Brand New OR Nurse - Any Advice?

linda2097 · Feb 5, 2009

1. Expect a lot of verbal abuse from surgeons and coworkers.

2. Buy a perioperative nursing textbook and study it.

3. Study surgeons' preference cards so you will be better prepared.

4. Expect to be overwhelmed with information. It takes years to learn how to work in the O.R.

Surgerygirl · Feb 5, 2009

1. Expect a lot of verbal abuse from surgeons and coworkers.
2. Buy a perioperative nursing textbook and study it.
3. Study surgeons' preference cards so you will be better prepared.
4. Expect to be overwhelmed with information. It takes years to learn how to work in the O.R.

Also.... Learn where all the supplies are... surgeons do not like to wait for anything.

As time goes on you will learn to anticipate the needs for each different case and surgeon.... it takes a long time.

folashade 37 · Feb 5, 2009

congratulation, I am also starting in OR this coming monday and I am excited.

nurseannika · Feb 5, 2009

I've been working in the OR for about 18 months now in an outpatient facility. I did not have a formal orientation.

I definitely lucked out with nice staff AND nice surgeons. I would definitely recommend buying a perioperative nursing book. Also, learning the instruments....that is probably the one thing that really is upsetting to me....not knowing what instrument is needed while both the surgeon and tech are yelling at you!!! It's very exhausting, but there is some down time during longer cases. Be very thorough with your charting. Positioning patients is very important....they can get some bad sores after lying prone on a stiff table for 2 hours or whatever. And try not to take the surgeon's attitudes too personally....perhaps they just got a page because their 3AM emergency case is crashing in ICU or something. Also, keep thinking and anticipating what is needed next....dressing, instruments, sutures, etc etc. Good luck!!! The OR is lots of fun, just stressful/different initially.

amuratet · Feb 6, 2009

grow a thick skin. that first year will be hard and you will be subjected to a lot of unfair abuse. It's not fair and management should not allow a culture where physicians and even other nurses are allowed to heap abuse on each other. Unfortunately, in my travel nurse adventures, I went to more facilities with toxic environments than healthy.

shaomai · Feb 6, 2009

The first week of orientation, we send the new nurses to central processing to put sets together and learn about sterilization. This has proved to be extremely helpful as for they learn some instruments and how the sterilization process occurs. After that we set them with a preceptor and spend six months with them. You should be evaluated everyday. Come prepared everyday with objectives as for that helps your preceptor. It is an exhausting orientation, but welcome aboard you will love it.

MamaCheese · Feb 6, 2009

Which hospital are you working at? I'm at St. Vincent @ Worcester Med Center. When I started about 2 years ago they did a 4 week AORN periop 101 program with us. We spent the remainder of the 6 months being precepted in each service. I have to say that most of the nurses, techs, doctors, and anesthesia staff were incredibly helpful and patient with us most of the time. It will take some time but prioritization, organization, and anticipation of your team's needs are the things that will make you a great circulator.

The thing that hangs new nurses up the most when being precepted is being shown different ways to do things by different nurses. I just sucked it all up like a sponge and did it whatever way my preceptor was showing me. You will eventually adopt your own style of doing things when you are on your own. Check out the stickied thread:

https://allnurses.com/operating-room-nursing/soooo-youre-observing-142748.html

Here's any oldy but goody originally posted by IssyM on an old thread:

