From Med/Surg to OR

Editorial Team / Admin · Dec 3, 2010

I personally haven't made the switch from med/surg to OR as I started in the OR right out of school. However, I have seen many nurses try to make the switch. Some have succeeded, some have not. Of those who didn't succeed, some decided that OR nursing was not for them. Others were given multiple chances and extended orientations and just didn't get it; they were advised to transfer to other departments or resign rather than be terminated. It does take a certain personality to work in the OR- you have to be assertive and a good patient advocate. You have to be able to deal with strong personalities- some of these surgeons have unbelievable egos. We even have one surgeon who will suddenly erupt with some of the foulest language you could imagine. Those of us who work with said surgeon know it's directed at the situation, not us personally, but some of the orientees/students get all freaked out by it. On the plus side, you can often see immediately the benefit of what we've done for the patient. You also only have one patient at a time, and there are NO call bells.

As far as questions, you definitely want to ask about orientation. Most of the hospitals around me have a 9 month orientation- 6 working directly with a preceptor and 3 solo but with a resource person assigned to those just off orientation to help out if needed.

Also ask about call requirements. Some hospitals are you're on call from the time your shift ends until 7am the next morning and you do whatever comes through the doors. Others may have specialty call- if you work in neuro, you'll get called in for the crani, whereas those who work ortho would get called in for fracture management. My hospital breaks up call into 8 hour blocks, and even those can be divided if needed. Find out if you will be assigned to a certain specialty or will rotate through all of them. There are also requirements for how long you have to get to the hospital once you're called. We have some folks who have to make special arrangements to stay with someone so that they can meet the response time requirements.

solneeshka, BSN, RN · Dec 4, 2010

I worked in med-surg for a year out of nursing school and made the move to the OR last summer. The benefits: TONS. The down-side: none. Really. Maybe I just have the magical "OR" personality that you hear about, but I can't imagine how anyone would prefer med-surg over the OR. Of course, there are a wide variety of experiences in the OR. I work at a large teaching facility, so the MDs are used to answering questions and they are reasonably well-behaved. Some of the stuff I read about here (like swearing during a procedure), I couldn't imagine happening at our facility. It also helps that because we are so large, everyone specializes so you only have to get really good at your particular area (ortho or neuro or whatever).

The following comments are based on my experience.

In the OR, you don't have to arrive until the start of your shift and you get to leave when it's over. (On the floor, you generally have to arrive early - unpaid- to start looking up your patients and their orders, and you don't leave until you're done with report and all your charting, which may or may not be as soon as your shift ends.) In the OR, most of the charting is relevant and useful information; on the floor, most of it was not useful, not especially meaningful, sometimes downright made-up, and really not ever looked at by anyone unless that patient happened to sue.

In the OR, you get lunch breaks and usually at least one other break during your shift. (On the floor, you're lucky to have time to go to the bathroom, let alone have 1/2 and hour to eat a sandwich and breathe during a 12-hour shift.) In the OR, you have the one patient that you're working on for the time that patient is with you. You may have several things you need to focus on about that one patient, but there is no such thing as having 3 or 4 (or more) other patients also waiting for you to do something for them. There are no call lights, halleluia! There is no standing in a patient's room for 20 minutes with your phone going off every 3 minutes, helping them to and from the bathroom because they refuse to use a urinal. There are no multiple requests for extraordinary pain meds that the patient knows the MD has DCed. There are no QH vital signs. There are no family members! (Not once the patient is out of pre-op.) There are no "code-browns." There is no getting stuck in a lonely patient's room while they decide that the middle of your 9:00 meds round is a good time for them to tell you their life story.

