OK, Y'all...I need some advice

[canesdukegirl, BSN, RN]

Normally I am a very patient person. I don't know what has gotten into me lately, but I am finding my patience wearing thin, and I don't like that about myself. Thankfully, I have some much needed days off in the near future, so hopefully this impatient feeling will pass. Now to my issue:

I work at a large university teaching hospital. We have new medical students, new PA students, new research students that are rotating through the OR now. They scrub in, and know very little regarding the "rules" of the OR; sterility, how to gown, how to glove, how to pass instruments, etc. I understand that part of my responsibilities as an OR nurse is to help teach these students. The senior resident is ultimately responsible for their med student, but the resident is also focused on other things at the beginning of the case (discussing outcomes with the attending before the pt is induced, positioning, draping, getting started, etc.). Every day this week, I have found myself to be the primary "teacher" to these students. The residents give NO direction to them at all. They look at me when they come in the room and I can see that they are nervous. It just burns my butt when staff members treat medical students like crap, so when I see that the students are at a loss, I will offer suggestions, give direction, and do a "quick and dirty" explanation of the general expectations while they are scrubbed in.

My impatience (or annoyance I should say) comes into play when after taking the time to acquaint the students to the OR at the beginning of the case (when I have a million things to do myself), I find that I am behind the 8-ball when it comes time for me to perform my own duties. Example: a new PA student had NEVER been in the OR. She had some remote knowledge of the OR from class time last year. When she came into the room after scrubbing, she was holding her arms next to her scrubs, hands up. I told her that she had to re-scrub and explained why. So she goes to re-scrub, comes in and I hand her a towel to dry off. She didn't know how to dry. I walked her through how to dry (all the while, the resident is draping the pt, which I should be helping him do), and then I gown her. She goes waaayyy up with her arms and contaminates herself when she hits my facemask with her sleeve. So now we have to start over. Meanwhile, the attending is wanting to get started, and I am trying to get my mayo stand up to the field, while this poor student is looking like she is going to cry. She comes back in, we gown, glove and then I tell her to stand next to the attending. She moves away from me by turning her back to me and walking straight into the bovie machine. *sigh. The attending is asking for the knife, and I can't help this student any longer. I feel badly for her, but I have to perform my duties.

This was just one example of the frustration I have experienced this week. Another med student was terrified of passing instruments, and after I showed him how to do it, he continued to pass them ring up to the surgeon. The surgeon was obviously getting impatient with him, and told him to listen to my direction. After he finally got that down, the next case he injected local subq. He passed the needle back to me point first. At the end of the case, he closed skin and threw the unguarded needle onto my Mayo stand. *sigh.

So here is where I need help from you guys: how do I remain patient and calm (on the inside...on the outside, I appear calm, but really I am sweating bullets because these surgeons want everything YESTERDAY) while still trying to help these students? I understand that the resident is the ultimate "teacher" and should actually be taking the time to teach these students, but they are so focused on the surgery itself to do the requisite teaching. Should I just shut my mouth, look the other way and let them drown? It is SO not in my nature to do so, because I know that they are TERRIFIED. I would be too! Should I talk to the residents before the case starts and ask what their expectations are? I feel like I am being a Polly Anna about it, but on the other hand, I don't want these students to be reamed for something that they don't have any experience with. Does this make sense?

Please help me out y'all!

[PetiteOpRN]

Do you have a nurse educator in your OR?

If there is a group all coming in at once, can she spend a day with them to do an OR refresher course? In the middle of a big case is simply not the time to learn the basics. Take the situations you have encountered to management as a patient safety issue. Maybe you can be the catalyst for change in this scenario.

[Mr. & Mrs. RN]

Wow, I can't believe you have to deal with all that. I don't know how you do it. I'm sure it causes you to miss things sometimes too, when you are focused on helping the student. Don't you have an OR educator or somebody that can go over the basics before throwing them into the OR realm? Doesn't seem fair to the student or safe for anybody, including the patient.

I agree with PetiteOp, maybe you can organize a committee to develop an OR 101 course for new students prior to them entering the OR suite. I'm sure those poor students would appreciate feeling somewhat competent when entering such a scary environment.

[canesdukegirl, BSN, RN]

Thanks for replying, guys. Yes, we do have an OR NE. They are required to educate the new staff nurses and they spend one day with the med students prior to their rotations in the OR. The NE is NOT required however, to instruct any other students, such as PA students, research students, OT and PT students. It is the understanding that the attending or the resident educate their students prior to their rotations in the OR.

Petite, I like your idea of perhaps changing the policy regarding this potential patient safety issue. I will follow up on that. Thanks!

[Scrubby]

Our medical students have to go through an orientation by our nurse educator. If they become a nuisance we basically kick them out the theatre and back to the nurse educator. We have enough on our plate without having to babysit and spoonfeed medical students.

[RN890]

I will soon be starting a career in the OR at a teaching hospital and this is one thing I'm not looking forward to. It is a huge safety issue. OR nurses should only be responsible for educating and training OR nursing students only!! It's not an issue of helping other professionals in a different field other than nursing, but the fact that this task falls on the OR nurse. I think it's nice of you to try to help them and I would definitely do the same because I know what it's like to be a new student..but at the same time you need to fulfill your job duties and make sure things are done correctly for the sake of the patient. I would definitely bring this issue up to your manager or clinical educator.

They shouldn't allow med students or any students for that matter to observe or participate without going over the BASICS like sterility in a hands-on educational setting! Unbelievable:banghead: