New OR Nurse Here

Ms.GoodGirl · Apr 27, 2012

Congrats on the job! I too precepted in the OR in nursing school & will be working soon as an OR nurse! I read everyone's comments & they're all very helpful, especially about being an active listener. I remember in my preceptorship, I told my preceptor he had crazy hearing skills because he could hear everything & because of it, was always a step ahead of the team. I would love to hear more OR nurses' advice & any helpful hints on survival!

lidleanjel · Apr 28, 2012

how is orientation going? my is going pretty well. It has been pretty crazy. I am at a smaller hospital we have 7 operating rooms and they dont realy have a training program for orientation.

I am just curious more on your facility's training program. What have they done/shown you from day to day? are you in a smaller hospital or a very large hospital?

NP Sam · Apr 28, 2012

how is orientation going? my is going pretty well. It has been pretty crazy. I am at a smaller hospital we have 7 operating rooms and they dont realy have a training program for orientation.
I am just curious more on your facility's training program. What have they done/shown you from day to day? are you in a smaller hospital or a very large hospital?

My hospital has 10 ORs. I have the tough task of keeping up with both my OR orientation and my nurse residency program, both lasting a year. I scrub pretty much every day unless I am specifically asked to help the circulators. I spend a month in each service so right now I am doing general, but get to scrub ortho also. I got a little taste of plastic surgery also.

Experienced my first code yesterday too and was in charge of documenting so you NEVER know how your day will pan out. I have a scrub person I scrub with who LOVES to teach and a nurse mentor who I scrub and circulate. Actually they are all mentors because they all love to teach. However, there are some cases where I am paired with random people. So far I can scrub a Broviac, hernia, and port removal by myself. Did my first open appy by myself and kept passing Adsons instead of thumb forceps. All I could say was "Sorry about that Doctor."What is yours like? Sorry so long but I like this new thread with all of us because it's current and I want to hear other stories and vents too!

canesdukegirl, BSN, RN · Apr 29, 2012

Congratulations to you! I hope that you will enjoy OR nursing as much as I do. I truly cannot imagine doing anything else.

A few tips:

1. Have some breakfast. If you have a high protein breakfast to start your day, then you won't be hungry like a third grader come 1100. I boil some eggs the night before and put them in a ziploc bag so all I have to do is grab the bag and chow down on my drive to work. When you are hungry, it's hard to concentrate on much else. Keep a jar of peanut butter in your locker so you can have a spoonful between cases if you need a boost. You'd be surprised at how well peanut butter can stave off hunger.

2. Keep a small notebook (a little bigger than your palm) and divide your notebook with stick on dividers designating each service you will rotate through. Further break down the dividers by surgeon. You can list the surgeon's glove size, pager and preferences. For each procedure, list the instruments, positioning, soft goods and suture needed. This takes dedication to do, but will become your "brain"; your own personal resource. I can't stress enough how much easier your day will be if you are well prepared. Get to work early to enable yourself to review and get centered for your day.

3. If you know what your assignment will be the next day, take the time to look up each pt's hx the night before. You should know basics but also know the latest lab values. There have been countless times that I have caught either a very high K+ or a high INR and brought this to the surgeon's attention at the beginning of the day. Sometimes the schedule can be shuffled in order to administer meds to bring the pt back to baseline prior to the procedure. Nothing makes a surgeon more irritable than having their schedule delayed, so if you can circumvent issues like that, you will be helping both the patient AND the surgeon.

4. Understand that it's a regular work day for you, but a lifechanging day for your pt. Anything you can do to let your pt know that you understand this very basic premise will allay some of their fears. Always know how to get in touch with the family if they are waiting while your pt is in surgery.

5. When your pt rolls into the OR, immediately tend to them. They don't care if your top priority is getting the ever elusive specialty instrument for the surgeon (who is ranting at the scrub sink about never having instruments). Their biggest fear is not waking up after anesthesia. Stay with them during induction and assist the anesthesia care provider with intubation. Then you can address other issues. Upon emergence, stay beside your pt, no matter how long it takes. Induction and emergence are the most critical times of surgery.

6. The OR can be brutal. You won't learn everything in a few months. Don't beat yourself up if you forgot something or if you contaminated something or if you didn't call for your next pt because you were dealing with a difficult emergence. It takes time, a few mistakes and some self-deprecating humor to get through your first year. When times get tough, keep telling yourself that your NM had the confidence in you to hire you, so you should in turn have confidence in yourself.

7. Some surgeons can be quite brusque. Most surgeons absolutely LOVE to teach. When appropriate, ask questions. Really try to understand what the surgeon is doing, what the rationale is behind their decisions. Surgeons will be more receptive to a newcomer if they know that you are interested in the surgery.

8. Be positive. Even when you have a crappy day and you feel like the Rainman of the OR, know that the next day brings more opportunities for improvement.

9. Take advantage of the educational opportunities provided by your Nurse Educator. If you have questions, feel hesitant or just can't grasp the whys and the hows of a particular procedure, use that resource. That's what they get paid to do.

10. Never lose sight of the fact that your pt's day is much more scary than yours. You are tasked to be their advocate when they are under anesthesia. Be assertive, BE their advocate.

Be gentle with yourself as you learn. You will have good days and bad days. Know that you are making a difference every single time you walk through the door. Be proud of yourself...and welcome to the OR!