How do you know you belong in the OR?

[sameasalways, ASN, RN]

Hi, I have been working on a Med/Surg floor for the past year after getting my associate's degree in nursing. We are basically the only floor in the hospital that gets the post-op patients. But we also get regular medical and neuro patients. I never wanted to be a floor nurse but this is the only job I could get..I wanted to be in a specialty like the ICU, or something..I have thought about the ER. I really love women's health though and Public Health. I know I need a bachelors degree for that and right now I can't afford to go to school. I am a single parent of a 14 y/o and 12 y/o boys. I'm posting here because I have been looking and looking for a different job lately. The 12 hour shifts are very difficult with being a single parent and not being home for my kids when they come home, not getting done with work sometimes until 9 pm on a bad day and no lunch, no bathroom break. On other days I am out of work at 7:30 and everything is fine. It depends on the call bell, and if a pt is going downhill or having issues with vitals. Also how many discharges and new admits and post-ops since each post op is a new admit too. Well one of the Doctors on the floor a week or so ago asked if I was going to apply for a job in the OR. I hadn't known they were hiring and I told him that. He said yes and that they need good nurses. I told him I would take that as a compliment and thanks as the elevator doors shut. Well yesterday I sent my application in after work. But I am so nervous and scared. I don't know if the OR is right for me. I llike to do things right, and it bothers me that on the floor I see short cuts everywhere and it gets me upset when I get a patient who says "No one has opened my abdominal binder since I got here". Or I get a pt with an NG tube and no one has verified placement and the nurse before me was giving the patient pills orally instead of crushing and putting them down the NG tube. Or I do a dressing change and the pt's family member tries to tell me how to do the dressing change even though the order says how, and then they tell me that no one has been putting this or that on the wound..that they were using this or that instead (which is not what the dr. ordered). This is one of the reasons I am not happy with the floor. I am not perfect I have made mistakes too and I have had to take shortcuts too but I really do not like to do it and I strive not to particularly when it comes to what I would consider patient safety issues..like checking a dressing or verifying NG tube placement ect. Yesterday that same doctor I told you about saw me at work and asked if I had applied, and I told him I had just sent my application in last night. He talked about how he believes no nurse shoudl go into the OR or ICU without atleast a year of Med/Surg experience, that a new nurse doesn't have the assessment skills they need there. And he said that the best nurses come from the Med/Surg floor. I asked him what constitutes a good OR nurse and he said "attention to detail". I explained to him I really am not sure what the role of the nurse is in the OR or what they do and that I have been thinking about shadowing to try to find out. I told him that another hospital I shadowed at requires a 6 month orientation in the OR. That the people that worked there stated that they always have new nurses in the OR saying they are constantly confused and say that they feel like they don't know anything and that this is normal because OR nursing is totally different from floor nursing. He said he was glad I applied and I said "well if I would have known that I would have used you as the person who referred me there" and he said "don't worry I already have spoken to the supervisor down there about you". I have to be honest I am really just shocked because I don't believe myself to be the best OR nurse candidate. I am totally unclear why he sees me that way because I feel that I do not have a lot of experience with this Dr. even though I do get his post-op patients frequently but I get all the surgeon's post-op patients. I am trying to figure out where he would come up his idea that I am the one for the job. I feel like I have just now gotten comfortable where I am and the stories I hear about OR nursing make me scared to start there. I don't know if I have the ability to multi-task to the extent they need people to in the OR. I am the kind of person that has to write everything down. I am not sure how the hours work there and this is the most important thing in regards to my family. On the application it says the hours are 7-3, 7-11, and 11-7. I am assuming you don't work weekend or holidays unless you are on call? I am 35 and these 13 and 14 and 15 hour days are about to do me in, and the stress is hard on me even worse because the whole time I am thinking about how am I going to make sure my kids are eating and have their homework done. I feel like I am being neurotic I don't know if anyone understands my concerns here but i was hoping someone might be able to give their opinion or experience on what it was like for them if they were a floor nurse and then switched to the OR...I would really appreciate that. Also, when I interview, what are some really important things for me to ask and find out before I should accept a position in the OR. My supervisor at my 3 month evaluation said I am very detail oriented and I am thinking maybe the Dr got this idea from my supervisor but I am not sure why that would happen. Also once again I have to say I have never ever thought of myself as detail oriented so I am not sure why they think that. I see myself more as someone clumbering through the med/surg floor and barely able to keep things working the way I think they should. There are a few other nurses on the floor with more experience than me who I think are much better candidates. My friend tells me they are that way because they have been doing it for years, not because I am not detail oriented. But I don't see things that I feel I should yet on the floor. I am making myself sound like one of those people that wants everything perfect and in my mind I guess that is how I think things should be. I guess that is unrealistic or even pretty much impossible on the floor unless you have years of experience AND still care after all the issues you are presented with on the floor. Thanks.

