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Discussion

New nurse!

Hello all,

I recently graduated from Nursing school, an got a job offer to start in the OR next week!! I'm super excited, but also very nervous. I don't really know what to expect, an I want to feel a little more prepared. Any advice? I love to hear from new grads an also the more experienced nurses! Thanks in advance :)

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    • Admin

    I've been in the OR for 10 years, although I've switched specialty teams a few times during that career. Things that I found helpful:

    1. Knowing what cases I would be on for the following day. This allowed me to get copies of the preference cards so that I could look them over at home (yep, that's right, at home- homework doesn't end with graduation).

    2. Breaking the learning into chunks. This day, focusing on setting up the room. That day, focusing on prepping and positioning. Some other day, focusing on documentation. Much easier to absorb and retain when not getting so overwhelmed by trying to do everything.

    3. Keeping a small notebook handy to write down useful/important information. My notebook for my current position (that I have so well memorized that I don't actually carry it around with me anymore) has a list of important phone numbers such as blood bank, PACU, service line coordinators, charge anesthesiologist, and so on. It also has a cheat sheet for how to order blood products and intraop lab tests (a necessity when changing from paper to EMR). And then there is a section for each surgeon I work with where I can write down little idiosyncrasies: preferred radio stations and things like that that wouldn't appear on the preference cards.

    4. Understanding that OR nursing is a whole other ball game- school has very little exposure (typically a single observation day) and it's extremely different than working on a med surg floor or any other type of unit. There's a common saying that it takes a year to begin to feel comfortable working in the OR. Don't expect yourself to get everything right off the bat- it's going to take time and there is a steep learning curve.

    5. Along with #4, understand that there are going to be good days and bad days. The bad days might be those where your patient doesn't make it off the table or those where just when it felt everything was clicking, it all feels like your first day again. Even us experienced nurses have those kinds of day: new equipment is purchased, new procedures are developed, and we have to learn from point zero how use/do everything.

    6. There are a lot of instruments and suture used in surgery. You may want to look into some books, websites, or apps that have images of instruments, what they are used for, and any alternative names. It can be confusing when someone asks you for a kocher clamp when everyone else calls it an oschner. (Yep, 2 names for the same instrument- and that doesn't include surgeon pet names.)

    7. Understand that when someone goes off, it's almost always at the situation and not directed at a single person. Surgery is routine to us, but it can still go real bad real quick. It's not uncommon to see a surgeon suddenly start using some impolite language (we have a few that could make a sailor/truck driver blush). Now, throwing instruments and directing personal tirades at staff is not okay, and a good management team will support their staff and ensure corrective action.

  • Quote
    • Author

    thank you so much Rose! that really helped me understand more about OR nursing. I will look up some material, I want to be prepared before I start. They told me I would be learning scrub nurse and also circulating nurse. What are the differences between those two? Also, they said after 4 months of my orientation that I will be placed on-call. Is that when they have emergency surgeries?

    thanks again!!

  • Quote
    • Admin

    Circulating nurses are outside of the sterile field and do primarily non-sterile duties. This would involve being the patient advocate, getting the room ready, assisting anesthesia as needed, placing urinary catheters, positioning, prepping, dispensing medications to the sterile field, writing down counts, documenting, and so on. This is a very simplistic explanation.

    The scrub person (does not necessarily have to be a nurse- many facilities utilize surgical technologists) is responsible for setting up and maintaining the sterile field, draping the patient, handing instruments or other sterile items to the surgeon, counting, and pretty much anything else at the sterile field. Some facilities that do not utilize medical students, residents, PAs, NPs, RNFAs, or CFAs in the assistant role may utilize other scrub personnel in a restricted assistant role. For example, at my facility, a PA, NP, RNFA, or CFA may assist the surgeon by using the cautery, suturing, and a few other things. Scrub nurses or surgical techs are restricted to holding retractors, cutting suture that the surgeon has used, and suctioning. This will vary by facility and is only how it is at mine. Again, this is a simplistic explanation.

    You may want to check out this article about OR nurses: https://allnurses.com/operating-room-nursing/what-do-operating-426443.html

  • Quote
    • Author

    Oh okay that's a great explanation thank you!! I believe that OR will be my niche. Thank you for your responses they were helpful. I want to be the best I can be. And learn as much as I can, an just be a competent an great nurse. So I will prepare, thank you again!!

  • Quote
    I've been in the OR for 10 years, although I've switched specialty teams a few times during that career. Things that I found helpful:

    1. Knowing what cases I would be on for the following day. This allowed me to get copies of the preference cards so that I could look them over at home (yep, that's right, at home- homework doesn't end with graduation).

    2. Breaking the learning into chunks. This day, focusing on setting up the room. That day, focusing on prepping and positioning. Some other day, focusing on documentation. Much easier to absorb and retain when not getting so overwhelmed by trying to do everything.

    3. Keeping a small notebook handy to write down useful/important information. My notebook for my current position (that I have so well memorized that I don't actually carry it around with me anymore) has a list of important phone numbers such as blood bank, PACU, service line coordinators, charge anesthesiologist, and so on. It also has a cheat sheet for how to order blood products and intraop lab tests (a necessity when changing from paper to EMR). And then there is a section for each surgeon I work with where I can write down little idiosyncrasies: preferred radio stations and things like that that wouldn't appear on the preference cards.

    4. Understanding that OR nursing is a whole other ball game- school has very little exposure (typically a single observation day) and it's extremely different than working on a med surg floor or any other type of unit. There's a common saying that it takes a year to begin to feel comfortable working in the OR. Don't expect yourself to get everything right off the bat- it's going to take time and there is a steep learning curve.

    5. Along with #4, understand that there are going to be good days and bad days. The bad days might be those where your patient doesn't make it off the table or those where just when it felt everything was clicking, it all feels like your first day again. Even us experienced nurses have those kinds of day: new equipment is purchased, new procedures are developed, and we have to learn from point zero how use/do everything.

    6. There are a lot of instruments and suture used in surgery. You may want to look into some books, websites, or apps that have images of instruments, what they are used for, and any alternative names. It can be confusing when someone asks you for a kocher clamp when everyone else calls it an oschner. (Yep, 2 names for the same instrument- and that doesn't include surgeon pet names.)

    7. Understand that when someone goes off, it's almost always at the situation and not directed at a single person. Surgery is routine to us, but it can still go real bad real quick. It's not uncommon to see a surgeon suddenly start using some impolite language (we have a few that could make a sailor/truck driver blush). Now, throwing instruments and directing personal tirades at staff is not okay, and a good management team will support their staff and ensure corrective action.

    Well said... that was a very nice explanation of the O.R. world.

  • Quote

    Welcome to the OR ! It is the most exciting place to work that I have found in 41 years of nursing! Rose has given you some great advice! I would also recommend that you check out AORN , I have found it to be a great networking opportunity and a great resource as well! AORN.org . Also be patient with yourself, truly it takes a while to get comfortable. But one day it just "clicks" and you feel like you are "at home" and would not want to leave this specialty! Good luck!

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    • Author

    Hello Nurse Sasha!! Thank you so much!! I will check it out :) an thanks for the goodluck, I'm super excited to join the world of OR nurses :)

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