Life After the OR

[PeanutintheOR]

Hi all,

I am quitting the OR. I just can't take it anymore. A little background: I'm a relatively new grad, about two years out of school, and I went straight to the OR after graduation. At first it was really hard, but I'm proud to have stuck it out longer than a lot of folks. My first OR hired ten new grad nurses in the time I was there; all but me and one other had quit by the time I left ten months later. I've had trouble in all three facilities I've worked in: the first one had a lot of bad-tempered staff and surgeons, the second had absolutely insane management, and the last...well, I'll tell you about it.

For some reason, this hospital just couldn't get it together. The in-room staff was great, but the support staff was awful. Our supply person never ordered anything until we were completely out, and because of arthritis in her hip, she wouldn't get up from her chair to help find specialty items. She'd just tell us "Oh, we don't stock those anymore," and I, the circulator, would have to go back into the room and tell a surgeon, who knew perfectly well that we _did_ stock the item he'd been using for the past ten years, that I couldn't get him what he needed. The instrument technicians could have been replaced with recordings that said "Find it yourself," for all the help they gave when your last pair of tenotomy scissors had just fallen on the floor. And the schedulers, they were the ones that pushed me over the edge.

It was funny in a "Why us, Lord?" sort of way when they scheduled twelve laparoscopic cases in one day (we only had five laparoscopy sets. Some cases were delayed by two hours while we turned them over.), and when they put our only MRSA case in as the first case of the day, we just moved that patient to the last case and had them sit in the isolation room in pre-op all day. But imagine my surprise when I came in one morning to find my first case scheduled as "Parotidectomy, sigmoid colectomy, and perianal sigmoid colon resection."

Waitaminute...parotidectomy AND sigmoid colectomy? It's been a while since I had basic anatomy, but aren't those at opposite ends of the body? And aren't they completely different specialties? And wouldn't there be some kind of contamination issue with working on the colon and the parotid at the same time? I left my poor scrub alone to open while I went to sort things out.

Come to find out, only the perianal colon resection part was on the consent. OK, I thought, we'll just set up for that. I consulted the preference card. It looked plausible. Lithotomy position, Yellofin stirrups, General Basic instrument set. We set up that way, and got ready to bring in the patient. Enter the surgeon, who promptly asked, "Where's all my prone position stuff?"

Yep, our card was wrong. Totally wrong. Abominably wrong. You see, the cards were generated based on the (completely erroneous) schedule, and consequently what we had was an excellent description of how to do a sigmoid colectomy with perianal resection, instead of a simple perianal resection. Oh, and our useless supply person was on leave having her bad hip replaced, so we had only a clueless temp worker supplying the OR. It took me almost ten minutes to find a lousy foley cath kit. I spent about 80% of that case out of the room, running to get supplies that we should have had pulled before the case. In my mind I pleaded with the patient, "Please don't code. Please don't code." My counts came out correct, but in my consternation, did I open something countable and forget to write it down? I honestly can't remember. I was so flustered and upset by being caught unprepared that, to my eternal shame, I started crying in the middle of surgery. In front of a student who happened to be having an OR observation day. Yeah, that's one that's never going to work in the OR, ever. Thankfully, the charge nurse saw what bad shape we were in, and came in to give me a break. I ran to the lounge, still sobbing, and kicked the bejeesus out of several hapless chairs. When I calmed down, I scribbled on a piece of note paper "Can't take it anymore. I quit. My last day will be Sept. 30." and taped it to the manager's door.

So, I need to get out of the OR. When it goes well, it's the best job in the world, but the stress is too much. I'm not sleeping, I'm eating compulsively, I'm suddenly afraid of a lot of things that never scared me before. My boyfriend tells me I'm much more irritable when I have a bad day at work, and there are so many bad days. Problem is, I still have to pay bills, so I need to find somewhere else to go with decent pay. Also, I've identified myself as a tough OR nurse for a couple of years; I have trouble allowing myself to do something I see as "not elite." Are there any ex-OR nurses out there who found happiness in other areas of nursing? Any suggestions on where I should go from here? Any advice on where to go from here?