You're main job is patient safety and comfort...along with making sure your doctors, anesthesiologist and scrub have everything they will need. Making sure the patient is transferred safely. Safety straps are on. Patient is kept warm. All monitors are on and VS are visible on machine, even though anesthesia is mainly focused on this. You may help anesthesia intubate patient, you may not. Some are pretty self-sufficient and don't want help, but always offer. Here are some tips i hope you find helpful.
Tips for a circulator before you bring patient into the room.
*Make sure your OR bed is locked and safety straps available! (For body and arms)
*Make sure your OR bed is in the right position for the type of surgery you're going to do. (Lap Chole. The C-Arm machine needs to fit under the table without the metal part being in the way) (If doing lithotomy or jacknife be sure the bed is positioned to where its supposed to bend) Also some doctors want cassettes on the table in case they want to do a flat plate x-ray, some don't care. Its good to have them on for big bowel cases.
*Make sure all your suction units on the walls work, have enough suction cannisters and tubings available in room.
*Make sure all the lights work.
*Make sure your room is stocked with supplies you will need throughout the day. (All different kinds of prep solutions, dressing supplies, lap sponges, xray detectable sponges, suction tips, towels, drapes, gowns, gloves, sutures, ties, lighthandles, positioners-like gel rolls etc, etc.)
*Make sure you have some kind of warming unit in the room (Baier Hugger or Warming Blanket Unit)
*Make sure your bovie machine works and that you have grounding pads.
*Make sure that your anesthesiologists checks their machine and cart to make sure all drugs and supplies are available, so you won't have to run or call out for it during the case.
*Have step stools available in your room, especially for the short doctors.
*Have 3-4 pillows availabe in the room. You never know when you're gonna need em. I like to put 1-2 pillows under patients knees, especially if they have back problems.
*If doing a Laparoscopic procedure which requires insufflation of gas into the belly. Make sure you have a full tank of gas. I've had to change out numerous tanks (what a pain), thank goodness they were not during the case.
*Check your preference cards and read over them 2-3 times. Sometimes you'll miss an item and then realize it was on the card and end up having to run or call for it during the case. If it takes forever to get it the doctor will have a fit especially if he knows it was on his card.
*If you're unfamiliar with any of the equipment have someone give you a quick inservice on it, or ask if someone can come in during the case to help you with it. It took me a few times to get used to the Laparoscopic monitor because i wasn't sure how to turn on the gas or take the light off, increase pressure or flow.
*Make sure you have a sitting stool for yourself. Haha. Its nice to a seat during the case, you really don't have to be on your feet all day.
Tips for circulating during a case:
*Make sure your scrub person has warm irrigation solution NaCl.
*When giving medication to the scrub person, make sure you look at the bottle closely, tell them what medication you are giving them, some want to see the bottle and check the expiration date!!! Also make sure your scrub person labels their medications. Some doctors will through a huge fit if they don't see anything labeled.
*After the patient has been draped and cords are being tossed off the sterile field. Always hook up the bovie (make sure the grounding is hooked up also), suction or other electrical equipment first before you do anything. Don't stop to answer the phone or run to get anything. One of the first things a surgeon will use after the patient has been draped is the knife, (or local injection) then the bovie. For Laparoscopic cases i like to hook up the bovie first, then the Laparoscopic camera, light and insufflation, then suction. But sometimes they throw off the Laparascopic first and the bovie cord second. You can do either or.
*Watch how many sponges your scrub person is going through. Its nice to notice when they only have 2 or 3 more left, you can ask them if they need another package. This includes sutures/ties/hemoclips. If you notice they go through supplies fast, have them available so you can quickly open it to them when needed. Keep track of supplies you open and your charges.
*Pay attention to your patients IV fluids. When you notice the bag is getting low ask the anesthesiologist if he/she would like another warm bag. Sometimes no one pays attention and the bag ends up going dry.
*Make sure your patients extremities stay on the OR bed. There have been a few times i caught the leg slipping off the table because of the SCD machine. Or arms fall off the armboard because they were not strapped. This is why i like to use arm straps.
*Pay attention to see if doctor may have to switch sides. If doctor is using a headlight you have to unhook him and switch and if he's using foot pedals you just have to move them where he can reach them.
*Pay attention to the case. Listen to what the doctor is telling his assistants, residents, medical students or scrub. This helps me out alot because it can put me one step ahead.
*If there are specimens make sure to ask the doctor what the specimen is and how he would like it to be sent. Also make sure if it is to be sent right away that you write your extension number on the card so the pathologist can call back to the room for results. (However, there could be a different policy depending on what hospital you work at) One time i forgot to write the number and the doctor was asking about the specimen, if i sent it and what was taking so long so i had to call the lab myself.
*If you're not sure what type of dressings the doctor will use then ask. I personally like to ask when they're starting to close, that way i have time to gather all my dressings supplies and have them readily available to open. With ortho cases (broken bones) i like to have them available earlier.
Circulating takes practice and repetition. I didn't think i could ever do it by myself but now i am. You will have many different cases but circulating duties are pretty much the same for each one, the only things that change are the instruments, supplies or anything you will need to call or run for
I know there are so many other tips but this is all i can think of for now

Scrubby · Feb 7, 2009

Hi All!
I just got hired today for an OR position in Boston woo hoo! I have six months of cardiac step down experience, but none in the OR. Luckily the hospital is putting me through a 6 month orientation program, but I was wondering if any nurses here working in the OR could give me some advice of what to expect at first, what I should brush up on and an other good advice you wish you had as a new nurse in the OR. Any advice would be appreciated, thanks!

Congrats. Are you going to be scrubbing as well?

I recommend Alexander's care of the patient in surgery. It's a great resource for periop nursing.

Don't let the surgeons get to you. They are not demigods, they eat,sleep and yes even go to the toilet like everyone else.

Try not to learn it all at once, take it one step at a time.

Ask lots of questions, it shows that your interested and not just there to waste everyones time.

If you not sure about something then ask.

Prioritise. i.e your scouting and there is a bleed going on. Don't answer the phone because you may need to open packs, get suction going, call for assistance.

Never leave the scrub nurse on their own. If you have to leave the room and get something then be quick about it. If the thing your looking for is not where it should be then don't waste time looking for it, go straight back say you can't find it, ring the coordinator for assistance.

Don't just learn the name of an instrument. Learn it's function, watch when it is being used during a case so you can have it ready in advance.

Scorpio, MSN, RN · Feb 7, 2009

thank you everyone for your advice! i am so excited to learn this field of nursing and i definitely understand that it is going to be a long process of learning in this specialty! i borrowed the Alexander book from my friend who is an OR nurse she also recommended that! Mamacheese, I will be working at new england baptist hospital in Boston! I am sure I will have more questions as time goes on, Scrubby: i will be mainly scrubbing and will also learn to circulate so here goes! have a good weekend everyone

summerhill · Jun 21, 2009

Hi cubbyRn,

I am also a telemetry stepdown Rn with 3 years of experience. I would like to find out from you how you are doing now assuming that you are in the training program. Do you feel that by being a telemetry nurse help succeed in OR training? I would also like to know some of the interview questions they asked you. Please share any experience. Thanks!

mismelis · Jul 10, 2009

Congrats on your new job in the OR! I have just left after 20 some years of life in the OR - some good some not so good but if given the choice I would say its the best place to be in the hospital. I now work in a private office starting IV's and giving meds for sedation for minor procedures. Even old nurses sometimes benefit from change now and then. Come to think of it, probably more of the old ones should move on and make room for the new faces. Enjoy and be the best you can at what you do.