New OR nurse feeling lost

mercys · Jul 22, 2010

Sadly there can be jealousy toward a new nurse,when she is attractive,hardworking and even helpful. Why,who knows. I would think you would be able to let the Manager know when YOU are comfortable circulating. Our new evening charge took 1 year to be ready. Try to hang in,hope for new hires. Personally I am thrilled to have a new nurse to help me with my work. Each person hired is less call for everyone whoohoo.Give it more time,I am sure things will get better.

Argo · Jul 22, 2010

It is fairly normal. The OR is a fairly tight nit group of people, more like a tight disfunctional family, especially with the size staff you have. They will come around and warm up to you, they are just feeling you out right now. You see alot of people come and go in OR work and ones that stick end up fitting in. I would say typically about 3 months and you start to mend with the group. You will be suprised how all of your experiences will tie together in the end, again probably 9 months to a year....

I am sure you will be good. Keep soaking up all the info and go with the flow of things. If you ever feel like you are doing something that could endanger the patient or yourself then let someone know you need some help. I will let people go on their own but I expect them to ask questions when they need to know something. I am always happy to teach and so is the vast majority of my staff. If one person is ****** then just go on to the next one. My OR is also 20-30s range. We have two nurses in their 40s.

canesdukegirl, BSN, RN · Jul 23, 2010

Unfortunately, this happens pretty regularly in any OR you may go to. I have worked in many different disciplines, and the OR was the hardest to mesh with. It is encouraging that you are a confident person, because you do need thick skin to get through your first year. When I was reading your story, it sounded EXACTLY like my first orientation into the OR. Very convoluted, expectations not drawn out and clear to you (it sucks working in a managerial vacuum) and no one seems to want to help you. The only reason they are taking this stance with you is because it was done to them; just keep that in your back pocket when you are learning and have to stave off the proverbial blows.

I will give you a few pointers to be able to adjust and perform well in the OR. I hope they help some.

1. Get there early. Like at 0630. This way, you have enough time to gather your thoughts and mentally prepare for the day. Get your room in order according to the first case posted in your room. Make sure the bovie and the suction are together if you can at all help it-this makes it so much easier when the surgeon throws them off. Make sure that you have a safety belt on the bed, and that you have positioning equipment in the room. Make sure you have prep solutions readily available, along with a clipper and some 1" tape. Have your bovie pad out and ready to put on the patient as soon as they are intubated. I usually take my pad out and loop it over the railing of the bed closest to the bovie machine. Get your drugs in the room before the patient comes back. Read your pref card. Make sure you have your back table pack on the back table, your ring stand closeby, and a couple of prep stands as well. Pop all of your canisters first, then take off the lids with the furthest one from you to be opened first so you don't reach over the other ones. Have gloves, suture, draping stuff on the mayo stand ready to be opened. You should have all of this done before the tech even comes into the room. It will give you credibility that you DO have your stuff in a pile, and they will respect you for being prepared.

2. When you are greeting your patient in the holding area, make sure that you are smiling and welcoming-they have been through so much to be prepared for this day, and it will make them feel secure that you recognize that. Greet the family as well, as they are likely even more scared than the patient. Do all of your checks-armband, consent, anesthesia consent, check lab values, allergies, and PMH. If you question something, make sure you ask the surgeon and the anesthesia care provider. They will never think it is a bother, but will be grateful that you are looking out for the patient. Tell the patient that the OR is sort of like a kitchen-loud! Also tell them that it will be cold, but that you will have some warm blankets for them when they get on the table. If they know this beforehand, they won't be so shocked when they are wheeled in. Don't forget-the greatest human fear is the unexpected.

3. When the patient rolls in, don't forget that they are TERRIFIED. Ask for quiet, and if you feel timid about this, simply comment to your anesthesia provider, "Wow, it's kinda loud in here." They will take the hint and ask for quiet. No matter what happens, YOU DO NOT MOVE FROM THE BEDSIDE DURING INTUBATION. This and extubation are the most dangerous times of the surgery. There are so many nurses that I see who are going about their duties, counting, pulling supplies, etc and are not paying attention to this important phase of surgery. When the patient has been successfully intubated, go ahead and put your bovie pad on, and loop the cord around the top or the end of the bed (depending on where your machine is) so that the surgical staff do not have to step over it. Double check that the pt has a safety strap on...sometimes the surgeons will take this off and not tell you...big no no. You are now free to count, pour your fluids, get the prep ready and position the patient.

4. Don't feel bad about being assertive in doing the time out. One time I had a very arrogant surgeon that thought the time out was bull, so I stated that my patient (that was prepped and draped for an ORIF of the femur) was having a TAH, and he said, "yeah, I agree...knife!" All of the surgical staff stopped and stared at him like he was the biggest a$# in the world. He never did that again. Don't back down from a surgeon-you are the patient advocate. After your patient is prepped and draped, stand by the bovie and suction to be ready to plug in. After the surgery is underway, keep standing by to make sure everything is going according to plan. Only then can you turn your attention to charting.

It may be helpful to you to make a small notebook of surgeon preferences. Do this daily so that you don't rely on memory...it is overwhelming to be in the OR. Also, write down frequently called numbers and tape them to the back of your badge.

