Hello all and thank you in advanced for taking the time to read this. I am a brand new Dec 2015 grad and new to the OR. I finished Periop 101 March 25 and I have been in rooms since. Now, less than 4 weeks later my hospital has me being a circulator by myself in GEN and GYN cases on April 26 and 29 with more solo cases planned for the following weeks. I am being told someone is on standby just a phone call away but none of that makes me feel comfortable. I am terribly nervous about the pace that they are moving me along because our OR is so desperate for Circulators.
I signed a 2 year contract that the hospital values at $5,000. I drive 140miles every day of the week. I knew about the drive before, but felt that I was so excited that it would be worth it. Well...needless to say this has not been worth it. I didn't know that I had so little hands on with the patient and I'm desperately missing patient care.
I'm concerned about losing my license if I make a mistake since my orientation seems to be rushed along due to the OR wanting to open more rooms up.
I turned down an ICU residency program and I really regret turning it down. I re-applied for it and had an interview that went really well. No offers have been made yet.
I am so ready to leave this job. I am desperate and would take honestly anything! Does anyone have any suggestions about my current OR job and whether it's smart for me to leave? And if my OR is moving at the normal pace for a brand new grad to the OR?
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 and safer for the patient. 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.
1) I would love to know the plethora of life saving med-surg basics that provide the fundamentals to fall back on in OR that are taught only in med-surg, and not taught to new grads in OR or in any other specialty. What do you consider "basic nursing"?
2) I didn't say that floor nursing will not help in OR, ever, under any circumstance. I said they're different skill sets and that a lot is not transferrable. The skill sets themselves are much more easily transferred from non-OR to OR than from OR to non-OR. The ability of someone to use those skill sets is an entirely different matter. And your experience in ED/ICU is sure as heck a lot more likely to make your job easier than coming from med-surg.
3) Fairly sure I made a reference to a case by case basis for just about everything and everyone.
4) What sounds great before you start school might not fit once you start school. What sounds great in school might not fit once you start working. What sounds good when you're sitting in med-surg might not fit once you transfer to home healthcare. What sounds good while in home healthcare might not fit once you're in ED. This applies to everything.
5) I'm fairly sure that the whole point of a practicum is to help establish basics/fundamentals & figure out which specialty might be right for each individual. I know a lot of nurses who started practicums in x specialty and couldn't stand it. I know nurses who started working in y specialty out of job market necessity, got stuck and were about to gouge out their eyeballs trying to wait a year to get into a different specialty. I know nurses who wouldn't be nurses if they couldn't be in OR.
My biggest issue is I don't feel as equipped as I should be. I am being rushed through an orientation because they want to open more OR rooms. I literally was on the computer for 3wks then went into a bunch of random surgeries and was then put in to run a room. I didn't struggle to run the room, but I wouldn't dare want a family member or myself to be looked over in surgery my myself having been rushed thru orientation! And that is sad to say!!
My biggest issue is I don't feel as equipped as I should be. I am being rushed through an orientation because they want to open more OR rooms. I literally was on the computer for 3wks then went into a bunch of random surgeries and was then put in to run a room. I didn't struggle to run the room, but I wouldn't dare want a family member or myself to be looked over in surgery my myself having been rushed thru orientation! And that is sad to say!!
Again, I'm curious, did someone actually say that they are rushing you through orientation in order to open more OR rooms? Or is this a hunch? Feeling? Guess? Compilation of a lot of different factors?
Regarding random surgeries... well. One of the most common comments that comes up from our trainees is panic because they are about to do a case they've "never done before". The nature of a larger hospital OR (not a surg-center where they only do breast implants, or only lap appys, or basically the same few surgeries over and over and over again) is that you'll never have experience with every surgery ever. Something new will always come up. And what you think you might know might turn into something that you don't know.
I can tell you that most people who come into OR don't feel all hunky-dory when they start to solo. A lot of them are nervous. There's no way to alleviate that feeling. Whether or not it's a valid feeling based in fact (i.e. you are in fact totally not equipped to be in the OR by yourself and are a terrible danger to everyone) or it's a feeling based on other factors (high achieving perfectionist, generally high anxiety personality type, first month jitters but you are in fact completely capable of being in the OR by yourself and utilizing the resources around you like your SLS, charge RNs, your OR educator, the nurse in the room next door, etc should you feel like you need some assistance) is a question that is important. You may be, in fact, completely capable. Maybe you need a smidge more time to feel more confident. If that's the case and you feel like you REALLY REALLY want to be an OR nurse but just need a couple more weeks of training, speak up to the people in charge. Get the couple weeks of extra training and go on to be the best OR nurse ever!
