Is it me?

  1. I am looking for advice...Brand new nurse, Brand new in OR. I am not sure if it is me, or this is normal. I'll attempt to keep it short and sweet! I have been in training for 11 weeks. After one month of training I was counseled because I was not anticipating what instruments would be needed, I was not prioritizing, and I was allowing my preceptor to do things. I would let my preceptor do things if I had never seen that procedure before ie. prep, get supplies in middle of case. If I have never seen a procedure, I cannot anticipate the unknown I was NOT sitting there eating bon bons, I have no problem saying I dont feel comfortable, or let me watch this time and next time you watch me..... Different preceptor daily, weekly.After 2 months of training, perform independently. Anticipating and prioritizing. Got rave reviews from preceptors, matters little to educator, other than being told you are where you are supposed to be.
    Second rotation: 2 days with one preceptor whom goes on vacation. Rest of week, and next week assigned various preceptors back in first specialty, whom say "call me in the lounge if you need something."
    This week...assigned daily preceptor in new specialty, I have 2 days experience in this specialty. No formal education as to instruments used in this specialty, procedures....only training received is location of instruments and machines. Preceptor walks in and says you are doing this all by yourself, I will just get stuff if you need it. I explain that I have never seen this procedure, and this is my third day in this specialty. To which she responds that I should know by now and be able to do it. Then she begins yelling that I need to get the sutures...so I go to get the sutures. She show up 45 seconds later saying I should be in the room and I need to prioritize because I can get the sutures later in the case...okay.... Evidently she gets paid not to teach, but to demean people for 8 hours a day. She left to take her break, and things went smoothly, I sent 9 specimens, documented, lights, sutures...etc. I dont know at day three all the instruments, sutures used and etc... She returns to sit on a stool and stare at me for the next two hours, not saying anything, not doing anything.
    Turns out she took a break to go tell my educator what a terrible job I did, how I cannot prioritize and I was getting the sutures when I should have been getting the patient, which she told me she was going to do.
    For me, it was shear chaos, she was raising her voice telling me 40 things at one time. I am frustrated because I am really trying. When I am being thrown with different preceptors in different specialties, there is no consistency, each preceptor has different expectations, different schools of thought. So I was confronted by the educator whom told me that I should have been able to do this indepentently. I explained that I am still not very fast, I have never seen this surgery before and add to that someone whom is telling you to do 8 different things at the same time, it is impossible. Am I supposed to know everything by now?
    I have never had a complaint from a surgeon, or resident. In fact I have received compliments from some of the most difficult to please. I never heard good job when I receive compliments from surgeons, or when I caught my preceptor handing off an expired implant, or when anesthesia was about to administer a med the patients was allergic to. Being a patient advocate doesnt really seem to matter here. But you see a case for the first time in your life, and you actually want your preceptor to help you the first time...Holy Makeral, you have commited a crime and they are going to let you know what a terrible nurse you are. There is alot of bullying going on here, intimidation, criticizing and threatening.I have had one great preceptor, she explained everything, then would wait and quiz you on it and again review if you missed something. She is what a preceptor is..a teacher.
    I am frustrated because I really am trying. I was told that perhaps I should do what some other people do which is come into work early to set up the room, unpaid. I am usure if it is the hospital, me or the OR in general. Is their timeline of expectations correct?
  2. Visit keepitreal profile page

    About keepitreal

    Joined: Jun '09; Posts: 5

    22 Comments

  3. by   TakeTwoAspirin
    It doesn't sound to me like it's you. If you are new to the OR, 11 weeks is no time at all for you to feel comfortable, or for them to be putting so much on you. It is ridiculous to me that you are being criticised for not anticipating! Seriously? If there is an educator for the OR you should schedule an appointment and sit down with them to discuss a more structured orientation because what is currently happening isn't working for you. Are there other new grads orienting in the OR, how do they feel? If you are not doing so already you should be documenting what does on every day. Did they promise you specific orientation period/schedule? I truly do feel bad for you because it seems like they have unrealistic expectations for you.

    I know that this doesn't help you, but it might make you feel a little bit better. Where I work, the orientation for new people to the OR is 6 months, with longer if you need it. I'm sure people on this board will back me up when I say that 4 - 6 months is pretty standard orientation for the OR. If you are going to get less than that I would seriously consider cutting my losses!
  4. by   elb252
    It's not just you!! The OR in which I have an internship right now has up to 6 months of orientation. Whether you are a GN or a RN, you are also required classroom work that will orient you to the OR. Unfortunately, you do kind of learn the instruments you need as you go along with each procedure, but usually other RNs or scrub techs in the room with you will certainly give you a hand in getting what you need, in learning, etc.

