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.
I had 7.5 years (8 now) and am CNOR certified. I have a lot of experience except I don't have neuro experience (I did open heart another team did neuro so I never did it before). That is a drawback for me but I told them straight up I don't do neuro (would love to learn though). I wouldn't expect an OR nurse to travel with only a year under their belt, I'd recommend more.
Such a great thread, thank you. I am curious about a couple things regarding the perioperative umbrella.
So is it correct to say that the AORN is the association of perioperative nurses, but only focuses on the OR and does not include PACU and pre-op? (I guess that's why Operative in perioperative is capitalized on their website!).
With that in mind, I am wondering if it is customary to only train in one specific area of perioperative services or whether it is possible to cross-train. The large hospitals in my area either have nurses do the OR or pre-op/PACU track after one year of med-surg. However, from reading threads on AN, it seems that some nurses work in all the different areas, albeit in maybe smaller hospitals? I realize the training for the OR is long and that PACU often requires a critical-care background so you wouldn't be able to train for both simultaneously, but in time and with additional training, is it possible to alternate among the different specialties of perioperative care (pre-op, OR, PACU) in the same hospital?
Specializes in OR, Nursing Professional Development.
Such a great thread, thank you. I am curious about a couple things regarding the perioperative umbrella.
So is it correct to say that the AORN is the association of perioperative nurses, but only focuses on the OR and does not include PACU and pre-op? (I guess that's why Operative in perioperative is capitalized on their website!).
Yes, AORN focuses on the intraop portion of nursing.
ASPAN (American Society of PeriAnesthesia Nurses) focuses on preop, PACU, ambulatory surgery, and pain management aspects of surgical care.
About ASPAN
Founded in 1980, the American Society of PeriAnesthesia Nurses (ASPAN) represents the interests of nurses who specialize in preanesthesia and postanesthesia care, ambulatory surgery, and pain management. With over 15,000 members and growing, ASPAN is the only professional organization dedicated exclusively to the practice of perianesthesia nursing. The Society serves its members by continually providing the latest in perianesthesia education, research, clinical practice expertise, standards and advocacy.
With that in mind, I am wondering if it is customary to only train in one specific area of perioperative services or whether it is possible to cross-train. The large hospitals in my area either have nurses do the OR or pre-op/PACU track after one year of med-surg. However, from reading threads on AN, it seems that some nurses work in all the different areas, albeit in maybe smaller hospitals? I realize the training for the OR is long and that PACU often requires a critical-care background so you wouldn't be able to train for both simultaneously, but in time and with additional training, is it possible to alternate among the different specialties of perioperative care (pre-op, OR, PACU) in the same hospital?
Even within facilities, this can vary. In ours, the OR staff is only in the OR. In our one specialty area, nurses rotate between preop, PACU, and the postop discharge area. In the general surgery area, nurses pick one and stay in that unit. At the hospital's surgery center, nurses rotate through preop, OR, PACU, and postop.
Specializes in OR, Nursing Professional Development.
What are the most common medications that nurses give in the OR?
Anesthesia obviously takes care of the anesthesia medications, and in my facility they are also responsible for giving the antibiotics in the OR. Preop gives the ones that need to go in over a longer time like Vanco.
So so what do I give? I actually don't give anything directly to the patient. However, I do dispense medications to the sterile field that the scrub will give to the surgeon. This includes local anesthetics, antibiotic irrigation, saline irrigation, or whatever else the surgeon requests. We also have some hemostatic agents such as Surgicel, Floseal, and Arista.
In in my specialty, I have bacitracin irrigation, saline irrigation, vein solution which is used to dilate veins harvested for bypass grafts and depends on who the surgeon is for what it contains, and usually lidocaine or bupivicaine local, either with or without epi.
What are the most common medications that nurses give in the OR?
I do transplant and general... For me it's ancef, heparin, bacitracin, marcaine...
But nurses here at my hospital don't give them, we mix them and give them to the scrubbed team or anesthesia. Those are the drugs I seem to use on every case.
