New to USA operating room

  1. Hi everyone,

    I'm new in USA, I been working in UK in the OR, I usually work in outpatient surgery where I was doing scrub and circulate in ophthalmic and ENT cases. Now I'm here in USA, they put me in main OR, which is 17 OR suites. I was so overwhelmed with the OR, as if it is my first time to work in OR. They have ortho, neuro, vascular, gen. surgery, cardiac, peds, cases. I am used to UK style where loads of nurses in the room to include also some orderlies. But here in USA, it's one scrub tech and one RN. And if the stuffs you need are not in the room either to call an orderly to get it or page overhead. I'm still on my orientation, could somebody give me advice as new in USA and new to main OR. I was thinking of transfering to ambulatory units but the experiece I'm getting in the main OR makes me a complete OR nurse. Only thing I"m scared to be alone in OR, my orientation will finish soon. What will I do? Is it all the same setting everywhere in USA?
    Is anybody here work from other country like UK then to USA? How would you compare the work?
    I'm so familiar with the instruments coz they do call different names from what I learned in UK. I got my book 'Instrumentation for oerating room". Any sugestion?? Especially the ortho cases I'm so confusion with the implants.
    Can somebody help me. I can not learn everything in just few months. Any websites about operating room. Your help is so much appreciated. Thanks a lot.
  2. Visit marie88 profile page

    About marie88

    Joined: May '07; Posts: 14

    14 Comments

  3. by   TracyB,RN
    Sounds like you might want to ask for a longer orientation... more time in each specialty.
    Can't help ya' with instruments... I never get to scrub.
  4. by   zuzi
    What would you like to know about ortho OR? Put your questions in order 1, 2, 3...and i will try to respond . Is OK , don't be so scarried....we could talk and to answer on all your ortho OR inquires!
    Hugs honey, keep going!
  5. by   marie88
    Quote from zuzi
    What would you like to know about ortho OR? Put your questions in order 1, 2, 3...and i will try to respond . Is OK , don't be so scarried....we could talk and to answer on all your ortho OR inquires!
    Hugs honey, keep going!
    Hi Zuzi,

    Thanks to your encouragement. I'm a bit confused with some of the srews and plates they are using in ortho. How do you differenciate which implants are you going to use for hands, feet, long bones etc? What about long intruments for laminectomy and retractors? What are the routine in ortho surg? What are the main intruments in ortho. They say it is easy in ortho, could please give me some tips as circulating. They are putting me everywhere in the OR. I'm a bit comportable in General surg and some laporoscopic surg.

    Thanks a lot.
  6. by   TracyB,RN
    Hopefully you have a great sterile processing department where you work, that properly labels such items. The surgeon will be deciding which specific items to use.. You just have to be ready & know where to find them. Lots of ortho specialty trays.. EXAMPLE: Distal radius locking plates & screws for an ORIF (open reduction internal fixation) of the distal radius

    Lots of plates & screws in ortho... Locking, non-locking, threaded, partially threaded, cancellous, cortical...

    Synthes has some GREAT INFO on their website (WITH PICTURES) that may be very helpful to you!!! Check it out...

    Get to know your surgeon's & their preferences.. Learn those cards.. They are there for a reason. Hopefully, your facility has them.

    As far as instruments go, think simple to complex depending on the case.
    You're going to open something, right? Knife handle, blade, tissue forceps, maybe some scissors. Depends on the surgeon. Each one may have his/her own "specialty trays" that only they use to operate with.
    We have a surgeon who has his own pelvic instrumentation, laminectomy instrumentation, etc.

    What exactly is confusing you about circulating ortho? Sometimes it's hard to keep track of what's going in & out of the patient, especially on a big case where lots of screws are being used. That's where it is up to you to PAY ATTENTION to what your scrub is doing & if you have to stand at the table to get your implants tracked, then you do that. As the circulator, you have to document all of those screws. Our tray lists come with a sheet that has every item inside the tray (2 copies one inside & one outside of tray). I started out using that to track what was going in & out.. Now, I'm so used to it, I usually don't need it, but am used to working with the same surgeon & am familiar with his ways. USUALLY. Can't ever be too comfortable, b/c that's when they're gonna throw something new at ya.

    Definitely go to the Synthes website. Spend lots of time there. You will NOT regret it. And if you do, I'll be really surprised. It helped alot when I first started ortho.

    They have neuro, ortho, and even trauma sections on the site, so check out EVERYTHING.
  7. by   zuzi
    i will tell you about trauma ortho:

    1. i had a lot of trays also specialized for each big type of surgery:
    -humerus
    -radius/cubitus
    -femur
    -tibia…..