    As an intern, I'm still learning the ropes of the OR as well, and I tell my preceptor as well that I need to see how things are set up before the procedure (just observe), and then I can assist the next time around. But it's very hard if you have different preceptors every time! Don't get me wrong, I know it's inevitable to have the same preceptor every day, but your experience sounds like absolute chaos! If I were you, I would be looking around at other teaching or well-known hospitals in the area...Good luck with everything! Post a note on my profile wall if you need anything.

    Erika
  5. by   keepitreal
    Thanks for responding. I did talk to the educator when I met with her and the unit director. After one month I was told by them that I should be functioning independantly and that maybe I was not cut out for the OR. I told them that switching preceptors was not helping. And showed them that according to the outline of expectations I was give, I am on tract. The educator responded that is an outline she had to draw up. And that is all. Our total orientation is 9 months. Gen, GU, GYN, Ortho, Vascular, Plastics. I just am unsure how on day three of my new specialty I am expected to be proficient. I did meet with the educator again after this girl ran and told her I was doing terrible. And she said that reguardless of this being my third day, I should know what I am doing and be in charge of the room. On Friday my preceptor left the room because the case was one that I had seen before, and I did fine. It seems like if I ask for help, I get into trouble.Mngmt and the educator seem to have an idea that somehow, you should be able to run a room during a procedure, in a new specialty within a day..... But I am soooo stressed out. I work my tail off, walking on egg shells, because irreguardless of logic, its my fault. I have tried talking to the educator. I am the only one going through the orientation at this time. I have spoken with another fairly new nurse, and she said the same thing...they would call her in the office and tell her what a terrible job she is doing. My fear is are all OR's like this? Is all of nursing like this...or is this mentallity and complete lack of support isolated to where I am???
  6. by   Heogog53
    I think that your OR educator and management is NUTS to expect a new person to fully function after the third day in a specialty. I remember that after I got out of my internship, I saw a lot of cases I'd never seen before and either the scrub knew enough to share with me and the docs preference cards gave me some idea of what I needed to do, or I'd run to someone who knew this doc for more info about both the doc and the procedure.

    How many rooms is your OR? That can also make a difference in expectations, no matter how foolish they are. The larger to OR, the more complex the cases, the more new cutting edge technology, the more difficult it is for you to function as a new RN in that OR.

    If you are talking about a small OR that does lots of right colectomies, inguinal hernia repairs, and the like(just a general surgery example), you still need time to figure out your basics.

    One pc of advice that a lot of preceptors give is for you to still down and try to break a case down into what you need to do to start it, etc. I tell people that a case is like a ballet; you have the warm up(getting all your stuff checked, seeing your patient, making sure that you have everything you need, such as bovies, TV monitors, meds, etc), open and count(if time permits before the pt arrives).
    Once the patient is in the room, helping to get the pt on the OR bed, safety straps, SCD's for the legs, if y'all do a preinduction timoe out make sure everyine is in the room for it, assist with intubation, foleyize if needed, get the sterile stuff close to the bed, hook up equipment, bovie, suction, etc. And oc course, the pre-incision time out.

    THEN, once everone at the table is settled, and only then do you start charting.

    As they begin to close, you get dressing together, call report, count, call for the next patient, etc.

    End of case, help extubate, do dressings, move the pt to the gurney, finish charting and off to PACU.

    Clean up and start over.

    I think that none of your preceptors has helped you break down organizational needs, nor have they given you a heads up about how cases start, develop, and conclude.

    When I started out, just bringing up the tables, hooking up the boive, suction, remembering fluids and any meds was almost more than I could remember. I got freaked out easily and felt as if the whole world thought I was as stupid a person as they'd ever seen, fromnursing management on down.

    I do think that your management is unreasonable. There are a lot of much more reasonable IR's out there. Keep in mind that all ORs have their issues, that while not the same they are very similar.

    I think as it was mentioed before, that if they keep telling you that you're no good, it may be time to look elsewhere/



    If you do lots of the same cases, then grqab all the hernia mesh and as many sutures as you can that'll be needed for the day-boxes, as it were. Or if it's lumpectomies, thyroids, and the like, make sure you have a bucket load of hemoclips, speciment jars, mammogram containers, etc....
  7. by   Moogie
    I think you sound like an intelligent, conscientious nurse. You sound like you are cognizant of your learning needs and are asking appropriately for some guidance. You don't seem to be blaming anyone else for what's happening, nor do you seem to be wanting someone to hold your hand.

