Needing advice and help

[karebear74]

I started in the OR about a year and half ago. Was circulating and doing pretty good at it. My preceptors though were rough at first and really didn't explain why we do what we do and just made me do it. So I know what to do in the OR as a circulator and my eval states I am really good at it. Then the Ortho team wanted me to join and start scrubbing with them. I was really nervous and still am. Still in orientation with it. And again new preceptor to me but same old stuff. She tells me what to do and sometimes not even how to do it but I don't understand why or blah everything. I have asked alot of questions and feel as if I am the stupid one. I just am one of those types that needs to know why and how and put it all together. For instance I have been in scrub orientation for 2 months now and just learned that the wearing of a surgical mask is only trully good for one hour before bacteria and the such invade. No one ever told me that. And as I scrub no one explained to me there are special ways to place instruments into dr. hands....until one of the dr's kinda got upset with me cause I handed her an instrument "the wrong" way. I can't expect the drs to explain to me my job or the residents. But my preceptor just says place it hard so they feel it. I am beginning to wonder if she knows the right way. Can I get any help?? Any place or book or explanation of how to do my job as a circulator/scrub would be great. We are a great team but I don't like how they teach. Thank you if you can help.

[linda2097]

Every new O.R. nurse feels the way that you do. You just have to be strong and patient. Eventually, you will understand everything.

Here's some ortho trivia....

The purpose of sterile helmet covers is to prevent contamination of the field because drills and saws throw bone and tissue at your face which bounces back to the field. If your face is not sterile, the tissue will bounce on your face which contaminates the tissue right before it falls back into the field.

Ortho surgeons are VERY strict about sterile technique because bone infections are so hard to treat.

Ioban is used to cover skin because skin cannot be sterilized without killing it. Prepping skin does not sterilize it. Thus, the best thing to do is cover it with sterile ioban.

The proper way to wear scrubs when circulating is to tuck in your shirt so it is less likely to touch the back table. Walk very carefully when near the back table. Keep your distance.

When prepping, saturate the skin. Ortho surgeons prefer a VERY thorough prep.

Ortho surgeons rarely use taper needles. They like cutting needles.

In addition to wearing a lead gown during x-ray, wear a thyroid shield too. Don't avoid doing so because other people avoid it. Lead goggles are a good idea too. It's your body.

If you sweat a lot, go ahead and wear a headband until your hairnet.

Wear eye protection when circulating. I once got used saline in my eye during an arthroscopy. Most circulators do not wear eye protection. So what. Be different.

When scrubbed, wear ortho gloves during all cases including non-ortho cases. I wear biogel gloves under ortho gloves. It takes only 1 needle stick to give you hepatitis or HIV. I don't care if the gloves are expensive. I am going to protect myself.

If your surgeon wants to use 2 bags of saline for pulse evac, and one of them has bug juice in it, use the one with bug juice last so it stays in the patient.

Do you have any other questions in particular?

[karebear74]

Oh my gosh! Thank you. I am at a loss of words right now...which is not usual. But I am sure I have a ton of questions, just drew a blank at the moment. Is there somewhere I can find out how to pass instruments to the drs correctly? Or is that just an experience thing? I know some of them how..slap it in so they can feel without looking away, but like others that they would hold differently..can't think of one off bat, maybe like drill or pin cutters...? I know there are more but anyhow.

[karebear74]

Oh and sorry may not have worked with this yet...pulse evac?? Bug Juice??

[inspir8tion]

Hand the instrument to the surgeon in such a way that he/she can use it in that position. They should not have to adjust the instrument. They should not even have to look at it. It would help you to watch how they use the instruments so you know what they are used for and can hand them over accordingly.

Oh my gosh! Thank you. I am at a loss of words right now...which is not usual. But I am sure I have a ton of questions, just drew a blank at the moment. Is there somewhere I can find out how to pass instruments to the drs correctly? Or is that just an experience thing? I know some of them how..slap it in so they can feel without looking away, but like others that they would hold differently..can't think of one off bat, maybe like drill or pin cutters...? I know there are more but anyhow.

[inspir8tion]

Bug juice is usually normal saline with just bacitracin in it or bacitracin and polymyxin B in it (depends on the surgeon). These are antibiotics (effective against bacteria aka bugs). Pulse lavage is a way to rinse the patient out with the bug juice. It can be done by gravity or with pulse lavage (force).

Oh and sorry may not have worked with this yet...pulse evac?? Bug Juice??

[karebear74]

Thank you very much and yes I learned today what a pulse evac was and the bug juice...we don't call it that but but we do use it. Again thank you to all for your patience and caring words. I am sure I will enjoy this site as I have learned alot thus far.

[linda2097]

You don't have to slap instruments into the surgeon's hand. Just hand it to him and press the instrument into his hand so he definitely knows it is there, kinda like a firm handshake.

[karebear74]

I know it is just a term one of the dr's used to speak of placing the instrument in his hand and I just continued to use it. Thank you

[linda2097]

I know it is just a term one of the dr's used to speak of placing the instrument in his hand and I just continued to use it. Thank you

Actually, it really is acceptable to literally slap instruments into their hands, or you can apply pressure instead of slapping, which is what I do.

[DNRme]

This never ceases to amaze me. I took responsibility for my learning when I was new in the OR. If you do something and don't understand why, buy an "Alexander's" and read! I was told that I had 6 mos to orient to the OR. At that point I was expected to be on call, with backup, for another month, then on my own. I have seen people who after 6 mos will say "I don't do neuro", or vascular, or whatever. If you are learning, you need to make your manager aware of the cases you still need to learn. Accept responsibility for your own career.

[NabiRN, BSN, RN]

I am also going through orientation. Some preceptors can explain better than others. In addition, in some cases, there's really no time to explain things thoroughly because there are so many things to do. I try to absorb as much as I can and then try to memorize my own questions until after the case is done. For example, regarding passing an instrument, ask your preceptor to practice with you when things are slow.

Although we should not expect doctors to teach us, many of them love to teach. As long as you are interested in improving yourself in the OR, they really don't have problems teaching you.