New OR RN needs help

Have you not been given a preceptor????? If not, you really should have a talk with your director! There is no way you should be on your own in any OR setting for a very long time. Our orientation process lasts 3 months for nurses with experience. As an OR director, I have only taken on a brand new grad 2x. The 1st time it worked out because the person had been working in Sterile Processing for 6 months and not only knew instrumentation, but had exposure to the OR setting. The 2nd time did not work out so well, I had to move that person to a different area. So, it is possible to do. Just don't try to do it alone, find someone you admire in the OR if you have to and ask them to be your preceptor if possible. Good Luck.

YES, you definately need a formal program with a preceptor. The OR environment is totally different from the floor. You need to develop your critical thinking skills i.e. labs etc. I also feel a new RN needs to have the experience of calling an MD at 3am for a tylenol order! Or learning to have the chart right in front of you and knowing your patient so you can give an intelligent answer to obnoxious questions. Otherwise you will get eaten alive!

Having been through a great 6 month training program then moving to a hospital that trains in-house was a great trial of my patience. The techs think they run the room and the RN's haven't developed the assertiveness they need for the responsilbility they shoulder. Not to mention the amount of equipment, postioning etc. you need to learn.

Sounds to me like the OP was just anxious and eager for the first day!? How did it go? Were you given a clear mentor or educational coordinator to guide you through the next couple months? Clear expectations of your goals and responsibilites? I know I was a little disillusioned by me observation days in the OR in nursing school, that hospital used a lot of techs so RNs didn't scrub in. Now in my hospital, I get to scrub a lot! But you did get a good picture of some of the things RNs do have to do!

Good Luck!

Perhaps my original post lacked enough details. IMO this unit and it's management really seem to be on the ball. Yes, I have a formal educational coordinator (who is very nice, BTW) and an extensive orientation (several months). I have not been assigned a formal preceptor as of yet (I'm fairly sure that I will be) but rather will begin by rotating through all of the specialties, just to see what all is done here. I am actually only in the OR for the a.m. of this first week and in the basement educational department in the afternoons completing organizational compliance, the standard computer documentation courses, videos, readings, and multiple choice tests for areas that are common to all new RN's. The reason that I felt lost on day one was because Joint Commission was in the hospital at 7:30 a.m. on my first day and honestly, my educator was just stretched extremely thin and felt comfortable putting me under the care of one of her very experienced OR RNs. Today, I spent the morning with my educational coordinator getting a good overview of the unit (in-house pharm, sterilization devices and procedures, etc.) and watching a few OR exclusive videos in her office. I feel as though I am being treated very nicely and eased in.

What I was looking for from you guys was maybe some websites (or recommended reads) that would help me to become familiar with some of the instruments before I actually saw them on the sterile field or being used on the patient. I have a scavenger hunt list a couple of pages long of items that are found all over the OR and I have to find all of their possible locations. I thought that it would help to know what I was looking for. My educational coordinator gave me a Mosby's OR text today that is going to really help, but I was just seeking some additional resources, advice, etc. to facilitate my occupational journey. I know that I have lots (and Lots) to learn but I am very excited about the prospect of doing just that. Thanks in advance for your responses.

What I was looking for from you guys was maybe some websites (or recommended reads) that would help me to become familiar with some of the instruments before I actually saw them on the sterile field or being used on the patient.

Mosby's "Instrumentation for the Operating Room" is a good start for instrument pictures.

Bravo on passing your boards!!! The OR can be a very intimadating place, it's very busy, always changing and you will feel "edgey" almost all the time.

I've been in the OR for 15 months, I had a formal 7 month peri-op internship at a large teaching hospital. The first month was in the classroom for 4 days and 1 OR observation day. The next 6 monthe I spent 1:1 with a preceptor. As I gained the skills needed I was given more responsibilty. This may seem like an excessive training but it is very effective. What is also very interesting is that when I started my program all the peri-op interns were all experienced critical care nurses.

