New Grad in OR struggling

Amistad, RN · May 25, 2016

StringOR;

I'm sorry you're going through this! Being a new nurse is tough. Being new to the OR is tougher! I've been a nurse for 3 years and recently started in the OR. As a new grad I definitely had days where I "shut down" from stress as you are describing, especially when I needed help and wasn't getting enough support. I cried a lot the first year and my friends and family had a hard time understanding my pain. I don't think any of my non-nursing friends are subjected to such stress at their jobs. Anyway, I am here to tell you that it WILL get better. You will learn to prioritize and multitask like a boss. It took 3 years and 2 changes in specialties but now I actually have fun being a nurse.

The OR might be challenging to you with an introverted personality. Teamwork is very important and you need to feel comfortable talking to doctors. I do know a few introverted OR nurses who are successful though. They work hard and don't cause drama which is appreciated by other staff. I would say try to stick it out and know that it will get better! Take lots of notes on physician preferences, it will pay off eventually! Best of luck to you!

acerbia · May 27, 2016

How are the people you work with? Are they team players? Do the cliques help non-clique co-workers? Do they cause drama or throw people under the bus? If you don't feel comfortable with your co-workers (on a fundamental level, not on a personality level), then this particular OR might not be for you. Be aware and open-minded, but strongly consider the behaviors of your colleagues.

Some aspects of the OR will get easier with time (i.e., multi-tasking, time management, communicating with doctors/surgeons, knowing where things are located and what resources are available to you), but there are some aspects that might not. If you have poor management and a lack of adequate education or training, that is not your fault. That can be a HUGE unhappiness factor, and that is not fair to you as a new nurse and a new OR nurse. Try to make an appointment with your educator or manager as soon as you can and discuss your concerns with them. That is their job and they should be more than willing to accommodate.

You will be stressed, you will cry, and you will hate everything sometimes. That much is normal and true for any nursing position, not just OR. However, if you have no support from coworkers or management, if the people are awful, and it's not a positive environment, that is not normal and its not fair to you. You might want to consider other possibilities if you can't make it work. The OR is not for everyone, and that is perfectly OK.

I have had a similar experience, although I'd argue that mine has been worse in comparison. I will not be staying in the OR.

Best of luck to you!

StringOR · May 28, 2016

Thank you for this! A lot of my coworkers are very helpful and are people I love to work with, but there are also a lot of people who throw others under the bus and are constantly speaking bad about many other colleagues. Some of them are downright mean and very unpleasant to be around. I can't tell if they are just burnt out from the job or if they lack any maturity whatsoever.

It is nice to know it isn't unusual to be this stressed and crying often during my first nursing job.

Acerbia- I would love to hear about your experience in the OR if you don't mind sharing.

AllieRN2 · May 29, 2016

I'm a new grad with 6 months experience in the OR and I'm here to say: It gets easier! I know how tough it is to be with a new face every day, especially since the preceptors usually have very different styles and insist on very different ways of doing things. Honestly just getting used to the commute and the schedule gave me a headache for the first month. Let alone all the yammering and "great advice," or "little secrets" people have for you daily. Hang in there though. It got a lot better for me when I left the general rotation through all the specialties and started to focus on my main specialty area. It became the same few faces over and over and that really helped. Time helps too, one day you will look around and realize you know what is going on and you know what is needed. I'm not 100% there, but I'm MUCH more comfortable than ever before.

Work on doing fun things outside of work. Get a message or join a gym. I'm not saying this flippantly, it's a MUST: leave work at work. You can read quietly in the break room if you want, you do not have to be socially involved with cliques or coworkers. Find ways to relieve stress and don't feel like you owe your coworkers anything. Just be there to do your job and take good care of the patient. You are learning, it's ok to be functioning at 50% if you have another circulator in the room with you. I think it is totally normal to feel overwhelmed in the OR at first. It comes with time. Cut yourself some slack. The OR is a great place to be, but the learning curve is STEEP.

Give it a few more months and see if you can make it your own. It might just be the culture of that facility that is not a match for you, or you might not be meeting your own high standards quite yet or something like that. I think you also might just be in the hardest phase of orientation: where you know enough that preceptors have high expectations of you to do it all, but you don't actually know any of the specifics for the surgeon/cases/extenuating circumstances/etc. Peri-op 101 and OR experience is valuable to have under your belt.

DanielOR_RN · Jun 2, 2016

Hi StringOR,

It looks like we seem to be in a very similar situation. I also started the Periop 101 program in February 2016 as a new grad nurse as well. I finished Periop 101 and I am in the precepting portion of my program. We have a lot of things in common. There are cliques in my unit too and it is so difficult. My worse day yet was today. As an introvert I find it hard to speak up and be completely open with people as soon as I meet them. Snarky personalities and remarks from scrubs have really irritated me, and some of them can be bullies. They don't know what to expect from us and they don't even know how far we are along the program, yet many of them expect us to perform at an expert-level which is outrageous.

Also, in all these cases there's a lot of things going on at once, especially getting thrown into ortho cases which can get pretty hectic and complicated, I felt like I was a stick in the mud. I found it hard to know what to do at certain intervals. I get tossed around with different preceptors who have different prepping techniques and nothing is really crystal clear at this point.

Another thing we have in common is management. Our management has constantly been changing, we are on our 2nd or 3rd manager, granted we are a Trauma hospital in a metropolitan area, I expected a bit more. In the middle of my didactic portion our educator went AWOL switching roles so we didn't get the best education other than from the modules and our whole group coming together to help.

