My OR exprience (operating room)

[peaceful2100, BSN, RN]

Hello everyone. This week me and another nursing student get our turn in the OR. After one day of being in the OR I can say that it is defintely not anything I will be going into as a nurse.

It was really interesting to see the procedures. I got to see a partial nephroectomy (not sure if I spelled that right) which is for those who can't tell what I am trying to spell removal of the kidney (part of it anyway). I also seen a couple of other procedures. It was not so much the procedures that got to me. It was the fact that IT was so cold. I was so cold I could not stop shaking no matter how hard I tried. After I left I got in my car I was still so cold I had to turn the heat on in my car and today it is almost 80 degrees outside where I live. Also I can't do OR because it will bore me. I am the type that want the patient interaction and in the OR I don't feel you get enough of that. I guess everything is not for everyone.

On the positive side I got to put my first foley cath in. It was a male patient and he was sleep before I put it in. The OR tech looked up at me and thought I touch my first glove on the non-sterile part with my bare hand before getting all the way on the nurse did not think so and neither did I but I changed anyway for the techs peace of mind and to be sure anyway. The nurse said I did a good job putting in the cath but she told me to relax a little patient will be fine. She told me that because she said I was not getting a firm hold of his you know what and she told me don't be afraid to grab it.

I don't know why I am like that putting a cath in a male or dealing with the male genital is the only thing that really bothers me. I wish it wouldn't. Or else I am not going to be a good nurse if it keeps bothering me.

Well got to go study for a pharmacology test I have coming up friday.

Take care:cool:

[studentcaroline]

A couple of weeks ago at clinical, I also obseved in the OR, and it was freezing!! It was so cold in there, and I was shivering! I put on lab jacket from the OR. Anyway, it is definitely cold! As far as the boring part goes, I enjoyed it. I can see what you mean in that it's the same old routine day in and out, as far as procedure pretty much goes, but I liked seeing the different procedures done, but I also would like to know a little bit about the history of the patient like why they're having the procedure done, and what their medical history has been like and things like that. Just thought I'd reply to your OR experience, since I just did that too! Now, I have to study for a mother/baby test tomorrow!! Yikes!

[KC CHICK]

Yes, it gets cold at work....only if I'm standing around (which isn't for very long.) Most of the time I have to take my jacket off because I get too hot from all the running I do. (yep, even w/the temp in the 60's)

I'm wondering if your clinical 'experience' started after the pt went under anesthesia, or, if you followed the circulator to get the patient. In my experience, the TIME of patient interaction is very short. However, the QUALITY of the interaction, and the impact that a circulating nurse can make, is incredible. You see, these patients can be the most SCARED patients that you can ever interact with. They know what's coming, have not been able to sleep the night before....let alone days before, and some even think that they will not live through their procedures.

An RN can make a huge difference in the patients OR experience in just a short amount of time. I've even approached patients in the pre-op holding area that have started crying at the site of me coming for them. The interaction can be intense w/the discussion of their fears, reassuring them that they will be well taken care of, and answering their questions. We also interact w/the family: I've made quite a few phone calls from the OR to family in the waiting area that need reassurance that all is going well.

I personally don't find the OR to be boring at all. There are so many different procedures in different specialty areas, that no RN can possibly be an EXPERT in all areas. There is also new technology coming to the OR all the time that the docs and staff must learn to use.

Also, your patients will not always be under general anesthesia. I've had many patients that have had procedures, such as a breast biopsy, under local anesthesia. These patients are alert and oriented during the entire procedure....and talk w/the staff the whole time. And for the patients that are "out"....the RN has to be the ULTIMATE patient advocate......the patient has no voice of their own under anesthesia. It is our duty to remind others in the room (even the docs) that there is a patient under those drapes. Even today I had to tell a tech to raise a mayo stand off a patients' toes.....sometimes people get careless or forget. We all know what 2 hours worth of pressure in one spot can feel like, don't we???

Anyway, you can probly figure out by now that I'm pretty passionate about this area. There is so much more information about OR nursing......I just don't want to make anyone read a novel.