    However, from what you describe, I would be scared out of my mind to have surgery at your facility. I would not want an inexperienced OR nurse, still in orientation, taking care of me or anyone I love---unless that orientee had proper back-up. It doesn't sound like anyone is watching your back. This sounds like a disaster---or a lawsuit---waiting to happen.

    Don't want to sound like Ms. Doom and Gloom here, but it is your license---and your career---on the line.
  8. by   GadgetRN71
    Op, I'll be blunt. You need to RUN as fast as you can from this place. I'm one for sticking things out in most cases, but they are not training you properly. Like someone else said..it is your career and license on the line.

    Places like that make me so angry...it's a well known fact that there is a shortage of OR nurses yet they're going to use you as a scapegoat for their failings. And make no mistake, it is them failing..not you.

    First off, you should have an educator who has the trainees back, not someone who is going to kiss the butts of staff. They should try to keep you as much as possible with the same people. You should not be penalized for asking questions. IMO, the dangerous nurses are the ones who think they know everything. And of course, your preceptor has to act professionally, not like demon spawn.

    Is this a community hospital or a teaching facility? I ask this because sometimes, the smaller places don't have a standardized training program in place. You may have people there who have been there decades and still think that the way you train someone is by hazing them to death. Or people don't get preceptor pay for teaching, which makes them resentful. Often, these places don't get new grads all that often, so they forget what it was like. Of course, there are teaching places that are bad too and no place is perfect.
    But your OR is truly failing you bigtime. And that is just wrong.
  9. by   keepitreal
    There are about 16 ORs. And the scary part is it is a teaching hospital...When I interviewed I was told the training is 9 months and longer for some people and that if you need more time in a specialty, that will be granted. WRONG..I had asked and was told that they have to "justfy" my position to those people above...whom these people are I am not clear. Anyways after 2 months in general I have functioned independently on lap choles, banding, gastric bypass, colon resections,etc...But it was after 1 month in general that I was called into a meeting with the unit director and the educator,whom informed me I should be running the room, anticipating the needs of the team, and not allowing my preceptor to do anything. They made me sign a letter that by 2 weeks I will be doing these things...Or I am fired!On this new rotation I have been there, now 4 days...and was again reprimanded and told what a terrible job I am doing because I should by now, day 3 of my new specialty, again be functioning independently, running the room, prioritizing. The educator is not supportive, she has instead taken on a managerial position whom everytime she says " I want to talk to you" you shiver. In fact in the last "talk" she said this person, (see above about sutures), has never said anything bad about anyone and is one of their best preceptors. I say if thats the case, she should a) not send me in different directions and b) realize that on day 3 of a new specialty, no one is ready to run the room. Which makes me frustrated because I feel the educator is always criticizing, and intimidating by saying things like that...I found out that the other fairly new nurse said they did this to her, but with a different preceptor. I am concerned that this is their modus operundai. Some of the preceptors are great, great teachers and others are not, its kinda a mixed bag. But they do get paid preceptor pay. They get no formal training on precepting.
    Heogog...thanks for your outline...it is overwhelming sometimes. I understand the flow...but have trouble sometimes if for example the prefference card is missing things...or they have pulled the wrong case..obvious things I can pick up, but not so obvious....I am clueless.. I was utilizing the help of my scrub tech the other day because she does this specialty all day every day...and was told by the preceptor that I cannot rely on her, that I should do this on my own..So there I was day 3 into my new specialty and I cannot utilize my preceptor, or my scrub tech..and then I get told what a terrible job I am doing...I thought part of this is asking for help when you need it!
    I am incredibly afraid of something happening, with legal consequences. I am incredibly afraid of being fired because my educator is always telling me what a terrible job I am doing. I am afraid that this is me, am I an incedibly slow learner? O that this is nursing in the OR or nursing in gerneral...but you guys have really helped to show me, that perhaps it is not the OR, but more of where I am. I know the OR can be a tough place, but I feel completly alone because my educator does not support me, and managment does not support me. I am 100% open to constructive criticism from anyone but I feel here, they dont know what that is. Again every day I end up wondering, are they going to fire me? Is it like this everywhere? And as we women do so well, what is wrong with me?
  10. by   fracturenurse
    Geez...you are being bullied. Funny, I saw an article on bullying in the OR and I was interested because my internship was horrible as well. My preceptors were horrible and always yelling and trying to make me look stupid as well. The only thing I had going for me was our OR director was understanding and kept trying to stop it. Somehow, I completed my 6 month internship and got the heck out of there. (We weren't required to sign anything then).

