ICU to OR, any advice?

chickadeepie · Sep 27, 2011

Hello Nursgirl

I don't have an answer to your question but is wondering if you can answer mine...how long have you worked in the ICU before applying for the OR position? I am currently working in the MICU/SICU for about 8 months now as a new nurse. I'm really interested in the OR but really want to go to a periop program...it seems like there are no more of these programs...

Chickadeepie

nursgirl · Sep 27, 2011

I've been in ICU for a couple yrs... I'm not sure about the periop program, I just know that the manager did tell me over the phone that there is typically 6 months orientation for someone with no OR experience, possibly more and it's tailored to the individual.

Monica08 · Oct 29, 2011

Im currently an OR nurse and I've had my rotation in the ICU way back. In the OR, you need to be focused and observant. You have to be able to be attentive and keep your attention to the things the surgeon is doing in order to anticipate the next instrument to hand them. sometimes they dont say a thing a just reach their hand out to you and they expect you to know what they want.

You also have to be thick-skinned. Surgeons tend to yell at you when you get it wrong -- its just their way of venting out. Dont and never hold grudges.

There are days when you dont get to sit down your entire shift because of long surgeries but there are slow days too. Like no surgeries at all.

nursgirl · Oct 29, 2011

thank you for your input Monica08!! I got the job and started this last Monday. So far I LOVE it.. of course I am still in the beginning stages of training with the 3 other RNs that got hired with me. We are training to circulate first and eventually will be trained to scrub. It is a HUGE OR where I work.. it took most of the week for us just to be able to get used to it and find our way around LOL It is like a giant maze of OR suites and supply rooms and anesthesia rooms and perfusionist rooms.

I was thrilled to get to observe and help out in 4 open heart surgeries yesterday. I'm sure for many of you that is something you've seen many times and are used to but for a nurse like me who is new to the OR it was awe inspiring!! I am constantly amazed at the coordination among all the various team members in the OR. I have learned so much in just this first week that it feels like my head might explode. LOL

I am loving every minute of it and will be mindful of your advice to not take things personally!

nursgirl · Oct 29, 2011

oh I should add that as we go along in our training we will eventually be assigned to a specialty....

hxk06 · Nov 2, 2011

nursgirl, That is great, You got the Job! I have a question about your interview process. How did that go? What type of things did you get asked?

Also how is your orientation organized? Sounds like you start out general but what does that mean. Are you attached to certain nurses all day? Any details would be appreciated. Thanks for your info inadvance.

nursgirl · Nov 3, 2011

ummm well I was asked all the typical questions such as "why do you want to work in the OR?" and "why do you want to work for this facility?". I was also asked if I would be able to be at work and clocked in within 30 minutes of receiving a page if I was on call. They asked me to describe a time when I was in conflict with a coworker or did not agree with their actions, how did I handle it, etc... lots of different questions where I was asked to basically tell them a story about a time that x/y/z happened and how did I handle it...

I was interviewed by the manager, then went to a separate room and was interviewed by a representative from HR, and then by the OR educator. The whole process took about 1 1/2 hrs..

our training to this point has been general to OR and as we go along I'm told we will be assigned to a specialty and then will have more training within that specialty.

SRNA4U, BSN, DNP, RN, CRNA · Jan 11, 2012

Hello,

I am currently an OR nurse, for about 9 years, and I have been in the ICU for about 2 years now and I currently work in both areas. I am currently active duty Air Force and I work on a Surgical ICU unit where we get neurosurgical, trauma, cardiothoracic, and renal transplant patients. On my days off, I work as an OR nurse in the civilian sector. I like ICU but I love the OR. I went to ICU to gain the experience I would need for CRNA school. As a result, I was accepted into a civilian CRNA program. I didn't want to go through the military CRNA program. I found a program that fit my needs and even allow students to take their core courses online before they start the program if they choose, which allow students to focus just on their anesthesia courses with a reduced course load of about 6-9 credit hours a quarter versus the 15-18 credit hout requirement of the military's anesthesia program. I will be separating from the military next year to start my anesthesia program and I am so excited.

