circulating nurse = "go-fer" with no use for "real" nursing skills?

[RunnerRN2015]

After 20 years of teaching, I'm back in school pursuing what I've always wanted to do: to be a nurse. I've always been interested in the OR and I am amazed at the number of RNs and fellow students who are trying to talk me out of it. Everyone tells me I'll be nothing but a "go-fer"....I will lose all my nursing skills.....I'll be stuck there because floors won't hire me since I'll have lost my skills. I don't know "for sure" that I want the OR but as of now it's high on my list of potential preceptor sites. The hospital system that I will be hired into is a large teaching hospital so 1) they use surg techs for scrubbing and 2) they use residents for first assists (which is a bummer because I would love to do that!). They offer a 6 month "periop 101" paid training program with a 2 year commitment. Nurses are taught to scrub in case techs aren't available or need to be relieved for breaks but it's mainly circulating duties.

Circulating nurses -- please share with me what types of things you do! I get to shadow in the OR in a few weeks so I'm looking forward to that but I know I won't see everything.

Thank you!

[shodobe]

The problem here is your getting advice from people who have never set foot in an OR and haven't a clue what goes on behind "The Door"! All of the answer above were correct and to the point. I've been at this for 38 years and still consider the best nurses in the hospital come from the OR. We all get a taste of floor nursing during school but that one or two days you get in the OR doesn't even come close to what the nurses deal with on a daily basis. I might not be up on some aspects of floor nursing because times change and so does floor nursing. But I could go and hold my own there, whereas they couldn't carry my scrubs. So your best bet would be to listen to OR nurses and not floor nurses.

[canesdukegirl, BSN, RN]

The beauty of OR nursing is that you focus on ONE patient.

Following is a typical day for me (when I am not in charge):

1. Find out what room I am assigned to the next day.

a. Look up each pt hx, along with labs

b. Review the surgical procedure, no matter how many times I've done it. It never hurts to read over the steps of each procedure.

2. At the beginning of the day, I text page the surgeon to ask for any special requests/requirements/positioning for the first case. I also ask who the resident will be. Meanwhile, I review the preference card and pull all specialty items, including gloves for the surgeon, scrub person, and resident (sorted in bins), and suture for the case.

3. While I am setting up the room, I get rid of all equipment that is not needed, and check to make sure I have an SCD machine, gel pads, positioning equipment, safety straps, and a bovie machine. I check the suction, check the OR lights, and make sure the proper bed is in the OR, and that it is locked. I also ensure that the proper radiographs are in the room and mounted/pulled up digitally.

4. As I am setting up the room, the anesthesia care provider is preparing meds. I make a point of talking to the anesthesia care provider about concerns, make sure that there is a current T&S/T&C, compare notes about any abnormal labs, allergies, and past surgical history. We briefly go over both the anesthesia plan, the surgical plan, and expected post-op status (meaning, will this pt go to the ICU intubated, go to a regular floor, or will they be d/c'd the same day).

5. After my room is set up and the scrub person has everything they need, I go interview the pt. This is the fun part.

a. You have to remember that your pt is absolutely terrified. YOU are their advocate, and they know this. It's amazing to me how quickly you can connect with another human in a five minute span.

b. I go over the usual questions (name, DOB, MR#, have them tell you what procedure they are having, allergies, metal in the body, etc.) and then I can calm my pt's fears by listening, offering reassurance, and anticipatory guidance.

6. The pt is now in the room, and I stop whatever I am doing to help move the pt over on the OR table. When the pt is supine and adjusted on the bed, I secure the safety strap. Then I get warm blankets for the pt. Then I conduct the pre-induction "time out". If someone isn't listening, I call them out on it, and start over.

7. I stand at the left side of the pt as they are being induced, and gently place my right hand on the pt's left arm. This small gesture is comforting to them, and is usually met with either the pt raising the left hand for me to hold, or a direct, silent gaze of acknowledgement.

8. I NEVER LEAVE the pt's side during induction. This is one of the most dangerous times of surgery. I assist the anesthesia care provider with intubation, and don't leave until the tape goes around the tube.

9. The resident/surgeon and I begin to position the pt, and when positioning is complete, the prepping/draping process starts. I assist the scrub person with moving tables once the drapes have been placed. I hook up the suction, bovie, and whatever else is required for the procedure.

