Lose Nursing Skills??

[trepinCT]

I am going to graduate from an ASN program this May (2009) and I loved my OR rotation!! I am 40 years old, worked as a CNA for 16 years, 5 of them in an OR, and I am not sure what to say to nurses(esp. instructors) when they tell me to do a year of med/surg and not to go straight to OR because I will lose my skills..UGH! That aggravates me. What I say now is , If I went straight to OR and a fellow student goes to med/surg for 1 year and she joins me next year and we both do 5 years in OR, then decided to both go to med/surg, I say that we are in same boat and she doesnt have that much more advantage over me..?? Besides I am not necessarily losing skills, I am gaining skills because:banghead: nursing school has been focused on medical units, not specialties...any input?

[Virgo_RN, BSN, RN]

Lots of food for thought here. Thank you all so much for your thoughtful replies, especially shodobe. I'll keep you posted on what I decide and what transpires.

[GadgetRN71, ASN, RN]

Thank you for your comments. There is one OR position posted, but it states "A minimum of 1 year current experience as an OR staff nurse required. Ability to independently scrub and circulate major cases in a full service OR.". Well, obviously I do not have that experience or that ability yet. Do you think I should apply anyway, in case they are willing to train the right candidate, or just to get my name in there for future openings?

Thanks in advance. You've been very helpful so far.

You should ask if your facility has a perioperative training course. Many ORs do..they'll take people from other areas and new grads and teach them. There is some bookwork and OTJ training. Usually, you'll be on orientation for about 6 to 9 months(this is adjustable though). I'd go to HR and ask if they have something like this in place. Good luck!:)

[Mourkoth]

I graduated nursing school in 1985. I spent most of my career in the ICU setting, with 8yrs in the PACU. I was burned out and wanting a radical career change. I was looking to exit the medical field all together. My wife suggested the O.R. I went through our facilities OR intern program. I realized just how comfortable I had become with my ICU skills and how little this experience helped me in the OR. It was really hard! The learning curve was really steep, (for an old guy). Last month, I completed one calendar year of being on my own in the OR. Early on, I was really nervous about losing my ICU skills. I would moonlight in the PACU on occasion when they needed extra weekend help. I would start the IV for Anesthesia, (after their first missed stick). I was having trouble letting go of those skills.

Last week, I passed a benchmark. It was our annual competency check off day. I let my ICU competencies lapse along with my ACLS. Now I am an OR nurse only! I have accepted that I will lose some of my ICU skills, but I have gained a host of new (equally difficult) skills as an Operating Room nurse that I aim to polish and hone to perfection.

We have to accept that the practice of nursing is so vast now that we can't hope to stay current in areas other than our focus of practice. The days of "a nurse is a nurse is a nurse" is long over.

[Virgo_RN, BSN, RN]

I did it. I just applied for the position.

[humblecirculator]

The topic of 'losing skills' when one works in the OR speaks to my heart :heartbeat.

I was drawn to the OR during an observation that I did a long time ago during nursing school. Even then, the 'nursing instructors' didn't support OR nursing, keeping the sentiment that 'OR nurses don't do anything' . What I witnessed was a nurse that stood 4'11" but had the personality of a 6' amazon...she commanded that the needs of the patient were top priority-she was constantly moving about the room, checking drapes, communicating with anesthesia, checking urine output, IVFs, watching the field like a hawk, documenting, answering pages, coordinating bloodwork, pathology specimens and results, keeping the surgeon 'in-line', showing the resident how to put his gloves on properly-it was AMAZING! From that point, I begged to do more time in the OR, only to be told that wasn't possible..., I just accepted it. I always kept the OR in the back of my mind, and one day, I friend of mine told me about an opening in the OR and that I should go for it-so I did and here I am!!

I've worked in the OR for a little over 3 years and it's the only one that I've worked in (I have floated to OP endoscopy and our OP surgery center). Prior to working in the OR, I worked Hem/Onc and ICU step down for a few years; private practice urology and cardiology; nursing home charge, meds, and treatments; private home duty; AND I was a nursing assistant for two years on an Isolation med/surg (total care) unit. So when I came to the OR, I had quite a hefty skills set. I did go through a 'rollercoaster ride' of emotions and learning during my first year-there's ALOT to learn to succeed as a nurse in the OR.

I think that if I came to the OR that I work in as a graduate nurse, I might not have made it through orientation (it was rough). One thing that I believe helped me was the fact that I had a developed a broad knowledge base of nursing care. That knowledge combined with new OR nursing knowledge, I believe, has produced a fine OR nurse ! Not to say that I think new grads shouldn't work in the OR, I think that if someone wants to be a nurse in the OR, then they should pursue it-whenever that is!

Nurses that work on the floor, whatever their 'specialty' is, faces many challenges during their work day-the patient's family (which in essence is our 'patient' also) is breathing down your neck, etc OR nurses face challenges as well, they just aren't necessarily the same ones as up on the floors.