I knew of an ICU nurse who went to the OR but from my experience, I see more OR nurses going to the ICU to get the experience needed for CRNA school. When I was stationed in Germany, I would say about 40% of the Army CRNA's were prior OR nurses. I think I have a great advantage over ICU nurses who don't have OR experience since as OR nurses, we know the flow of the OR cases. We know the anesthesia equipment and we assist on many of the regional blocks, spinals, and epidurals. The ICU component really helped bridge the hemodynamic monitoring, medications, and ventilation management of the critically ill patient. I enjoy working both areas and have no problems working both. I often find that because of my ICU experience, the anesthesiologists at my OR civilian job tend to ask me to help setup their a-lines, Vigileo and other monitoring devices, which really isn't my job as an OR nurse but I don't mind helping. I remember doing a case and as soon as the monitors was applied on the patient, the pt had EKG changes. I grabbed the EKG machine but the OR nurse assigned to the room and the surgical PA did not know how to place the EKG electrodes. I jumped in and less than 5 mins we had the EKG done. I see lot of OR nurses tend to feel uncomfortable caring for ICU patients especially when its time to prepare postop for the pt to return back to the unit. Many forget about the transport monitor, ambuy bag, and O2. From the ICU, we go on transports all the time to CT and MRI.

You will enjoy the OR internship process. You will get to learn how to circulate and scrub very interesting cases. As bedside nurses, we kind of know what's going on w/pts in the OR but as OR, we know the specifics about the various implants used for patients. We know how they are positioned and how it could affect them postop. As ICU nurses, we know patients that are on APRV ventilation, who require surgery, will need to have their vent taken with them to the OR since anesthesia machines don't usually have this capability for this type of ventilation or they may have to be placed on CMV-assist control, which some patients on APRV don't tolerate too well. I really enjoy the OR and ICU.

Best Wishes

cdsga · Jan 11, 2012

I went from SICU to PACU then to the OR. The shift hours were better and so I would say that I got experience taking care of a multiple of post surgical critically ill patients and then worked very closely with anesthesia in the PACU. My ICU skills have made me invaluable to the OR. I now know how to put all the pieces of patient care and education together because of the knowledge and experiences I obtained through the years. I have no anxiety when surgeons ask for things because I know the cause and effect relationships, and ditto for anesthesia. I will tell you it took several years to feel confident and speedy in the OR, but I did enough bedside procedures in both the ICU and PACU to understand sterility and working fast. I think that your skills with drugs, drips, emergency situations gives you a leg up that other nurses who never worked in the ICU will never have. So take an OR course and internship and go for it.

CheesePotato, BSN, RN · Jan 12, 2012

Good Day--

First of all, congratulations on getting the job. I know that orientation can feel like...well...forever, but trust me, it is worth it.

I know this is long winded and I....I am so sorry.

A typical day, huh? Well, I don't know if this is what you had in mind....forgive my rambling, but I'll describe for you not just a typical day, but today, in fact, at my level one trauma center of employ.

My day starts out with the typical eye rubbing and strings of profanity that generally accompany the incredibly rude blaring of my various alarm clocks. My alarms feel as if they are rebelling and going off early today as I stumbled into bed late last night after being called in for an open tib/fib fracture and blown apart ulna/radius. But such a thing is a lucky injury when one decides to do battle with a mini van. Blasted vans have this horrible tendency of winning.

I digress.

Fill in normal morning routine information here -->XXX .....aaaaaaand here -->XXX.

The elevator deposits me safely by the surgery locker rooms and after donning my armor of periwinkle and my bouffant helmet, I brandish my pager and dart out to see what there is lurking on the scrolling board. Scarcely escaping the locker room, I find myself being summoned down to the charge desk by He Who Shall Not Be Named, AKA, the charge nurse.

And so it begins.

As a member of the trauma team, it would seem that my day begins early as I am dispatched to assist in a Level I coming up hot from ER. It is 0630 and I find myself working on an individual who decided that the train on the tracks wasn't really moving, so heck, why not cross? The tally: Crani, pelvis, belly, and two blown apart femurs, arms pretty much unscathed (how in the hell that happened....I'll never know). Partridge in a pear tree unavailable for comment. Typical organized chaos of too many alpha male surgeons all trying to mark their territory, the mandatory emergent placement of a couple chest tubes, a crash cart and what feels like endless amounts of blood product later, and we're finally underway. Blah blah blah, drain to the head, ex fix to the pelvis and femurs, irrigate irrigate irrigate, spleen removed and we are sashaying up the ICU. Job well done, snow cones for everyone.