On the other hand, maybe you just aren't meant for OR which is, again, not at all an insult to you, but just a statement of a potential fact. ICU might be the place where you find yourself completely at home, confident, and have the hands on patient care that you desire. In which case, get your butt over to ICU and kick some ass.
Again, based on your initial post, it seems that you don't really love OR. If you're not happy in OR, you'll be perpetually miserable and it just won't be good for you on any level.
If you want some more personalized advice or just a sounding board, I'm happy to talk to you on the phone or something. Just PM me. I'm tired of arguing here about other things.
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.
I never said that.
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.
Different as in NON-NURSING, which is my point. Paperwork, consents, orders, what kind of patient care nursing are you doing in the OR?
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.
This is a "ton of crap", RNs are the most versatile profession I have ever worked with, so I aint buying that "ton of crap" for a second.
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.
And then all this baseless crap you spew here... this is just mind-blowing you believe this way.
No I do not think 10 years of floor nursing makes you better at responding to emergencies, but it does give you a basis for dealing with patients, understanding how patients react to stressful situations and how to help them work through these things.
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.
These two paragraphs we have already addressed. TBH, I just skimmed thru them.
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.
I have always believed, no matter how much two people disagree they can always find common ground, you saved it for your last paragraph... I agree 1000% with your last paragraph. This is another way we set our young up for failure.
I wonder: do you work in the OR? It sounds like you do. Do you have MDAs in your OR, I do not and I rely very heavily on my circulator. I let them intubate, they push drugs, etc etc. I really have to have a competent circulator in the OR. My circulators are ex-ICU nurses and they are they best on the planet!!!
Yes, you're correct. I did not accuse you of saying that. My statement was "unless you believe". Not "You said that (xxx)."
"Different as in NON-NURSING, which is my point. Paperwork, consents, orders, what kind of patient care nursing are you doing in the OR?"
We have "patient care nursing" in the OR, just not in the same way, nor the same quantity, as other specialties. Which I did very specifically state above, where I pointed out that "OR is not a "patient care" specialty in the way that floor nursing is", that floor nurses who like that aspect of their positions will be sad that OR does not contain the same volume of direct patient contact, and that it is most definitely less "hands on". Please don't quote things out of context.
This is a "ton of crap", RNs are the most versatile profession I have ever worked with, so I aint buying that "ton of crap" for a second.
I'll try to overlook the grammatical errors here ("RNs are the most versatile profession" makes absolutely no sense) and address what I suspect to be the spirit of your statement. Please point out where I said that nursing isn't a versatile profession, or that nurses can not be versatile. Good lord. I said that there are different skill sets needed and that some skill sets between specialties overlap more than others.
And then all this baseless crap you spew here... this is just mind-blowing you believe this way.
My supposedly mind-blowing, beliefs are based on data points collected from personal experience from myself and others who work with me and are therefore, by definition, not baseless. I said "our new grads" and "our trainees" and "we teach" which I thought clearly indicated that this is the experience I have had at MY OR, not at every OR ever in the known universe. I have not completed a peer-reviewed study over the course of 20 years. I do not claim to be the leading expert on any of this. I do claim to have seen, first hand, the situations which I described.
No I do not think 10 years of floor nursing makes you better at responding to emergencies, but it does give you a basis for dealing with patients, understanding how patients react to stressful situations and how to help them work through these things.
You didn't state that floor nursing makes you better at responding to emergencies. You DID state "A new grad does not have the skill set to help me in an emergency ". A non new grad presumably is no longer a new grad because they have obtained experience from somewhere. Enlighten us all as to the sudden acquisition of the above-referenced skill set, and where you believe they should obtain it, because you're simply contradicting yourself at this point.