As far as dealing with nasty attitudes...it is the reality of the OR, I am sad to say. I dealt with exactly the same thing that you are going through now. It is tough, and I thought multiple times that I chose the wrong line of nursing. But consider this: you are impacting a patient and their family in such a profound way. Surgery scares the bejesus out of everyone. You have been blessed with the knowledge and the skills to make this patient have a good outcome. You are the one that the family is waiting to hear from, you are the one that can calm the patient prior to surgery, and you are the one who is the patient advocate. You have so much influence at a very scary time in someone's life. You make a difference, and you will do well in the OR if you remember that the PATIENT is the focus. Continue to do what you are doing...it takes a while for the OR team to accept new members. With your confidence and your perseverance, you will be accepted, no doubt. It takes about a year to be comfortable in the OR. You probably feel like Rainman in the OR right now, but trust me, it will pass. You will get into a groove and people will come to respect you. Ask questions. Read up on the surgeries the night before. If you garner yourself with knowledge, you can't go wrong.

Good luck to you! I am pulling for you.

BethCNOR, BSN, RN · Jul 24, 2010

Ah, another example of the OR eating their young! I don't know why this happens, but it does. I try really hard not to do it, but have to admit, I have been guilty of it. It takes a long time to learn the OR and to feel comfortable. I tell all the newbies I orient that it will probably take a year.

I agree with what canesdukegirl told you (even though I don't prefer her college selections. lol). Keeping a pocket notebook is a great idea. Nobody can remember everything. I've been doing this for 28 yrs and I still need notes. You will remember more and more as your experience grows.

Just keep doing what you are doing and the staff will come around. For whatever reason, OR people make you prove your worthiness. Just remember that your patient is your #1 priority.

Hang in there and good luck.

canesdukegirl, BSN, RN · Jul 24, 2010

Beth, I totally knew that was you! Hi Mama!

lepetitoiseauRN · Jul 25, 2010

Thank you all for the wonderful replies. I only wish I had nurses like you at my hospital. :)

I took the past couple of days at work to try and have a better perspective despite how much things have been bringing me down. It ended up being better because on Thursday I was paired with a nurse who is actually one of the only somewhat nice people in my OR and on Friday, my manager finally admitted that she's had practically no time to spend with me and actually went over a few things with me that I'd been needing some information on. I also had a nurse from our larger sister hospital over because we were short-staffed and she really seemed to enjoy teaching, which was so refreshingly helpful. Next week promises to be really crazy so we'll see what happens.

I know that this is the specialty I want to be in and I will get through these next few months regardless, but it's just been so frustrating, particularly gritting my teeth through the more difficult people, especially when my first instinct is to give them hell in return. On the off chance that things don't improve, I'll be contacting our main hospital to see if there's a possibility of my coming on to one of their teams. But, that's my just in case. I'm not bailing on this OR mentally or physically yet. I believe in my ability and I'm going to push through this.

Again, thank you all so much for the encouraging words and tips. Special shoutout to canesdukegirl (ahem, even though I, like BethCNOR have different colleges I root for!) - I will be printing this out and putting it into my notebook (I do carry one). I'm very routine-oriented and used to establishing a routine checklist in my head of how to do my work. Everyone does things so differently and in such a scattered manner that it's been hard for me to lock it down, much less get into a groove. This is exactly what I needed!

BethCNOR, BSN, RN · Jul 25, 2010

You need to establish your "own groove". There are things that you do for every single surgery, no matter the specialty. Getting a routine will help you feel a little more organized. Just remember to go with the flow when somebody interrupts your pattern.

mamamiah · May 25, 2011

canesdukegirl, that was a great post, i am a new circulator and found this extremely helpful. I still have to develop my little groove within the OR. I always feel overwhelmed especially when anesthesia wants to roll back with the patient quickly. I still take the time to check the chart and question the patient. it makes for a very stressful time.

ChristineAdrianaRN, BSN, RN · May 25, 2011

As a lurking floor nurse with hopes of moving to the OR one day, this was a really great post. Thank you to everyone for your helpful replies to the OP, as I'm sure this is something most new OR nurses go through.

Also, re: the timeout...we had a surgeon recently (not at our hospital, at another area hospital, but he's staffed with us too) that took out the wrong kidney. :eek: He's got quite the reputation for being an arrogant jerk, too. I bet he had the same attitude about the timeout, and the rest of the staff sadly did not advocate for that patient.

flipflopsRN · May 31, 2011

I just started a job in the OR, fresh out of nursing school. Yeah I know you should have a year of med-surg...but it was the OR that offered me a job despite all my applications to different floors.

I had the same feelings...still do sometimes. I'm finishing up periop101 and while it's not particularly helpful for day to day functioning, I'm doing my best to read all the stuff so I can at least be confident that I know the right way to do things in the OR, even if it's not the most preferred or efficient way.

I too was amazed at the big egos. I found my rotations in other departments like holding, PACU, SPD, and even one day to scrub in, very helpful in seeing others' point of view. Everyone in the OR should have to spend a day doing someone else's job. It's very enlightening. I think circulators get picked on alot b/c everyone else is scrubbed in and standing their with their arms folded not doing anything, and its easy to forget that the circulator is only one person with only 2 legs and 2 arms and can only do or get one thing at a time.

I'm still only a few months in and I have days where I think I picked the wrong specialty..but I'll put in my 2 years and see what happens.