    2. trauma is a plus, you could use more than usual trays…so be prepared to have more than usual instrumentations, some time you can use 2, 3 trays in the same time.

    3. plates and screws –special trays by categories as you know (locking, non-locking, threaded, partially threaded, cortical) and by numbers (also i am curios if the numbers are the same like in europe???). as soon you will see them one time and know for what are used, you will not them forgot ever!

    4. instruments: are a looooooooot, try to find an atlas for orthopedics, some time surgerons use special names (nick names for them), or could “spoil” them with diminutives, each surgeon with his preferences.

    some tips:

    -make yourself some cards with routines per general type of surgery: femur, humerus….
    - try to see asap what surgeries are scheduled for today and who the client is?
    - ask your self …..what wrong could be happened, just in case to be prepared!
    - be fast but sure by your self you are a rn be proud of that!
    - anticipated the surgery steps so be prepared for what will be next!
    - anticipated the client reactions in surgery time, be prepared!
    - anticipated the surgeon needs only in surgery time (loool) and be prepared!

    last but not least… control your self!
    hugs from an old orthotrauma or but young in her heart! :icon_hug:
  8. by   marie88
    Thanks to all of you:spin: , for encouragement. I usually take notes during surgery but sometimes it is always busy and I'm running out of time. Our surgeons preference is not as good as where I came from. I really love OR so I'm trying to learn as I can. My problem is I always getting different cases not what I used to do in the past. I think they want me to be jack of all trades, master of none. But I want to stick and specialize in one area, is it possible? what would you suggest?? any help and advice are acceptable.
  9. by   TracyB,RN
    If you're having trouble, be firm with the person that is coordinated your orientation. You really need to stand strong & demand (nicely) a longer orientation in the areas that you are not comfy with. Stand up for yourself & your future patients by telling your supervisors you need more time for all the other stuff (not the ears & eyes you are used to)
    I am lucky that I get to usually stick with one doc, one service (ortho). BUT, there are the days that I'm on call, or my surgeon isn't working, so you have to be familiar with everything.
    I'm wondering if Alexander's Care of the Patient in Surgery might be a helpful reference for you.
    OR, you could come to IL & I could refer you to my facility, I get a bonus, you get to work in eyes/ent because nobody wants to do it where I work... LOL
    Oooh, especially eye trauma.. Ikkky for most people.
    For me.. more trauma=more excitement
  10. by   marie88
    Thanks a lot Tracy. You are really lucky to stick in one Doc and one service. If I am like you I would be happy. I'm sure you master the ortho cases. Thanks for sharing the syntes web, it is very helpful. I find myself more comfy in gen. surgery although most of the surgeons are snob. Ortho surgeons are more friendly and approachable. It is a good experience though, to be in different cases. But I want something that I will enjoy doing. I have experience in OB-GYN FOR FIVE YEARS. Is there any hospital with separate OR for ob-gyn? Any new trends in ob-gyn? I was still thinking of going back to eyes and ent.

    I do have Alexander book and instrumentation.

    Tracy, any tips and advice on lami spinal fusion...

    Thanks a lot...

    Quote from TracyB,RN
    If you're having trouble, be firm with the person that is coordinated your orientation. You really need to stand strong & demand (nicely) a longer orientation in the areas that you are not comfy with. Stand up for yourself & your future patients by telling your supervisors you need more time for all the other stuff (not the ears & eyes you are used to)
    I am lucky that I get to usually stick with one doc, one service (ortho). BUT, there are the days that I'm on call, or my surgeon isn't working, so you have to be familiar with everything.
    I'm wondering if Alexander's Care of the Patient in Surgery might be a helpful reference for you.
    OR, you could come to IL & I could refer you to my facility, I get a bonus, you get to work in eyes/ent because nobody wants to do it where I work... LOL
    Oooh, especially eye trauma.. Ikkky for most people.
    For me.. more trauma=more excitement
  11. by   GadgetRN71
    Quote from marie88
    Thanks a lot Tracy. You are really lucky to stick in one Doc and one service. If I am like you I would be happy. I'm sure you master the ortho cases. Thanks for sharing the syntes web, it is very helpful. I find myself more comfy in gen. surgery although most of the surgeons are snob. Ortho surgeons are more friendly and approachable. It is a good experience though, to be in different cases. But I want something that I will enjoy doing. I have experience in OB-GYN FOR FIVE YEARS. Is there any hospital with separate OR for ob-gyn? Any new trends in ob-gyn? I was still thinking of going back to eyes and ent.

    I do have Alexander book and instrumentation.

