am really enjoying it! :-)