New Grads with no patient care experience in the O.R

[Joanni61]

Recently in the O.R.where i work there has been discussion about new grads with no patient care experience working in this area. Many of my coworkers as well as I feel they need med surg experience at least 1 year. I know the new trend is they should . I personally and others feel they should first learn assessment skills ,learning to assess the full body starting I.Vs learning basic skills before venturing into this unit. I personally feel its putting the staff in an awkward position as well as the new grad.

[RNFANP, BSN, MSN, RN, NP]

Honestly, it really just depends on the person.

I came to the OR after spending a year or so in the Emergency Room. For the first 6 months, I felt like an absolute idiot and almost went back to the Emergency Room where I knew what I was doing and felt comfortable. The OR is such a different beast that I think even with floor experience, it is going to be a steep learning curve.

Also, where I work, a majority of our RNs have never been outside the OR. They were new grads to the OR or had come from different surgery centers with absolutely no floor/ICU/ER or other experience. They are terrific OR nurses and I would want them on my team any day of the week.

Then there was the case of a nurse who came from us from the floor and unfortunately the OR was just not a right fit for her, despite her experience.

All in all, do I think people should have more than just OR experience to make them well rounded - absolutely! I encourage any students that come through to go through the ER right out of school - you learn all your skills, critical thinking, and time management (I personally could never work the floor, it would kill me ?). But! I do think that new grads can be properly trained right off the bat in the OR if there is a support system in place to help them grow and thrive.

[Rose_Queen, BSN, MSN, RN]

I went into the OR as a new grad. I actually turned down a hospital that required all new grads to start in med/surg. I was absolutely miserable in med/surg clinicals and probably would have burned out and left nursing if I'd been required to work there. Just like some aren't cut out for the OR, some aren't cut out for the floor, and why should that count against them? Personally, my unit prefers new grads to floor nurses changing specialties- the new grads come expecting to have to learn a lot while the floor nurses get so discouraged at basically being a beginner. We've lost so many experienced floor nurses from the OR because they couldn't cope with starting over. Besides, if a nurse knows that floor nursing isn't for them and has the opportunity to get right into the specialty they want, why shouldn't they?

[brownbook]

I'm not an OR nurse. I worked many years pre-op and PACU, I occasionally did moderate sedation in the OR, and I guess you could call it circulating in GI.

I did start out in med/surg and generally encourage, but don't insist, new grads start there.

I'm confused by your post. Where you work the OR nurse does a full body patient assessment and starts IV's?

[Ruzan]

I will approach this in an obviously biased reply. I just graduated in December and took my NCLEX last week and passed. Today was my first day of a 6-month AORN Periop 101 nurse Residency program at my local hospital. Nursing is a second career for me, I left my career as a computer programmer to chase something that I am passionate about. I entered nursing school with the goal of becoming a circulating and scrub nurse. I get where you're coming from that nurses probably should have a year of bedside nursing, but I am thankful that my local hospital does not require it. My interests in nursing start and stop in the operating room.

These first couple of weeks are kind of cool though, they have me following a patient through pre-op, in the OR, and through pacu. I believe this will help me see the whole picture of patient care in the perioperative area.

[murseman24, MSN, CRNA]

On 1/18/2020 at 2:39 PM, Joanni61 said:

I personally and others feel they should first learn assessment skills ,learning to assess the full body starting I.Vs learning basic skills before venturing into this unit.

You do assessments and start IVs as a circulator?

[OUxPhys, BSN, RN]

The "needs 1 year of med/surg" is a myth. In my personal opinion this stems from old school nurses who push this because back in their day no one started in the ICU or OR as a new grad. Times have changed. Not everyone can start in an ICU as a new grad but if they can then why not? I feel like new grads in the OR are great because like one poster said they come in with no experience and are willing to learn whereas experienced nurses are starting from square one.

A lot of major medical centers have OR programs tailored for new grads. I have never worked OR but from what I understand most IV's are started by anesthesia anyways (if I am mistaken by that please let me know).

[Rose_Queen, BSN, MSN, RN]

2 minutes ago, OUxPhys said:

what I understand most IV's are started by anesthesia anyways (if I am mistaken by that please let me know).

My facility’s preop nurses are responsible for starting IVs. The only exception is children, who are gassed down and then anesthesia starts the IV once they’re out.

[brownbook]

All, a total of 2, surgery centers I've worked in pre-op nurses start the IV. The few times I've gotten IV sedation a nurse started my IV.

I've heard rumors of facilities where anesthesia starts the IV.

We even start them on children after careful evaluation of the child's demeanor. Anesthesia will do it after their gassed if there's the slightest issue.

Many children handle it very well, with Emla and or lidocaine sub q.

[RNFANP, BSN, MSN, RN, NP]

Our CRNAs usually start the first IVs of the morning and then from then on it's the Pre-Op nurses. Most of our OR nurses don't start IVs but I've thrown in quite a few in the back as a Circulator (during emergencies/to help out if the CRNA is busy) just to keep my skills.

As for full body assessments, I don't do a comprehensive exam but mostly looking at different IV sites, tubes, and most importantly any skin issues. We have to document if there is any skin issues, just as a way to cover that those issues were present before surgery and could not be claimed as injury from surgery, positioning, etc.

[Joanni61]

Thank you for responding. In our facility pre op nurses do start IVs and the O.R nurses do start IV on children CRNAS, which we have 2 only start them if all else fails, and intra op IVs do blow and sometimes if we run into issues with unexpected problems may occur i think experience does matter. IVs are not the only thing that to me is important. Experience in problems that can arise in an intense situation i feel is . Thank you for your responses

[brownbook]

It would be hard to disagree that when issues with unexpected problems arise in an OR you'd want a nurse who has some experience.

Of course that is true in any area of the hospital. A serious issue with unexpected problems that arise on med/surg, you'd want the same.

New grads have to start somewhere. Reminds me of the "joke" about don't go to a hospital in early July if you can help it. That is when new residents their residency.

Ideally all these areas have good, quick, experienced back up and a nurse knows when to call for it. I know that can be a more complicated issue in an OR when almost all your co-workers are tied up in their own rooms and can't easily leave. You are kind of isolated.