[Rose_Queen, BSN, MSN, RN]

The only way to find out if you belong in the OR is to go there- ask for some shadow days, which while not showing you everything that OR nurses do, will give you a basic idea. Try to observe something other than cardiac surgery, those cases run for hours, and you won't experience the turnovers (lather, rinse, repeat) of some of the more common cases- hernias, lap choles, cystos, ORIFs, things that can be done in 1-2 hours vs 7-8 hours. Just be aware that the OR seems to attract people with strong personalities, so be prepared to deal with that. You also have to be able to be a strong advocate for your patient, as they (usually) are asleep and unable to do so for themselves.

P. S. You should try to edit your post and break it up a little- a long block of text is difficult to read, and there are several posters here who would give up.

[jessrene, LPN]

You sound like your priorities are correct for ANY nurse, whether they are OR trained or not. ....patient safety and skillful care. The previous poster is correct, the OR brings out strong personalities in people. When you interview, I would advise you to ask for a tour and shadow experience to set your mind at ease about your ability to work in that environment. It's (the OR) not hard to figure out if you are a good nurse, just different. Like team nursing, everyone tries to maximize the strengths of the team members and minimize the weaknesses. You should not advertise your uncertainties and fears but rather your passion and strengths during the interview process. Give yourself a chance to be seen in your best light, and make sure the uncertainties you have are seen as attention to detail. OR managers like that. LOL

[sameasalways, ASN, RN]

Hi , sorry the post was so long I didn't realize it was when I wrote it. I am definitly not willing to accept a job there unless they allow me to shadow first. I need to get a general feel for the environment and how the people work together. I think the important thing for me is that it would be a supportive learning environment. I already know it would be completely different from floor nursing and that there would be a lot to learn. I really love to learn, but it has to be a supportive enviornment for doing so. After reading a lot of posts here it seems there is a lot of bad management going on in some different OR's. Currently I am blessed with a completely wonderful nurse manager on my floor. It is the one reason I would not accept a position somewhere else in the hospital on another floor, other than the fact that even though the med/surg floor is the most hectic floor I still know my manager is supportive and great and when I talk to others and see what is happening on their floor I would have no desire to change floors, not to mention floor nursing is floor nursing is floor nursing. I am interested in a specialty if I have to change positions.

-Has anyone made the transition from floor nurse to OR and what was that like for you personally?

-When you say the OR attracts "strong personalities" I hope you don't mean crazy. As in serious personality disorder crazy? Can you clarify what you mean? Thanks.

-I am a quiet grounded person until you get to know me and that is when my wacky sense of humor comes out. Personally I always joke that I am A.D.D. which is why I am having a hard time with the Dr I previously mentioned and my supervisor saying I am detail oriented. I know much more detail oriented nurses than me. Not a lot..but still.

-I have no sense of direction. No really. It took me forever to figure out which end of the floor was which; however, I have heard some other individuals (doctors and patients) say they had no clue which side they were on either, and which set of elevators was closer to each. All I can say is thank God for the GPS.

-How do you see the job outlook for OR nurses? Stability and growth? Thanks !

Hope I didn't make things more complicated than what they already were... :-) Thanks for all your feedback.

[Rose_Queen, BSN, MSN, RN]

-has anyone made the transition from floor nurse to or and what was that like for you personally?

i haven't made the transition, i came to the or straight from school. however, i have seen other nurses come from icu or med-surg units. some made it, others lasted through orientation and then when on their own floundered and decided to leave.

-when you say the or attracts "strong personalities" i hope you don't mean crazy. as in serious personality disorder crazy? can you clarify what you mean? thanks.

no, not personality disorders. more like the take charge/ assertive/ sometimes aggressive types. it's not uncommon to see people butt heads, but good management will put a stop to anything that crosses the line.

-i am a quiet grounded person until you get to know me and that is when my wacky sense of humor comes out. personally i always joke that i am a.d.d. which is why i am having a hard time with the dr i previously mentioned and my supervisor saying i am detail oriented. i know much more detail oriented nurses than me. not a lot..but still.

that's pretty much how i was when i started. it took me a few months to come out of my shell. just be aware that we in the or can have a pretty sick sense of humor- sometimes it's the only way we can deal with what we see. we have a saying in my or- if you weren't crazy when you started, you will be by the time you're off orientation.

-i have no sense of direction. no really. it took me forever to figure out which end of the floor was which; however, i have heard some other individuals (doctors and patients) say they had no clue which side they were on either, and which set of elevators was closer to each. all i can say is thank god for the gps.

i know where the icu is, where the er is, where blood bank is, and where the cafeteria is. other than that, i'm completely lost. i have to use the signs for visitors to find anything else.

-how do you see the job outlook for or nurses? stability and growth? thanks !

i've been in my job for 5 years, and have only moved up 2-3 slots in seniority. or nurses tend not to leave the or. however, it's a guarantee that people will always need surgery. it seems we can't get through a shift without doing at least one appy, and i'm amazed that people living in my area still have appys and gallbladders at the rate we do them. however, no job is recession proof, and we've been having "low census" days where we're told not to come in the next day. happens about once a month, but we're also in our summer slowdown, so hoping things get better once everyone's done taking vacations (both patients and surgeons).

hope i didn't make things more complicated than what they already were... :-) thanks for all your feedback.

-poet

[canesdukegirl, BSN, RN]

OK-can I just send a shout out to POET?!? Right on the money...again! You understand the OR very well, and I wish that you worked with ME!