    I'm sorry this is happening to you-I wish I knew exactly what to tell you but I don't. You probably should leave and find a job that is more healthy for you elsewhere. You can't go through that everyday. Is there someone above the director you can talk to? Maybe HR? I'd hate for nursing to lose a good OR nurse because of the idiots in this OR. Do you think you can survive the internship? Once you get off of it, things will change when you are on your own.

    I wish you lots of luck and please keep us updated.
  11. by   shodobe
    Yelling gets nothing accomplished. The problem I can see right away is the number of preceptors you have. All OR nurses have have the peculiar quirks, good or bad, and everything they say should be scrutinized closely. There a few people who say that I can be a bit soft when training people. I get my point across and that is whats important. Belittling and being downright mean accomplishes nothing. This is where the term, "eating the young" comes from and gives OR nurses a bad rep. 11 weeks is a bit short of being comfy. I know management wants people trained as quickly as possibe so you can be assigned a room, but at the risk to the patient and the mental anquish for the nurse. See if you can have just one seasoned preceptor for you circulating duties all the time. If you are to trained as a scrub then you will get different people, because of specialties, and will have to suck it up! Also, it isn't like this everywhere but is prevelant in a lot of hospitals, unfortunately.Good luck
  12. by   keepitreal
    I agree yelling gets you no where...I have one preceptor assigned to me for this specialty..and she said she thinks I am doing great, but she is on vacation. So my preceptor changes daily with whomever is assigned to this specialty. So the specialist in this rotation thinks I am doing fine, but the other one felt I should be running the room after 3 days...As does the educator, and management. I just dont know what is normal. Like I said this is my first job as a nurse therefore, I have nothing to compare it to...Which is why I reached out on here to talk to people in other ORs to find out what is normal...
    I think I definetly need to talk with someone concerning this...I am not sure what HR can do...And fracture nurse, I do feel that I am being bullied...I am not sure if I can make it another 6 months if its going to be like this. Dont get me wrong, I have had a few great preceptors. But when I get a bad one, and the educator and management don't even consider what I am saying, or better yet turn what I am saying against me, it is truly frustracting. I am seriously considering leaving...I would have been out of here after 30 days but my concern is how does this look on a resume? And more importantly, how do I ensure that this never happens again? Ask to shadow for a day? I mean this place made it sound like they were totally supportive, compasionate and had a great training program...maybe for the sadists
  13. by   loricatus
    Quote from keepitreal
    I have never had a complaint from a surgeon, or resident. In fact I have received compliments from some of the most difficult to please. I never heard good job when I receive compliments from surgeons, or when I caught my preceptor handing off an expired implant, or when anesthesia was about to administer a med the patients was allergic to. Being a patient advocate doesnt really seem to matter here. But you see a case for the first time in your life, and you actually want your preceptor to help you the first time...Holy Makeral, you have commited a crime and they are going to let you know what a terrible nurse you are.

    This is the key point of your post. You are a threat to those toxic employees & this is a prime example of eating the young. Do your time until you can find a job elsewhere as an experienced nurse & leave without looking back. Just ignore what they say and follow your gut where you are in your training. It helps to maintain sanity by remembering that you are only there to get what you can from them to use someplace else that will value you as an employee.
  14. by   shodobe
    You know, some places are just the wrong places. It doesn't mean you aren't a good nurse and could be a great OR nurse. There are those who do feel threatened for whatever reason. I am not sure why your manager is taking the opinion of just one of your preceptors. A total review by all of the preceptors is necessary for a complete evaluation, unless you really have screwed up somewhere. It doesn't sound like it at all. Attitude is a trait that all OR nurses possess. If you give the opinion that you are comfortable with all negative opinions from people then they will back down somewhat. You have to remember that OR nurses are the best in the hospital, IMHO, and some really take that as the gospel. They want you to reflect that in their training and feel if that doesn't happen then they look bad. Maybe this preceptor just doesn't like you for some reason. Is she old, craggy with a wart on her nose? Are you perky, bubbly and cute? Sometimes there just isn't an answer.

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