New Grad in OR who wants to quit in less than 6 mo

Editorial Team / Admin · Apr 30, 2016

That is an unfairly fast pace to be expecting a brand new OR nurse to be able to circulate alone. Have you taken time to sit down with your supervisor or educator to discuss how you feel about how your orientation is going? If they are willing to work with you, the job may be worth salvaging. If they're so short staffed that they're sacrificing proper preparation of new nurses and won't reconsider, it may not be a healthy environment. Only you can decide whether that $5,000 is worth it.

As for losing your license, take a deep breath and then look at reasons people lose licenses. The vast majority have to deal with criminal activity, drugs, alcohol, or unsafe practice due to drugs or alcohol.

CaliNurseLouisiana · Apr 30, 2016

That is an unfairly fast pace to be expecting a brand new OR nurse to be able to circulate alone. Have you taken time to sit down with your supervisor or educator to discuss how you feel about how your orientation is going? If they are willing to work with you, the job may be worth salvaging. If they're so short staffed that they're sacrificing proper preparation of new nurses and won't reconsider, it may not be a healthy environment. Only you can decide whether that $5,000 is worth it.
As for losing your license, take a deep breath and then look at reasons people lose licenses. The vast majority have to deal with criminal activity, drugs, alcohol, or unsafe practice due to drugs or alcohol.

Thank you Rose_Queen! I've voiced my concern to my manager and the educator. The educator simply says that I'm doing great and she had great feelings about me. And the manager knows that her educator isn't the greatest, and simply says that their is no way I won't be in a room solo. She stated that this is the correct time period. I disagree. I don't want to get thrown under the bus knowing that my precepting wasn't adequate.

fauxpaus · Apr 30, 2016

Our OR (a level 1 trauma center) trains our circulators to solo after 4 weeks initial training, on all levels of what they consider "general" cases. After a few weeks of "soloing" the trainees move on to other specialties (ortho, neuro, vascular, plastics etc) where they are paired for a couple weeks and then "solo" those specialties for a couple weeks. The pace the OP describes appears to be on par with the speed at which our OR, and others that I know about through friends, trains new staff. I don't know what's unfair about the pace. Our trainees are also right next door to another circulator who can assist. There are additional resources a phone call away. Eventually a trainee just has to dive in to the deep end. Either way, has administration stated that there is some sort of accelerated pace due to short staffing? If not, that's entirely speculation.

The tone of the post from the OP seems negative towards OR in general. 140 miles per day sounds like a huge time sink and waste of money, especially if the job at the other end is not one that someone loves. OR is not a "patient care" specialty in the way that floor nursing is, and any nurse who loves that aspect of floor nursing will be sorely disappointed by the OR. Our "patient care" is different but in no way less important. I have no idea why less "hands on" with the patient is a surprise, but ok.

If the OP described just some general nervousness about soloing but a love/interest for the position in general, that would be one thing. In this case, there is fear, disappointment about the position, regret for being in the position and for not having taken another, desperation to leave, amongst other things. Given those points, I can't imagine why the OP would stay in the position at all. This isn't even taking into consideration the financial considerations such as the commute. Factoring in opportunity costs, this only supports leaving the position. Is it "smart" to leave? For the OP's happiness, job satisfaction, finances...I imagine that it's the only reasonable choice.