Every hospital/OR is different....Best advise is keep your eyes nad ears open, ask questions, prepare for each day by reading up on the procedures that are scheduled for your OR that day. I had a very well respected (and kind of loud) Neuro surgeon one day ask me to point out the structures/nerves that he was operating on, to see if I was prepared for the day scrubbing with him. I was able to answer his questions because I prepared for my day. You need a working knowledge even if you are not "doing" the surgery to know what to expect. (Sorry I'm kind of rambling)

Good Luck, I love the OR and I hope you will too.

Rolling Thunder...Congratulations on becoming an OR nurse. I am sure your preceptor/educator will have some good resources for you if you ask, but if you want to get a head start try Alexander's Care of the Patient in Surgery. Not only does it give a brief overview of the procedure, but it details the most commonly used instruments in each.

One other thing. Although it may have seemed the circulator was running for items and answering pagers, I can assure you she was also watching her patient. You will soon learn that being a circulator is much like being a ringmaster. You will have to be aware of everything that is happening in the room and be the advocate for your patient as others focus on the surgical procedure. What you were privledged to observe was an experienced circulator who made the job seem like an everyday occurence.

Kidsrme

Maybe try Alexander's Care of the Patient in Surgery. We had to read that for our orientation, and it helps a bit... but its repetitive and a good cure for when you can't sleep. :wink2:

RollingThunder, congrats and welcome to the profession of (perioperative) nursing

Thank goodness you have an educator, I am currently in OR orientation--- I do not have a "nurse educator" and I am precepted by different people everyday. -- No structure whatsover

I managed to do a lot of homework on my own so here's a websites I hope can help you.

www.health.uab.edu type in perioperative nursing in the search bar

I left out one important thing----- you may find it helpful to refer to your med-surg textbook. It is said that operating room nursing is totally different IMHO certain things are basic to nursing. Never forget that! Your med-surg text will give you a little insight into surgical intervention for medical problems including symptomoloy of pts pre-op and diagnostic test they may have gone thru pre-op or will have intra-op

Never forget your med-surg foundations----

ASSESSMENT- what case are you doing? know your pt, know your surgeon, informed consent signed? Psychosocial- pt/family anxious

Remember your developemental stages so you can interview your pt

Remember your OB/GYN rotation-- check pts last HCG if applicable

DIAGNOSIS- what is your pts diagnosis, why is the pt having this done, know that it's the left leg not the left breast

PLAN- get room ready, set up, trays, meds, sutures, equipment, do you have blood avail, do you need to call x-ray, are the sales rep here yet? etc.

IMPLEMENT- get case started, call time out, advocate and care for your patient throughout the intraoperative course, be vigilant for any breaks in sterile technique -- run around go for this/go for that :chuckle listen to the surgeons whine (not officially in job description)

EVALUATE- closing time, counts, case is over, uneventful, take pt to recovery room or SICU (tumor removed, aneurysm clipped, fracture reduced etc)

YOU KNOW THIS YOU WILL BE FINE BUILD ON WHAT YOU LEARNED IN NURSING SCHOOL:rolleyes:

Here's my .02 :)

MAKE THEM teach you to scrub all specialties! Talk to the manager and express this and she will give in.

Then I highly recommend that after a year with that hospital move on to a hospital with minimal to NO techs. I have nothing against techs but it is best to be able to scrub a lot as well as circulate.

The only places in the USA that have few or no techs are some places in California and parts of New England and a few places in Washington state.

The University of Washington Medical Center in Seattle is huge and has only a few techs. They will put you through a SIX MONTH orientation as a newish OR nurse in which you learn to scrub just about everything.

If you don't get comfortable with scrubbing early then you will never pursue it and you'll be stuck in OR's that have a 50/50 RN to tech ratio and that limits you a lot...and also makes your job a bit boring.

No disrespect to those OR nurses that don't scrub...but they simply cannot get a job in many of the better OR's in the country...where working conditions are the best for nurses(unions)...where we get the most respect and the best pay and benefits...and that's Parts of New England, NW Washinton state, and parts of California.