Leaving for me isn't an option either as I signed a 2-year contract. I've always known the OR was my world, and I sincerely believe it does get easier. We just have to stick it out. My co-workers who are ahead of me and who will soon be on their own says that there is a routine, we just have to find it. Best of luck to the both of us!

calsmithlewis36 · Jun 2, 2016

I just recently finished up the Periop 101 course in May. I'm not a new grad nurse, but I'm coming from psych of 5 years. I have signed a 2 year contract and I have been with many different preceptors also. I learn from each different encounter and make it into my own. I take a lot of notes on the different doctors, look at the preference cards, and review my assignment for the next day. Also, I take tons of pictures on the room setups if it's something I haven't seen before. I would really try to talk with your charge nurse about what is going on. Just remember it usually takes at least one to two years before you feel comfortable in the OR. Give it sometime and I hope it works out for you. Best wishes.

cpkRN · Jun 2, 2016

You sound just like I did when I started out and I'm now an OR educator and in leadership with our national organization. I was passionate about my job and knew I didn't want to be anywhere else.

I had a CRNA tell me I would never make it, that I was just too quiet for the OR. Once I was confident enough to find my voice, she regretted saying that (and we're friends to this day)! It takes time. It will take months beyond your orientation to feel confident and, even then, there will be days where you feel like you've been knocked down.

I can't tell you how many times I cried all the way home from work in orientation. I was "kicked out" of orientation and taking call after 4.5 months (was supposed to be 6) due to short staffing at my first hospital. I took every challenge possible and fought to learn everything I could, even if that meant looking things up at home. I kept a notebook of surgeons, preferences, and procedures and kept a "work journal" of sorts to look back on. It's so funny to read it now but I remember how healing it was.

I went 6 months by 6 months. I told myself I had to make it through orientation, then a year. At the year point, I felt much better. Still "green," but better.

I tell my students that there's a reason we can't sit for CNOR certification for 2 years - it takes that long to feel comfortable!

SandraFenway · Jun 3, 2016

Document the changing preceptors and surgery types. Send an email to the surgical director requesting assignation to one or two preceptors that will work with you to get you where you need to go. Send a time/ date stamp email to administration where you express your concerns. It sounds like your training program is not serving you due to a variety of coincident circumstances. You are at risk of failure, good training programs are few and far between in surgery. It is not your fault.

BUT! Surgical nurses are in short supply, you ARE valuable. Unless you want to just suck it up and hope for the best, now is the time to formulate a plan to get this facility to do the right thing and properly train you. It's not the 15k, that's the least of the worries here. The facility has invested in you big time, training isn't cheap & they really don't want to lose you. Let them know they are in danger of seeing you walk out the door and give them a chance to make some changes.

SandraFenway · Jun 3, 2016

Also, one of the biggest elements of success in the OR is feeling like you are working well, moving towards a common goal of safe surgery for your patient. This is when attaboys can really help develop the team and give you a feeling of security as you learn. If they are switching out your preceptors willy nilly, you will feel more lost and alone. It's a crippling feeling. The preceptors won't know you, will interrupt your actions or leave you high and dry. Not very confidence inducing!

Trac78 · Jun 4, 2016

First, I am so sorry this is happening to you. I have been an OR nurse for 14 years. Just like you I came to the OR straight from Nursing School. I Love OR Nursing. I was very shy when I first started. So afraid of making mistakes. I thought everyone was watching me putting the foley in, prepping, heck putting a warm blanket on a patient. Make your mistakes now. That's how you learn. That's actually how I teach...I tell people what I did wrong, so they don't do it. I did not get comfortable in the OR until 2 years later. Some days I am still unsure.

The OR is a very high stress workplace. The surgeons can be like working with 2 year olds who are having tantrums. OR nurses commonly eat their young. But it can also be a fun, organized, and teamwork oriented workplace. Your "team" makes or breaks your day. The scrub techs I have worked with over the years have taught me so much and they have saved me many times!!!!

Being with different preceptors is sooo difficult because all the nurses do things differently, achieve the same goal, but want you to do it their way. I understand that frustration. Could you try to negotiate and settle on 2?

I think there is a national shortage of OR managers. I live in Delaware. There are only 4 major hospitals in the lower part of the state. Two have openings: one for an OR manager, the other for an OR Director. They have been vacant for months. I believe the one hospital, the position was filled for 3 days before she gave her resignation.

Being stuck without an OR Educator is not good. You may have to start writing down your own goals to achieve each week in the OR for certain cases. Such as: for this case I want to do all the positioning, prepping, and paperwork. Or something similar. Unfortunately, this time period without an OR Educator will count toward orientation. Then, in so many months they will tell you that you are on your own. Then ask why you can't function on your own. But, they don't realize you haven't had proper orientation. I've seen it happen too many times. Might not be a bad idea to start sending weekly email updates to your manager that your orientation is not going well, just so there is a paper trail that she was advised.

My advice: it will get better. Hang in there. Like others said make your own notes of surgeons preferences. Also, come to work early if you can just to get a little prepared and not feel rushed. If you're in a long case, think about what positioning aids, meds, supplies, or equipment you need for the next case. Ask questions if you are unsure of something. This is your learning time. And the cliques...they are everywhere. It's better if you don't get involved.

But if you absolutely hate it, how much is your happiness worth?

violetislet · Jun 6, 2016

This was totally me (minus the quiet part ), about 8-10 months ago. I started out as a New Grad in the Main OR of a Level 1 Trauma Center. Orientation was incredibly challenging: different preceptors, different surgeons, different scrubs and different procedures each day. And people weren't particularly nice to the newbie, either. It got better once I got off orientation, and I finally feel like I've found my stride. I still circulate different services daily, but I feel more confident and capable than I did when I began almost a year ago. The one thing I'm still struggling with is call. I got called in this weekend and worked a full shift, in addition to my usual 40+, and my young son and spouse and I really despise when I get called in. Part of the job, though. The vultures do back off once you get off orientation, so hang in there and know that you're not alone!