New Grad OR Nurse- Job Not Going Well

[Rn052015]

0

I am a new grad RN-BSN who began working my first RN position at the beginning of October. I am in a surgical department, and before accepting this job, had never seen or been in a surgery before. To say the least, the transition has been extremely difficult.

One of the reasons I wanted to get into this facility/position is because they have an "extended orientation" program for new nurses. However, after getting into the position, most of this "extended orientation" consists of going to classes that are not relevant to my department/are very floor-focused. Because of this, I have only actually been in the surgical department about half the time since I have been hired. It has been very difficult to get into a routine in my department because it has been so inconsistent. On top of this, the days when I am in my department are with a different preceptor each day, so again consistency with learning is lacking. I have also been told that I will be getting training on certain things (charting, instruments, etc) since I was hired, and have never gotten trained on them. At this point I am just learning and hoping I am doing things right without the official training I was told I would receive.

I am now just over 3 months in, and am not "where I should be" according to my coworkers and supervisor. Regarding this, I am also the first new grad/person in the orientation program to enter this department. I feel that I am seen as having worked there for over 3 months, when really I have only been in the department about 6-8 weeks. I am just beginning to feel comfortable being on my own with more basic procedures, and do still sometimes forget small things that I later remember. I feel like every little mistake I make is highly held against me, taken to my manager, and I am in general seen in a very negative light.

I do like the work I am doing, and want to continue to work in this department, but at this point I am starting to get worried I will be fired for not knowing everything and feeling comfortable quickly enough. I don't feel that my orientation experience has been very adequate, and not what I was expecting when I was hired, but at this point I am also beginning to doubt myself and my abilities.

Anyone else that works in the surgical field, or even just in a specialized department they had never worked in before, had a similar experience?

[Rose_Queen, BSN, MSN, RN]

The first thing I'm going to suggest is to read the article "Tips for New Operating Room Nurses" here in the OR forum. That article relates what I felt helpful both when I started in the OR and when I changed specialties.

The second suggestion I have is for you to sit down with either your unit educator and/or your manager to get clarifications of what their expectations are, what they want you to do to meet those expectations, and what you think they can do to help you meet those expectations.

[Rn052015]

I did just read the Tips article, and while it is helpful, I feel like I am already doing most of those things. I have a notebook that is full of little things I need to remember, important names and phone numbers, etc. I look at preference sheets as early as possible, and write down notes on those as well to look over later, and if I know what surgery I will be in the next day, I look up info on it the night before. I have books of instruments and sutures, as well as count sheets, that I have been looking over to try to get a more full understanding of these things, but I do feel that especially in regards to the instruments, it's hard to learn at home without the physical instruments to look at.

I feel that more of the issue is multitasking/timing of things and forgetting small details. For example, I forgot to grab a chart from a patient room when I was transporting, and had to run back to the room to get the chart after the patient was in the OR. I understand that this takes more time and shouldn't happen a lot, but it is difficult to get negative feedback on what I feel is so minute and was eventually taken care of. These are the "little" problems I am having, and I feel like I am trying to concentrate on doing the right thing and what I need to do next that sometimes I forget little things such as this. I have been told that I need to think more about the bigger picture instead of focusing on each task, which is just hard at this point when I am still learning and taking notes. I do feel that I have gotten better at things such as this, but am apparently "not where I need to be."

I do also feel that communication is an issue, as I have talked to my manager a few times, and the feedback is generally "just keep working at it and looking things up" "try to focus on the bigger picture" and "the goal is for you to function independently as a circulator." I do understand all of those things, and am trying to get to that point, just not really sure how to be comfortable with everything and get there more quickly.

Thank you for your response and feedback!

[memolei]

I'm a new RN grad doing residency in the OR. I've been there about the same length as you and I'm barely getting my strides in with simpler, general cases. Our program lasts 6 months (~24hr/week), but I've been told when I'm hired full time, I am expected to function on my own within 6 months with little assistance. I'm also taking peri-op 101 in conjunction with residency which has been really helpful in my learning of the what, why, and how's within the OR.

I have an assigned preceptor I'm with when I'm on the floor that I use as guidance throughout my day. I usually get into a groove by the 2nd procedure at the start of each week. I've been trained to do things consistently in order/sequence to not forget those "small" things. I, too, am having trouble with managing my time (why am I the only person with a oily face at the end of shift?? LOL), but I know what I need done while keeping my patient safe. In time we will find more efficient ways of doing things, but my priority right now is doing it right, even if that means I do do it 2-3 steps slower than the more experienced nurses. To help with end of case: I pile everything I need on my chart when they're close to finishing (specimens, belongings, tags, charges, etc..) so that I can grab and go.

