CVOR vs general OR

[Jeffster]

I have some questions concerning the differences in working as a CVOR nurse vs general OR. What are the pros to working in the CVOR vs general surgery? What are the cons to the CVOR vs general surgery? Is it a better fit if you like to do the same surgeries everyday vs needing to know all the different services in the general OR? Do CVOR nurses in general take more call than in the general OR? If you want to travel could you work in the general OR for a year and then in the CVOR for a year and travel or would you likely need two years dedicated in the CVOR for traveling? Does it seem more stressful in either? Thanks

[Rose_Queen, BSN, MSN, RN]

Having worked in both main OR and CVOR, it really boils down to personal preference. I liked working with the same small team and surgeons every day. Although the foundations of the cases were the same, between the different surgeons and the different surgeries there was still some variety, but not as much as switching from colorectal to neuro to ortho all in the same week. As for call, well, my facility offered an extra dollar per hour of call time if you hit a certain level of hours. There were only two departments to ever get there: CVOR and IS. It was not uncommon for me to hit 100 hours of on call per pay period if I was covering the weekend. 

[Jeffster]

Hi Rose_Queen,

Thanks for the reply. It sounds like CVOR has a lot of call. How hard was it to transition from the main OR into CVOR. Did you adjust fairly quickly? 

[Rose_Queen, BSN, MSN, RN]

I adjusted to circulating fairly quickly- my preceptor was out of the room and available by phone by the end of the first week. Scrubbing took longer, because we were expected to help go on pump with the surgeon while the PA was harvesting vein so it was learning a lot of new things.

[Jeffster]

So it sounds like a lot of skills transferred in. Thanks again for the replies.

[NedRN]

Basic OR skills will get you a long way in CVOR in my opinion. Enough so that I have directed first timers in CVOR several times while scrubbed in. Fear of "complex" surgeries, perhaps defibrillators, and the more common strong personalities found in staff and surgeons seem to be the biggest issue in resistance to doing CVOR.

Still for me, I spent an extra year in CVOR after a first year spent floating all services to ensure my skills would be up to snuff for traveling. At my teaching hospital, we didn't have scrub techs, so fully half of our orientation was scrubbing. Typically scrubbing is easier than circulating as the focus is much smaller. However CVOR I consider scrubbing harder simply because you have to pay close attention for several hours while the circulator does very little except at the beginning and end of cases. Which made it ideal in my hospital to scrub one case and circulate the next. On a simple CABG, scrubbing becomes somewhat routine - looks really hard, but every case follows the exact same line so you know what the surgeon is going to do next and what they will need. Pediatric open is more like general surgery, each one is different.

The intensity of CVOR is what makes it interesting. I tried to stick to mostly that for my first few years of travel, but then I got over it. Happy to work in most any service. Fear of eye surgery affects most OR nurses though but even that is not so difficult with the expert scrub most eye surgeons bring or is available in OR staff.

[Jeffster]

Hi NedRN,

Thanks for the response. That response gives me some good insight. I am considering doing CVOR in the future. What would you say are some things you like about it over the OR main, and some things you don't like about it as much. It seems there is more call required. Do you find yourself getting called in more often than the main OR or just being "on call" more? Do you start off learning hearts and vascular or is that separate. Is there much overlap in those surgeries? In general do you experience more codes? Have you noticed as a traveler the culture differences in CVOR vs main OR if so, What? Anyone can feel free to answer those or give input. Thanks

[NedRN]

Historically there is some hostility between CVOR and general OR staff, each believing the other is treated favorably. And this is clearly true at a number of hospitals I have been to. They are very separate departments in many hospitals with no interservice floating. Isolation breeds fear of the other.

Yes, there can be a lot of call. Any hospital that is trauma level one is required to have a team available around the clock. In some places, call can even be a majority of your check and hard to get extra call. At one hospital, call added $600 a week, stayed there for 8 or 9 months without a single callback! Very unusual indeed but highly surgeon related. But generally call pay sucks, especially for travelers with staff often being paid more. If staff isn't paid more, that means there is even more pressure on travelers with mandated call.

