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 , 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.
That stinks. If you wanted to have a pissing contest, ICU nurses deal with much more complexity and ambiguity than PACU nurses any day. It's too bad anyone has to be mean . . . but you're not taking it personally and seem like you have a handle on it. Seems unwise on their part, since you could make theur lives unpleasant later on, but there's no accounting for people.
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. :)
Does your hospital have an IV team? If so, maybe try to get some hours with them and practice. If not, always volunteer and try for all IVs that come along in your unit. Some of my ICU co-workers were poor in skill and constantly asked those who were stronger to start theirs. I always leapt at the chance. BTW, from another post, this is another reason for doing a year or two on the floor or ER before you do your ICU rotation. They get alot more IV sticks then ICU nurses. And yes, even if you go directly to ICU and then CRNA school, eventually, you'll become as skilled as the rest of them.
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
these are the very patient to practice. if a pt has a site that even looks like it might need changing i would start a new iv. if i thought the 22 butterfly wasnt going to be good enough, they got a new one usually started with a 18.
it helps if they are sedated and ventilated too, takes some of the pressure off. also try a couple of days in preop holding. everyone gets an iv there.
I think all of us SRNAs have had some of these things happen to us, but it's good to hear from others and what has happened to them:) I put in my first combined spinal/epidural this week and my hands shook more than I think they ever had!! Last week I had a gallbladder pop on me when the surgeon was removing it through that little laparoscopic hole. Not one drop fell in the surgical field, everything went behind the drapes on anesthesia. Not funny at the time, but I had a good laugh with him this week and brought in a large shield for the next gallbladder:chuckle I totally agree with the lidocaine and the IVs...it takes a while to get used to it, and in the end I'm not sure the lidocaine hurts less than the IV needle would. Thanks for sharing and good luck!
My hospital does have an IV team. I worked on the floor for a year and it was just so busy, I couldn't imagine taking the time to learn to start my own IVs. When I oriented to the ICU I did spend a shift with an IV nurse. I placed a few, but that was 18 months ago. I hate to try an IV just for practice on a wide-awake patient, especially if they have a central line. I just never seem to see a vein I could work with. Maybe I should start sticking anyway. A day or two in preop hold sounds great because some of those patients would have decent veins and I could gain some confidence before trying the LOLs or the obese patients. Maybe if/when I get accepted to school I'll set that up.
Quincke, that is gross! I don't think anything in the ICU compares with having a gallbladder explode on you. Makes a good story though.
While I'm blabbing on - I'm currently studying for the CCRN. How did the people here find it? As hard as they thought, easier, harder? What did you wish you'd studied more? The cardiac stuff is requiring all my brainpower since I'm not familiar with 12-leads and what happens when different parts of the heart infarct.
my first day in the OR (i am a past ER nurse for reference) - i forgot some of my things in the room and i remembered in the locker room - so i went back in to get them WITH NO HAT - boy that will sure piss off an OR tech/nurse..
I don't know how to thank all of those who shared all of their "fumbling moments" here on this forum. I'm so glad that I'm not the only one feeling incompetent during my first week in the OR. Here's my first "screw up":
Eventhough we've been in school for at least a month, the overall OR exposure that we had was minimal. My first day in a case started early at 730am. I was in the OR by 6am. Worked on checking the anesthesia machine, calibrated the 02 sensor, etc. Managed to put out and label all the syringes on the cart. Went through the whole thing again over a second time. Seemed like everything was ready to go.
Went to preop my patient, waited outside the surgical room for my CRNA to arrive. I was doubly anxious to meet the CRNA, since we were all forwarned in advance that this CRNA was very meticulous and that "we better know our stuff", or she'll give us a hard time about it. Well, fair enough I thought, and so I eagerly waited that morning. The patient was already in the room, but I waited outside the room as we were instructed earlier on, that we were to wait for our CRNA to arrive before we could "touch" the patient.
The CRNA finally arrived at 7:25. Introductions were made, hands shook, and she said, "So, tell me about the patient". After having told her the patient's history, we entered the room. Here's where the fun begins (and when I mean fun, it means NOT FUN FOR ME).
I began to place monitors on the patient. I felt nervous, since it was my first case alone with a CRNA and started to tape the patient's arm on the armboard,
1. FORGETTING that it was a right hip replacement and that the patient will be turned onto the right side after intubation.
2. Everyone was present in the room, including the MDA who just walked in at the very last minute, expecting that all drugs were drawn up so that he could push the meds for induction (this MDA apparently was notorious for being "in a hurry"...scarry, I thought.
3. I took my place at the head of the table, preoxygenating the patient, as the CRNA was getting ready to draw up the meds. All of a sudden, her voice echoed throughout the room, asking me, "DID YOU CHECK YOUR ROOM?!" Why, yea, I said. After which, she pointed to an EMPTY drawer where a drug cart ought to be. I looked and shook my head in disbelief! She stormed out of the room and got a drug box.