I'm still not proficient with all the instruments being used. I haven't scrubbed into any cases, and have been told that once I do, the instruments and circulating will be a lot easier/less stress knowing what to anticipate what comes next. I'm expecting they will begin to have me scrub in at the end of my residency / upon full time hire. In the mean time, if you're able to, go down to your sterile department to have hands on time with common instruments?

Knowing expectations from your nurse manager is important though. What exactly are they expecting from you at this point, and where do they see you 2, 3, 4 months from now? If you can, maybe arrange to follow a single nurse for a week or two at a time. I myself am thinking of asking to start following nurses that specialize to really immerse and get more comfortable with those cases (ortho, vascular, neuro, etc).

Do they have goals for you? If not, maybe you can talk to them to maybe set goals on tasks you would like to learn/work on. I set goals for myself each day/week.. focusing on interviewing, focusing on room prep, focusing on hooking up the patient to monitors, machines, assist anesthesiologist, different tables/positions, etc etc. Within my last 3 shifts, I've focused on charting and feel comfortable enough to do it on my own now. On my radar next is to follow a Surg Tech so that I can be more familiar with where common supplies are.

[sageone]

OMG-I could have written this. The expectations are so high-I have only worked as a circulator 20 some days with weeks of class work filling the rest of my 3 months since I have been hired. My boss used to be great but now we have 3 circulators leaving (1 already quit) so she doesn't understand why I am not further along. She told me that so and so were much further along at this point than you are. My confidence is gone. The snarky comments make it even worse-we never hire new grads, why did they put you in this dept, you need to be more than book smart to work here, you shouldn't wear clogs and on and on it goes Geez. I am trying so hard. Some of the preceptors are of no help and teach me nothing-they are on their phones ALOT!. I have a meeting this coming week so I wonder how that is going to go. I am determined to stick it out because I really love working in this type of environment but I sure hope they continue to give me a chance. It seems to me though that it's sink or swim.

[sageone]

oh and extended orientation-well that sure isn't happening.

[Rn052015]

Going down to sterile supply to look at the instruments is one of the parts of training I keep being told I am going to do, but it has not happened yet! I do think this will be very helpful for getting a better grasp on the instruments.

I definitely wish I could follow one person around for a week or two, but with differing schedules in our department, I don't think that this would be possible.

When I have asked about expectations and goals, I get a very vague answer, mainly just saying we've never had someone in this program before, so we don't know exactly how it will work, we just want you to be an independent circulator.

At this point, I do feel comfortable with most of the "tasks" individually (getting the room ready and patient info, interviewing the patient, prepping, hooking up machines, charting, etc.). It is more of just an issue of timing and knowing exactly what to do when. Especially during a case I have not been in before, when I am trying to understand the procedure and take notes on Dr preferences and such, it is difficult to focus on everything I need to do! My manager is also having me basically everything in a case with a preceptor in the room if I have questions or do something wrong, so it isn't really possible to focus on one thing at a time.

I do feel that I am improving and becoming more competent/confident each day I am in the department, and am really just hoping that I can get to the point that my department wants me to be at!

[Rn052015]

Glad to hear someone else is going through my same experience!! (Although sorry you are having this issue as well!) I feel exactly the same way- at the beginning my manager seemed very understanding of my not being in the department as much, but it seems that I get further and further behind the "expectation" because of these classes, and now it is no longer acceptable. On the bright side, I only have a few more weeks of classes, so hoping things will improve once I am actually in the department full time!

I have also heard the snarky comments- you have to do more than memorize, your critical thinking level isn't high enough... It's hard to get to the level of critical thinking when I am still learning the basics and tasks that need to be done! I feel that a person needs to be comfortable and confident in what they are doing before beginning to critically think about situations. Again, I am hoping this will come with time and confidence level.

For the most part, my preceptors have been pretty helpful, except for sometimes at the beginning they would just do things for me instead of letting me know what needed to be done and having me do it, or I would do something wrong and they would correct it without telling me, so I was still doing it wrong the next time! With the exception of a few (who often answer with "I'm not sure, not something we specifically need to know for our position"), most are good at answering my questions. I am sure the difficulty with preceptors makes your situation even harder!

I also want to continue to stick it out and keep progressing, but am also hoping I am given this chance

[fauxpaus]

I think that most people feel a bit of panic when they first start to train. After they get dumped out into the ocean, they learn it's not so bad There's a lot to learn, sure, but catch on to the basics, the similarities between procedures and services, and then the little minute things will eventually come along! :)

[jeckrn, BSN, RN]

From what I have read here this is why I do not encourage any new RN going into to a specialty area. You need to learn nursing basics before you can fall back on that to help out in difficult situations.

[flower123456]

Just make sure they aren't planning to fire you. Make sure you document things through email. We had a new grad who just started was told similar things and she was pulled into an office 6 months after orientation and was fired. I honestly think it was because she didn't fit in with their team. Sad but true. Working in the OR is like high school all over again.