New to the Operating Room

canesdukegirl, BSN, RN · Oct 12, 2010

I feel your pain. This happened to me as well. ORs are usually short staffed (the bigger university ones that I have seen anyway), and it hurts the new nurses who are trying to learn. There always seems to be an issue with hiring new nurses and getting the staffing up to par. If it isn't the budget, then it is staff out of FMLA, or there is a hiring freeze, or the NM doesn't really understand how bad it really is. Anyhoo...

I love the fact that you have worked in the SICU. That gives you an ENORMOUS leg up in your learning. You already know how to handle an emergency, who plays what role and what your contacts are. You know a bit how the OR runs, and when anesthesia takes over or when surgeons must take action. You already understand sterility and basic functions in the OR.

This is my advice to you: you have been there only 3 weeks. It is OVERWHELMING to learn the OR. Most nurses, even ones with experience in a small ambulatory OR have to adjust to working in a large OR. It is a different beast. There are many dynamics and many MANY people fighting for control. The reason I point this out is because part of the difficulty in working for a big OR is that you must take into account the various p***ing contests, recognize it for what it is, and let it roll. For most nurses, it takes about a year to really be comfortable in the OR. If you keep that in mind, you may not have so much fear when you are out on your own. Be gentle with yourself. This ain't easy stuff!

Now, as for your learning experience...you are doing the right thing by talking to your NM about your frustrations. It is your responsibility to convey those frustrations to your manager, but that's about all you can do. The ball is now in her court. I would not hold my breath about things getting easier. Now you must make things easier for yourself. It sounds kinda harsh (and believe me, it is not my intention to make you feel badly, but I know EXACTLY what you are going through, and I am trying to save you the frustration of expecting the environment to change, because chances are it will not) but if you really want to work in the OR, you have to be your own cheerleader now.

You are going through the Periop 101 course-that's a good start. When you get back to the OR, you are frustrated that your preceptor isn't really teaching you because of the staffing shortage, right? So you are relegated to just standing and watching because that's about all you can do with no direction, right? It makes you feel like you aren't learning or contributing, right? I GET IT. I have been there. Remember that you are learning, and it is sometimes painful to grow. You came from a unit in which you were likely a very strong nurse and had lots of autonomy. The shift in your responsibilities is probably difficult for you to adjust to since you are a "doer" and not a "just stand by and watch" kind of person. Recognize that you are back in the learning phase, and it can be tough to adjust to that alone.

When you find yourself in the position that you are just watching rather than doing, assert yourself. Pay close attention to your preceptor and those around her. Figure out the "feel" of the flow. The next time your preceptor is scrubbed in, pull a gown and gloves for yourself and scrub in with her! I seriously doubt she will stop you and you have nothing to lose. If you are in the circulating role and your preceptor is busy, ask what supplies you can pull for her. Pull suture and gloves for the next case. If you help her to gather supplies, you will then be benefiting her because she has help, and you will be benefiting yourself because you will then learn where everything is. Ask if you can interview the patient for the next case yourself and check the chart for consents, etc., when she is busy. She will see this as a welcome help, and will also sub-consciously view you as a "go getter" and will try harder to include you in teaching. It worked for me, but I had to assert myself to a large degree.

Don't be afraid to ask questions. If your preceptor is busy and it is obvious to you that she can't stop to answer your questions, ask the scrub person. They usually appreciate being included in training new nurses. Many scrubs have a wealth of knowledge.

Also know that you are in a unique position: you already know a lot of the trauma surgeons from working in the SICU. When you are in their OR, ASK QUESTIONS. They already have a comfort level with you and will be glad to help you. They are probably ecstatic that you are in the OR now and want to help you learn.

Be patient with yourself. There is so much to learn. If you are anything like me, you want to be shown something once and then get frustrated with yourself when you don't master it right away. It will take time to learn this stuff, and since you are likely going to be rotating through many services, as soon as you learn something, you are on to the next service and have to start all over! Don't feel as though you must KNOW all of this stuff cold. The staff certainly don't expect you to, the surgeons don't and your manager doesn't. We all had to learn this stuff, and we all know that it takes time. You will not be expected to run a room or to scrub a case without stumbling a bit when you get out on your own.

