New to the OR

Argo · May 15, 2010

set aside all of what you think you know about nursing during your precepting phase.....

pick up all the good traits from your preceptors and brush aside all the bad....

take it one day at a time and dont let the surgeons get to you right off the bat, they are like kids testing their parents or bullies trying other little kids, if you give them a good response that they are pushing for they will keep pushing....

dont be or get lazy, set your own room up, get your own stuff ready, be prepared for YOUR cases, dont expect anyone else to do it for you but help all that you can once you are ready....

if you have multiple, similar cases in the same room all day, and size of the room permits, set up for the biggest case of the day so your turnovers arent so difficult....

be fast, efficient and safe... yes that is very possible

dont ever trust anyone else to check your patients consents and/or other paperwork that is NEEDED to proceed safely and legally, it is your license and your patient......

learn as much about everything as you can, instruments, equipment, anesthesia, blah blah blah. it will make you a much better nurse.....

good luck

katOR · May 15, 2010

I started as a new grad in the OR in January and the best advice I can give to you is to keep a small notebook with you and write down surgeon preferences for certain procedures, glove sizes, drugs, etc. The preference cards aren't always that up to date where I work so my "go to book" has been beyond valuable. Also, take time to learn your instruments and where they are stored! You'll need to know what you are looking for when your tech or scrub RN asks you for a certain instrument and if your facility is anything like mine, there isn't always someone to get it or help you find it. Good luck in the OR. I'm sure you'll love it! It's a GREAT place to work.

RogueRN · May 16, 2010

Great advice so far...

I would like to suggest getting into a ROUTINE so you don't miss anything. For example, when I'm circulating this is how my day goes:

1) Check my assignment

2) Get morning report

3) Look at the cases for the day, and if applicable, highlight which pts have right or left side sites mentioned (especially in ortho, etc. - so you pay attention to correct site)

4) Go to my room and check the following: Bed (correct one? is it locked?), Positioning Equipment (correct? do I need more/less?), Suction (cannisters present? suction working?), Implants (are they available?)

5) Depending on your hospital, I check and see what drugs I need if pharmacy doesn't already have them ready

6) Check to see if other necessary folks are present: sales rep (esp in ortho/neuro), nerve monitoring (for spine surgeries), cell saver tech, etc.

7) Help my scrub tech/nurse open and help facilitate getting the appropriate instrumentation

I have a routine for when I pick up my patient as well...

1) Review the chart

-Consent - Correct procedure? Is it signed by pt, witness, surgeon, and anesthesiologist?

-History & Physical (depending on hospital policy, it's good for 30 days in most)

-Labs (check Hemoglobin/Hematocrit, electrolytes, wbc's, etc. - anything abnormal?)

-Current EKG

-Orders from surgeon's office

-Medical clearance (if necessary)

2) Interview pt

-Introduction

-Check name band, confirm date of birth

-What procedure are you having done?

-When was last time you had something to eat or drink?

-Any allergies?

-Do you have contacts, glasses, or jewelry on?

-Any metal on your body from hip/knee replacement/broken bones (if applicable)?

-Health history review (history of seizures? breathing problems? heart problems? high blood pressure? diabetes? GI issues like acid reflux?)

-Medications?

-Surgical history

-Any questions?

3) Explanations/providing comfort

-Talk through everything with a pt and their family - they appreciate that!

-"Keep your hands and arms inside the vehicle at all times... We'll be going through some narrow hallways."

-"It's cold in the room but I will get you warm blankets."

-"You might see a lot of people in the room; we're all there to take care of you."

-"I'll be right next to you as you're falling asleep."

Those are just a couple of examples. Hope that helps!

Risgirl · May 17, 2010

Rogue RN - you are awesome!! I'm keeping your post in my notes so if I ever get into the OR I'm prepared. Thanks for offering your advice to all of us OR hopefuls! :yeah:

Mr. & Mrs. RN · May 17, 2010

There we go, I fixed it. I had to copy and paste the word document into paint, save as a picture, upload it on tinypic.com, and then post it on here, haha. Much better though

Mr. & Mrs. RN · May 17, 2010

Oh geese, that did not publish the way in looked in the box...sorry

Mr. & Mrs. RN · May 17, 2010

divokevan · May 19, 2010

Hey! Congrats on the new position!

Anyways, I just got hired in an OR 3 months ago. I would agree that you need to make a routine especially at first when you feel very task oriented as I do now. There is less chance to mess up this way. I made a little acronym for the beginning of the case to remember everything (its dumb but helpful)

S - apply your scd's and turn them on

I - Induction help

F- Foley insertion

B- Apply the bovie

P- Position

P- Prep

Every day I would be like running through these things... "okay, I'm on F and next I'll be on B". It sounds funny but it helped me learn the basics.

Soon, you will get that down and be where I am... just trying to figure out the equipment differences and what's needed for various cases and incoorperating charting! Ugh... what a headache! Especially when you have to deal with crazy scrub techs that want to do things only when they want to do them even if you have to prioritize your patient. (Sorry just had a bad day!)

Let us know how its going!