Got an OR internship..now what?

I also am doing my senior internship in surgery. I am very excited, this is what I have wanted for years. The educator for our OR loaned me a couple of books to review before I started. If you are going to a larger hospital, they probably have an education dept that has resources for you. The most helpful has been "Competency for Safe Patient Care During Operative and Invasive Procedures" by Phippen. I had a couple of weeks to look things over and get a little bit of head start. I just completed my first week - it was a huge amount to take in - but I loved it. Good luck to you!

dhelin: That's awesome. The hospital I am going to is kind of small but does routinely have students since there are about four nursing schools and one medical school in town. Are you just observing so far or what? Do you get to do any pre-op stuff like start IVs or put in foleys or anything? I think I might order that book since I'm sure it wouldn't be a bad reference to have on hand.

Talked to my preceptor and she seems nice but pretty old-school. She said she likes students to have goals they want to meet during their internship. I honestly know so little about the OR that I am not even sure where to start with goals. I have a week and a half to think about it. Any ideas fellow nurses??

Hey DLuxe,

First off, congrats on an OR preceptorship! They can be quite hard to come by. Like you, I was the only student in my class to have one...and it's paid off! I've had two OR-related job offers since graduation. This setting is unlike any other, and people tend to either love or hate it. It's very team oriented, and of course with every team, you have a multitude of personalities. It's no secret that surgeons can be divas. Try to pick up quickly on the personalities of the different team members, because you will be working very closely with them. Let rude comments roll off your back, and don't take anything personal.

One of the most important things to learn quickly is identifying your sterile field. Watch for the blue drapes and don't turn your back on it! If you have a question about whether something is sterile or not, ask.

Getting a book is a great idea. I ordered the Pocket Guide to the Operating Room by Goldman. It's been pretty helpful. I've heard Alexander's is good too. You should review cases the night before so you know what to expect. Knowing something about the surgeries before you see them will help make a good impression by showing you are prepared and will help you ask good questions (ask a lot!). An additional source for knowledge is the AORN.

Don't be afraid to jump in and start doing stuff! There's lots to do while prepping the room and the patient for surgery. I didn't start any IV's during my preceptorship, but I put in plenty of foleys. Watch carefully as your preceptor shows you how to position patients. I had several goals surrounding this because it's such an important aspect of surgery. Communication skills can be a big goal too. One of the last goals that I had was to run a case (almost) on my own. The OR may seem overwhelming at first but you will surprise yourself at how much and how quickly you will learn.

Good luck! Let us know how it goes! :-D

Hexen,

Thanks for all your wonderful advice. For my first week objectives I put to become familiar with the physical environment of the OR (since I've never been in one), sterility and patient safety. I sometimes have a problem with filtering what I think before it goes flying out of my mouth, especially if I am happy or feel comfortable so I will try to remind myself to listen and get a feel for everyone first! The teamwork is one of the things that draws me to the OR so communication and not taking things personally need to be goals for me.

I am really excited, I hope I don't freeze to death in there!

PS- How did meals/breaks go for everyone? I was planning on just bringing a bunch of snacky foods that I can inhale in a few minutes if needed.

You're welcome! Also check out the OR sticky "Sooo you're observing in the OR" because there's really great advice in there. Those sound like great objectives so far. As you spend a few days in the OR you'll pick up on more ideas as well.

The hospital I precepted at was great about breaks, and for the all-too short time I was there, there was always a relief nurse. We had at least one 15 min break and a lunch. Occasionally there was some time between cases which would allow for a quick snack too. Not sure about other hospitals. Make sure you eat a good meal before your shift!

You (probably) won't freeze to death...they should give you a jacket to wear with the scrubs! The lead aprons sometimes keep you warm too. ;-) When's your first day?

My first day is next Wednesday (10/26) and the internship is 216 hours over 6 weeks but we can stay an extra week if we want and our preceptor is OK with it. Finally a clinical experience without care maps!!

I am so bummed out right now!

I just spoke with an HR rep at the hospital I am applying to for after graduation and she said they don't hire new grads in surgery!! They mostly just hire them to med/surg floors. BLARGH.

Now I am worried I will be extra behind since my internship isn't on a normal floor.

I am awesome, they should hire me anyways. I might surgery at the top of my "which positions you are applying for" list anyways! I am getting a BSN in accelerated program and I have a BS in biology, I am a member of sigma theta tau, I will have graduated both programs with honors (cum laude and magna cum laude). I will have a six week stint in the OR. Come on! Not cool.

Sorry for the rant.

D,

If you know you want to work in OR, then this internship will help you get there. It's a lot easier to get a foot in the door to the OR when you've already had a little bit of experience, and that experience can be hard to come by. I had similar thoughts when requesting my OR preceptorship, that perhaps I should've done med-surg instead. In my experience with my graduating class, those who had their preceptorships in specialties seem to be finding jobs sooner. That's not to say those with med-surg preceptorships won't find jobs, but the majority of students will have their preceptorships there. You can stick out from the rest of the crowd when applying for positions in your specialty, and apply for med-surg positions as well. In reality, there won't be just one hospital you are applying to after graduation, and some hospitals do have programs for new grads to enter the OR. Don't get bummed out yet, you haven't even started! It sounds like you have some awesome credentials, and be proud of your placement. The OR is rare! :)

H,

Thank you for the words of encouragement! Unfortunately in the short term I really only have this one facility. I am relocating to a small rural midwestern town with limited options. I guess one year in med/surg won't kill me, right? Right? It will probably be good experience and will make me more well rounded. Trying to look on the bright side here.

I am a little less patient since I am a bit older than most new grads and I am ready to start the career I really want!

OK, first off, don't fall for the Otis elevator trick. Orthopedic surgeons think that is hilarious. Second, there is only ONE kind of sterile sleeve no L or R residents think this is hilarious...whatever. Now, I hope you get to scrub as well as circulate 'cause that's the role that gets you hooked on surgery and teaches you the most about surgery. Circulating teaches you about being a pt. advocate and being the queen of everything.... just like the song. If you get to scrub-in, keep your eye on the surgical field as much as possible and ask questions 'cause surgeons LOVE to teach new nurses about surgery. It also builds rapport. Alexander's "Care of the Patient in Surgery" is a great textbook. I also recommend Berry & Kohn's "Operating Room Technique" to build fundamentals especially if you get to scrub. Get your assignment the day before and look up the procedure so you get to look smart by knowing a little about what's happening. When you are new in the OR, you sort of get amazed and overwhelmed (aka deer in headlights phenomenon) so PREPARE ahead of time. Relax and you will learn more. NEVER skip breakfast. Even a protein bar on the way to work it's better than nothing. I hope you like the OR and have good experiences. I have spent a working lifetime there and some days I miss it (but not the calls @ 2 am). Take care of yourself so you have a long and prosperous career as an OR RN! Good luck!

OK, first off, don't fall for the Otis elevator trick. Orthopedic surgeons think that is hilarious. Second, there is only ONE kind of sterile sleeve no L or R residents think this is hilarious...whatever.

Thanks for the tips! I am glad everyone is saying that asking questions in generally well received because I LOVE to ask questions. I will of course check with my preceptor and surgeon first. I bought the pocket guide to the OR and hopefully I will have access to other resources at the hospital so I can get an idea for the cases ahead of me.

I start bright at early (6:30!) tomorrow morning! So excited!

Thanks everyone for the kind and encouraging words! Not all nurses eat their young