CaliNurseLouisiana · Apr 30, 2016

Our OR (a level 1 trauma center) trains our circulators to solo after 4 weeks initial training, on all levels of what they consider "general" cases. After a few weeks of "soloing" the trainees move on to other specialties (ortho, neuro, vascular, plastics etc) where they are paired for a couple weeks and then "solo" those specialties for a couple weeks. The pace the OP describes appears to be on par with the speed at which our OR, and others that I know about through friends, trains new staff. I don't know what's unfair about the pace. Our trainees are also right next door to another circulator who can assist. There are additional resources a phone call away. Eventually a trainee just has to dive in to the deep end. Either way, has administration stated that there is some sort of accelerated pace due to short staffing? If not, that's entirely speculation.
The tone of the post from the OP seems negative towards OR in general. 140 miles per day sounds like a huge time sink and waste of money, especially if the job at the other end is not one that someone loves. OR is not a "patient care" specialty in the way that floor nursing is, and any nurse who loves that aspect of floor nursing will be sorely disappointed by the OR. Our "patient care" is different but in no way less important. I have no idea why less "hands on" with the patient is a surprise, but ok.
If the OP described just some general nervousness about soloing but a love/interest for the position in general, that would be one thing. In this case, there is fear, disappointment about the position, regret for being in the position and for not having taken another, desperation to leave, amongst other things. Given those points, I can't imagine why the OP would stay in the position at all. This isn't even taking into consideration the financial considerations such as the commute. Factoring in opportunity costs, this only supports leaving the position. Is it "smart" to leave? For the OP's happiness, job satisfaction, finances...I imagine that it's the only reasonable choice.

Thank you fauxpaus for your reply. I agree absolutely with what you have state. Additionally, I am not trying to degrade or devalue the circulators role in the OR. I think it's an honor to care for anyone, especially when they are so vulnerable. It does feel good to hear that your facility does the same thing with brand new nurses who have never worked in the OR. I don't completely agree with that method. I am a quick learner so I'm catching on fast, but I'm simply nervous by the pace and the amount that I might be missing due to the quickness. Nursing school only really familiarizes you with the floor, which I feel has left me with a deficit. I believe my orientation has been cut due to staff shortage, but I don't think you should cut corners with brand new people. My hospital had 13 ppl in a 6mo period including surg. techs and nurses.

The factors that you have stated are all the reasons that I would like to leave.

CaliNurseLouisiana · May 1, 2016

Our OR (a level 1 trauma center) trains our circulators to solo after 4 weeks initial training, on all levels of what they consider "general" cases. After a few weeks of "soloing" the trainees move on to other specialties (ortho, neuro, vascular, plastics etc) where they are paired for a couple weeks and then "solo" those specialties for a couple weeks. The pace the OP describes appears to be on par with the speed at which our OR, and others that I know about through friends, trains new staff. I don't know what's unfair about the pace. Our trainees are also right next door to another circulator who can assist. There are additional resources a phone call away. Eventually a trainee just has to dive in to the deep end. Either way, has administration stated that there is some sort of accelerated pace due to short staffing? If not, that's entirely speculation.
The tone of the post from the OP seems negative towards OR in general. 140 miles per day sounds like a huge time sink and waste of money, especially if the job at the other end is not one that someone loves. OR is not a "patient care" specialty in the way that floor nursing is, and any nurse who loves that aspect of floor nursing will be sorely disappointed by the OR. Our "patient care" is different but in no way less important. I have no idea why less "hands on" with the patient is a surprise, but ok.
If the OP described just some general nervousness about soloing but a love/interest for the position in general, that would be one thing. In this case, there is fear, disappointment about the position, regret for being in the position and for not having taken another, desperation to leave, amongst other things. Given those points, I can't imagine why the OP would stay in the position at all. This isn't even taking into consideration the financial considerations such as the commute. Factoring in opportunity costs, this only supports leaving the position. Is it "smart" to leave? For the OP's happiness, job satisfaction, finances...I imagine that it's the only reasonable choice.

I have 2 questions: what is included in your initial training for those 4 weeks? Is this process the same for brand new nurses as it is for OR nurses with experience?

fauxpaus · May 1, 2016

OR nurses with experience here don't get training...they get a few days of refresher/assessment, and then maybe if they are particularly deficient because they are coming from a surgical center and not in actual trauma hospital, they get a few opportunities to train in specialized cases. specifically specialty trauma cases, such as endo AAA's or whatnot. If the experienced OR nurses with the OP are getting 4 weeks of training before soloing...wow...

