Not a real nurse?

Argo · Feb 17, 2010

What skills are you loosing? It will happen in any specialty area but when you need them, you need to be good. Like starting a new IV on a sedated pt in a dark room.... starting a Foley under the drapes with very limited space.... knowing ten times the amount of meds that you never use on the floor on any regular basis and not having the time to look every one of them up....

TakeTwoAspirin, MSN, RN, APRN · Feb 17, 2010

You could find another job, or you could understand that we are their for our patients when they are at their most vulnerable. When things go wrong in the OR, they go wrong quickly and usually badly. At those times you will need every ounce of your nursing training. It takes a highly competent and intuitive professional to be able to assess a patient within a few minutes of meeting them AND gain enough trust from them that they will put their life in your hands.

In my time in the OR I have given CPR to patients, heart massage, clamped bleeders, packed open fractures while the surgeons attend to "more serious" injuries, pushed drugs and/or blood when the patient crashes, etc. Of course, if this doesn't sound like real nursing, there are plenty of other departments that would love to have someone who want's a more "real" experience.

nrsman1 · Feb 18, 2010

I don't mean it in a bad way. But I guess I havnt had all those experiences yet.

SandraCVRN · Feb 18, 2010

I have been in the OR for about a month and a half and cannot help but get the feeling every once in a while that I am not a real nurse I feel like all of my schooling went to waste and all my skilled are evaporating away. How do you get over this feeling?

It's just a different kind of nursing... You are the advocate for your pt. IMO right now you are trying to learn "skills" involved in the OR, just like in nursing school and it felt like putting in a foley or ng tube was the most difficult thing in the world, but in reality it just a "skill". Anyone can learn skills, it's why we do these things that make you a real nurse. Or the one day when everyone talks to a pt then you find out something they didn't tell anyone esle and realize you need to get the md or anes to come back and talk to the pt again, possibly delaying or cancelling a case. At that point you have to worry aout your pt not if someone gets mad at you.

Are you a new grad??

Argo · Feb 18, 2010

99% of the time it is smooth sailing and standard OR nursing, check pt off for things you need to have to be legal and within hospital policy, I always do a basic assessment(allergies, iv access, pre-existing wounds that need to be noted.....) of every pt that comes up to the OR floor since I am the manager, I want to be sure what my nurses and I might be in for, check h&p, check consent, make sure orders are filled out.... this should take less than 5 minutes.......

Make sure the room is ready for the case, possitioning equipment and pt possition aids/padding, correct audio/visual stuff(video towers), make sure the tech has what they need to do the case(it will take a while to know this stuff but you will be able to pull and open a case for a tech eventually and scrub further down the road but focus on your circulating job for now), make sure all drugs are pulled and anesthesia has what they need(art lines, central lines, masks, LMAs, ET tubes....)

Next bring patient to the room, possitioning, prepping and making sure the pt isnt going to be injured during the case because of possitioning..... sometimes you have to start the peripheral lines or art lines(central lines done by advanced practice or MDs at my place), start foleys blah blah blah blah blah....

Then on top of this you have to be on your toes to watch what is going on, a good OR nurse will see what is going on and hear what is going on too. I always watch whats going on with the pts vitals and will ask anesthesia when I think something is wrong..... I always train my new nurses to watch this too....

Then you have the 1% of the time that the S hits the fan and you have to just know and be able to preform whats going on..... you dont typically have a code team in the OR, when it is after hours it is you and the people in that room and unfortunately alot of the time surgeons arent a big help.... I have had interventional radiologists and cardiologists literally run out of the room when a pt coded..... Anesthesia and you will be the key players.... I have had to intubate a pt for someone before on more than one occasion when they were unable to get it and had given a long acting paralytic...... There are times that a 30 minute case turns to a 5 hour case and you didnt put a foley in, you have to now...... while they are operating and draped..... You could have a pt code and be doing chest compressions while they are closing the wound as quick as they can. throw a stapler on the field ASAP so they can close that would ASAP and start doing your thing..... When I have nurses doing stuff off the floor I always listen for an overhead call for a code where they are at.... I will always send 5-6 people including a CRNA or Anesthesiologist to help them...... It will scare you how many people get the "deer in a headlights look" when it hits the fan..... you have to be up on your skills...... Those are nursing skills...

Argo · Feb 18, 2010

also, to get over it, just remember that you are training in an area that ALOT of people want to and try to get in to. There are not that many that can handle it though. I have literally had employees leave crying after a couple of days cause they could not take it.... believe it or not..... There are also those that just dont get it........ I hope you last, it is a good career with great marketability in it....

nrsman1 · Feb 18, 2010

Thank you all very much. Oh and by the way I am very new, only had my RN for 1 1/2 months

carluvscats · Feb 18, 2010

nrsman1, it looks like we started the OR about the same time. It really is just a different world, isn't it. I think sometimes that those who have been doing it for years and years forget that it's completely different from anything that was taught/shown in nursing school. Those in surgery speak a different language, have strengths in areas I never even thought of (like the ability to anticipate needs of docs/techs/the patient)........... and the need for a backbone made of steel is an absolute must! It is not for the faint-hearted.

Ultimately, patient advocacy seems to be the focus of the nurse in the OR, in everything from the paperwork to positioning, to making sure that tissue samples are sent off correctly.....I'm thinking you are doing more nursing than you realize. :)

I wish you the best in your new career!

ellebanna · Feb 18, 2010

hei, your years in college is not wasted because you are in or..it is one of the most rewarding specialty of nursing career...it's on you of how you'll devote yourself as the patients' advocate during surgery..still your young in practice, once you have a year of experience or more inside the theater...you'll soon realize that our duty is a fulfillment.

Libitina · Feb 21, 2010

Hi OP,

I too am new (well, relatively now) to theatres. I came straight out of training into it and had virtually no theatres experience. I felt like a first year on my first placement.

Nearly 6 months in I am now beginning to find my feet, though still with a heck of a long way to go,lol. Speaking to friends who got jobs on the wards, they feel the same too. The difference is, over here anyway, that we get a LOT more support from our colleagues. I had a good 3 months + of supernumerary status. Friends had anything from 1 day to 1 week for the lucky ones one the wards.

You will get there. It won't take as long as you think. Don't beat yourself up.

rubichick · Mar 11, 2010

I just got my license in August and started in the OR circulating right way. The way I look at it, those who work in the OR can always go to Med/Surg to fill in if necessary, but those on the Med/Surg floor can not walk into the OR and do the same. It might be difficult for me at first, but it would all come back to me and not be out of my capabilities. A Med/Surg nurse may not even know what a RIRS is or what a debakey is, but you do.