I don't think of vascular and open hearts as being related. That said, skills, especially scrubbing, have a lot of overlap.

I could care less what service I work in, and float freely. I might prefer vascular and general (feels easy and calm) but I never turn down an assignment. In the beginning, the drama and intensity of open hearts was appealing. Where else do you stop a patient's heart on purpose and revive them? Every single patient on pump is effectively coded. But that wears off.

[justine_ferren_cnor_crnfa, RN]

@Jeffster I have been in the CVOR as a DNP RN First Assistant for the past 3 years. I scrub-in with our dedicated high-risk CV team that does our most challenging cases (re-do's, open aortic surgery, any cases requiring DHCA, or where STS risk profile meets a certain threshold). I was hand-picked for the team and started as a scrub nurse before moving into a first-assist role.

• Intensity: As many have mentioned, the intensity of the CVOR was the first thing I immediately noticed. Everybody is an A-Player and the expectation is that you perform to that level or you will not be on the service very long. The cases are much longer (which I liked) and can be heartbreaking as DOTs (while not common) are much more pervasive in high-risk CT surgery.
• Preparation: As a scrub nurse and even more so as a First Assist in CVOR, every team member is expected to show up to cases having done a full review of the patient's presentation, scans, procedure, operative steps, etc. When I started in general and trauma, I did not have to spend the nights before cases actually studying the procedure.
• Etiquette: CT Surgeons are definitely unique breeds and we have 3 that do the high-risk cases. Each one has different styles even when doing the exact same case. They are all intense in their own way and they all have short tempers. For example, the female surgeon will not hesitate to snap at me if we are not ready to time-out by the time she scrubs in. She expects that the patient is draped, prepped, equipment is in the room, etc. by the time she scrubs in. Each one uses their own hand signals for instrumentation.
• Crisis Situations: Intraoperative codes are not uncommon during our cases and everybody is expected to work in "controlled chaos". We do simulations often and everybody knows their assigned job. Often times, I am assigned the role of cardiac massage as the surgeon attempts to identify the issue and the perfusionist is scrambling to get us back on bypass. While our codes are more methodical and everyone is highly trained to do their roles, I find them far more intense in CVOR - there is absolutely nothing worse than losing a patient on the table in an elective case.

I have rarely met a CVOR nurse that was not passionate about the CVOR - I think you have to be to perform well. The stakes our high and the call can be overwhelming. As a DNP First Assist, I round with the team (which I didn't do as a scrub nurse), so I get that extra interaction, which I personally enjoy. I love the CVOR but it does take time and a certain personality.

[justine_ferren_cnor_crnfa, RN]

On 7/17/2022 at 10:56 AM, Rose_Queen said:

Having worked in both main OR and CVOR, it really boils down to personal preference. I liked working with the same small team and surgeons every day. Although the foundations of the cases were the same, between the different surgeons and the different surgeries there was still some variety, but not as much as switching from colorectal to neuro to ortho all in the same week. As for call, well, my facility offered an extra dollar per hour of call time if you hit a certain level of hours. There were only two departments to ever get there: CVOR and IS. It was not uncommon for me to hit 100 hours of on call per pay period if I was covering the weekend. 

Hi Rose -

Did you scrub and circulate during your time in CVOR? Which did you prefer? Marathon cases?

[Rose_Queen, BSN, MSN, RN]

Being a facility that heavily utilized surgical techs, my primary role was circulating. And I did not mind that at all! I have a tendency to have hot flashes almost constantly, so being in a gown under the lights was pure misery for me. 

[justine_ferren_cnor_crnfa, RN]

@Rose_Queen You definitely seem like you thrive in L1 Trauma more and probably got to scrub-in, especially during PEA operative resuscitation attempts!