Goodness gracious. Yes, you're absolutely right, all OR nurses have no idea how to deal with patients in stressful situations and no idea how to help them work through "these things". We just stow all compassion, people skills, ability to listen, and any semblance of humanity in our lockers. Seriously? In any specialty, there are RNs who lack all those skills. In any specialty, there are RNs who excel at those skills. I'm sure that you realize that not only are we have to not only "deal with patients in stressful situations" and "help them work through these things", we have to do it in a compressed time frame, during what could be the scariest moments of their lives. You're right in that no, we don't have all day to sit with a patient and do a full 12 hour shift of psychological support. We do have to provide the patient with the best possible support during the brief time we get with them, whether that be in preop, rolling back from preop, or the few minutes that the patient is laying on our table, about to close their eyes and hope that they wake up. Those of us who are concerned about helping patients through stressful situations pull up a chair in preop, talk to the patient for however long is necessary, talk them through each moment on that table to distract, soothe, keep calm, and provide support because there is no one else to fulfill that role. When the patient is about to go under, we are the last voice they hear, the last face they see, and the hand they feel in theirs. In the awful cases in which the patient is awake for a procedure, some of us will climb under the drapes and talk to the patient to do all these things for them and keep them from panic when the central line being placed without anything but local. In an awake trach, some of us are holding the hand of the patient and talking to them throughout the entire procedure. We help patients deal with stressful situations whether or not the surgery is routine and scheduled or is an emergency coming through the elevator, the patient shot 3 times but still awake and screaming. We can't dial the chaplain. We can't call the family and ask them to come sit with their loved one. We don't get to call for a psych or social services consult. It's us, and only us. We have the honor, the privilege, and the great responsibility to do that for our patients. These are not skills learned from experience on the floor.
As for whether or not I work with anesthesiologists, the answer is yes. We rarely work with CRNAs as the facility is a level 1 trauma center and teaching hospital, so CRNAs are only utilized for the cases done in outlying (MRI etc) or outpatient. It is not within the scope of practice here for RNs to intubate. We provide assistance as needed.
I'm not going to continue to argue my points. I don't have the time, or the energy after being on call for so long. I'll continue any discussion with the OP in PMs.
My question have you ever worked anywhere but the OR because that is the tone of your posts. Just being able to do a basic assessment; knowing how to respond to an emergency can be the difference between life and death. Floor nursing builds on the fundamentals an RN learns in school and how to prioritize. If you have know idea how to prioritize you will be running your butt off. Basic nursing is what a new RN does and learn in their first year.
My question have you ever worked anywhere but the OR because that is the tone of your posts. Just being able to do a basic assessment; knowing how to respond to an emergency can be the difference between life and death. Floor nursing builds on the fundamentals an RN learns in school and how to prioritize. If you have know idea how to prioritize you will be running your butt off. Basic nursing is what a new RN does and learn in their first year.
I have, and a "basic assessment" and prioritizing are not the exclusive purview of floor nursing. Saying so would be incredibly absolutest and untrue.
I can't say that I have "know idea" how to prioritize. I do "know" that people can prioritize without being finger fed. "No", I do not think that all skills that make a good nurse are either inherently present or learned. Some ideas, concepts, or skills that are taught require additional time, training, and practice for some people, whereas for others the exact same things might be absorbed in 1st grade (like "know vs no", or learning proper use of the semicolon). It might take someone a year to learn how to prioritize. It might not require someone time to learn how to prioritize because s/he already does it instinctively. It might take a lifetime for s/he to learn that s/he is an incredibly bad prioritizer.
In the context of this thread, telling me that basic nursing is what a new RN does and learn(s) in his/her first year is essentially defining a word using the word in the definition. It provides absolutely no information and in this case, no specifics.
Here is the real question that I dont think anyone bothered to dig deeper into. The OP states that they FINISHED A PERIOP course, these are typically 6 months of OR specific training with hands on and didactic items. AFTER THE PERIOP COURSE she was put into a service line on her own with backup for 4 weeks. This is ample training and at this point I am sure the managers and educator feel it is probably a make it or break it time....
OP if I am wrong in my assumption of your experience in the periop program you say you completed please let me know. If I am right then it is time to apply what you have learned in that course and get over your nerves, I guarantee that ICU nursing will be no easier.
As far as a CRNA having circulators intubate for you on a regular enough basis to make it a bragging point, that is ridiculous and I dont think it is something you should ever state publicly again. Have I ever intubated for someone that just couldnt get the angle? sure.... Have I ever started an art line for someone that just couldnt get the stick? sure..... Definitely something that they would talk about or I would state happened to staff in my OR. I know/no better.....
Specializes in OR, Nursing Professional Development.
Here is the real question that I dont think anyone bothered to dig deeper into. The OP states that they FINISHED A PERIOP course, these are typically 6 months of OR specific training with hands on and didactic items. AFTER THE PERIOP COURSE she was put into a service line on her own with backup for 4 weeks. This is ample training and at this point I am sure the managers and educator feel it is probably a make it or break it time....
OP only graduated in December. Definitely not 6 months. If the orientation is anything like the current version in my facility, the new nurses complete all computer modules ​of AORN Periop 101 prior to setting foot in the OR. So it's possible OP completed the computer portion and is only recently actually in the OR.
