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]

Why do patients have to be completely naked, even underpants off for (for example) a blepharoplasty? Or other "minor" surgeries not close to that area of the body?

It may vary by facility policy, but there are a few practical reasons for removal of undergarments:

Infection control. Depending on the patient, their culture, their personal hygiene habits, those undergarments may pose an infection risk, especially as they are not fully contained within a patient gown. OR personnel aren't permitted to wear "outside" clothing such as long sleeves under their scrub tops, reusable cloth hats not laundered by the facility, warm up jackets not laundered by the facility because we can't control the laundering process- is it freshly laundered, was the water of the appropriate temperature per infection control standards...

Soiling. It is not uncommon for a patient to lose control of sphincter muscles, whether it's bowel or bladder. Doesn't happen every time, but it does happen. If a patient soils their undergarments, then they have nothing to wear home when discharged other than the mesh panties the facility can provide. Additionally, some people don't realize just how much of the patient is required to be prepped for a procedure. Yes, we're working around your umbilicus to repair a hernia, but because we prep wide enough to provide access for a laparotomy as well as large enough that the opening in the drape is over prepped skin, there is the possibility of getting prep solution on the undergarments, and some of them can permanently stain.

Does that mean it's 100% followed? No. Many of the nurses I work with allow patients, especially pediatric and developmentally delayed patients, to keep their undergarments on until they are anesthetized and then remove them if necessary for access to the surgical site. I don't allow my patients to keep their undergarments because of the fact that working in cardiac surgery, I need to prep the groin into the field as well as the fact that foley placement is required.

Why does every piece of jewelry need to be removed? Can electrocautery arch to the jewelry? Or is it to prevent jewelry falling off? A ring on a finger for a inguinal hernia or a bunionectomy? All jewelry off? Or cover with tape?

A couple of reasons for this:

Hospital liability. Sorry, but I don't want the responsibility of you possibly losing your jewelry or other belongings. It's happened where a patient came in with a ring or other piece missing a stone and tried to blame it on the facility- fortunately, there was documentation of valuables upon admission, including the fact that there was an empty setting on the ring. Some nurses will allow taping of jewelry and document their butts off. Some patients we've brought to the OR with the ring in place because it can't be removed easily. Once they're asleep, we have some tricks to remove it without cutting (which is our absolute last resort) and then immediately take it out to the waiting room and place in family's possession.

Another reason for removing jewelry, particularly nose and tongue rings or other facial piercings, is the fact that it can be a risk for aspiration during anesthesia or injury during other necessary procedures. Nobody wants to see a tongue ring disappear down the throat when placing an ET tube or damaging a nose piercing when placing an NG tube.

Swelling that can lead to vascular compromise. Generally seen in longer and more complex surgeries. Patients are receiving IV fluids, may be positioned without moving for several hours. With my cardiac population, it is not uncommon to see hand/finger edema at the end of the procedure. A ring that may have been a bit snug to start with is now cutting off circulation to the rest of the finger. My mom had "minor" breast surgery and had to have her wedding band cut off before hand due to the fact that it was so snug and her surgery was on her left breast, meaning risk for lymphedema postop causing swelling that would be an issue with blood supply.

Electrocautery isn't so much of a reason, unless the path between surgical site and grounding path would include the jewelry. Best practices and AORN recommendations (at least the last version I've read) do recommend removal.

[springchick1, ADN, RN]

Infection control. Depending on the patient, their culture, their personal hygiene habits, those undergarments may pose an infection risk, especially as they are not fully contained within a patient gown. OR personnel aren't permitted to wear "outside" clothing such as long sleeves under their scrub tops, reusable cloth hats not laundered by the facility, warm up jackets not laundered by the facility because we can't control the laundering process- is it freshly laundered, was the water of the appropriate temperature per infection control standards....

This also varies by facility. At my hospital, we wear are scrubs in from home, we can wear cloth hats (although they have to be covered with a paper bouffant), and the same for long sleeve shirts and jackets. It was a cost saver for the hospital. Although o have a feeling we will be going back to hospital laundered scrubs eventually.

[PaulBaxter]

Two questions, one simple, and one open ended.

First, I've recently started shaving my head (middle aged guy, don't ask...). Are men without hair on their heads still expected to wear the surgical hats? It doesn't really matter to me, I'm just curious.

Second, I'd like to hear about the mistakes nurses make in the OR. What mistakes do you commonly see from new nurses in the OR? What sorts of mistakes are the ones you see the most overall? What kinds of things make you say, "geez, I wish that someone had warned me about this during my training?" Also, what would the the MOST IMPORTANT mistakes to avoid? What mistakes do YOU remember making when you were new?

I'd love to hear from anyone in OR nursing about mistakes.

[springchick1, ADN, RN]

Two questions, one simple, and one open ended.

First, I've recently started shaving my head (middle aged guy, don't ask...). Are men without hair on their heads still expected to wear the surgical hats? It doesn't really matter to me, I'm just curious.

Second, I'd like to hear about the mistakes nurses make in the OR. What mistakes do you commonly see from new nurses in the OR? What sorts of mistakes are the ones you see the most overall? What kinds of things make you say, "geez, I wish that someone had warned me about this during my training?" Also, what would the the MOST IMPORTANT mistakes to avoid? What mistakes do YOU remember making when you were new?

I'd love to hear from anyone in OR nursing about mistakes.

Yes. Everyone wears a scrub hat in the OR. Hair or not:). You may not have hair on your head but you do have dead skin cells that can slough off into the sterile field.