CaliNurseLouisiana · May 1, 2016

OR nurses with experience here don't get training...they get a few days of refresher/assessment, and then maybe if they are particularly deficient because they are coming from a surgical center and not in actual trauma hospital, they get a few opportunities to train in specialized cases. specifically specialty trauma cases, such as endo AAA's or whatnot. If the experienced OR nurses with the OP are getting 4 weeks of training before soloing...wow...

Experience nurses are getting exactly as you stated at my facility.

MorgantonCRNA · May 1, 2016

Losing your license takes a good amount of hard work. You will be ok. Get out of this situation ASAP and get into a NURSING job.

New grad in the OR: arrrgghhh!!!!!!

This comment is too late for you, OP, the damage is done, but maybe some other new/soon to be grad will read this.

A new grad HAS NO BUSINESS is the OR.

A new grad does not have the skill set to help me in an emergency (the circulator is my right hand (wo)man. In an emergency, it is just me and you!)

A new grad will learn next to nothing about nursing in the OR.

The biggest crime we, as a profession, can make is to set our young up for failure. Placing a new grad in the OR is just that.

I was going to add some disclaimer down here about not wanting to hurt anyone's feeling etc etc to be about PC, but PC is what is screwing up this country, I am not going to be PC this, if it hurts your feelings, that's not my problem, patient safety is my problem.

fauxpaus · May 1, 2016

Losing your license takes a good amount of hard work. You will be ok. Get out of this situation ASAP and get into a NURSING job.
New grad in the OR: arrrgghhh!!!!!!
This comment is too late for you, OP, the damage is done, but maybe some other new/soon to be grad will read this.
A new grad HAS NO BUSINESS is the OR.
A new grad does not have the skill set to help me in an emergency (the circulator is my right hand (wo)man. In an emergency, it is just me and you!)
A new grad will learn next to nothing about nursing in the OR.
The biggest crime we, as a profession, can make is to set our young up for failure. Placing a new grad in the OR is just that.
I was going to add some disclaimer down here about not wanting to hurt anyone's feeling etc etc to be about PC, but PC is what is screwing up this country, I am not going to be PC this, if it hurts your feelings, that's not my problem, patient safety is my problem.

Actually, that's a ton of crap, IMO. Unless you believe that a new grad HAS NO BUSINESS BEING IN ANYTHING OTHER THAN MED-SURG/STANDARD FLOOR NURSING. A new grad at my hospital gets 6 months OR training, 1 month in ICU or ED, and 1 week on the floor. The reason that so much training is given in comparison to ED or ICU is because it involves a completely different skill set. It requires some skills that anyone learns in nursing school plus its own set of non-transferrable, extremely specialized knowledge. I'm not saying that OR is "better" or "more advanced" or "ultra elite" or anything. IT'S JUST DIFFERENT. The most trouble that we have in my own OR, actually, is with EXPERIENCED RNs. They have a lot LESS ability to acclimate to a new, entirely different environment. They have a lot MORE TROUBLE learning these non-related specific skills. New grads that we teach still have open minds and are just, in a way, continuing their education. Taking an EXPERIENCED RN is like sending them back to school for a degree completely unrelated to what they know and are familiar with. "We know you have been a floor nurse for 25 years, Jane Doe, now wouldn't you like this degree in engineering"? Experienced floor RNs do NOT respond better in emergencies. To assume that someone who has 10 years of floor nursing experience is amazingly better in the OR than a new grad is ridiculous. Our new grads are a lot more comfortable in the position a heck of a lot earlier, able to handle emergencies a lot better, learn quickly in training and on the job, etc. Responding to emergencies in the OR is NOT THE SAME as responding to emergencies on the floor. Our EXPERIENCED RNs take, by far, the longest to transition in their roles. They have to UNLEARN a lot of what they know. This is not an insult to experienced RNs. This is not an insult to floor nurses. This is the reality of OR nursing. This is the truth. It is different and to say otherwise is a lie.

