New to OR - is misery, frustration, and anger typical?

[msancheeze, BSN]

After working on the floor, I started an OR nurse residency in February and have become more and more discontent with my job. I understand that the gnawing, raw anxiety and sense of discomfort/doom is normal and will pass in about 1.5 - 2 years, but I fear I will implode, or perhaps spontaneously combust, before I reach that point. Is it the facility or maybe nursing is not for me? Please allow me to list a few of my frustrations:

1. No leadership. The department has been without a manager for over a year.

2. Absent clinical coordinators. We needed a rep for a case and had no idea, the patient was already on the table with no ENT coordinator in sight. I thought the surgeons were going to explode! How am I supposed to know this - I'm brand spanking new!

3. Incomplete, outdated or missing maps/prefernece cards. At this point, I'm only as good as the guidance of the scrub and the map infront of me. Essential equipment, medications, suture, etc are not listed or pulled. On a good case, I actually know what the surgeon is asking for. On a typical case the essential item is located in an offsite building and the needed med is not carried in house. Again, if this crap was listed or if someone would tell me I need it when I ask "Is there anything extra we need for the next case?" I would have it ready and waiting. The absent clinical coordinators are responsible for updating maps, go figure.

4. Lack of communication.

5. Poor adherance to policies and procedure.

I have voiced my concern over my frustrations to the director of periop services because I think it boils down to a big heaping patient safety issue and I feel that I'm not enabled to do my job safely or efficiently. I know others have voiced thier concern as well. Did I mention we have lost 30 nurses within that last year and an additional five within the past 6 months? I would really, REALLY like to leave but I feel trapped by my lack of experience (what OR would hire me?) and a two year work contract. I can stick it out as long as I can for the sake of experience, but at what cost - my sanity, my happiness and my license? Any advice is greatly appreciated.

[#1rnstudent]

Sounds like you work at my hospital. The only thing that keeps me going is the thought to "Keep Calm & Carry On". I hope things improve for you. Sometimes docs are nasty like that to new people just because they can be.

[ORNurse1]

It sounds bad. I had a similar experience so I keep a index card book and for each case and surgeon I made my own preference cards with hints and drs preferences including nusic they like it helps in the long run and something you can pass on to newer nurses.

[Argo]

Like ornurse1 said. Make your own preference cards and hold on to them. Take your time and ask questions to the surgeons to note on Your card. After That you should never have to ask again. Stick it out for 1-2 years and move on. Most places are like this one, very few have their stuff together for a perfect experience to happen. With time under your belt you will become very comfortable and never need a preference card again. I still have my personal cards in my locker even though u haven't used them in 2 years.

[mondragon]

I understand your dilemma.I am a new RN grad. and I had to make a decision between my job and my license. Well,I left the job. We are required to do IV sedation for EGD cases,which are done on the floor,in the patient's room. My dilemma was my nurse supervisor put me on call,which means you have to do EGD cases when on call,well I was not ACLS. By law you have to be ACLS certified to do IV sedation.So the first case I was called in for I asked the weekend nurse supervisor to remain with me.As soon as Monday came I went to the educator and told her I need to get in the ACLS class,and she got me in within 3 days. Ok,now I am ACLS, but I had no orientation to the EGD's.I did not know what the policies were,what paperwork needed to be charted on,what the policy was for monitoring the patient after IV sedation.During this whole process,I went to the nurse manager,RN charge nurse and educator several times and told them I need a RN preceptor.When I did not get any results,I put my concerns in writing,and gave all 3 a copy.Then I had a meeting with the 3 of them.So all this time I am still being assigned call,being made responsible for IV sedation cases.A month later I went to the Administrator about this,in the end I was told I should not have gone over the nurse managers head,that I should have gone back to her,regardless that I followed the chain of command.In the end I cleaned out my locker and turned in my badge.I would rather have my license and no job,than to have neither.Your situation may not be as bad as mine. Others have given you good advice,buy a small spiral index book and take notes,you will only need to wing the case the first time,take notes,and the second time you will know the case.However,never ever do any thing that would risk your license.When in doubt about hospital policy,follow AORN recommendations.

[canesdukegirl, BSN, RN]

Wow-it sounds like you are working in a managerial vacuum. With no support and no guidelines, how can you possibly feel good about work? My first OR job sounds quite like what you describe, and after staying there for 3 months with no supervisor (the position was supposedly being filled, but I heard a year later that it never was), a very nasty and self-righteous preceptor (who actually sabatoged me one day to see if I would fall on my face), and incomplete pref cards, I talked to some friends who worked in other ORs to see if they faced the same problem. Most of them said that the issues I was dealing with were extreme, and more importantly, unsafe practice. So I got the hell out of there with my self-esteem a bit bruised, but my nursing license intact! I was immediately hired on at another hospital, so don't think that just because you don't have enough OR experience that you will not be hired. Most managers that you interview with will understand your dilemma and gladly take you on-you seem like an intelligent individual.

Look to see if other hospitals are hiring and start applying! It can never hurt to apply, and you may feel a huge sense of relief just because you are opening doors. Good luck!