New grad straight to OR - bad idea?

[kubelkabondy, ADN, RN]

So I am a senior in nursing school and will be graduating at the end of this year. Up until a few months ago, I had no idea what specialty of nursing I wanted to get into, so I thought I would just start in med-surg since that’s what everyone seemed to be advising. However, a few months ago, I came across a video of an OR nurse describing her role, and it got me really interested. Fast forward three months, and I have decided that I am interested in becoming an OR nurse. I have not shadowed yet, but I will in just a couple weeks.

There are a few things that appealed to me about the OR. One of them is the teamwork aspect of it. I have always preferred working in a team to working independently. With floor nursing, although you have support available if you need it, you are primarily responsible for your patients, you are usually alone in the room with them, and you often have to make independent judgment calls regarding their care. I dislike this about floor nursing.

Another thing I like about the OR is being able to focus entirely on one patient at a time. I work as a CNA on a med-surg floor right now, and I see the nurses constantly running around from room to room, juggling 4-6 patients and all their family members. I enjoy patient interaction, but I think that this constant cycling through new patients and family members every shift would burn me out fast. This is especially true because I am an introvert. Lastly, I am fascinated by surgery and anatomy. I have spent hours watching videos about different types of surgeries over the past three months since deciding that I’m interested in the OR.

That said, I have a few concerns that I’m wondering if anyone might speak to. Firstly, I’m worried about being able to get a job in the OR as a new grad. I know that OR residency programs exist, but I’m not sure how competitive they are (I live in a major metro area), and I will have an ADN, not a BSN, although I have a BA as well. I have requested OR placement for my senior practicum, so if I get it, hopefully that will improve my chances.

Another concern is whether or not it’s a good idea to start out in the OR. Although I would learn a ton of new things, part of me feels like it’s somewhat of a shame that I wouldn’t be putting to use so much of what I’ve learned in nursing school – doing H2T assessments, med passes, starting IVs, etc. If I started out in the OR and decided years later that I wanted to do a different type of nursing, I imagine I would be totally unequipped and would be as clueless as a new grad, even with years of OR experience (except for foleys and charting). I wonder if people who start out in the OR have difficulty changing specialties a few years into their career because hiring managers think their OR experience is too irrelevant. I also wonder if my lack of experience as a floor nurse would put me at a relative disadvantage in the OR compared to nurses who came into the OR with years of floor experience.

Finally, I wonder if I have the “right” personality for it. I have read numerous posts on this site saying you have to have a super strong personality and thick skin to work in the OR. I am not quite sure what to make of this. I understand that situations in the OR can be very intense, and that OR nurses are likely to get yelled at by surgeons from time to time. However, I kind of feel like you have to have a strong personality and thick skin to work as a nurse in any specialty. As I said, I am introvert. But I am NOT shy. I am an introvert in the sense that constantly meeting and interacting with new people burns me out quicker than my more extroverted peers, which is one reason why floor nursing appeals to me less. But I am not afraid to speak up and advocate for my patients, even if it means stepping on some toes. In general though, people perceive me as being a little more reserved and cool-headed; I am not someone who wears their emotions on their sleeve. I have been yelled at plenty by patients and it usually doesn’t bother me much. But that’s not the same thing as being yelled at by a doc or even another nurse, and that’s never actually happened to me in my short time as a nursing student and CNA. I think that I could probably get used to it over time.

Wow, I didn’t mean to write so much, but if anyone’s reading this, I would greatly appreciate some feedback/advice!  

[Rose_Queen, BSN, MSN, RN]

14 hours ago, kubelkabondy said:

Firstly, I’m worried about being able to get a job in the OR as a new grad. I know that OR residency programs exist, but I’m not sure how competitive they are (I live in a major metro area)

I'm in a middle-sized metro area not too far from a large metro area, and we are hurting for OR nurses. It's simply not a specialty nursing students get exposed to, so they tend not to consider it. Now, it would depend on the employer (I interviewed with one that required a year of med-surg before doing anything else... no thanks!), but there are many that are willing to consider new grads. I started in the OR as a new grad almost 16 years ago (as in, my 16 year anniversary is less than a week away) and while I've changed things up (day shift working mostly general surgery/night shift being jack of all trades/cardiac team/now professional development specifically for periop), I have never left the setting.

