new grad at an ambulatory surgery center

Published

I just received my license two weeks ago. I'm in California and found a job at an ambulatory surgery center.

I've always wanted to be an OR nurse. I had experience as a PCSA in the OR at a major teaching hospital so I have learned to open, grab equipment, and set up, tie up surgeons/techs, but not to the point that I can circulate on my own. I will need time to be fast I think.

I feel like I am struggling at my new job. First the surgeon thinks I did more and had expected more, even though he knows I am a new grad. He is giving me a longer orientation, a month. I will need to do pre op (start IVs), intra op, and recovery. There is a very experienced LVN there.

This surgery center does GI, plastic, some gynecology/general cases.

Just yesterday, I had trouble tying the back of the surgeon and I have tied people so many times as a PCSA... I am not good at starting IVs. Maybe it's nerves. Some of their sutures are hard to open. the anesthesiologist is an *******, he is surprised that I wasn't exposed to that in my job as a PCSA.

Just yesterday in the recovery room, a pt was desaturating, and I freaked out... having taken ACLS and BLS I didn't think of doing the jaw thrust, giving oxygen, which is like the basics on NCLEX!

I'm really nervous and I worry I won't make it through... I would love a job like that though. Also, I feel that I am used to being at a big major teaching hospital instead of a clinic where I do everything, including doing paperwork, answering phone calls at the front desk

It sounds awful, like a night mare!

Are you the only RN there? Is there a charge nurse or manager? You do the paper work and answer the phones! The doctor is paying you the salary he should be paying 3 people! He knows it. That is why he is giving you more orientation. Not many nurses would take the job. No experienced nurse would! He is putting his profit, not having to pay more salaries, over patient care!

You need to look for another job. But if you want to stick it out......is the LVN friendly, helpful? Personally I would have no problem letting the LVN run this "circus" for a while, be the "boss" until you can get settled. Can she do the IV's? Let her. Later on when you get a better handle on the job, on slower days, you can "practice" your IV starts when you're not so nervous and under such pressure. Getting good at IV's is 50% psychological.

Can't the LVN answer phones and do paperwork?

You are out of luck with the anesthesiologist. Keep your chin up and ask him for help, advice. He can't be more annoyed with you, be more of an ******, than he already is.

I have an RN precepting me. the other RN is busy doing botox and other injections, and can help me out sometimes. There is a girl who talks to customers about options, two more that do the paperwork and sit at front desk.

I really would love the work I do there, and i'm grateful he is wliling to train new grads, just worried I can't make it thru.

I find that at teaching hospitals, there is more of a chain of command. The LVN there is basically teaching me... she circulates, gives meds (even IVP), is IV certified, and that is under t he license of the MD. She does discharge teaching as well. I'm not sure that's within her scope of practice as a LVN. Basically, when we circulate in the OR, I am the RN that signs paperwork.

I think having to learn pre op, circulate and recover within a month is a great challenge. they definitely aren'tmajor cases, like spines, etc.

For the salary he's paying me, not many BSNs will take it, but I will learn to do botox injections, etc. which is what I Would like. also, I wouldn't lose nursing skills.

From your post I was visulizing a small one surgeon clinic with only you, the LVN, the surgeon, and ****** anesthesiologist! Your reply makes me feel better.

Still it sounds really tough!

Maybe have a heart to heart talk with the surgeon. Something about you love the job and opportunities, are really greatfull for his support. Ask him, or tell him, what areas you need to focus on. If you are floating from pre op to OR to PACU all within one day or week you cannot feel comfortable in any one area. If you could circulate only OR one week, then only work pre op one week, then only work PACU one week you would have a chance to get some semblance of a routine down.

I would put becoming profecient at IV's on the back burner for now. Sure, maybe, if you, the patient, and a coworker, are in a perfect place and time, no ones rushed, give it a try. But that skill will come later when you're more relaxed.

Take a deep breath, you have taken on an extremely tough job. Many experienced RN's will not "float". Will only work OR, or PACU, or pre-op. It is hard and scary

+ Join the Discussion