4. Once all the drugs were drawn up, I heard another question from her asking, "AND WHERE IS YOUR SUCTION?" Oh NO! The yankeur was missing! Great! I thought to myself, as I nervously hold the mask over the patient's face. THIS IS NOT GOING WELL.
Finally, after the patient was intubated (CRNA intubated), the patient was repositioned. When the patient was put on the vent...the CRNA gave me a 10 minute lecture and BOY, did she make no attempt to lower her voice and instead, made everyone in the that room hear her tell me:
"This is unacceptable and you are unprepared. I oughta send you home right now. I should not tolerate this kind of incompetence!" And, while holding her right thumb and index finger close together in front of my face, she said, "You are this close to being kicked out of this room!" Would you like that? To which I said, (firmly looking her straight in the eyes) "No, I would rather stay".
No matter what I did to explain what had happened with the missing suction piece and missing drug box in the cart, was utterly useless. She wasn't going to accept it.
I felt so little at that very moment. All eyes focused on me, including the surgeon who was probably laughing inside, enjoying this scene that was taking place before his very eyes.
After the case was over, I had 2 other cases with the CRNA. I stood my ground and maintained my composure. But deep inside, I was thinking to myself on how totally unprofessional she was to me for a minor oversight that I had done. THE PATIENT WAS NOT HARMED! This I kept repeating in my head.
I've been a nurse for over 8 years, and I have never encountered this kind of humiliation from another colleague. IS THIS THE NORM? I thought over and over. But, fortunately it is NOT.
I did learn from that experience. I make sure that it would not happen again. But, for some reason...the mere thought of being with her again (and I'm sure I'll be with her again) gives my stomach a rumbling now and then. But, I won't give in. I am here to learn. I won't let her beat me to a pulp! YEY! Whewwww....sorry for the long venting.
Vinnysca I am so sorry that you received that type of treatment. There is a way to teach without belittling the student. Some of my best instructors were the ones that took the time to get to know me, taught me, tested me and then applauded me when I learned the material. Hopefully as you progress through your education and career you will remember the treatment you received and NEVER pass it along. Kudos to you for remaining professional and good luck with school. It does get easier! :chuckle
although vinny got it pretty good, he's not the only one. i think when it comes to gettin it from preceptors, the older ones are worse than the newer ones. i think it's like raising kids, you do as you are taught. i was told in the older days clinicals were like boot camp.
and vinny, after about 6 months i got real good at checkin that suction :chuckle
darn if it dont seem someone comes in and takes it off after i go to get the pt.
Eventhough we've been in school for at least a month, the overall OR exposure that we had was minimal. My first day in a case started early at 730am. I was in the OR by 6am. Worked on checking the anesthesia machine, calibrated the 02 sensor, etc. Managed to put out and label all the syringes on the cart. Went through the whole thing again over a second time. Seemed like everything was ready to go.
3. I took my place at the head of the table, preoxygenating the patient, as the CRNA was getting ready to draw up the meds. All of a sudden, her voice echoed throughout the room, asking me, "DID YOU CHECK YOUR ROOM?!" Why, yea, I said. After which, she pointed to an EMPTY drawer where a drug cart ought to be. I looked and shook my head in disbelief! She stormed out of the room and got a drug box.
4. Once all the drugs were drawn up, I heard another question from her asking, "AND WHERE IS YOUR SUCTION?" Oh NO! The yankeur was missing! Great! I thought to myself, as I nervously hold the mask over the patient's face. THIS IS NOT GOING WELL.
After the case was over, I had 2 other cases with the CRNA. I stood my ground and maintained my composure. But deep inside, I was thinking to myself on how totally unprofessional she was to me for a minor oversight that I had done. THE PATIENT WAS NOT HARMED! This I kept repeating in my head.
Point of my story...
CRNA school is tough. LET'S ALL HANG IN THERE!!!
Vinnysca,
I too am saddened by your CRNA's attack. I always tell my students that I will never, never sabotage them in anyway. I had some, not many, who'd take apart my suction or some other such nonsense. I even had one who put a hole in my bag and asked me why I didn't check the circuit. This is never the way to teach. My question is, was the CRNA responsible for the drug box? and second what did happen with the suction?
Also, the CRNA coming in at 7:25 is totally unacceptable IMHO. If the CRNA was so concerned about her/his patient, and knew you were brand new, they should have been there way before. I hope all is better right now for you. And yes, Hang in there.
, CRNA yelled at surgeon and made me feel better :) (the sterile field was right next to the door)
A day or two in preop hold sounds great because some of those patients would have decent veins and I could gain some confidence before trying the LOLs or the obese patients. Maybe if/when I get accepted to school I'll set that up.
apaisRN, RN, CRNA
692 Posts
That stinks. If you wanted to have a pissing contest, ICU nurses deal with much more complexity and ambiguity than PACU nurses any day. It's too bad anyone has to be mean . . . but you're not taking it personally and seem like you have a handle on it. Seems unwise on their part, since you could make theur lives unpleasant later on, but there's no accounting for people.