 

14 hours ago, kubelkabondy said:

I wonder if people who start out in the OR have difficulty changing specialties a few years into their career because hiring managers think their OR experience is too irrelevant.

I've worked with many who have gone on to other specialties: ICU, med-surg, ICU, labor and delivery, hospice, and others. It's not so much the experience but the support received in a new environment.

 

14 hours ago, kubelkabondy said:

I also wonder if my lack of experience as a floor nurse would put me at a relative disadvantage in the OR compared to nurses who came into the OR with years of floor experience.

Purely anecdotal here. Our new grads do better than nurses new to the OR with years of other experience. For those with experience outside of the OR, they have had difficulty coping with essentially being back at ground zero. The OR is a totally different world.

[kubelkabondy, ADN, RN]

4 hours ago, Rose_Queen said:

I'm in a middle-sized metro area not too far from a large metro area, and we are hurting for OR nurses. It's simply not a specialty nursing students get exposed to, so they tend not to consider it. Now, it would depend on the employer (I interviewed with one that required a year of med-surg before doing anything else... no thanks!), but there are many that are willing to consider new grads. I started in the OR as a new grad almost 16 years ago (as in, my 16 year anniversary is less than a week away) and while I've changed things up (day shift working mostly general surgery/night shift being jack of all trades/cardiac team/now professional development specifically for periop), I have never left the setting.

 

I've worked with many who have gone on to other specialties: ICU, med-surg, ICU, labor and delivery, hospice, and others. It's not so much the experience but the support received in a new environment.

 

Purely anecdotal here. Our new grads do better than nurses new to the OR with years of other experience. For those with experience outside of the OR, they have had difficulty coping with essentially being back at ground zero. The OR is a totally different world.

Thank you so much for sharing this information! This really puts me at ease about my decision to pursue the OR. 

[Jadebsn, BSN]

Wow! Congratulations on being so passionate about nursing! That is a great attitude and I applaud your willingness to reflect on the best path for you. I had a similar background and may have a few added insights for you(?)...

I went into nursing school with the express desire to be in the OR, but ended up getting some other experience while I waited for an OR residency to open. (This experience came through multiple temporary placements through medical temp agencies). Although I found the experience very valuable I also found that I was still dedicated to getting into the OR. If you are unsure about the OR, there are always these kind of short term opportunities to help you check in on your choice. 

I have seen many new grads (including me) get into OR residencies, and what I saw as a common thread was a senior placement in the OR. I myself did not have a choice at my school but made sure I joined AORN early, completed some of their modules, and stressed my passion during the job interview for the OR.  Any program takes 3-6 months to orient a new OR nurse so jobs are very careful who they invest their time in, if at all. If your candidate job does not have a residency, you may want to consider paying $$$ to get a certification from AORN or CCI (coming soon?) To show some readiness for the job if they do not offer training. Experience or an OR residency is essential, but certification (Peri-op 101) seems to be the preferred gold standard.

Those are just my 2 cents from seeing your questions...I am more than happy to chat with you via email or phone if you would like a friendly ear. My email is [email protected].  As mentioned, OR nurses are in high demand and I would like to encourage anyone like you who shows interest! Good luck and feel free to get in touch. ?

 

[RickyRescueRN, BSN, RN]

Both posters above make outstanding points . I Entered the OR just over 2 years ago after having worked in ICU then ED / Trauma and then for the last 18 years as a Flight RN on a helicopter.  And this is where I think your question regarding prior in patient experience benefits one or not. I hate to say it , but all my years of nursing really did not prepare me for the huge learning curve in the OR. I think new grads are great OR candidates as they are already in the learning mode; have no experience to compare things to; absorb everything and are in the novice phase ( Benner) vs me the experienced nurse /expert who had to become a learner again and novice again and accept that I was no longer confident or competent in what I was doing. That was a big change for me, but I embraced it and now two + years later I am settled in neurosurgery and able to scrub and circulate all the neurosurgical operations that we do at the large academic hospital where I work (8+ neurosurgical ORs).  