    Tracy, any tips and advice on lami spinal fusion...

    Thanks a lot...
    There are hospitals that specialize in the care of women and babies. They do gyn surgery and maternity. Also, I agree with Tracy-be firm about what you need for training. Don't let them push you before you are ready.
  12. by   TracyB,RN
    Hmmm, I think Northwestern Memorial Hospital in Chicago has an OB/GYN surgery section for OR... Chicago nurses?? Am I right???
    I think their website is www.nmh.org but I'm not positive.

    As far as lami stuff, positioning is absolutely crucial. Do you guys use a Wilson frame or do you have a specialty table, like the Jackson table with a spine top? LOVE that table!!!

    Foley, padding, pillows for under knees, covers for the frame or the pads on the Jackson spine top... TEDS, SCD's,
    meds: thrombin kit, gel foam, powdered gel foam (our surgeon likes it mixed with thrombin)....

    One thing that might help you, is requesting a brief meeting with your surgeons... when you meet with them, have them LOOK at their preference card. Hand it to them & say "I'm trying to make BOTH of our jobs easier & need you to review this to make sure it has your requests correct." This has never failed me, as long as I have updated the requests.
    Try it... It just may work, but whatever you do, DON'T ever let the surgeon think you are nervous... Be confident & admit when you don't know something. Most surgeons are more happy to listen to themselves talk by teaching... so take advantage of the lesson & empower yourself by really HEARING what the surgeon is telling you, even if it is only for that surgeon's specific cases...


    lami spinal fusion.... had one myself not to long ago. Feeling the best I've felt in 3 years....
    Last edit by TracyB,RN on Jun 2, '07
  13. by   marie88
    Thanks a lot Tracy,

    We are using wilson frame and four post frame depends on the surgeons' preference. We use jackson table and the ordinary OR table depends on surgeon or pts wt. For positioning x3 pillows under shins, padding and scd.

    One more question about ortho. When/where, which case/ type of ortho surgery do you use the splint and the cast? so, that I can anticipate the needs. Thanks a lot...

    By the way I'm not in Chicago and in the west coast...

    Quote from TracyB,RN
    Hmmm, I think Northwestern Memorial Hospital in Chicago has an OB/GYN surgery section for OR... Chicago nurses?? Am I right???
    I think their website is www.nmh.org but I'm not positive.

    As far as lami stuff, positioning is absolutely crucial. Do you guys use a Wilson frame or do you have a specialty table, like the Jackson table with a spine top? LOVE that table!!!

    Foley, padding, pillows for under knees, covers for the frame or the pads on the Jackson spine top... TEDS, SCD's,
    meds: thrombin kit, gel foam, powdered gel foam (our surgeon likes it mixed with thrombin)....

    One thing that might help you, is requesting a brief meeting with your surgeons... when you meet with them, have them LOOK at their preference card. Hand it to them & say "I'm trying to make BOTH of our jobs easier & need you to review this to make sure it has your requests correct." This has never failed me, as long as I have updated the requests.
    Try it... It just may work, but whatever you do, DON'T ever let the surgeon think you are nervous... Be confident & admit when you don't know something. Most surgeons are more happy to listen to themselves talk by teaching... so take advantage of the lesson & empower yourself by really HEARING what the surgeon is telling you, even if it is only for that surgeon's specific cases...


    lami spinal fusion.... had one myself not to long ago. Feeling the best I've felt in 3 years....
  14. by   zuzi
    I don’t know in USA, but from are I am from, we used splint and cast for the most synthesis and realignment fractured bones with screws and plates, or only with Ender or Kuncher centromedular sticks or metal wires, for grafts surgeries…I don’t remember now many…they are a lot. Ask who will do the splinting or casting, do you have tech, how do you contact him, be prepared before! Or you will do by your self?
    Ask your self…”IF they will let this surgery without cast or splint or immobilization….COULD IT BE DAMAGE?” If the response will be YES, be sure that they can require a cast there.
    Oh Yes and ideea to talk with surgeron before the surgery is GREAT, ask about the surgery and what aditional material he need it, don't let him to see that you are scared (some of them could be little jerks) but in the same time be honest with you and with him if you don't know about, be professional, ask him what number of screws he want, if he need them (he can mesure aprox over the Rx) how many he belive that will need it, what other altenative of surgery he will consider if the main one could not be applied (from some resons)..be prepared for other altenatives, if he will use electric coagulation or prefer ligatures (prepare all), think and talk with him before surgery...is good! Be professional!

    Belive in your self...you are a good.. a good surgery ortho nurse! Zuzi hugs you!
    Last edit by zuzi on Jun 5, '07

close