10. I perform the pre-incision time out, and again, if someone isn't giving me their full attention, I will call them out on it and begin again. Once, I had a very "bullheaded" CRNA in the room, who thought that the whole pre-incision time out process was stupid. As a result, he would always pretend to be terribly busy with more important things, and didn't give his full attention to the time out process. We had a male pt who was having an ORIF of the tibia, and I announced during the time out, "This is pt XYZ, DOB 4867, MR# 9999999, no allergies, consented for an ORIF of the tibia and a hysterectomy". The CRNA's head was bent down, doing "something terribly important", and responded "Agreed!" Everyone else in the room stopped and laughed. The CRNA never made that mistake again. Of course, I announced the correct time out once I had the bloke's full attention.

You may lose some clinical skills, yes. But you also gain some incredible knowledge. It isn't everyday that nurses can actually SEE peristalsis, or SEE the plaque in an artery. I could go on, but you get the picture.

Go for the OR. It's absolutely amazing.

[RunnerRN2015, ASN, RN]

Canes,

Thank you for sharing. Your post confirms my desire to be an OR nurse.

[RunnerRN2015, ASN, RN]

UPDATE: I had my OR shadowing day last week. I LOVED IT! I'm definitely doing one of my 2 preceptorships in the OR.

[lkatsimpson]

I have been an OR nurse for over 21 years and I would not change a thing about my decision to go straight into the OR from nursing school. I was also told that I would lose so much of what was taught in Nursing School but I can tell you that I gained so much more. I feel that my time in the OR was the most incredible time. Even if you do the same procedure over and over they are never the same. I developed my back bone in the OR. I enjoy teaching new nurses about surgery and how they can get involved in my exciting career and many have later thanked me for my advice. I will tell you now that the OR is not for everyone. Some can not get over the blood and guts and overwhelming pace that an OR nurse faces daily but once you get the hang of it there is nothing like it. I like to call it controlled chaos. Good luck in your shadowing and I hope you get with a great RN who can answer all your questions.

[BennyBear]

I know you've already made your mind up but I just read your post and wanted to throw my 2 cents in. I generally find that those who discourage you from working in the OR are the ones who have the least, or no experience at all, of the actual OR. Standing in the corner for an hour watching your patient have a lap chole during the 'patient journey' does not consitute in any way as actual OR nursing experience. As a student nurse the majority of your clinical rotations are spent in non-critical care areas, and in my experience when they do their critical care rotations they get assigned to the ER or the ICU. Hence, the OR has this ridiculous reputation that you will lose all of your skills based on no evidence whatsoever. I would argue that actually it is the cream of the crop that end up in the OR. It is generally classified as the most specialized area of nursing practice without advanced certification and requires skills that you will never learn on a Care of the Elderly ward or the outpatient clinic. The skills you will use in those places are generic, run-of-the-mill nursing interventions that basically we can all do. As great as that is, the skills you will learn in the OR are skills that most other nusres will never attain. So, you could theoretically do their job with your eyes shut, but they could not do your job without additional training. Which is why they are very quick to dismiss it. It's called an inferiority complex. The surgical patient comes into the hospital for the sole purpose of having surgery, and you are there to take care of them at their most vulnerable. The ward nurse will wipe their brow and tickle their chin before and after the event, but you are there for them during the actual surgery. it is exciting, complex, challenging and the ones who try and put you off are the ones who would not be capable of doing it. I wouldn't want to do anything else!

[ratona]

I have to tell you I was in your shoes about 4 months ago. I just recently graduated as an RN in April and was hired an an OR nurse.I spent about a month reading this very same site and trying to understand what I was getting myself into. I am not trying to insult anybody out there but OR nursing is not for everyone. First of all you will spend your day reading preference cards and running around getting things for the tech who will say to you....You guys are the OR *******, you are the doctors ******* and you are our *******....and you know what....it is true! your day starts with your morning meeting around the core desk to get your assignment,then you run to your room to get preference cards to get an idea of what to get for the case but the catch is.... you have not idea of what it is you are supposed to get, then you start connecting things in your room(you spend most of the day trying to figure out where to plug things so it all runs smoothly)....no nursing yet! then you turn every single thing on to make sure it all works..bovie,suction, storz tower ,etc....does any of this sound like anything you learned in school?....anyway then you run to see your patient for about 15 minutes you make sure all signatures are in the chart, make sure blood is available etc(only part of the day where some nursing applies) the you take your pt back to the room. Anesthesia does all the work(iv, antibiotics,give blood ,etc) you only watch them at work. then when the doctor comes in after positioning you get to call a time out, they start, and you start documenting on the computer(no time to watch anything) then the tech starts asking for things, you get to run around the or like a mad woman and after it is all done you get to do it all over again....sounds like fun? not for me , my advise dont do it!!!! good luck!