I think you would be able to change specialities down the line if you chose to do so without too much of a struggle . Most nursing specialities offer training programs nowadays for experienced nurses making the transition. 

Like RoseQueen stated, hospitals across the US (and indeed internationally) are becoming short on staff and the OR is particularly badly hit I think due to the fact that student nurses get little to no exposure to PeriOperative nursing during their schooling so typically don't choose it as a specialty. Many OR baby boomers are retiring as well. 

Do your research well ( sounds like you are already, watching Youtube videos etc) and definitely do a job shadow where you are exposed to all the roles of the OR RN , not just circulating. RoseQueen has some great posts and articles here for nurses interested in our specialty and they served a great resource to me when I was moving from the critical care specialties over to the the OR one. Best of luck to you in your future endeavors. 

[kubelkabondy, ADN, RN]

On 7/2/2021 at 10:42 AM, Jadebsn said:

Wow! Congratulations on being so passionate about nursing! That is a great attitude and I applaud your willingness to reflect on the best path for you. I had a similar background and may have a few added insights for you(?)...

I went into nursing school with the express desire to be in the OR, but ended up getting some other experience while I waited for an OR residency to open. (This experience came through multiple temporary placements through medical temp agencies). Although I found the experience very valuable I also found that I was still dedicated to getting into the OR. If you are unsure about the OR, there are always these kind of short term opportunities to help you check in on your choice. 

I have seen many new grads (including me) get into OR residencies, and what I saw as a common thread was a senior placement in the OR. I myself did not have a choice at my school but made sure I joined AORN early, completed some of their modules, and stressed my passion during the job interview for the OR.  Any program takes 3-6 months to orient a new OR nurse so jobs are very careful who they invest their time in, if at all. If your candidate job does not have a residency, you may want to consider paying $$$ to get a certification from AORN or CCI (coming soon?) To show some readiness for the job if they do not offer training. Experience or an OR residency is essential, but certification (Peri-op 101) seems to be the preferred gold standard.

Those are just my 2 cents from seeing your questions...I am more than happy to chat with you via email or phone if you would like a friendly ear. My email is [email protected].  As mentioned, OR nurses are in high demand and I would like to encourage anyone like you who shows interest! Good luck and feel free to get in touch. ?

 

Thanks so much for your encouraging post and for sharing about your experience! Since my initial post, I have had the opportunity to shadow in the OR at the hospital I'm currently working at and for me it cemented my goal of working there as a nurse. I absolutely loved it, it just felt like a good fit immediately, and I felt that could envision myself in that environment. Although of course at the same time I felt like a fish out of water because it's so different from the floor and they really teach us nothing about OR nursing in school. I saw an ORIF of a sternal fx and a lumbar laminectomy. The nurses all had great things to say about working there and encouraged me to pursue my interest in it. Even the surgeons asked me questions and were very interested in teaching me, which is so different from my experience on the floor where doctors rarely acknowledge my presence. I especially loved the teamwork aspect and the ability of the nurses to give 100% of their focus and attention to one patient at a time.

My major concern now is that I won't be able to get into an OR residency program because I will only have an ADN (I have a bachelors in another field). I live in a major metro area, and it seems that most of the big hospitals here, including the one I work for, either strongly prefer BSN-prepared nurses or flat out don't hire ADN nurses. Moving to a more rural area is not really going to be an option because of my partner's job.

But now that I have my sights set on the OR, the idea of working on a med-surg floor for a year while doing my BSN is really unappealing to me. I just don't feel like the floor is a good fit for me, and I also feel like the skills I'd gain there would for the most part not even be applicable to working in the OR. I just worry that I would be miserable and that it would be a waste of time. I have seen so many new grad nurses burn out on the floor, and many of them came into the profession with the desire to work there. 

I am glad that at least I will be doing my senior practicum in the OR next quarter. Hopefully I will be able to find a residency program in my area that is willing to give me a chance. I will definitely follow your advice about joining AORN as well and going through the modules.