Carry a small notebook with you and write everything down. Break the notebook up into services. I have a notebook with each service tabbed and then smaller tabs for each procedure. Write down positioning, prepping, what drugs you need, which instruments you need, what special equipment and supplies you need. Write down the glove sizes for each surgeon in that service. It is tremendously helpful.

Hang in there! You can do this, but you gotta get over the frustration. Remember that you ARE PART OF THE TEAM. The OR is a wonderful place, and you learn soooo much. I am pulling for you!

Miniash · Oct 15, 2010

Thank you so much for your reply canesdukegirl! Its been a rough go... already got repremanded by my manager, by expressing my frustration to a fellow co-worker who is experiencing the same thing. Its really unfair... and I feel like im at a loss. The conflicts of personalities are a little much to bear, but I try to still be cheerful and helpful nonetheless. Im starting to miss the SICU and my autonomy/respect I had there from fellow surgeons (I am working for another healthcare system now.. so the docs are not familiar with who I am)... the new group of docs think im a lost soul or something. piff... i am going to give it another go for now... never been a quitter, but I do hope it gets a little easier!

Destiny12 · Oct 15, 2010

I am currently thinking about pursing the OR field, so I cannot provide any personal opinions but I will say this remain positive. Do not give up, if this is what you really want keep your head up. I really believe that nothing good comes easy. I wish you all the very best in your new and exciting career.

LuvScrubs2, BSN, RN · Oct 16, 2010

Yes Keep your chin up....... Good Luck

ORRocksRN · Oct 23, 2010

I am also experiencing the same frustration. I have lots of experience as a student in the OR, but am currently in orientation in my first job. my current preceptor doesnt seem to want to teach me anything. The other nurses and scrubs I encounter are more helpful than she is. I've never had a precepted experience where I had to ask all the questions, and force my way into the situation to learn it. She would do everything if I didnt, and would never talk to me. and its not like she's busy, she is doing puzzles during the case!! I have tried to tell her/ask her to guide me, SHOW me, but she either wants to do it herself or send me off to do it. Never guide me or mentor me, or watch me, and thats what i need, someone to talk me through it while I do it. I have been very communicative with her, and get nothing back. No communication, no feedback. I am frustrated and worried that I am going to end my orientation and still not know how to do anything. I have considered talking to the educator and asking if there is another preceptor available, but I don't want to complain either. I am entirely grateful for this job. I have 12 more days with her before I switch to a new preceptor. Should I just suck it up and try to get whatever i can from her, or should i stop wasting my valuable training time and ask if there's another person I could be assigned to?

daVinciNurse · Oct 23, 2010

Speak up and ask for another preceptor. If you don't look out for yourself, no one else will. And if you don't speak up, no one will know the struggles you are dealing with daily. Of course, you may ask for another preceptor only to find out no one else is available....but at least you will have your concerns heard--you may consider putting your request in writing so that it is documented. You wouldn't want it to come back to you in the end that "you never said anything" etc. Remember to state the facts and avoid judgmental statements, both in writing and in conversation with the educator. Not every preceptor/student match up is a good match. And there also comes a point where you learn everything you can from one person, but still have lots to learn--everyone teaches differently, just as everyone learns differently. As an RN who scrubs and circulates, a few years ago I was assigned to teach an LPN to scrub--an LPN who "no one else wanted to teach"--I spent the better part of 3 months scrubbing with her and it got to the point where she "hit a wall" so to speak and was still struggling with a few things-I could only teach her "my way" but we all know there is more than one way to accomplish the same result-- so then she moved on to another preceptor to fine tune her technique and has done VERY WELL since. So back to my point--not everyone can teach to each individual's style of learning...so speak up and get the most out of your orientation period. Good luck, please don't give up!!