cut and run?

[ltpbrt]

Long time lurker, first time poster.

I’m a 2nd degree new BSN grad questioning my choice to come to the OR.

Before and during school I knew that hospital floor nursing was not for me. My interest had always been public/community health but I was discouraged from going directly into that field after graduation from all sides. I also knew very early on that I want to go on to advanced practice sooner rather than later. The OR caught my interest during clinicals as an exciting alternative to working on the floor where I could gain some nursing experience. I shadowed several times before being hired to circulate at a very large university level 1 trauma center (with a guaranteed 6 month orientation and 2 year contract). I loved the idea of 1-1 patient care and having a front row seat to things many people and even some nurses never get to see but that make such a difference to the patient and their family.

We had several weeks of classes and OR days and now are in rooms all day every day, but the excitement and rush I felt walking into the OR at the beginning has turned to pure dread. Our program gives us a new preceptor each day and even though they are all skilled and very helpful, this makes every day feel like day 1, not to mention rarely getting to see the same case twice as we are currently “case chasing.” Each afternoon my preceptors tell me that I did a great job and that I won’t have any problems being out on my own. The issue is that at this point I don’t even think I WANT to run a room on my own. I find circulating to be very mentally and physically challenging but I don’t ever see myself finding joy or personal accomplishment in it. I get to speak to my patient for about 15 minutes max and then never see or hear from them again. I find myself wanting to know about their PMH and treatment plan but have actually been discouraged from looking into these by preceptors. My job is to keep them safe in the OR while also managing to get the scrub person/attending/residents everything they need (no small task!). I really believe that I need more opportunities for hands-on patient care and clinical practice. My mental health is starting to take a major hit and I’ve been physically sick several times with stress and anxiety over possibly making such a huge mistake right out of school.

I know the OR has a steep learning curve and I can’t expect to feel anywhere close to confident for a year or two. I also know people say “you either love it or you hate it”. My question is, what if you hate it? Should I cut my losses and apply for jobs in the field I had originally wanted? Is this as black or white as I think or is there a gray area I’m not seeing? Any advice is much appreciated.

[beachgirl17]

Hello ltpbrt,

It sounds like you are progressing well in your orientation. You didn't mention how far into orientation you are.

I, too, was a second career/degree BSN with now 10 years of experience. Two years were spent on the med-surg unit and I hated it with a passion. In retrospect, I now value that learning experience. Anyway, I wanted to transition out of med-surg, but without a clear picture of what I wanted. I shadowed in the OR for a bit and then decided to apply and go for it. I trained in a level 1 trauma teaching hospital with an orientation that sounds similar to what you detailed including the frustration of never seeing the same case twice and having varying preceptors. It has now been 8 years since I've come to the OR and overall, I'm happy with my nursing specialty. I just wanted to give you some background on myself first.

My thoughts on your situation:

-You stated you find circulating to be very physically and mentally draining and I would agree. I find that I am exhausted when I am a period of learning. You are learning something new every day, every case. It is tiring. It will get better. I still learn something new every day and I take pride in seeking out new opportunities. Yes, I find the OR to be physically demanding; however, I feel it may be less so than other specialties.

-I understand that we may only interact with our patients for a limited time while they are awake, but consider it from a different angle. I take great pride in being responsible for someone when they are at their most vulnerable while under anesthesia. It is an honor to be an advocate for them. No, we don't get many thank you's from patients and families, but my advice is to take personal satisfaction from a job well done. On another note, having worked on a med-surg unit, there are also downsides to having a lot of patient and family interactions. It can be great, but it can also be very draining.

-I do encourage you to consider their PMH and plan of care. Their surgical procedure is one step along the path to wellness/palliation. No, I may not have a lot of time to delve into their history, but I think it is important to know. If you work on a floor, you often do not have time to know all the fine details either. Your preceptors may not be encouraging to get into the PMH and plan of care, because they want you to focus on the surgery and other tasks. You can delve into this more when you are on your own.

-Are you learning to scrub or will you be given that opportunity later?

-If you want to continue with education, then paths might include being a first assistant, an APRN that sees patients in clinic and assists the surgeon, becoming an OR educator, or.....(I'm sorry, I'm drawing a blank).

-I find that when I am overwhelmed, angry, bored, or any other non-positive emotion in the OR or driving to be my job, I stop and think of the wonder of the human body and the rare experience I have in watching how it works. Cheesy, I know, but seriously. So many people in life are sitting in a cubicle, typing away, but I am in the OR seeing anatomy and physiology in real life and I am awestruck every time I really think about it. It's just easy to miss that feeling of awe when you are feeling mentally and physically drained.

-Now, should you cut and run? It's truly personal and I can't give sound advice without knowing you, but I just wanted to give some food for thought. Good luck on your decision to stick it out or cut and run.

[FurBabyMom, MSN, RN]

I think you’re honestly in part of the adjustment period – although I think there are actually several. The novelty has worn off a bit, and you’ve yet to really truly settle into your routine, and your flow. You’re right, it’s a LOT, and the adjustment period is significant. You sound a lot like I did while I was on orientation. It got better when I got to my permanent team and began developing relationships with coworkers.

Have you asked your preceptors why they don’t think looking at PMH is a good idea? Is it maybe because they want you to focus on orienting and getting the routine of what you need to do as a circulator? However, you need to know some to provide good care…. When I have an all-day case (or even part day routine-ish case), I have time to look at the H&P and need to when I call the ICU for report. Alternatively, if I have an emergent case, I may not get a chance to do that. I’ve been in cases where we know nothing – maybe not even really what happened due to working in a Level 1 trauma center.

Regarding understanding treatment plans, when you’re more familiar with surgeons and residents – you can ask questions about what brought them in, how did they know there was a problem, what does this mean, what else will they do, etc. Once you have a routine, you’ll learn to listen to the conversations the surgeons have with their residents and students. Many surgeons in teaching hospitals are more than willing to teach. Ours teach our staff a great deal, it allows us to understand their needs and thoughts about what next that much better.

I agree with the prior suggestion – there is a really special relationship we have with our patients. We get to talk to them and their families for 5-15 minutes, and in that time, gain their trust that we’ll keep them as safe as we can. Sure, the patients and families don’t really remember us, but we’re SO important to their care. I am the person who considers the person unable to speak, move or think for the duration of their procedure. I am the person who sees the entire room – anesthesia, the patient, the surgeon, the scrub and other things.

I agree – you might become an RNFA or APRN, or you might go into education. You may decide you like anesthesia and after some time go to ICU for a year or two then go to CRNA school. You may decide you want to take a leadership role and move on that way. I’m sure there are committees you can get involved with, as well as other “skills” you can learn.

What mistake(s) specifically are you worried about possibly making? Do you know what is causing your anxiety? PLEASE do not chase perfection. That will paralyze you. It should be collaborative in the OR – so be willing to provide and take feedback. Think about the things that are similar to all cases (induction, setting up, emergence from anesthesia – and begin to process meds given from the field and by anesthesia).

Are you learning to scrub or just circulate? Will you be able to learn to scrub eventually?

With all of that said, it's a very personal decision for you to make, and I recognize that.