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

Specialties Operating Room

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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.

Specializes in Psychiatry, Community, Nurse Manager, hospice.
2 hours ago, brownbook said:

As a new grad I had absolutely no idea where I wanted to stay. Very few hospitals were hiring new grads. What would you have advised me to do?

I started out in med/surg and enjoyed it very much. I was asked to transfer to ICU after 5 years as I had floated there often. Almost every nursing job I’ve had I kind of fell into. There is no where I’d like to stay. I always enjoyed floating and working different areas of my hospital.

I would have advised you to do just what you did.

If you know what you want, go for it right out of school.

If you don't know what you want, then go somehwere that will help you find out. Med surg is a good starting experience then, and you may decide to stay.

Many people will find out they need to leave their first job after a year (or less) because it wasn't right for them and that's okay. We should not intentionally create that situation though. Go for what you think you want.

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32 minutes ago, murseman24 said:

Please explain to me how. Getting supplies and maybe starting another IV?

Exactly. Maybe even mixing a drip, or getting whatever your facility uses for infusing PRBC quickly, etc.

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Specializes in anesthesiology.
28 minutes ago, brownbook said:

Exactly. Maybe even mixing a drip, or getting whatever your facility uses for infusing PRBC quickly, etc.

Mixing a drip = "here, take this vial and put it in this bag, prime the tube and hand it to me please". My point is once again, nothing gained worth spending time on a med surg floor before going to the OR. Getting supplies and starting an IV is basically it.

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Wow. The replies on this thread shock me some. The overwhelming attitude of "that's anesthesia job" or "I just do this" or "I don't assess"...if we give up what sets us apart from our coworkers with different educational preparation, well, they're cheaper to employ. Regardless of the fact that anesthesia "typically" manages the patient medically, that doesn't absolve you of being a registered nurse. You still have a license, and that matters for a lot of reasons.

I came to the OR with stepdown/floor experience. I used assessment skills every single day I was assigned as an OR nurse - whether scrubbing or circulating. I may not have documented all of my assessment, but I was noting and assessing things. Furthermore, as an OR nurse, at the very LEAST you should be assessing and documenting a thorough skin assessment. This is particularly true for your "little old" lady or gentlemen and/or trauma/emergent transfer into facility patients. Not to mention positioning needs change completely based on patient status.

While I trusted many of the CRNAs I worked with, there were some CRNAs and many young anesthesia residents who I didn't quite trust. I have called for anesthesia "help" more than a few times, and don't regret it. I've had to be the primary monitor nurse many times for local anesthesia only cases - in which case I'm monitoring the patient (not a CRNA), I'm monitoring IV antibiotics/IV access, I'm documenting on vitals and patient response.

You better believe that while anesthesia gives what they give, I know what they give it for and why and/or when it may not be the right choice for a patient. I know all of the meds we give on the field and all of the same information about those. You basically have to know these things to adequately plan care for a patient who, for example, refuses blood products. MANY hemostatic agents should not be given as they are derived from human factors or blood components. I know about what the issues can be with airways and how to handle all of the problems we encounter with airways in my facility.

The number of times I've been in situations where we've called for "help" and the incoming anesthesiologist (generally not the assigned attending) comes in the room and asks certain nurses what is going on, what the story is. NOT their resident, the nurse. That may just be that we're better "known" than the newer/younger residents. The surgeons I work with do it too. Of the attendings I've worked with, I've NEVER had one of them fail to call me back immediately. I don't ask them to call me NOW unless it's a specific level of urgency.

As for my skills, knowledge and critical thinking ability - I am good for more than "here mix this for me." Certainly better then "go grab this". I certainly did do that and help where needed. My value is more complex than that. The surgeons and anesthesiologists who specifically ask for one of a few specific staff members (myself and a handful of others) to be in their most complex cases don't do it because we're good at playing fetch.

With that said, I do not necessarily believe that one has to be experienced to be a good OR nurse. It is different, but mostly because we don't learn much about pre intra or post procedural care in nursing school. Understanding patho, anatomy, management of a variety of issues, and having excellent assessment skills will serve you well. You can get it as an OR nurse, if you're taught to think through the situations but that stuff comes faster if you have floor, stepdown or ICU experience.

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Specializes in OR.