OP only graduated in December. Definitely not 6 months. If the orientation is anything like the current version in my facility, the new nurses complete all computer modules ​of AORN Periop 101 prior to setting foot in the OR. So it's possible OP completed the computer portion and is only recently actually in the OR.
Agreed, that is why I asked OP for clarification. However, I would feel that 4 or 5 weeks with a mentor in GEN and GYN cases THEN having the mentor stand back and be available would also be enough. Everyone learns differently though, this place just needs her to be one of these kinds of learners..... If it isnt a good match then they may be at the point that they either push them to quit or succeed.....
I didnt personally go through a periop course but I have put some of my staff through it. I was taught in the OJT style after graduation and it was kind of sink or swim, I learned to swim really quick..... BUT I did have some prior OR experience and knew the staff and surgeons at the hospital I was at very well.
OP only graduated in December. Definitely not 6 months. If the orientation is anything like the current version in my facility, the new nurses complete all computer modules ​of AORN Periop 101 prior to setting foot in the OR. So it's possible OP completed the computer portion and is only recently actually in the OR.
I started Peri-op and finished Peri-op ONLINE course March 28. And have been in rooms since. There was NO classroom portion. There was NO supplemental ANYTHING to go along with the online course. The educator took me 1 day to look at a Major, Minor and GYN sets. She stated practice with this for a bit. This was 1 day! She took out some of the most popular needles. And lastly we showed me how to scrub my hands and put on a gown and gloves. That was March 28-30, March 31 and onward I have been in a room.
Here is the real question that I dont think anyone bothered to dig deeper into. The OP states that they FINISHED A PERIOP course, these are typically 6 months of OR specific training with hands on and didactic items. AFTER THE PERIOP COURSE she was put into a service line on her own with backup for 4 weeks. This is ample training and at this point I am sure the managers and educator feel it is probably a make it or break it time....
OP if I am wrong in my assumption of your experience in the periop program you say you completed please let me know. If I am right then it is time to apply what you have learned in that course and get over your nerves, I guarantee that ICU nursing will be no easier.
As far as a CRNA having circulators intubate for you on a regular enough basis to make it a bragging point, that is ridiculous and I dont think it is something you should ever state publicly again. Have I ever intubated for someone that just couldnt get the angle? sure.... Have I ever started an art line for someone that just couldnt get the stick? sure..... Definitely something that they would talk about or I would state happened to staff in my OR. I know/no better.....
I suppose I wasn't specific/clear enough on my first post when I commented on this. Now, at my own facility, there are 4 weeks paired before soloing IN THE OR, only AFTER the didactic training, which is why I felt (with the information available at the time) it was not an unreasonable amount of training/unreasonable timeline. My own training was much faster paced and very sink/swim.
Regarding the CRNA comment...I agree 100%. It's not as if intubating is just a small part of the job, easily delegated off to another staff member. Relying heavily on your circulator to do your job is not something to boast about. If your defense is that no (or know!), you don't rely on them, you just "let" them intubate, then that's equally ridiculous as you're compromising patient safety for...what? So that your circulator can be entertained? So that you can get a cup of coffee? So that you can become better friends with the circulator by "letting" them do your job? I can't think of any answer that makes any sense, because why would the most qualified person not be the one performing the intubation, in any scenario (that does not involve training)...?
fauxpaus
38 Posts
1) I would love to know the plethora of life saving med-surg basics that provide the fundamentals to fall back on in OR that are taught only in med-surg, and not taught to new grads in OR or in any other specialty. What do you consider "basic nursing"?
2) I didn't say that floor nursing will not help in OR, ever, under any circumstance. I said they're different skill sets and that a lot is not transferrable. The skill sets themselves are much more easily transferred from non-OR to OR than from OR to non-OR. The ability of someone to use those skill sets is an entirely different matter. And your experience in ED/ICU is sure as heck a lot more likely to make your job easier than coming from med-surg.
3) Fairly sure I made a reference to a case by case basis for just about everything and everyone.
4) What sounds great before you start school might not fit once you start school. What sounds great in school might not fit once you start working. What sounds good when you're sitting in med-surg might not fit once you transfer to home healthcare. What sounds good while in home healthcare might not fit once you're in ED. This applies to everything.
5) I'm fairly sure that the whole point of a practicum is to help establish basics/fundamentals & figure out which specialty might be right for each individual. I know a lot of nurses who started practicums in x specialty and couldn't stand it. I know nurses who started working in y specialty out of job market necessity, got stuck and were about to gouge out their eyeballs trying to wait a year to get into a different specialty. I know nurses who wouldn't be nurses if they couldn't be in OR.