Thanks for reading,

Peanut

[Crux1024]

While I cant help you with advice of life outside of the OR yet (Im trying to breakout myself) I can sympathize with your situation. Ive been an Surgical Tech for over 6 years and know what it takes for the OR nurses to be efficient AND comfortable with the job. You sound like a good, hard worker, but you cant improve on what everyone else stubbornly hangs on to. Bad hip or no, someone should have been back there to help find ur supplies. And those schedulers need to be wrangled in. Arent there guidelines they schedule by?

My best wishes for you to find what you need to be happy.

Dont let anyone steal your sunshine!

[locolorenzo22, BSN, RN]

I think what you describe is a very valid reason why my hospital won't hire new grads for the OR center.

My heart goes out to you, and may you find where you fit, and may your new workplace know what a good nurse you are.

[openheartmary]

WHEW! What a nightmare you've been living. The OR where you work seriously needs some revamping, reorganization and new management!

So the charge nurse gave you a break. How sweet of her. Where is the Nurse Manager, the Director! Who is the Director of your Supply Chain and why didn't the surgeon insist one of these people in charge be brought into the OR to ante up some answers!

Our surgeons understand that we do the very best we can for them to make their cases run smoothly and if we were experiencing your types of situations, they would have administration either in the operating room or they would be over in administration verbally venting to everyone what was going on. (My personal opinion is your facility probably needs a new CEO.)

I hate the thought that after making it through the extremely hard process of learning to circulate in the operating rooms that you would leave. You obviously have what it takes to do this job! Is there no one there to hold these necessary departments accountable?

HUGS TO YOU!

[openheartmary]

Also, please check out under "Specialties" the Operating Room Nurses link. You'll find a lot of support and suggestions there.

[PeanutintheOR]

Well, the Nurse Manager is so busy she's almost impossible to find, the Director even more so. And the Supply Director I've never seen, but apparently neither the Nurse Manager or the Director has any authority over the supply people at all. I forgot to mention in my wall o' text that two weeks ago the management decided we needed an extra operating room, so they cleared all our supplies out of the spare OR they used to live in, and moved them to two separate rooms (so you now have to guess which one to look in first when an angry surgeon wants to know why you don't have any spare prep kits in the room. Joy. ). Anyway, that's another reason I couldn't find what I needed when I needed it.

I like to think everybody is tearing their hair now, because I noticed something strange about my scheduled cases the very day after this whole debacle. The last one was scheduled as "exploratory laparotomy, axillary node dissection." OK, that doesn't sound right, either. Cautioned by the day before, I asked the charge nurse to verify the procedure with the surgeon. Surprise, it was supposed to be an axillary exploration! That's right, we somehow scheduled an 83 year old woman for a completely unnecessary major abdominal surgery! Hooray for us!

The best I can figure out, our new scheduler hasn't had a course in medical terminology, and so doesn't understand what she's being told to schedule. So she just schedules everything that _sounds like_ what she heard the surgeon call in (ex lap, axilla, whatever, right?) and figures we'll sort it out on our end. She surely doesn't know that we get our preference cards from the schedule, or that we won't know that the schedule is wrong until we check the consent, at which point we'll get chewed out for delaying the case while we get the right things together. I need out, STAT.

[Sunflower3]

Hi Peanut,

So sorry you're going through this! As a former OR nurse, I have 'been there and done all of that', so I DO understand your situation.

What you're describing is burnout from the OR. Probably time to find another area of nursing.

Here's what I did: although I had a strong Med/surg background before working in the OR, I realize that this was your first area of nursing. Think back when you were still in school, was there an area during clinicals that you enjoyed or that you may want to explore? I understand what you're saying by working in an elite field, and I took this great experience of circulating back to telemetry floors. I feel completely comfortable with whatever the monitors tell me, and help out others who are not as knowledgeable, especially during crisis or code situations. It has made me an even better floor nurse, to have the specialty background experience. I no longer have the load of stress that I carried working in the OR, although I won't say that the floor is without its own stressors, like unit politics.

So, I would recommend the ICU environment, since you are familiar with monitors, code situations, specialty IV meds, sedation, vents, etc. Depending upon your preferences, you could also go to Med/Surg telemetry floors, and teach other nurses what you know, so that the patients reap the benefits of your experience. In fact, I realized that I like teaching so much, that I'm now getting an MSN in Nsg Ed. I really believe that I've found my niche in nursing, thanks to all my experiences in all the specialties I've worked in.

Hope this helps in some way!

Sincerely,

UnitRN01

[Jarnaes]

I'm sorry you have to work under such horrible conditions.