It is only 1039.

So I get to provide lunch relief by scrubbing out a few scrubbers, which, frankly, I adore as it gives me face time with my docs.

So here's the story: yeah, surgeons expect a lot of nurses, but here's a couple tips in order to be well received:

1. If you don't know....say you will find out and do so. Docs respect follow through.

2. Don't patronize them. Don't suck up either. They can smell bull$%#@ a mile away and it irritates them beyond reason.

3. Until you have been in the OR a while, keep your head down, your focus keen and your mouth shut. What this translates to is this: A knowledgeable, practiced nurse can watch the monitors, track the case and talk. A blabbermouth who knows nothing and is not paying attention earns no friends and fast. If your scrubbers and fellow nurses don't respect you, your surgeon picks up on it and is a lot less likely to trust you.

4. Repeat back. It lets them know you heard them and are going to complete whatever it was they demanded/asked for. Very helpful in Level I such as the one above due to the chaos of so many docs/nurses in one room. It's just good communication.

5. Saying hello never hurt anyone.

6. Eye contact is good.

7. Get to the bloody point! If you have a question, ask it direct and concise. Don't ramble. And try to cut out as much fluff from your info as possible. They don't care that the patient enjoys the smell of a freshly opened can of sardines. What does the patient NEED?

Yeah. As I was saying. Lunches, scrubbed in, chatting with docs. They are funny and strange little creatures. I learned a few great knock knock jokes while performing a breast biopsy. But that shall have to keep for another time and place.

1203

AAAAaaaaaah. Finally able to sit down and have a cup of coffee. Wait. Never mind. Heart patient from this morning is bleeding like stink. Yay for crashing bring back hearts. Coffee abandoned.

Pour and cut. Nothing quite like literally dumping betadine on a chest and tucking arms while under the drapes to get the adrenaline running. It's a beautiful thing when hearts go well. But man when they go ugly....it's worse than a close up of Willie Nelson's plastic surgery. Crashing onto pump. Aorta dissecting. Boat loads of product, placement of a balloon pump, and one pair of shredded pants later (yes, my pants exploded.....don't ask how), and things have finally simmered to a point where I can go back to my abandoned coffee and leave the room nurses to it.

1444

And....and then it happened. That sound. That sound can only mean one thing. Sure as shootin', my page squeals to life, heralding the arrival of the chopper and some poor torn up soul needing skill, attention, magic and a prayer.

I go with HWSNBK (charge nurse) down to the trauma bay to receive the patient with the ER trauma staff. It doesn't look good. Someone stood on the wrong side of a shotgun.

I would love to say that something could be done....but not this time. We can only do so much and it's a pity when modern medicine proves futile.

1630.

I wander back up the locker room and shed my scrubs and disappointments, reminding myself to leave them with the evidence of a rough day in the laundry hamper.

Sure, there are days that are not quite like this, but I dare say they are becoming fewer and further between. The patient population is showing up for care at a later point....almost when nothing can be done and the cases are more critical. Then there is the trauma aspect.

But I wouldn't trade it for the world.

You, as an ICU nurse, have the leg up of seeing the patients after they are done with the OR side of things and not all OR nurses have such an experience. Your bedside skills of managing drips, etc, will not go to waste. You are probably already pretty bold as you have experience, and as far as not taking things personally, you are an ICU nurse--I would hope such a point is behind you.

I'm sure you will do well. Trust in the instincts you have developed and absorb as much as you possibly can. Ask intelligent questions and embrace the private, little known world that exists behind the double doors.

As far as specialties...if you are given the choice, the main advice I can provide is for you to follow your passion. If you don't like hearts, for whatever reason, no matter how cool they seem.....for pity's sake, don't join the heart team. You have to be willing to be woken in the dead of the night and rush through snow, snakes, high water and Twinkie shortages to get to the case in under 30 min. Therefore, love what you do so when you do get called in, it's all good--you are right where you want to be.

Remember, you can always change teams and cross train in other areas. I started out as Ortho....now, I go where I am needed: hearts, neuro, etc.

Welcome, my friend, to the dark side

gallatea · Jan 20, 2012

What an amazing reply. I'm contemplating OR too eventually after getting some general experience. Decisions decisions for integrated practicum.