I had a nursing school instructor who told all of us that we needed two years on the floor before pursuing anything in the OR. As one previously commented, I was also miserable in my med/surg clinicals and started to doubt my nursing school decision. That was until I entered the OR for the first time and I knew without a doubt that was the only place in nursing I wanted to be. I entered a peri-op 101 program after graduation and have no regrets. Blood, guts, bone and tissue, burning flesh smells... no problem! Some nurses were born for the floor and they get mad props from me for that! I personally would have probably left nursing within my first year had I been forced to do floor nursing.

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Specializes in Perioperative nursing.
5 minutes ago, RuNs_4_her_life said:

I had a nursing school instructor who told all of us that we needed two years on the floor before pursuing anything in the OR. As one previously commented, I was also miserable in my med/surg clinicals and started to doubt my nursing school decision. That was until I entered the OR for the first time and I knew without a doubt that was the only place in nursing I wanted to be. I entered a peri-op 101 program after graduation and have no regrets. Blood, guts, bone and tissue, burning flesh smells... no problem! Some nurses were born for the floor and they get mad props from me for that! I personally would have probably left nursing within my first year had I been forced to do floor nursing.

This describes me perfectly! All throughout clinicals, I knew that I loved taking care of people and being a nurse was my dream, but bedside nursing was not for me, at least not in a high ratio med surg unit. I'm getting ready to start my second week of the periop 101 program and I am so excited to learn everything about my new career. I am also thankful that my location allows us to scrub as I think that will alleviate burnout and allow me to broaden my skillset.

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Specializes in Operating Room.

The year or two of med/surg is outdated thinking. The OR is a vastly different beast than the floor. Give me a new grad to train in there any day, because floor nurses are too set in their ways.

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Specializes in Operating Room, CNOR.

I disagree with requiring med/surg first; they are too different. I started immediately in the operating room. However, the place I started had an AORN periop 101 training program that lasted 6 months. That is what's most important, in my experience and opinion after 10 years as an OR circulator. I actually went back to med surg for a year, to get that "well rounded" experience. I would say it did NOT make me a better OR circulator. It just made me burn out and nearly loose my health and sanity while working med/surg. There is NO good reason to put someone through that in order to make them a good circulator. The skill set is so extremely different.

However, having new grads in the OR WITHOUT a solid periop 101 program for 6 months is a recipe for frustration and failure. I am of the opinion that this definitely should not be done without a designated training program in place. NOT just throwing them to preceptors.

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Specializes in O.R.

There is no program prior to for the new grads in my facilitiy so i disagree

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Specializes in Operating Room.

I think that anyone with a true desire to learn and passion for the OR can learn it and do it well! The OR is no place for a new grad who thinks they know it all. But I’m glad to take any newbie under my wing who genuinely wants to learn!

However, most of our best nurses had experience somewhere else before coming to the OR. Med Surg, ER, PCU, ICU, PACU, even a dermatology office. I think that it is really helpful to have your critical thinking and problem solving developed before coming over, just because when it hits the fan in the OR, it can REALLY hit the fan. I think that’s the kind of “back up” anesthesia really needs, that someone mentioned earlier. I throw in IVs every once in awhile but the true support comes in more pressing situations.


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Specializes in Corrections, Surgical.
On 1/19/2020 at 12:40 PM, Rose_Queen said:

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?

I hated med surg clinicals. Even the nurses that worked there hated it. The hospitals that I went to the med surg nurses always seemed to get the short end of the stick. I knew from the beginning of nursing school I wanted to be an O.R. nurse. I even got an interview for a position for the O.R as a new grad. This was in the beginning of COVID-19 when school was still open. Now that hospitals are not doing non essential surgeries I don't know where I stand in the hiring process. But I know that med surg wasn't for me. I would literally take ANYTHING else.

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I really think it depends on the training offered by the OR. I was recently hired into the OR as a new grad where there was very little structure to the orientation.

For example, no skills or didactic portion, one of the techs would simply show you a machine set-up once quickly before the patient was brought into the room. There wasn't a designated preceptor, a different preceptor each day. There was no continuity to the procedures during training, laparoscopic one day, ortho the next day etc. My logins weren't activated until I reminded my manager that I was never set-up, several weeks into my orientation. When I started in the OR rooms, 8 weeks into orientation, I still had not started Periop 101.

I resigned 12 weeks into my orientation, at that point I still hadn't started Periop 101.

My experience was negative, but it didn't have to be. If the hiring OR has the resources and has a structured plan for orientation of the new grad I think it could work.

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