Specializes in OR 35 years; crosstrained ER/ICU/PACU.
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Anesthesia obviously takes care of the anesthesia medications, and in my facility they are also responsible for giving the antibiotics in the OR. Preop gives the ones that need to go in over a longer time like Vanco.
So so what do I give? I actually don't give anything directly to the patient. However, I do dispense medications to the sterile field that the scrub will give to the surgeon. This includes local anesthetics, antibiotic irrigation, saline irrigation, or whatever else the surgeon requests. We also have some hemostatic agents such as Surgicel, Floseal, and Arista."
True, Rose_Queen, to all of the above. However, I've been in emergent situations where the anesthesiologist or CRNA is having difficulty maintaining an airway, where I've had to push Sux & Propofol quite a few times as they worked. I also have had to start secondary IV's for them; I've had to know how to prepare, calculate, & administer Nitro drips, Dopamine drips, Neo, etc, on the pump. I've also given code drugs (Epi, Lido, Amiodorone, Atropine, etc). So don't assume you won't have to ever do anything but dispense local, irrigation, etc, to the sterile field. There are times that your critical care skills will be called into play! And over my 33 years in the OR, I've seen almost all!
Specializes in OR, Nursing Professional Development.
True, Rose_Queen, to all of the above. However, I've been in emergent situations where the anesthesiologist or CRNA is having difficulty maintaining an airway, where I've had to push Sux & Propofol quite a few times as they worked. I also have had to start secondary IV's for them; I've had to know how to prepare, calculate, & administer Nitro drips, Dopamine drips, Neo, etc, on the pump. I've also given code drugs (Epi, Lido, Amiodorone, Atropine, etc). So don't assume you won't have to ever do anything but dispense local, irrigation, etc, to the sterile field. There are times that your critical care skills will be called into play! And over my 33 years in the OR, I've seen almost all!
(So do I, but because it would actually be a violation of my facility's policy as I am not certified to push those drugs, I didn't really want to post it and make it seem like it's routine)
I have pushed boluses of vasoactive meds when the anesthesia provider is sterile for line insertions. Am I really supposed to do it? No, but I'm the only one with a license and not sterile.
Really been enjoying this thread. It's answered many of the questions I either wasn't sure how to ask, or felt a bit dumb about asking.
I think in general the sorts of questions I've had have been ones about just what the OR nurse job is like in general. I figure I'm neither better nor worse than anyone else in picking up the skills and knowledge (I assume any normal and motivated person can learn the basic job skills over time), but want I want to know is if the job would be a good fit for me.
The things I think I would like, based on what I've heard, are learning technical skills and working with a good group of professional folks each day (with a bit less patient contact than some other areas).
It might be nice for me to hear about what a "typical" sort of day might look like for an OR nurse, and also what a difficult day would be like. Which sorts of things might make for a difficult day, aside from obvious things like being called in when you don't feel like it, or having to work more hours that day than you expected.
Specializes in OR 35 years; crosstrained ER/ICU/PACU.
It might be nice for me to hear about what a "typical" sort of day might look like for an OR nurse, and also what a difficult day would be like. Which sorts of things might make for a difficult day, aside from obvious things like being called in when you don't feel like it, or having to work more hours that day than you expected.