Thanks for sharing your contact information as well - I will gladly take you up on that. I am the only person in my entire cohort of 30 students that is interested in the OR, and none of the nurses I know in my personal life work in or know anything about the OR, so it's been great to at least be able to connect with OR nurses online.

[kubelkabondy, ADN, RN]

On 7/3/2021 at 3:48 PM, RickyRescueRN said:

Both posters above make outstanding points . I Entered the OR just over 2 years ago after having worked in ICU then ED / Trauma and then for the last 18 years as a Flight RN on a helicopter.  And this is where I think your question regarding prior in patient experience benefits one or not. I hate to say it , but all my years of nursing really did not prepare me for the huge learning curve in the OR. I think new grads are great OR candidates as they are already in the learning mode; have no experience to compare things to; absorb everything and are in the novice phase ( Benner) vs me the experienced nurse /expert who had to become a learner again and novice again and accept that I was no longer confident or competent in what I was doing. That was a big change for me, but I embraced it and now two + years later I am settled in neurosurgery and able to scrub and circulate all the neurosurgical operations that we do at the large academic hospital where I work (8+ neurosurgical ORs).  

I think you would be able to change specialities down the line if you chose to do so without too much of a struggle . Most nursing specialities offer training programs nowadays for experienced nurses making the transition. 

Like RoseQueen stated, hospitals across the US (and indeed internationally) are becoming short on staff and the OR is particularly badly hit I think due to the fact that student nurses get little to no exposure to PeriOperative nursing during their schooling so typically don't choose it as a specialty. Many OR baby boomers are retiring as well. 

Do your research well ( sounds like you are already, watching Youtube videos etc) and definitely do a job shadow where you are exposed to all the roles of the OR RN , not just circulating. RoseQueen has some great posts and articles here for nurses interested in our specialty and they served a great resource to me when I was moving from the critical care specialties over to the the OR one. Best of luck to you in your future endeavors. 

Thanks so much for your reply. It's a relief to hear that floor nursing experience doesn't count for much in the OR, because I really don't want to work on the floor. A lot of people including some of my nursing school instructors have made it seem like it's a mistake not to start out in med-surg and that I'd be "pigeonholing" myself by starting out in such a niche area of nursing, but I feel like it would be a bigger mistake to take on a job that I'm not comfortable doing in a specialty that I have no passion for.

Based on the research I've done (most anecdotal), it seems like there is better retention among OR nurses and they are much less likely than other specialties to burn out and leave the profession. Given that, it's surprising to me that more nursing students aren't interested in the OR. I do think part of the reason why is just a lack of exposure to OR nursing and a lack of knowledge about it. Even my instructors in nursing school seem to know almost nothing about the different roles of the RN in the OR.

The one negative thing I have heard some OR nurses on this site mention is that surgeons can sometimes yell or even be verbally abusive towards the nurse when things are not going well. I wonder if this has been your experience? If so, I'm guessing this would be more the case with trauma surgeries where the outcomes are less predictable?

It wasn't at all my experience on the day that I shadowed. In fact, I was pleasantly surprised by the camaraderie I observed between the doctors and nurses in the OR. It felt much less hierarchical than the interactions between doctors and nurses on the floor.

[Rose_Queen, BSN, MSN, RN]

2 hours ago, kubelkabondy said:

My major concern now is that I won't be able to get into an OR residency program because I will only have an ADN (I have a bachelors in another field).

I can say that in my facility, a BSN is preferred and if not already held completed within 2 years. There are some units (ICU, ER) that get so many applicants they won’t consider anyone without a BSN. On the other side, you have units like the OR that so badly need staff they don’t care about the BSN being completed prior to hire. There is a lot of nearing retirement OR nurses, and because of the limited exposure during nursing school, few applicants. I would expect that of those that prefer a BSN but don’t require it, you’d have a pretty decent shot. Don’t be afraid to network before you graduate. Join AORN and attend the meetings. Get to know people already working in the OR. Sometimes it’s who you know over what you know that can help you land that first job. 

