New OR nurse needs some advice

nurserobyn89 · May 17, 2012

Hey! I have been an OR nurse for about 1.5 years and a nurse just as long. I promise you it DOES get easier. My internship was 9 months long but we had to learn to circulate and scrub all the services that we render. As time goes by you will learn to anticipate the needs of the surgical team depending on the service, surgeon, and type of case and you will already have it ready to go so there will be less scrambling believe it or not! It does take time to feel comfortable running a room efficiently alone. By my six month I would say I felt prepared but I also had done a 3 month externship in perioperative services during nursing school. There are still times when new equipment or supplies arrive or things get moved around or I am circulating/scrubbing a service I do infrequently, I have to run and search (freak out! lol) but thats why you have coworkers to help you. In the OR we are all a team. If people (namely surgeons!) become impatient do not take it personally just keep trying and you will become more efficient as time passes. If you love the environment and perioperative services I say stick it out. Nursing school does not prepare you for a career as an OR nurse...it's an entirely different world. PS. what helped me locate and remember where things were was stocking some of the rooms at the end of the day (depending on your OR and sterile core setup). Also, even if I have done a case 100 times with the same surgeon I still make it a habit to check my PL and with surgeon or coordinator depending on the type of case prior to the start of the surgery to ensure I have everything ready. Just give it time and you will become awesome!

Good luck!

smiggers · May 17, 2012

Thanks so much for the reply. It makes me feel so much better to know there is a light at the end of then tunnel. The reason I am being rushed is because we are short staffed. I want to really like it and hope that after another 4 months i can feel more comfortable. I think that dooing the same case over and over is the key thing. Thanks again for the support i really appreciate it.

glb1960 · May 17, 2012

Hey smiggers, Hang in there. NO ONE knows everything about the O.R., not even 20 year vets. We have a saying around our O.R. whenever a surgeon requests some obscure clamp, retractor, lap instrument or whatever, we share the info with the others and then declare that we all learned something new today, time to go home!It will get better. Unfortunately, it took me to the 12 mo. point to feel really comfortable. I kept copious notes on the different surgeons arrangements and set ups so I could refer to them instead of asking all the time. Also, our pick/preference cards have modifiable areas to include some of the surgeon preferences for another resource. At the end of the day, sit down with your notes and reflect a little. Give yourself credit for the cases that went smoothly. Disect what was less then smooth on the other cases, jot down corrections in your notes for the next time and compare the next time for improvement. Treat this position as a nurse note using the DIAP formula:D) data - what case, what went well, what didn't.I) intervention - what do I need to improve to have better success next time?A) assess - Am I improving? What in my notes is not accurate? P) plan - how to get better. What things are happening at roughly the same point in each type of case. Can I anticipate better? Most importantly, develop a third ear. Surgeons will give you clues, if you hear them. My ears always perk up when the surgeon is asking for some instrument that I am unsure was opened onto the sterile field, suture I didn't open, asking for sponges after we have counted off 5, ect... That way I can already be moving towards the supplies before the tech asks me for something. Sounds hard, I know, but break it down to steps:1) Incision = listen for retractors, clamps, pickups, "gas on", another trochar.2) Mid case = new blades, different cautery tip, different lap tools.3) closing = sutures, dressings, casts/splints.You'll come up with your own verbal/timing triggers.Good luck, Gary

smiggers · May 17, 2012

Thanks Gary for the support it truly make me feel a lot better. I think i need to give myself time as it has only been 2 months so far. time will tell. :)

CIRQL8 · May 17, 2012

Hey, Smiggers! Sorry for your less than optimal experience. Others have written valuable advice. But know this: the learning really never ends. I've been in the OR for15 years and new things are happening every day. I constantly et exposed to things I've not had a lot of experience in. If they tell you that your orientation is up and you don't feel comfortable with it, have some documentation as to which toes of procedures that you need more exposure to. Make it clear that it would be unsafe for you to practice alone in those cases without supervision or assistance. But eventually, you must take what you've learned and use it as a basis for everything. I mostly do laparoscopics, bellies, urology, and gynecology. I rarely do ortho. However, I know how to prep an extremity. I know who to ask about the location and need of certain equipment. If my scrub is competent, they can help guide me. It's not about what you don't know. It's about what you do know and how you Cambodia on it and think use your critical thinking skills. I don't mean to sound callous. You do need an adequate orientation process. 4 months for a circulator won't cut it Who told you that your time may be that short and why? Speak about your concerns with your educator or your preceptor or some other trusted person in the department. Ask who you can approach with your concerns. I don't know you and I am not criticizing you. I have had orientees who don't really seem to care. Try to teach and they just get the gazed over look. They don't ask to do anything nor do they attempt to. Don't be that orientee. Elbow your preceptor out of the way of you have to. Insist that you do that prep, insert that foley, get that item the surgeon asked for. No question is stupid. Ask for clarification. Watch and pay attention. Learn the procedures, why they are done, and how they are done. What materials and what equipment is needed. Why is it needed and how is it used. You can use all that information and carry it on to the next case. And the next one. You will be great. Have confidence in yourself. Good luck.