1. I made the transition from the floor to the PACU to the OR. The reason the doc suggested YOU to work in the OR is because he has probably picked up on the fact that you like for things to be done the RIGHT way. This is paramount in the OR, and no shortcuts can be taken. I strongly believe that the reason I am comfortable in the OR is because of the experience I had on the floor.

2. Since the OR is typically very fast paced, you must be able to manage several important things at once. Floor nursing will have trained you to this mindset. There are strong personalities there because there is so much to be responsible for, and YOU have to control things. Because it is the expectation that the circulating nurse runs the room, and is captain of the ship for that room, it sort of molds a nurse into a control freak. Some nurses do not understand when to back off, but some take things in stride and are able to run the room and the surgeon's schedule with efficiency and grace.

3. There is nothing at all wrong with being quietly grounded and in fact, this is desirable. When you become comfortable and familiar with the routines of the OR, start being humorous and wacky! Totally acceptable!

4. Who DOESN'T get lost in unfamiliar territory?! I got lost in my own house when I first moved in...kept opening the closet door in order to find out that it was NOT the bathroom. Sheesh! You will become familiar...no worries!

5. I believe that OR nurses will always be in demand. Especially good ones, like you will probably be.

I say go for it. You have the backing of a doc already. It will be difficult at first. Hang in there, and do your day of shadowing. It is nice to only worry about one patient at a time. I think you would be great at it from the description that you give of yourself. I know you would like the hours better. You may have to take call, and may have to do holidays once a year (just one, not all). Other than that, you should be golden, depending on your facility and their expectations. They will let you know all of this during your interview.

Keep us posted!

[sameasalways, ASN, RN]

Thank you guyz so much. I am walking in to this with an open mind and looking forward to shadowing in the OR and hopefully get an idea of what the nurse does in the OR! Thanks thanks thanks!

[LAM2010, BSN]

Details and being able to speak up - it sounds like you have great skills as a med-surg nurse - so with your patient's safety your top priority, you shouldn't have a problem voicing what needs to be said, no matter if it's a patient, scrub tech, assistant, another RN OR a doctor! I am a quiet person until you get to know me, too, and detail oriented and I like routines and perfection (although I don't get all bent if it's not perfect - I just fix it), and I quickly learned to speak up. I am even able to tell the meanest surgeon how I'm going to fix something when he thinks I've goofed. I still have a ways to go, though (I'm a brand-new nurse with my first job being in the O.R.! - I still get a preceptor for a lot of cases). But what motivates me to take charge is my patients' safety. It isn't hard when you keep that in mind at all times - which is one thing ALL nurses do, no matter what area you work in.

Anyway, in the O.R. you get one patient at a time, when they're gone, you're usually done with them, and you don't have to deal with their families except when you call them to give them hourly updates from the O.R. :) You still get to be a caring nurse because they're usually scared before surgery, and you have a quick opportunity to gain their trust and make them comfortable and help them feel safe (my favorite part). You will need to be a bit open-minded when you start, since it is a different world, a different pace, and there will be different routines.

[sameasalways, ASN, RN]

Thanks all of you! I think the only thing that concerns me at this point regarding that job is that there is a possibility I will be moving after about 6-9 months. I am concerned how that would affect my ability to find a job somewhere else? Also my gut instinct tells me it is unethical to accept this position if in the back of my mind there is a chance I may be moving in 6-9 months. I really never wanted to be a floor nurse and I do not like my job to put it mildly. I respect the opportunities it presents to me in regards to experience and the acquisition of nursing skills and time management and the possibility to transfer to a different more specialized area of nursing; however, I reiterate that I do not like it :-( I don't think in my heart that this is the right rationalization to accept a different position somewhere in the hospital with the knowledge that I may be moving in the future. What do you think you would do in my situation? Am I over-thinking things?

[Rose_Queen, BSN, MSN, RN]

First of all, find out if you have to sign a contract. Because orientation for new OR nurses can take 6 months-1year, some hospitals require that, or you have to pay. If you really are going to be moving, then it seems wrong to me that you would only work there basically for as long as the orientation lasts, especially as it could then be up to 18 months before the OR would have a fully trained OR nurse functioning on his/her own. (Sorry, I'm a little jaded here because we have had several nurses who got orientation here, and then were able to go elsewhere claiming 1 year experience. We don't require a contract.)

[sameasalways, ASN, RN]

I understand and you don't have to apologize. personally I wouldn't feel confident about my skills in six months in the OR anyway...I know this because as a new nurse I wasn't completely confident in six months. Actually there is always something to learn..I think it would take 2 years to really feel comfortable as a new nurse on a busy med/surg floor. I just now am getting comfortable but not enough to feel like I can handle anything that is thrown at me..someone who is critical would def. put the fear in me..someone who suddenly can't breath, someone who needs a rapid response called...a code situation...but how can that not be scary? Well I guess after so many you would get accustomed to it but there is no way for me to know that right now. I do want to make it clear that my goal is not to leave in six months, rather that my personal life has been in upheaval for the past year and I am in situation that needs to be resolved and I hope and pray that in the next months it does.