If you believe that a new grad can't handle the knew knowledge, the greater skill set, or the responsibilities of an ICU or ED nurse after they have been trained appropriately, then at least your argument would have some merit (if those things were true). If you think that to go to ICU or ED a nurse has to have a certain amount of experience on the floor first, that would make your argument better (if it were true). I don't agree, at all, but that's your opinion. It's a very case-by-case basis. It is and always will be. Some of us are more open to change, able to handle the stress, adapt quickly, learn new skill, etc than others. This statement will probably make some people upset, but honestly, you know that this is true...not all RNs are created equal. Some RNs struggle through nursing school, barely pass, take NCLEX 8 times, get into the easiest possible RN job and still have trouble. Yes, these RNs probably are not straight-into-OR-after-graduating material. Some RNs didn't blink going through nursing school, didn't have difficulties, passed NCLEX with on the first try in the minimum number of questions, and can go straight into iCU/ED/OR and keep on sailing without any hitches. The argument that someone might do better with ICU/ED after having some experience on the floor has a heck of a lot more merit than saying that someone will do better in OR after experience on the floor, since, excusing my repetitiveness, OR has almost NOTHING TO DO WITH FLOOR NURSING, whereas at least ICU/ED are much more like an advanced, stepped up version of floor nursing (a crude analogy, sorry to those of you in ICU/ED).

Regarding "A new grad will learn next to nothing about nursing in the OR"? Yes, You're correct. They won't learn about floor nursing. It's not floor nursing. It's a different type of nursing. A whole heck of a lot of what we learning in nursing school DOES NOT APPLY or IS NOT NECESSARY, which is why, as I said above, there is so much f'ing training. Completely unrelated skill set above and beyond what we have already learned in school. Some skills are transferrable. Most are not.

As for setting our young up for failure...well...I beg to differ. I'm going to be controversial here, I know, but IMO the biggest mistake in our profession is not understanding that not everyone who wants to be a nurse can/should be a nurse. Nursing school coddles a heck of a lot of people. NCLEX is not meant to be taken 8 times. We can, and should, weed out people who are not meant for the job a lot earlier. Our complacency and Americanized afraid-of-hurting-feelings-so-everyone-gets-a-trophy mentality, combined with schools all wanting to look like they have the best graduation rates creates a bar that is much lower than it should be. That's a hazard to our patients. A complete idiot working in ANY nursing specialty is still an idiot and can kill a patient, no matter how many years of experience they have.

fauxpaus · May 1, 2016

To be clear, my prior post was not directed at the OP. Her situation is an "OR vs other" question, not a "to be or not to be a nurse" or "do I have to sit in med-surg prior to doing ICU" question.

