First Day in OR

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Thought I'd post this for a fun response. What was your first day/days in the OR like as an RNAI. The only way we get through these instances is to laugh, otherwise we'd burst from embarrassment. It is such a hard thing for us smooth type A's to screw up in front of others, but humor me with your screw ups so I'm not hopefully the only one. Here's my screw ups:

1) Bumped into the sterile field very first case :uhoh21: even though had been drilled in lecture to STAY AWAY :angryfire from it at all costs. Surgeon yelled at me :crying2: , CRNA yelled at surgeon and made me feel better :) (the sterile field was right next to the door)

2) Couldn't and really still can't mask a patient to save my life!! All the air comes out the left side of my hand. I was told I have small hands and would have to learn how to adapt. Stood there fumbling with the mask fit, pt apneic, no air in rebreather, and APL closed all the way just to try to get some flow ( jeez, what an idiot I am), while the MDA and CRNA laughed and joked with me.

3) Every intubation I have tried I have had some former surgical resident colleague/friend right there making fun of my technique, especially when I goosed the patient.

4) I actually cut my patient's lip the first time I tried to intubate.

5) Stupid lidocaine for IV starts!!!!!! My hand shook and it's like all of a sudden I don't even know what intravenous means. All of these stupid patient's veins have disappeared on me. What do you mean I have to put a 16 gauge needle in !?!

6) I was practicing intubating on the mannequeins, their heads are like the weight of watermelons! So I tried this like twenty times and the next morning I couldn't lift my arm to shoulder level, my shoulder was like cement. I thinkk I need to do some one-armed push ups.

7) It's been two months now and I can at least bag and mask, managed to get the tube in some tracheas, transport without hitting the walls, find my way to the ORs, squeak out my goals for the day to the CRNA, do the preop assmnt without looking like a nursing student, give report to PACU RNs without getting my head bit off, and chart without too many mistakes on those tiny tiny tiny boxes for vitals every five minutes.

It's amazing how much you learn in a short time, much at the expense of looking like an idiot :chuckle.

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Yay! Sounds like you're through the worst part of being a newbie in the OR. I swear, every time I've been in the OR I've contaminated the table with the instruments on it. And I can't transport a patient without hitting walls either. Do they have a class on that?:)

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Thanks for the laugh! I had "one of those days" at clinical today myself. :chuckle

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I swear it would be so much more helpful if they just brought us into an empty OR and had us learn to put arm boards, monitors, etc without the hustle bustle first. I still can't get those darn arm boards on.

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Would you believe that charting on those itty bitty boxes is one of my greatest fears of becoming a CRNA (along with many others, of course). I have very large handwriting and can hardly chart on my ICU flowsheet and it is three times the size of the OR flowsheet. Thanks for sharing your experiences!

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:rotfl: :rotfl: :rotfl:

trust me...there aint nothin you can do one of use hasnt already done, since the dawn of srnas. sounds like your preceptors are friendly and good.

my first attempt at intubation went like this (i had intubated b4 i got into school so it wasnt my first).....

md with left hand in brace, preceptor 25 year navy crna,

obese man 350 pounds no neck.

as i slide the blade to the back of the throat md *she* starts asking what do you see what do you see. i cant bail you guys out if you cant get it, what do you see.i cant bail you out.

crna rolls eyes. :uhoh3:

me....right now i see alot of tounge. (remember i just put the blade in.)

md,,, ok get out crna get in there and take over.

second pt female 280 no neck.... repeat first scenario.

we all have had our doozies, keep you head up....and do some of those one arm pushups. :chuckle

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OK, now my anxiety level has risen steeply. I am starting in January and am nervous but so extremely excited and ready I can;t stand it. I feel like a senior the last week of high school (short timers). I remember the blunders I made as a new ICU nurse/new grad to top it off. These accounts of real experiences really help. Thanks to all for sharing and keep the thread going!!!

