Med surg to OR?

[isthatso?]

Hi all,

I have been a med-surg nurse for two years now. I feel comfortable on the med-surg floor (though it does get very crazy at times). I am interested in an OR position where they are willing to train. What difficulties did you guys face when you transitioned to the OR? I am very nervous about making such a change as med-surg and OR are different animals. Any advice or suggestions would be greatly appreciated.

Thank you :)

[none the wiser]

Learning surgeon preferences and knowing where things are/what the heck they're asking me for has been hard. And I surely miss knowing what I'm doing. You're starting from square 1. Basic things that seem like "common sense," and coworkers think you should know...you won't know them. It's like being a new grad.

They say it gets better after a year, but I'm only 3 months in so I can't vouch for that :)

That said, I'm not sorry I left the floor. At all.

[brownbook]

Generally speaking it is hard to get into OR nursing. Some OR nurses I know were able to "transition" into OR by working as an in hospital GI sedation nurse and being aggressive, learning all they could about the scopes, their use, and how to clean them. Often the in hospital GI and OR are in the same area. A go-getter, pushy, GI nurse may get the attention of OR personnel. Your desire to work OR is great, just don't give up if you find a few road blocks.

[canesdukegirl, BSN, RN]

I worked on the Med/Surg floor for a couple of years before I went to the PACU. Curiosity got the best of me, and I decided to find out what was behind those scary OR doors.

I am SO glad that I did!

And yes, it is scary. Like None stated, it is exactly like being a new grad again. You have to learn all about sterile technique (things like not turning your back to the sterile field, staying a foot away from the back table, learning to pour solutions without contaminating the table with your arm, or contaminating the solution itself when you are opening the vial/bottle).

But you will pick up the rules quickly. It's nice having one patient at a time. However, if you are circulating, you are taking care of the needs of:

1. The patient

2. The surgeon

3. The resident

4. The anesthesiologist

5. The scrub nurse/tech

There is a lot of coordination involved in circulating. Your priority is always the patient, and being a pt advocate is front and center since they are under anesthesia.

I think the toughest part of acclimating to the OR is remembering this when the surgeon is demanding your attention for whatever reason.

Let's take this scenario, for example:

You are standing at the HOB, assisting anesthesia staff during induction and the surgeon asks you to go out of the room and get him XYZ tray. You know that induction and emergence are the most critical times during surgery, and your priority is the safety of your pt. You respond that you'll get the tray after induction.

A lot of surgeons view anesthesia as a separate entity (this has always confused me, because we can't do surgery without anesthesia) and they believe that anesthesia personnel should have their own assistants in the room for induction. There ARE anesthesia techs around, but they are spread so thin that they can't always be in the room. The surgeon starts to lose patience, because the induction proves to be difficult and lengthy. The surgeon asks you again to go get the tray. You stand your ground, even though everyone in the room (besides the grateful anesthesia care provider) is watching and waiting for your response. It can be nerve racking when you are new.

Another scenario:

You are doing an ORIF of the femur. The pt was involved in an MVA, and also has a mandible fx. You have already checked the consent, which clearly states that the pt is consented for an ORIF of the left femur. You do the pre-induction "Time Out" and everyone agrees. The pt has received Versed and the anesthesiologist is preparing to induce.

A resident from the OMF service comes in and asks the anesthesiologist to let him try a closed reduction of the mandible prior to intubation. The anesthesiologist hesitates, because there isn't a consent for this procedure. She looks to you for guidance. You tell the OMF resident that the pt is not consented for a closed mandible fx. The OMF attending comes into the room, and asks what's going on. You relay the information to him, and he rolls his eyes, stating, "We do these all the time in the ED. The pt and I already discussed this and he's fine with it." You reply, "But there is no consent for a closed mandible fx, so you can't do it." The attending gets hot under the collar and elbows you out of the way, attempting to do the reduction anyway. What do you do?

These are some extreme examples of what challenges you may face. Overall, cases go smoothly, and everyone gets along.

I encourage you to shadow for a day in the OR. I suspect that you will fall in love with surgery!

Good luck, and keep us posted!

Canes

[alodocios]

i am a newly hired nurse in a Periop intern program and a new nurse who hasn't started yet,(I start in June..Yay) but when i was shadowing during the interview process for my intern program, i watched my OR nurse advocate for her patient with such grace, i knew i wanted to do this. They wanted to use alcohol on the patient. The mood in the OR was light and fun, music was flowing, and the Nurse asked, would you want alcohol on you? But she kept the mood light while insisting that they not use alcohol, they tried to override her three times, but she insisted, while still keeping the mood fun and she got her way and advocated for her patient's best interest. So canesdukegirl"s examples make perfect sense. We are advocates first and can't forget that especially when we are new nurses in intimidating situations.

[rangersfanatic09]

Canes,

Thank you for your insight into scenarios in the OR. Those are definitely things that I hadn't considered. Would you say that those scenarios are encountered often? I know you said that everybody generally gets along but I was curious as to how often this battle of wills takes place in your experience. Thanks!

[shelbias]

I was a telemetry nurse who moved over to Periop nursing. While it is important to know the different tools they use there, it's more important knowing where to get them when needed. Also, don't lose touch of the things you learned on the floor. For instance, I had to help run a code for a crashing patient on the table (patient, thankfully survived). Everyone else didn't really know what to do because they haven't done so in a long time. I was really glad for the telemetry experience under my belt.

Lastly, be kind to everyone. It helps you get through the various personalities in the OR. :)