[cdsga]

When you are a new nurse and have no clinical experience-the post by Ratona would be true. You spend a few years learning to put things together. I recommend that you make your nursing experience what it is. In fact I would recommend everyone determine what the definition of nursing actually is. OR nursing is not for everyone, and I could say that for any other area as well. An excellent OR nurse will assess the patient quickly, bring that assessment to the OR, verbalize and lead care based on that assessment. Will implement care in positioning, anticipating issues that may occur based on the patient assessment, understand the procedure that is to be performed, lead the team by communicating and participating in care, and safeguard the patient throughout the entire procedure-Meaning, the nurse knows the latest information on policy, procedure and regulatory mandates, anticipates and prepares properly for the case to stay present. There's much more to it than that, but in this quick post-that will get you started. Lastly evaluate the patient at discharge. More personally, evaluate your nursing care-as well as the team. Self-evaluation makes you better prepared for the next case and can make things better for those around you. The nurse leads process improvements-and this can be case improvements also-not just hospital based quality indicators.

You make any nursing care what you want to make of it. Mediocre or exceptional. Totally up to you.

[ArtieRN]

I was in the same position as a new grad just a few months ago. I was lucky to choice between a neurosurg floor position or an OR fellowship. There are times I still wonder if I made the right choice to not take the opportunity to develop my basic skills as a nurse (in fact, I could probably do quite well in any unit with a few years in that job), and if my experience really were just what ratona described, I'd be regretting it like crazy! I'm still learning and have had a lot of hiccups, but it's been an enjoyable experience so far. Some benefits to the OR are the instant gratification of fixing a patient's problem within a day, getting to work as a team on one patient instead of the lonely autonomy of 6 med-surg patients and endless documentation, and sedated patients while putting in foleys. I've also really come to appreciate just how much knowledge and problem solving skills are required as circulator or scrub. It's not floor nursing, no, but it's just as challenging mentally and, yes, physically.

There are times where it seems thankless and mindless, and there are some people who are definitely not meant for the OR, but trust me. It's totally possible to have a bad periop nurse. Even in my inexperience, I can see them. The other nurses see them and expect the best. Just like in any other specialty in nursing, you are a patient advocate. Your job is to protect your patient who is in their most vulnerable state while under your care. You're the last face they'll remember seeing before being wheeled into the surgical suite. You're the one who makes sure everything runs as best as they can. Sometimes it's someone wanting their boobs done, and sometimes it's a 9 year old bleeding out of every orifice, and you're the one who convinces a doctor that his life can be saved. I've seen it, and it's beautiful.

As for traditional nursing, I'm hoping after getting my BSN and CNOR-certified in a few years, I can also start doing pre-op or PACU. Then who knows?

[pookyp, LPN]

I have to tell you I was in your shoes about 4 months ago. I just recently graduated as an RN in April and was hired an an OR nurse.I spent about a month reading this very same site and trying to understand what I was getting myself into. I am not trying to insult anybody out there but OR nursing is not for everyone. First of all you will spend your day reading preference cards and running around getting things for the tech who will say to you....You guys are the OR ******* you are the doctors ******* and you are our *******....and you know what....it is true! your day starts with your morning meeting around the core desk to get your assignment,then you run to your room to get preference cards to get an idea of what to get for the case but the catch is.... you have not idea of what it is you are supposed to get, then you start connecting things in your room(you spend most of the day trying to figure out where to plug things so it all runs smoothly)....no nursing yet! then you turn every single thing on to make sure it all works..bovie,suction, storz tower ,etc....does any of this sound like anything you learned in school?....anyway then you run to see your patient for about 15 minutes you make sure all signatures are in the chart, make sure blood is available etc(only part of the day where some nursing applies) the you take your pt back to the room. Anesthesia does all the work(iv, antibiotics,give blood ,etc) you only watch them at work. then when the doctor comes in after positioning you get to call a time out, they start, and you start documenting on the computer(no time to watch anything) then the tech starts asking for things, you get to run around the or like a mad woman and after it is all done you get to do it all over again....sounds like fun? not for me , my advise dont do it!!!! good luck![/quote']

What you described is EXACTLY what I saw the RN doing the other day when I was shadowing. I was like I couldn't do this EVERY day! Lol I got bored after 25 mind there. Very repetitive.

[MereSanity]

What you described is EXACTLY what I saw the RN doing the other day when I was shadowing. I was like I couldn't do this EVERY day! Lol I got bored after 25 mind there. Very repetitive.