:rotfl: :rotfl: :rotfl:

trust me...there aint nothin you can do one of use hasnt already done, since the dawn of srnas. sounds like your preceptors are friendly and good.

my first attempt at intubation went like this (i had intubated b4 i got into school so it wasnt my first).....

md with left hand in brace, preceptor 25 year navy crna,

obese man 350 pounds no neck.

as i slide the blade to the back of the throat md *she* starts asking what do you see what do you see. i cant bail you guys out if you cant get it, what do you see.i cant bail you out.

crna rolls eyes. :uhoh3:

me....right now i see alot of tounge. (remember i just put the blade in.)

md,,, ok get out crna get in there and take over.

second pt female 280 no neck.... repeat first scenario.

we all have had our doozies, keep you head up....and do some of those one arm pushups. :chuckle

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Your posts took me back over 44 years and the opportunity to relive those old days. Back then we were just taken into the OR and were assigned a room with a CRNA. We had had no classes yet, and I couldn't even start an IV. In those days, all you needed to get into anesthesia school was an RN, which I got three months earlier.

My second day involved giving open drop ether for T & A's. No IVs, no monitors, no endotracheal tubes, but you sure did learn how to observe patients. Anesthesia is so much easier today!!

Remember, CRNAs are known for their excellent clinical skills and ability to avoid problems. You all will do great.

Even after all of these years, I still have dreams about anesthesia. Last night it was a difficult intubation on a baby and all of the equipment failed. I guess it was a nightmare and not a dream.

YogaCRNA

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Jewelcutt,

Didn't anybody tell you that during the first two months you do a double anesthetic technique, yourself and the patient! I can't begin to tell you how much sevo and forane I inhaled during the first two months because of my poor mask technique . Things get better with time but you will still have fun moments. For instance on wednesday we gave a pt etomidate and vecuronium. Now as you know vec takes a couple of minutes to work but the pt is not moving during the time you are waiting. Well this pt was actually raising his arms off the table a couple of minutes after the drugs were in. MDA yells at me did you put vec in that syringe, to which I yelled yes. But inside of me all I'm thinking is s--t, s--t! I am now second guessing myself and thinking how this MDA is going to crucify my a---. You have to understand that this MDA never has anything positive to say to any student, but he can always highlight your mistakes. The pt eventually settled down and I was able to intubate without difficulty. Trust me there is a god somewhere. I can't begin to tell you how many times I have thought it was all over in that OR but I managed to escape with only a few wounds. It is definitely challenging, but it is so much fun!

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Jewelcutt,

That is too funny! We all go through the same stuff. The IV thing is hilarious. I have probably started thousands of IV's and many 16g, but as soon as you add that lido..poof...the vein is gone! You go into anesthesia school as an experienced nurse and become "stupid" and grow 10 thumbs on your hands!

We all experience the same things...fumbling over things that we could have done with our eyes closed before entering the program. I have more stress over giving report in the PACU than anything. I never know when I'm going to get my a@# chewed!

The sterile field thing is funny too b/c I did the same thing on my first day! First thing I hit when I went through the door with the patient! NOT GOOD! Then with the same patient, as I went to push the propofol, the core of the IV port pushed in and the IVF and drugs poured all over me, the surgeon and the floor! The CRNA was laughing at me and I was glowing red! I had to grab a whole new IV line and set it up while everyone on the room was staring at me and waiting so they could get the case started. Oh well, that's the life of an SRNA. Thanks for sharing!

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Why does PACU chew you out?

I have very limited IV skills now as our MICU patients have central lines and/or are so obese/frail/anasarcic that there's no way a beginner could practice on them. Another thing to be embarrassed about when I get to be an SRNA. :)

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It sometimes seems that PACU gets crap from everyone, including residents and they can pass the buck to the lowest member of a totem pole, SRNAs in their opinion (esp juniors). They just get away with it because they can, that is until we graduate and then things change. Perhaps it is out of jealousy, I don't know. It is like we weren't even critical care RNs before we got in school in the first place.

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