2 hours ago, kubelkabondy said:

The one negative thing I have heard some OR nurses on this site mention is that surgeons can sometimes yell or even be verbally abusive towards the nurse when things are not going well. I wonder if this has been your experience?

Surgeons, although some of them may think they’re God, are humans. They get frustrated. And sometimes they let that frustration out. Have I worked with surgeons who have let out some very colorful language? Absolutely. Have I worked with surgeons who have stomped their feet and had a mini tantrum? Yep. Have I worked with surgeons who have thrown instruments? That only happened once and he was sent to anger management by the hospital before he was allowed to schedule another case. 

The key is what are they angry at and who/what are they taking it out on? There’s a difference between anger/frustration at a situation and letting out some steam by creating some very colorful combinations of bad language and getting angry at a person and taking it out on them in a non-constructive manner (having a debrief at the end of a case of “hey, I really prefer ….” is totally different than “what the (expletive) is wrong with you? Didn’t you read my preference card?” in the middle of a case)

[Kendrer]

On 7/7/2021 at 2:07 AM, kubelkabondy said:

Thanks so much for your encouraging post and for sharing about your experience! Since my initial post, I have had the opportunity to shadow in the OR at the hospital I'm currently working at and for me it cemented my goal of working there as a nurse. I absolutely loved it, it just felt like a good fit immediately, and I felt that could envision myself in that environment. Although of course at the same time I felt like a fish out of water because it's so different from the floor and they really teach us nothing about OR nursing in school. I saw an ORIF of a sternal fx and a lumbar laminectomy. The nurses all had great things to say about working there and encouraged me to pursue my interest in it. Even the surgeons asked me questions and were very interested in teaching me, which is so different from my experience on the floor where doctors rarely acknowledge my presence. I especially loved the teamwork aspect and the ability of the nurses to give 100% of their focus and attention to one patient at a time.

I am so happy to see this post!  I am even further behind you, but I have always dreamed of being an OR nurse.  Although I am keeping my mind open as I go through my clinical rotations in nursing school, I really feel that the OR is where I want to be. My husband is an aortic aneurysm device rep, but he spends most of his time in the OR with the surgeons.  I love anatomy as well, and have a background in Athletic Training.  Please keep us updated as you continue on towards your goal!  I am just beginning nursing school, but am already trying to figure out when I can job shadow in the OR as I know my nursing school doesn't have any OR rotation assignments either.  

 

[kubelkabondy, ADN, RN]

17 hours ago, Kendrer said:

I am so happy to see this post!  I am even further behind you, but I have always dreamed of being an OR nurse.  Although I am keeping my mind open as I go through my clinical rotations in nursing school, I really feel that the OR is where I want to be. My husband is an aortic aneurysm device rep, but he spends most of his time in the OR with the surgeons.  I love anatomy as well, and have a background in Athletic Training.  Please keep us updated as you continue on towards your goal!  I am just beginning nursing school, but am already trying to figure out when I can job shadow in the OR as I know my nursing school doesn't have any OR rotation assignments either.  

There were a couple of device reps in the room when I shadowed also, and there was a lot of back and forth communication between them and the surgeons which was interesting to watch. Definitely recommend shadowing as soon as you can to get a feel for it! Don't know if you work as a CNA/PCT or have plans to while in nursing school, but if so, working in pre-op or PACU might be more valuable experience than working on a general med-surg floor. I think you have the right attitude of keeping an open mind while having a strong inclination towards perioperative nursing. I will try to post an update when I have one. Best of luck to you! 

[NeuroORRN]

Personally, I feel like a new grad would do better coming to the OR with experience.  It is one, tough environment.  Having some thicker skin from building experience with physicians outside of the OR will help.  That being said, I work with New grads in our hospital everyday. 

[kubelkabondy, ADN, RN]

On 8/20/2021 at 2:51 PM, NeuroORRN said:

Personally, I feel like a new grad would do better coming to the OR with experience.  It is one, tough environment.  Having some thicker skin from building experience with physicians outside of the OR will help.  That being said, I work with New grads in our hospital everyday. 

Thanks for your input! Would you say that the OR is a "tougher environment" than a med-surg floor, or just tough in a different way?