We all have different skill sets and levels of skill-doesn't it make sense that if nursing itself is so diverse, wouldn't the skill sets required of nursing be just as diverse? Even from floor to floor, there are different skills that a nurse has to have-So, to say that you would 'lose skills' working in the OR is just ridiculous . You will build on the skill sets you already possess, gain new ones and integrate the two, just like you would do if you went from med/surg to the ICU.

I think that this misconception rests somewhat on the saying that if you don't use it, you lose it...but you still do patient assessments of vitals (including pain), neuro, skin integrity, cardiac, respiratory, GI/GU, musculoskeletal, endocrine; interpretation of labs, etc. These assessments aren't performed necessarily the same, but they are still done.

Since working in the OR, I understand the 'big picture' of a surgical patient-from pre op teaching to discharge and home care. Being a part of the actual surgical process of a patient's hospital experience brought it all together for me. If you can understand the disease process and understand the surgical procedure, then it is easy to figure out the pre op and post op care/teaching needed; its something I like to call nursing common sense. Of course tho, one can only gain this experience and skill set by becoming an OR nurse!!!:loveya:

[GadgetRN71, ASN, RN]

I did it. I just applied for the position.

Congrats! Hope you get it!!:)

[Fun2, BSN, RN]

I did it. I just applied for the position.

Good luck!!

[fracturenurse]

I did it. I just applied for the position.

Good luck, keep us updated!

[Virgo_RN, BSN, RN]

Thanks, guys! I also found out who the NM was and sent her an email. I hope I get a response!

[baxtersmomRN]

I must admit I'm ignorant about OR nursing. When I first began my prereqs to get into NS, I always pictured myself in the OR. Once I began NS, the emphasis in clinicals is on the nursing unit, and we only got a two day rotation, in our second year, in the OR. On my first day, I got to watch a lady partsl hysterectomy and an open abdominal exploration on a woman in her third trimester. My second day, I got to watch the Holy Grail of operations (for me), a 3 vessel CABG.

I remember being so excited to actually get to be in the OR. But then, the experience left me flat. I'm not sure what it was specifically, but I left the experience feeling that I might get bored, doing the same thing over and over again.

Now, after a little over a year on the nursing unit, I'm finding myself revisiting the idea of the OR. One of the main reasons is that I find the constant interruptions of actual patient care to be very taxing and unwelcome. When I really need to be starting a blood transfusion and the family member is harassing me about what medications I'll be giving Grandma tonight, and how hungry she is and can't I get her some low sodium broth, I'm thinking "I can only do one thing at a time. Would you like me to get some low sodium broth, or put some blood in her so she doesn't go into V Tach?". And yet, I have to smile pretty and not **** off the family member because then I am the Mean Nurse and they might complain, or if something goes wrong, sue.

I come from a technical background, so machinery doesn't scare me. In my old career, I was responsible for banks of highly technical broadcasting equipment that required the ability to perform precise operations, and in depth knowledge of settings and calibration in order to be good at my job, and I was. I had to synthesize a large amount of data and coordinate it so that the equipment operators could make sense of it. I created a database in Access, when I didn't even know the program at all, but just kept at it until I knew the program inside and out and had created a database/worklist that became the standard for my workplace because it was so efficient and effective.

I guess a part of me fears that my colleagues would see my moving to the OR as throwing in the towel and admitting that I can't hack it on the floor. The thing is, I don't know if I even want to hack it on the floor. I know I'm a good, competent nurse, but I'm just not feeling like I'm where I want to be. I want to find my passion. I want to love my job. I want to focus on patient care instead of pleasing family members whose judgment of good patient care has nothing to do with the fact that I'm keeping their family member safe, but whether or not they have a mustard stain on their gown. I want my technical skill to be the measure of my nursing care, not how "nice" I can be in the face of rude, demanding family members.

I know this thread is a little older, but Virgo, you nailed it with this post!! Everything, and I mean everything, you said is verbatim as to how I am feeling right now! I could not have said it any better!!

I have an extensive background in instrumentation and worked in a couple of different OR areas as a core tech and instrument tech.

My one year of RN experience is coming up in Feb. I have been in the med-surg area since graduation. I currently work in an observation area in the ED, but it is considered partial med-surg. An opportunity presented itself recently to enroll in a surgical internship in my hospital, and I interviewed for it yesterday:D! So, I hope everything works out! Again, thanks Virgo!

[Virgo_RN, BSN, RN]

Best of luck to you!

[pgmjc18]

Hi TrepinCT I saw how you helped someone with their nursing personal statement, and I was wondering if you wouldn't mind taking a look at mine. I would really appreciate this. I read your critique on the essay from the guy from the philipines and I thought your advice was excellent. So let me know, thanks.