Well Paul, a typical day starts with most of us getting to work early, in order to get into scrubs, & I usually go to my OR & do a wipedown of everything with antibacterial wipes, including my phone, computer, door handles, as well as OR lights & all flat surfaces. We usually have our 1st case carts in the room & supplies/instruments spread out, ready to open, by the night shift staff (if they aren't busy doing cases). Before opening for our 1st case, all staff meets at the control desk for announcements, & any cases/instruments that need to be coordinated for the day. While my tech starts opening the supplies & instruments needed for the case, I gather meds I may need from the Pyxis, as well as any extra equipment that may be needed. I try to get everything for the whole day, so I'm not running too much between cases. I then log on to the computer, to input my case, & finish opening with my tech. Then the CRNA & I plan what may be needed for our patient, as we go to Pre-Op. We check the chart together, then go into the patient's room & introduce ourselves. We verify the patient's identity, check allergies, verify the procedure with them. We make sure all ordered lab work, EKG, Xrays are done & in the chart; as well as the surgeon has signed & verified the consent as well. We let family members say their farewells & with a warm blanket we're off the the OR. Keeping our patients warm, calm, comfortable, & maintaining their privacy is tantamount to everything we do. After getting the patient onto the OR bed, we make sure they have enough blankets, a pillow under their knees for back comfort, no lumps or bumps under them. We assist the CRNA with sedation, intubation, spinal/epidural, or regional anesthesia. Somewhere within this time frame I have to do a count with my scrub, before the procedure starts, as well. After that, it's time to insert a foley if needed, position the patient (if other than supine), prep, get the surgeons in & gowned, & the patient is draped. Before anything else, it's time for the Time Out: assuring we have the right patient, the right procedure, the right site, sterility has been verified, we have the correct equipment, medications, (& allergies), etc. The scrub doesn't hand over a scalpel until the Time Out is done. Once the surgery starts, I call Family Services to notify the family of the start time: it seems like eons to them, but the time between us taking the pt into surgery & actually starting is very busy. I finally can get my charting on the computer going; there are 16-18 pages to keep up with, & sometimes I feel like all I'm doing is sitting by the computer! One of the most important jobs we have as circulators is to keep our eyes on the field, making sure sterility is maintained; we make sure our techs have what they need; I also check with the CRNA frequently to see if they need anything. I run for implants, more meds, other equipment; more irrigation fluid, more gloves if someone contaminates theirs. There is always something to keep us on our toes. Once the case winds down, there is the closing count, then the final count that need to be done. Dressings, help with patient wake-up, get them to PACU where we give our intra-operative report. Run back to the OR, help clean up, turn over, get the next case cart in the room, & do it all over again.
I always buy good running or walking shoes for work, just about every year. Expect to be on your feet a lot; our computer stands were height-adjustable, so I often stood at mine, because as soon as I sit, someone needs something. I keep a small bottle of Ibuprofen in my pocket, along with chapstick (it's so dry in the OR). You never know when you will end up with a headache, backache, or whatever ache, & need to throw down some Ibuprofen. There are days when I get told to eat lunch @ 10:30, & days I haven't eaten lunch till 1:30. You learn to grab crackers from the break room as you run from the OR to pick up your next patient in Pre-Op. Maybe you get lucky & your CRNA says they need a "pee break" before getting the next patient, so you take advantage of that, too. Yes, we start early, we stay late, especially if someone on the next shift "isn't comfortable" taking over from you in your specialty, which being Neurosurgery for me, happens a lot. Nobody wants to come into brain surgery not knowing what they're doing, & the docs don't want them there anyway. I try to use it as leverage to leave early another day, if my room is done early. I don't have little kids, & my husband is a Neurophysiologist, so he understands if I'm not home "on time" because many days he isn't home either! I don't mind staying over, to keep my docs happy, & to assure the best possible care for my patient & their family (we keep in touch thru Family Services, especially during long procedures). I won't touch on taking call, as you know you'll miss Holidays, birthdays, events, etc. You'll be tired, hungry, thirsty, achey. But for the most part, we have weekends & holidays off (except for your required call) so it isn't all terrible. It just seems it when you're actually stuck being there. The best place I worked was an Ambulatory Surgery Center, for 7 years, where we had no call, no nights, weekends, holidays AT ALL. Too bad my husband's place transferred us. All in all, I wouldn't trade any position in the Medical Center where I am now. OR Nursing isn't for everyone, but for those of us who love it, it's the BEST!
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pixiestudent2
993 Posts
How much experience did you have before you started traveling?
Do you feel confident on assignments?