Yes, we've all had a day where something is totally screwed up, i.e. confused scheduler, or a wrong pref. card/set, but to have to fight those battles every day is too much for anyone.

I would find a new OR position. At this point, anything would be better than your current place. Good luck.

[uscstu4lfe]

i'm a med-surger looking for a way out. i was thinking about OR, but now i'm not so sure about that! i can certainly understand your frustrations and your "wanting out of it" feelings. in nursing school we were in the OR for about a month. my experience was pretty positive. just an occasional cranky surgeon or crazy surgical technician. i really like the role of the circulator. you're there, but you don't have to get too dirty in the case. also, totally lame, but i like the temperature of the OR as well. ;-)

[RN1989]

i really like the role of the circulator. you're there, but you don't have to get too dirty in the case. also, totally lame, but i like the temperature of the OR as well. ;-)

Apparently you didn't have much ortho in your rotation. There's nothing like spending the day squishing in your shoes because the OR was flooded with irrigation solution when the surgeon took WAY too long to do an arthroscopic procedure. And don't forget having to crawl on the floor under the drapes to rearrange lines, retrieve dropped instruments, or my fave - crawl under the surgeon's gown to retrieve the pager tied to his scrub pant string that is now down INSIDE his pants because he forgot to take it off before starting.

Circulating and scrubbing is hard work and not always clean.

I also have so appreciated the throwing of surgical instruments by a surgeon that doesn't like the only one that happens to be sterile because he has already done 3 of the same cases that day using his favorite instruments first. Have had wire cutters go flying by, scattering scalpel blades. And then there is the careless surgeon that nicked my gloves while suturing, not once, but twice while I was scrubbed in.

And if you like the cold O.R. remember, as a scrub, it never gets cold enough.

Be sure you are going to the O.R. for the right reasons and not just because you are running away from medsurg. The O.P. has posted very real stories that are played out all over the country every day. The grass isn't always greener, the manure just smells a little different.

[GadgetRN71, ASN, RN]

i'm a med-surger looking for a way out. i was thinking about OR, but now i'm not so sure about that! i can certainly understand your frustrations and your "wanting out of it" feelings. in nursing school we were in the OR for about a month. my experience was pretty positive. just an occasional cranky surgeon or crazy surgical technician. i really like the role of the circulator. you're there, but you don't have to get too dirty in the case. also, totally lame, but i like the temperature of the OR as well. ;-)

Well, you have to realize that the OP is working in a nightmare OR. Seriously, I have never worked in a OR that screwed up(and I've worked in some doozies!).

OP, if you truly want out, then you have to do what is best for you. The OR is not for everyone. Me personally, I went right to the OR out of school and I am very happy. New grads can flourish in the OR, but, you need good support and people who like to teach. There are good ORs out there.

But, no shame in realizing the OR isn't the place for you either..Good luck.:)

[GadgetRN71, ASN, RN]

Apparently you didn't have much ortho in your rotation. There's nothing like spending the day squishing in your shoes because the OR was flooded with irrigation solution when the surgeon took WAY too long to do an arthroscopic procedure. And don't forget having to crawl on the floor under the drapes to rearrange lines, retrieve dropped instruments, or my fave - crawl under the surgeon's gown to retrieve the pager tied to his scrub pant string that is now down INSIDE his pants because he forgot to take it off before starting.

Circulating and scrubbing is hard work and not always clean.

I also have so appreciated the throwing of surgical instruments by a surgeon that doesn't like the only one that happens to be sterile because he has already done 3 of the same cases that day using his favorite instruments first. Have had wire cutters go flying by, scattering scalpel blades. And then there is the careless surgeon that nicked my gloves while suturing, not once, but twice while I was scrubbed in.

And if you like the cold O.R. remember, as a scrub, it never gets cold enough.

Be sure you are going to the O.R. for the right reasons and not just because you are running away from medsurg. The O.P. has posted very real stories that are played out all over the country every day. The grass isn't always greener, the manure just smells a little different.

The throwing of instruments would not be tolerated by my hospital, and it wouldn't be tolerated by me. We've sent surgeons to anger management for that.

Most "bully" surgeons back down when you give it right back. I must be spoiled, because none of our docs(even the few jerks) would ever even think of throwing instruments. We've got em' trained right!