Sent from my iPad (so excuse any typos and autocorrects!!) using allnurses.com

RNOTODAY, BSN, RN · May 20, 2012

I have much to say, but I am in a rush, so I will put it in one sentance......learn where to get things.....it takes time... a hell of alot of time... but pple know this.... once you know where to get things....

RNOTODAY, BSN, RN · May 20, 2012

It's not about what you don't know. It's about what you do know and how you Cambodia on it and think use your critical thinking skills

lol cirql8.... another autocorrect victim.......!!!!!

Traveler4life · May 20, 2012

Imagine starting in a new OR every 13 weeks! Having to learn a new charting systems, new surgeons, a new core of supplies organized in ways that make absolutely no sense! It's always funny to me when I listen to nurses in other specialties complain about how hard it is to start over in a new place. I travel ER as well on occasion so I know first hand.......being an OR nurse is soo different from any other kind of nursing!! I think it's fabulous! Hang in there!!

-T

ebear, BSN, RN · May 21, 2012

Smiggers, Don't sweat it. At 2 months, you are just now getting your feet wet. Keep a little notebook in your pocket and jot down things to remember. DO NOT let them put you in a room alone until you have more experience under your belt. It matters not if you are short staffed. Volunteer to help with cases you are not familiar/comfortable with. Scrubbing as much as you can will help you become a better circulator. You can do this! Keep hanging! :hug:

Lorodz · May 22, 2012

Hey, Smiggers! Sorry for your less than optimal experience. Others have written valuable advice. But know this: the learning really never ends. I've been in the OR for15 years and new things are happening every day. I constantly et exposed to things I've not had a lot of experience in. If they tell you that your orientation is up and you don't feel comfortable with it, have some documentation as to which toes of procedures that you need more exposure to. Make it clear that it would be unsafe for you to practice alone in those cases without supervision or assistance. But eventually, you must take what you've learned and use it as a basis for everything. I mostly do laparoscopics, bellies, urology, and gynecology. I rarely do ortho. However, I know how to prep an extremity. I know who to ask about the location and need of certain equipment. If my scrub is competent, they can help guide me. It's not about what you don't know. It's about what you do know and how you Cambodia on it and think use your critical thinking skills. I don't mean to sound callous. You do need an adequate orientation process. 4 months for a circulator won't cut it Who told you that your time may be that short and why? Speak about your concerns with your educator or your preceptor or some other trusted person in the department. Ask who you can approach with your concerns. I don't know you and I am not criticizing you. I have had orientees who don't really seem to care. Try to teach and they just get the gazed over look. They don't ask to do anything nor do they attempt to. Don't be that orientee. Elbow your preceptor out of the way of you have to. Insist that you do that prep, insert that foley, get that item the surgeon asked for. No question is stupid. Ask for clarification. Watch and pay attention. Learn the procedures, why they are done, and how they are done. What materials and what equipment is needed. Why is it needed and how is it used. You can use all that information and carry it on to the next case. And the next one. You will be great. Have confidence in yourself. Good luck.
Sent from my iPad (so excuse any typos and autocorrects!!) using allnurses.com

thank you for your post it is very helpful!

insa · May 26, 2012

I'm 6 months out from my OR orientation. The truly terrible days are coming much less frequently now. It really does get better. My orientation was supposed to be nine months, but it stretched out to almost eleven, even though my unit is perenially short-staffed. If you're not ready, you're not ready.

Everything else I could say has already been said by other posters, but I will add this: I have found Evernote to be quite useful as a way to keep my notes organized. I write hints sheets on individual surgeons, on specific types of cases, and on some of the less frequently used instruments. It's especially good for instruments because you can take photos with your phone. The pace is so fast that I seldom look back at one of my notes before I'm doing a case; I think just the act of writing the notes helps me absorb the content more effectively. But it is nice to have that reference. Remember everything with Evernote, Skitch and our other great apps. | Evernote

Good luck!