new grad on open heart OR team

CheesePotato, BSN, RN · Jun 2, 2012

Good morning--

First of all, I wish to congratulate you on graduating/passing your boards. ::throws confetti:: Yay!

Right then. Now that’s out of the way, let’s chat, shall we?

I will do my absolute best to speak in some semblance of order, but I warn you, I just got off a night of trauma call and I’ve had a Starbucks Venti awesomeness with three shots of ground epinephrine and I am pretty confident that I no longer have individual heart beats.

But I am awake, if not a bit disorganized.

Enough rambling. (Do you see?!)

Is the Heart Room a good place to start out as a new grad in surgery?

Well, everyone has to start somewhere, right? And to be fair, that depends on each individual. Some folks are just born with the ability to think on their feet and thrive in high stress situations. Not to say that the Heart Room is all high stress…I mean, let’s be realistic here, for about half the case the patient is technically dead…but when it goes bad, it goes ugly and how. So that is where that wonderful adrenaline junkie tendency shines. After all, you are no good to me if you are catatonically rocking the in the corner as opposed to taking over compressions/massage on an open chest cracked fresh in Cath Lab.

But back to whether or not this is the place for you, it also depends on personal preferences. You may not like the Heart Room, and that’s okay. You may not like the team dynamic or feel that you fit in with the members of the team. That is also acceptable. It doesn’t make you any less awesome or make the team a gaggle of jerks. It just means it’s not for you; try not to worry about it too much--you’ll find your place.

I cannot stress enough how important it is that you fit and work with your surgical comrades. When the days are rough, when the surgeons are having a meltdown, when the case goes to hell in a hand basket, meeting eyes with your team mates across a chaotic room and sharing an eye roll, a wink, a sympathetic crinkle at the corner of the eyes acts as a long distance pat on the shoulder and reassuring unspoken words of “I know, I see it too. Wanna get a drink later? God this is a hot mess. Ugh. You are doing awesome.”. When you have found your team, it’s like finding a long forgotten well worn pair of jeans: it just fits and feels right.

Is it possible to become a Heart Team member as a new grad and succeed? Absolutely. Give me someone with critical thinking skills and the desire to muscle through the low moments and succeed and I can turn you into a Heart Nurse.

As far as call requirement/burn out concerns, each person has their threshold of enough. I, personally, work five days a week, a least one double a week, take week spans of trauma call, at least one weekend a month of scrub call, and pick up heart call here and there. I may be unbalanced 98 % of the time, but I am not burned out. I’m a workaholic.

It’s a problem.

BUT!

The call requirement you are faced with isn’t terrible, really. It’s about what, two-three days a week? Not too bad. Depending on your home life, it could be quite manageable.

Now that I’ve rambled for a while, let’s break it down in words of caution and advice:

Do you have questions prepared for when you go and shadow? You should. You very much should. Itemized list of things to consider to follow:

~~ What is the call turn-around time expectation? (Average time for many facilities is 30 minutes)

~~ On average, how often is the call team called out?

~~ How often, on average, do the various surgeon experience emergency bring-backs?

~~ How many heart cases a day are performed on average?

~~ How long does the average heart case take?

~~ How many cardiovascular surgeons are there?

~~ Will you be required to assist in Cath Lab? If yes, is there additional orientation given to this portion?

~~ Does the heart team also perform all vascular cases? If so, what are they and is there separate orientation/additional time given to master theses cases?

~~ What is expectation of your role/abilities at the conclusion of the sixth month orientation? I.e. Are you expected to fly solo and take call when it is over or will you have back up for a while?

~~ What happens if it is deemed that additional orientation time is necessary?

~~ As you are the first new graduate they have orientated to the Heart Room, what is their plan of action as far as addressing what are going to be unique needs?

~~ What does the team/team members feel makes a good heart nurse?

In a nutshell:

This is not going to be a fun transition--not in the classic sense of the word “fun” anyway. I’m laying that out on the line right now. Anyone who tells you otherwise is a liar.

It’s a different set of perceptions, practices and cultures in which you will be immersed without consideration or mercy. It will be overwhelming, at times frustrating, a touch terrifying, and it may push you to limits you didn’t realize you had. You will have mornings of nausea and anxiety, night times of tossing and turning due to an over stimulated mind and afternoons where you would offer your left arm just to have the chance at a nap. Know that this will pass.

Your back will ache and you will discover muscles you never even knew you owned. I promise you, you will break a nail to the quick at least once and not even realize it until half way though the case. You will quickly realize that the gym shoes you own don’t do @#$% for your feet and Aleve is your new best friend.

There will be days you wonder if it’s all worth it….and only you will know the right answer.

Approach this with a sense of patience and long term goals. Know that nothing happens overnight. Learn to be gentle with yourself. Get in touch with your inner humility. Never be afraid to ask questions and be diligent in receiving good, reasonable answers. Take the time to note minor victories and major improvements.

It’s a different world and an interesting opportunity. I wish you the best of luck.

Word.

canesdukegirl, BSN, RN · Jun 2, 2012

Wow Cheese, you certainly answered that question enthusiastically!

OP, there is truly nothing else I can add to Cheese's answer. Everything was thoroughly covered!

Editorial Team / Admin · Jun 2, 2012

We've had so far three nurses come straight to the heart team with no other OR experience. Two of them are doing great, and the third one has left for "greener pastures." So yes, a new grad can succeed on the heart team, if they have the right temperament for it.

I have to say that you really shouldn't make any decision whatsoever until you've had the opportunity to shadow. It's a different world from the interview, and I'm surprised they made an offer before you shadowed. It gives the team a chance to see how you interact with them as well as for you to see "the real world" of OHS.

I'd have to say that the six month orientation sounds like a great opportunity- even for zero OR experience, our new hires got 12 weeks. Those who did need a bit of an extension did get it, but it's not a guarantee. Our two newest hires will be taking call technically before their orientation ends, although both of them are doing an awesome job and will be fine. Another thing to look at is "buddy call". Will you have the opportunity to take call with someone else, so that you aren't all by yourself for that first emergency case? Or will the other person on call be able to help you out? We have three people on call each night, and for the first time a new RN is on call solo, one of the other people is also an RN. That way, while they have their own position to fill, they can also be a resource. Very helpful my first solo call- we did an emergency OPCAB (off pump coronary artery bypass) and I hadn't yet seen one, which involved a rather different room setup.

You also might want to look at the number of cases done. I know that the number of OHS cases we do in one month actually surpasses the number of OHS cases done at the rival hospital across town- for the entire year! So those at the other hospital who do OHS also have to do other specialties, whereas the only time my heart team is in other specialties is if we are slow (almost NEVER happens!) and the main OR is begging for help with lunches.