I will tell you this: last week, I had my worst day in the OR ever. It was still better than my best day ever on the floor. There actually is one downside and that is that because I worked nights on the floor and I work days in the OR, I lost my night differential so now I still have to pick up shifts on the floor once in a while to make up the difference in pay. It makes me so sad to have to do that! Whenever I head in for one of those pick-up shifts, I can feel my stomach tighten up with the lack of knowledge of what's going to slam me in the face this time. The OR is not 100% predictable, but it is much, much, much more predictable than the floor. That allows you to be prepared and have more control over how things go. Part of my problem on the floor is that I am someone who cares about giving great care to my patients, and it makes me angry when I don't have the resources to do that. Nurses who don't give a crap (and unfortunately, there are many) don't mind the floor so much, and I think they prefer it because they have so much more autonomy and it's so much easier for them to get away with under-working. You can't do that in the OR. You're on a team there and everyone has to pull their weight. But the team-work is the thing I like about it the best.

Things to ask about in the interview:

How long is orientation? What determines when you come off? (Our policy is that orientation lasts as long as the nurse needs it to. The ballpark is a year, unless you have previous OR experience.)

What hours are the shifts? Is it straight days, straight nights, weekends or weekdays, etc.? What's the policy for working weekends?

Why is this position available? What happened to the person whose spot you're looking to fill?

What's the turnover rate like in nursing in this department? Do nurses turnover quickly or do they tend to stick around?

How do the doctors treat the nurses? (No one is going to say, "Oh, they're just awful!" But you might be able to glean some information based on how they handle the question. Do they give a tempered response or do they enthusiastically tell you the MDs are great?)

Who would be your preceptor? Can you meet with him/her during the interview?

Ask the interviewer what they see as the best things and the biggest challenges of working there.

Be sure to emphasize the benefits of your med-surg experience: you can start IVs if needed (although OR nurses don't generally do this, which is why they generally suck at it and it can be handy to have someone who can do it), you've been in codes more than any OR nurse probably, you have a good grasp of how the different areas of the hospital work, if you need to deal with patients coming from or going to the floor then you know the issues that the floor nurses face preparing patients for surgery or caring for them afterward and can be an effective liaison, you are accustomed to intradisciplinary work, etc.

You'll do great! I think everyone should work OR! :yeah:

daVinciNurse · Dec 4, 2010

I was a med/surg float for about 2 yrs before transferring to the OR. All i can is a bad day in the OR is still better than a good day in med/surg!! The other responses you've gotten here have been great, so I don't have much else to add. However, I will mention that it is not always practical to have ONE preceptor in the OR. Some nurses are stronger in certain specialties than others....so you want to be precepted by the nurses strongest in the specialty you are in. I was lucky and had one preceptor for the first 6 weeks--we did all general surgery with a few other cases thrown in from time to time. That helped me learn my "OR Routine"--room set ups, case requirements (instrument sets, equipment, sutures, positioning devices, etc), preference cards; when circulating that meant how to interview a pt, check the chart, get the pt in the OR and ready for surgery, then back out to PACU; when scrubbing it meant learning to gown/glove the rest of the team, a basic back table set up and how to pass instruments, cut suture, etc. Once I mastered that, I could focus on the specialties and the instruments/equipment. I was on orientation a good 9 months (scrub and circulate) and by the time I'd been there 2 years, I found myself teaching some of the new staff! Wow! If you learn a good basic routine, you'll be able to handle the "out of the ordinary" because the basics will just come naturally. It is not an easy specialty to learn, it takes a lot of time, but if you put the time in, it is so worth it. One patient at a time. What other speciality can offer that?? Best of luck to you!!

linguine · Dec 4, 2010

Good luck to the OP with your transition!

nursingismydream · Dec 6, 2010

thank you so much for all your input. It has been so helpful. I think that my interview tomorrow will be such a great experience. I am actually more excited then nervous. Go figure.

solneeshka, BSN, RN · Dec 7, 2010

thank you so much for all your input. It has been so helpful. I think that my interview tomorrow will be such a great experience. I am actually more excited then nervous. Go figure.

How did it go?

nursingismydream · Dec 8, 2010

My interview went very well. The manager called today and we are going to proceed with the next step. Again, thank you all for the wonderful advice. I am nervous, but excited for this possibility.

JohnDeyet · May 10, 2013

2 years later, how would you say you like OR? was the switch worth it? Floors is tiring for me and i've been there for 2 years now, thinking of OR... What say you? Thanks