A lot of the mistakes that new nurses make are typically things like forgetting equipment, contaminating things, and not getting positioning quite right.

[Optimistic_RN_]

Im approaching my last quarter of nursing school and I have preceptorship placement in the OR for 120 hours i was just wondering how likely it may be that i land a job in the Or as a new grad or is there usually more experience necessary for such a specialty .

[Rose_Queen, BSN, MSN, RN]

Im approaching my last quarter of nursing school and I have preceptorship placement in the OR for 120 hours i was just wondering how likely it may be that i land a job in the Or as a new grad or is there usually more experience necessary for such a specialty .

This will depend on the facility. Some will accept new grads into the OR; others won't. Even experienced nurses who have zero OR experience have to go through the same extensive orientation as new grads in the OR. It will also depend on whether there are open positions that you can apply for- sometimes open OR positions are hard to find. Either way, take advantage of your preceptorship to make a good impression. Look through some of the threads on this forum to get some ideas on what to do and what not to do, be a team player, etc.

[Optimistic_RN_]

This will depend on the facility. Some will accept new grads into the OR; others won't. Even experienced nurses who have zero OR experience have to go through the same extensive orientation as new grads in the OR. It will also depend on whether there are open positions that you can apply for- sometimes open OR positions are hard to find. Either way, take advantage of your preceptorship to make a good impression. Look through some of the threads on this forum to get some ideas on what to do and what not to do, be a team player, etc.

Thanks

[guest769224]

Why do patients come back from OR with their eyes taped closed some of the time? Intubated patients that is

[Rose_Queen, BSN, MSN, RN]

Why do patients come back from OR with their eyes taped closed some of the time? Intubated patients that is

To protect the eyes. Most people assume that people's eyes close automatically when they are asleep; often, that is not the case in the anesthetized patient. The tape helps keep the eyelid closed. Some anesthesia providers will also place lubricant in the eyes before taping them shut. Helps to prevent dry eyes or corneal abrasions. In some surgeries, the patient may also have protective eye wear placed- we do this with our cardiac robotic patients so that the eyes are protected from the robot's "arm". They have foam adhesive around the edges to keep them in place.

[ORNerd, BSN, RN]

RoseQueen, thank you for this thread! I have an interview coming up on the 12th and this has been so informative!

[Optimistic_RN_]

I'm currently interested in being an OR nurse i graduate in 3 months and I just interviewed for the position of operating room aide and will transition to nurse upon passing nclex ..the position is in the ortho OR , is it easy to transition into other OR specialties because I'm more interested in general surgery but am willing to accept what ever is currently available

[Spiker, ASN, RN, EMT-P]

Future_RN2016, there is a lot to learn in order to function well in an OR. I worked for almost 25 years in an OR where we took night, weekend, & holiday call. I'm not sure what your facility is classified as, where it's located, & how specialties are handled. In a smaller hospital (I worked in a 200 bed one) we specialized for the day shift scheduled surgeries - I was Vascular & Neuro - but because we took a lot of call, we had to know it all. In a large trauma center, where I spent my final 5 years, we had 24/7 staffing, yet still took call if other urgent cases came in. It all depends on staffing. At any rate, it takes a good 9-12 months to become knowledgeable with all specialties! There are so many of them, & within each specialty, there are so many surgical procedures to learn about: instrumentation,equipment needed, positioning (& equipment for that), medications needed, etc. Multiply that by how many surgeons are in that specialty, & you needing to know their particular needs & quirks for all of the varying procedures! Now add needing to learn where to find said instrumentation & equipment, & anticipating what else may possibly be needed, & have it at hand. Did I mention charting? Most facilities use electronic charting, which takes awhile to become familiar with; there are a good 16-18 pages of computerized charting with the program our med center uses. It can be frustrating trying to get it done, as well as keep an eye on the surgery, the sterile field, helping anesthesia staff, performing counts, etc.

I'm not trying to scare you; you'll have plenty of help I'm sure while you orient. I've been an OR RN for 33 years, after working the 1st 5 years of my career on a surgical floor. My easiest job was in an Ortho Surgery Center: 27 docs, but at least only 1 specialty, with sub-specialities divided up into hands/forearms, shoulders, hips, knees, ankles, & fractures. No weekends, nights, holidays. I worked there for 7 years, it was busy, but a great way to go: I thought I'd put that out there as another aspect of OR Nursing for you to think about. There are many ambulatory surgery centers these days, most are fairly new, state-of-the-art facilities.

I know I made it sound difficult, but OR Nursing is my passion. Don't be afraid to jump in. You'll learn to multitask, to prioritise, organize, anticipate, think on the fly & outside the box! And always carry a pad of paper in your pocket to take notes as you learn things, as well as make lists of what you need for your room stock, next procedure, etc. I can guarantee, if your scrub tech asks you to go to the sterile core for 5 things, you'll forget at least 1 of them. And there's another point I'll make: in my 33 years, I've managed to learn how to scrub almost all but open heart surgeries. Brain & spine, General, Ob-Gyn, Uro, Vascular (peripheral & descending aorta), Plastics, ENT, Maxillofacial, Opthalmic. Being able to scrub gives you another perspective of what we do for each patient; you're seeing the anatomy up close, & gaining insight for the surgical procedure itself. It also can make you more marketable as you move along in your career, having the dual skill-sets of Circulator AND Scrub Nurse. Good luck to you, getting ready to start you career just as I'm ending mine.