There is nothing boring about theOR for me...I am severely ADD too! A small hospital maybe but not a bigger one. I hate floor nursing and will never do it again! I even did ER nursing for awhile but nothing did it for me like the OR! Love it! Been there 6 years now. Just got my CNOR this year.

[Stacey30]

I have to tell you I was in your shoes about 4 months ago. I just recently graduated as an RN in April and was hired an an OR nurse.I spent about a month reading this very same site and trying to understand what I was getting myself into. I am not trying to insult anybody out there but OR nursing is not for everyone. First of all you will spend your day reading preference cards and running around getting things for the tech who will say to you....You guys are the OR *******, you are the doctors ******* and you are our *******....and you know what....it is true! your day starts with your morning meeting around the core desk to get your assignment,then you run to your room to get preference cards to get an idea of what to get for the case but the catch is.... you have not idea of what it is you are supposed to get, then you start connecting things in your room(you spend most of the day trying to figure out where to plug things so it all runs smoothly)....no nursing yet! then you turn every single thing on to make sure it all works..bovie,suction, storz tower ,etc....does any of this sound like anything you learned in school?....anyway then you run to see your patient for about 15 minutes you make sure all signatures are in the chart, make sure blood is available etc(only part of the day where some nursing applies) the you take your pt back to the room. Anesthesia does all the work(iv, antibiotics,give blood ,etc) you only watch them at work. then when the doctor comes in after positioning you get to call a time out, they start, and you start documenting on the computer(no time to watch anything) then the tech starts asking for things, you get to run around the or like a mad woman and after it is all done you get to do it all over again....sounds like fun? not for me , my advise dont do it!!!! good luck!

I can understand why you may feel this way, because as a new OR nurse you do run your *** off at first. But pay attention to the experienced OR nurses around you and you should see that they're not running around nearly as much as you are. This is because over time you WILL convert those DPC's to memory and you WILL be able to anticipate the surgeons' and techs' needs. Setting up your room at the beginning of the day doesn't really take all that long. I look at the pick sheet on each case cart and pull all my suture, MIS stuff, etc for each case before morning report so that's less I have to do when turning over my room between cases. I also order all my meds for each case and pick up from pharmacy at the beginning of the day. You'll learn each procedure, and you'll learn how each surgeon does things during that procedure. You'll be able to anticipate when they might need more laps or suture. As for documentation? That shouldn't take you long to do. Charting takes me maybe 10 minutes tops. There are certain segments to the periop chart you can fill in before the patient even comes into the room (i.e. case attendance, cautery info) so that you can focus on that patient once they come through the door. You will develop the ability to multi-task, and you'll develop an "OR ear"- the ability to document while paying attention to the field and listening to your mumbling surgeon because let's face it, they're not gonna stop what they're doing and turn to you to ask for things. Last time I checked, multi-tasking is a big part of floor nursing too. So is organizing your time.

I work in a pediatric hospital so anesthesia brings the patient into the room (I don't have to do a pre-op interview, but I do accompany patient to PACU for post-op report), this gives me time to help the tech set up the room. Like PP's said, once that pt rolls through those doors all your attention is on them. I assist my anesthesia personnel during induction. Since we're working on children, we use gas induction then insert the IV and put them deep with IV anesthesia (saves the kids and parents a lot of undue stress trying to place an IV pre-op). I assist with IV insertion, placing the BP cuff and pulse ox, and in the case of children toddler-aged and up I help with distraction techniques to try and keep them calm as they get the mask. This is the fun part. If it's a girl I might ask if she likes getting her nails done. If yes, I tell her let's paint your nails. I take her hand in mine and say now I'm putting the polish on. Can you smell the stinky nail polish? (this is where anesthesia switches the gas on.) This really helps calm my patient and makes induction a lot easier on us. If my patient is a boy then maybe he's flying a jet and he can smell the stinky jet fuel.

I pay close attention to anesthesia monitors during the case as well. Intra-op hypothermia is a big issue nationwide especially with NICU patients, so I make sure the pt's temp doesn't get too low (or too high for that matter) by consulting with anesthesia before adjusting room temp or the Bair hugger. If you have a CRNA or anesthesia resident/fellow in the room who you watch like a hawk because you don't necessarily trust their competence, it is up to you to step up and call the attending into the room to assist them if they can't get the pt's sats under control.

So in a nutshell, a good OR nurse can document, pay attention to the field, anticipate the needs of the surgeon/tech, monitor the patient's vitals/sats/co2, and document all at the same time. Oh, and keep med students/nursing students/other observers from contaminating the sterile field. If that's not nursing then I don't know what nursing is!