[peaceful2100, BSN, RN]

Well KC chick now that you put it like that I see now. I only had yesterday for 7 hours and today for about 4 hours to observe so that was not enough to see what it was like. All the patients I observed was under general anesthesia. I just don't think I would be a good fit. I think that is natural. My cousin's wife who use to be an OR nurse until she switched to Mother/Baby told me last night don't worry about it. She said some people can handle OR while those same people who can handle OR cannot handle Pediatrics or vice versa.

[KC CHICK]

Peaceful,

You're right about that. Don't think I could deal w/peds....heard too many stories from my friends about abuse type cases. Wouldn't be able to handle that.....Thank goodness there are people out there that can.

[CarolineRn]

KC CHICK, you make the OR sound even more intriguing to me than it already is! I'm only a Level I ADN student, but I have known for years that I always wanted to work in the OR. We haven't had our OR rotation yet-we get that in LEVEL II, but just got a phone call today from a hospital that has a great Nurse Tech program, and they want to hire me as a NT as soon as I fifnish LEVEL I. (Dec.) In the mean time, just so I can start working, they are hiring me as a Clinical Tech, and it is in the OR, so I am soo excited! A very good friend of mine is in this Nurse tech program, and is a LEVEL IV student, she graduates in Dec. and this hospital is hiring her on in the OR. She's had almost 18 months of orientation through the program, so she will do just fine. I, myself, am pretty scared however, since this program is every bit as intensive as the nursing program. But I am very motivated, and will strive to do my very best.

As I understand it, as the Circ, you are responsible for total patient care before, during, and after the procedure, as well as maintaining counts, anticipating needs, etc...

Also, to studentcaroline (that's my name too!) Since you are responsible for the patient as a circulator, you will be quite familiar with the pt's history. The only downside I can see is wondering how the pt made out after they leave recovery.

Anyway, KC CHICK, please feel free to write that book on "Life In The OR" anytime, I'd love to read it! :)

Caroline

[KC CHICK]

Hi Caroline,

That is so exciting that you will be able to work in the OR during school!! I wish that I'd been able to do that. The job I have now is actually my first job in healthcare.

You will be surprized at what they will let a nurse tech do in the OR. My hospital just started hiring nurse techs this year. They can assist the RN in setting up the room and even scrub in (belly up to the table) and hold retractors during a case. It's a pretty cool gig for a student.

You mentioned that the circle RN takes care of the pt before, during, and after the procedure. That's true in some hospital settings, but not all. That RN is a perioperative nurse (perioperative = pre, intra, and post surgical care).

At my hospital, we are Intraoperative RN's only. We go to pre-op to pick up the pt and get report.....a pre-op RN takes care of pt care before surgery. We take care of all pt needs during surgery, then deliver the pt to PACU where a recovery room RN then gets report from us and takes over pt care.

BOY HOWDY!! Does a circle RN have to anticipate needs!! We have to help the scrub, the CRNA, keep an eye out for the patient (always!), and get our own work done. As I'm learning, it's almost like a beautifully choreographed dance if everything goes perfectly....kinda weird, huh?

You are correct about the responsibility to maintain the counts. It's now a huge responsibility. It was legally ruled at one time that the surgeon held the utmost responsibility, then it changed to the surgeon and nurse, now ...i think ( if i've heard correctly) it is the whole responsibility of the RN. Pretty important. Specimens are another important responsibility of the RN. We have to make sure that they are handed off the field (and don't go into the trash...oops!), are labled correctly (it's a little bit of a prob if a breast biopsy is from the left and gets labled "right"....very bad), and sent to lab.

Just thought I'd explain the difference and add another chapter to "Life in the OR" by Anne.

[prmenrs, RN]

I absolutely LOVED my OR experience in nsg school--it was 4 weeks long, in A/C (in June in Camden, NJ, where you need it, and the rest of the hospital was NOT), and I had a terrific time.

I got to circulate on lots of stuff, scrubbed w/another RN on several cases (lots of hysterectomies, because in those days, it was Catholic birth control), even scrubbed alone on a hand case and a couple of D&C's.

I would have done that after graduation, but they demanded experience, and I didn't have any, natch. But those 4 wks were GREAT.

When a baby from NICU goes to OR, an RN goes, too, and anesthesia is great about letting me watch; I'm still fascinated by it, love watching the anatomy, and finding out how they do what they do--the best was watching a myelomeningocele. The assistant was late and I was standing across the table w/ an unobstructed view, now I finally understand how they repair that defect!