jeckrn, BSN, RN · May 1, 2016

Actually, that's a ton of crap, IMO. Unless you believe that a new grad HAS NO BUSINESS BEING IN ANYTHING OTHER THAN MED-SURG/STANDARD FLOOR NURSING. A new grad at my hospital gets 6 months OR training, 1 month in ICU or ED, and 1 week on the floor. The reason that so much training is given in comparison to ED or ICU is because it involves a completely different skill set. It requires some skills that anyone learns in nursing school plus its own set of non-transferrable, extremely specialized knowledge. I'm not saying that OR is "better" or "more advanced" or "ultra elite" or anything. IT'S JUST DIFFERENT. The most trouble that we have in my own OR, actually, is with EXPERIENCED RNs. They have a lot LESS ability to acclimate to a new, entirely different environment. They have a lot MORE TROUBLE learning these non-related specific skills. New grads that we teach still have open minds and are just, in a way, continuing their education. Taking an EXPERIENCED RN is like sending them back to school for a degree completely unrelated to what they know and are familiar with. "We know you have been a floor nurse for 25 years, Jane Doe, now wouldn't you like this degree in engineering"? Experienced floor RNs do NOT respond better in emergencies. To assume that someone who has 10 years of floor nursing experience is amazingly better in the OR than a new grad is ridiculous. Our new grads are a lot more comfortable in the position a heck of a lot earlier, able to handle emergencies a lot better, learn quickly in training and on the job, etc. Responding to emergencies in the OR is NOT THE SAME as responding to emergencies on the floor. Our EXPERIENCED RNs take, by far, the longest to transition in their roles. They have to UNLEARN a lot of what they know. This is not an insult to experienced RNs. This is not an insult to floor nurses. This is the reality of OR nursing. This is the truth. It is different and to say otherwise is a lie.
If you believe that a new grad can't handle the knew knowledge, the greater skill set, or the responsibilities of an ICU or ED nurse after they have been trained appropriately, then at least your argument would have some merit (if those things were true). If you think that to go to ICU or ED a nurse has to have a certain amount of experience on the floor first, that would make your argument better (if it were true). I don't agree, at all, but that's your opinion. It's a very case-by-case basis. It is and always will be. Some of us are more open to change, able to handle the stress, adapt quickly, learn new skill, etc than others. This statement will probably make some people upset, but honestly, you know that this is true...not all RNs are created equal. Some RNs struggle through nursing school, barely pass, take NCLEX 8 times, get into the easiest possible RN job and still have trouble. Yes, these RNs probably are not straight-into-OR-after-graduating material. Some RNs didn't blink going through nursing school, didn't have difficulties, passed NCLEX with on the first try in the minimum number of questions, and can go straight into iCU/ED/OR and keep on sailing without any hitches. The argument that someone might do better with ICU/ED after having some experience on the floor has a heck of a lot more merit than saying that someone will do better in OR after experience on the floor, since, excusing my repetitiveness, OR has almost NOTHING TO DO WITH FLOOR NURSING, whereas at least ICU/ED are much more like an advanced, stepped up version of floor nursing (a crude analogy, sorry to those of you in ICU/ED).
Regarding "A new grad will learn next to nothing about nursing in the OR"? Yes, You're correct. They won't learn about floor nursing. It's not floor nursing. It's a different type of nursing. A whole heck of a lot of what we learning in nursing school DOES NOT APPLY or IS NOT NECESSARY, which is why, as I said above, there is so much f'ing training. Completely unrelated skill set above and beyond what we have already learned in school. Some skills are transferrable. Most are not.
As for setting our young up for failure...well...I beg to differ. I'm going to be controversial here, I know, but IMO the biggest mistake in our profession is not understanding that not everyone who wants to be a nurse can/should be a nurse. Nursing school coddles a heck of a lot of people. NCLEX is not meant to be taken 8 times. We can, and should, weed out people who are not meant for the job a lot earlier. Our complacency and Americanized afraid-of-hurting-feelings-so-everyone-gets-a-trophy mentality, combined with schools all wanting to look like they have the best graduation rates creates a bar that is much lower than it should be. That's a hazard to our patients. A complete idiot working in ANY nursing specialty is still an idiot and can kill a patient, no matter how many years of experience they have.

You have given reason why no new grad should go to any specialized area for at least one year since they do not have any fundamentals to fall back on. During the first year of nursing you are learning the basics and to give you an idea of what area of nursing you would like to do. You stated that floor nursing will not help in the OR. I totally disagree with this. There was many times when I first started working in the OR that my experience in the Med-surg, ED & ICU made my job easier to learn and safer for the patient since I was on top of basic issue and only had to focus on learning my OR skills. When you say that experience RN's have to unlearn what they have learned is wrong, when they move to the OR they build on the skills they already know. Are there some nurses who do not make the transition will, of course there are just like new grads. What sounds great in school might not be the fit for you once you start working. I agree an idiot is an idiot no matter where they work and amount of experience. But smart nurses lacking experience can still kill a patient because they have not learned how to do basic nursing yet. Some nursing schools only care about keeping the seats filled for the money since college is a big business. Other schools have high standards and will fail out students in the last week. I know this because I had a fellow student dropped on the last day of clinicals.