Newbie OR Nurse

[LJOHRrn]

I'm currently in week 9 of 12 of orientation as a new OR nurse in General Surgery (vascular, robotics, gyne, breast, GI, bariatrics). I more than love this new job, and while the friction is unpleasant as hell, I know it's making me a stronger nurse, woman, and person.

But...

This week my preceptor has been on "Hall Monitor Status" meaning she sits outside the OR to give me a feel for being the only nurse in the room, but she comes in to help/takes over when needed. The only time I feel ok and comfortable right now is with lap choles and some longer cases where I have time to think and process what I need to do.

The faster and bigger cases (Gyne, wound debridement, colon resections, etc) I get so flustered to the point that I just get lost and have NO IDEA what the heck to do.

I struggle with most of the instruments and knowing what to get when the surgeon/techs asks for them. Didn't know they called fog a Fred until this week.

I get flustered with knowing the equipment, how to connect it, how to position it in relation to the sterile field.

I get flustered when my lack of (but growing knowledge) holds up the room, especially in emergent cases and situations. I feel ineffective and like the kid sister your mom makes you take with you to the playground so you can hang out with your friends.

I was a nurse for 7 years prior in long-term care and was a big fish in a little pond. Now I'm a tiny fish in the ocean, and I'm not doing so great with not knowing anything, or that I can be an effective part of the team delivering patient care.

I know it will take time to learn and anticipate what will be needed so I can organize the room and improve the flow of the case...

But I don't have time to do that with my orientation ending in 3ish weeks. I know I will never be alone and that help is an overhead page away, but I don't feel like I'm going to be ready in 3ish weeks. I feel like I am more of a liability than a resource at this point even with three more weeks to go. My educators would be flexible with my orientation and add another week if needed, but I'm not sure that will be enough. I've posted on here before and other, more seasoned OR nurses/techs have stated orientation needs to be at least 6-9 months due to OR nursing being so specialized, but that's unrealistic.

What do I do. How do I cope with this. I'm not quitting or giving up but I get tired of crying in what is now my favorite bathroom stall on lunch breaks.

[Rose_Queen, BSN, MSN, RN]

Why are you only getting 12 weeks of orientation as someone new to the specialty? That raises a red flag to me.

Have you reached out to your educator and manager about extending your orientation?

[springchick1, ADN, RN]

12 weeks isn't long enough for someone new to the OR to learn everything. A good orientation should take 6 months minimum. Like rose said, speak to your educator (if there is one).

[Kliska]

I do agree with the previous posts, its sounds like some longer orientation is needed and thats ok! I was lucky enough to start my career in the OR in an environment that allowed me about a 6 month orientation, which I definitely needed.

In the mean time, some small pointers that helped me when I first started and was feeling oh so overwhelmed:

The computer charting can wait. Focus on the case and if you fall behind in your charting you can always catch up during turnover.

Know that most of the equipment is designed so that you can really only hook it up correctly one way. In other words, it will only fit in the hole if you're plugging it in correct, so just keep trying until it goes in.

Lean on your scrub! At the beginning of the case, aside from checking your dpc, keep asking your scrub what's missing. "What else could the surgeon possibly need? Can you think of anything else we might use? If this goes bad, whats the first thing you're going to need?"

If you have any free time, ask your preceptor to take you on a tour of the supply room to point out any highlights they can think of and take notes if you need to.

Know that you WILL get it, but it takes time. If you're in a position that doesn't feel like its safe to you, you must speak up. These patients are depending on you during their most vulnerable time and if that means you have to demand a few more weeks of orientation, it's worth it.

Keep your chin up! It gets better!

[NurseDusty]

I started in the OR in January after working 8 years in other areas and now I finally feel more comfortable. I don't know everything but that is ok. It takes time and really what helped me in the OR the most is taking extremely good notes. In my previous jobs I could come to work and know what to expect.

Now, working with different doctors/ set ups I have all of my notes on hand because it is a lot to remember. Ask for a longer orientation and tell them you really don't feel comfortable yet.

[Froggybelly]

Why are you only getting 12 weeks of orientation as someone new to the specialty? That raises a red flag to me.

We only offer a 16-week internship for new circulators, regardless of prior experience. The 6-9 month ideal is few and far between in my metropolis.

[guest655229]

We get 10 weeks of rotating though each service. Then we get roughly 3 months of orientation once we're assigned a team. If you have any previous experience at all you get pulled off sooner. They say orientation can be extended if need be. We are required to pass AORN's Peri-op 101 to stay but they allow an unspecified number of attempts to pass. This is a level I, world renowned trauma/transplant center that does over 100 cases a day not including CVOR. Fast paced, high acuity with over 350 RN's on staff.

[LAM2010, BSN]

It will get better. 12 weeks is not enough time to feel 100% proficient. If you know your way around the O.R. and everyone's names, you're set! (Sort of, haha. You know where to go for help). The rest comes with time. Even 6 to 9 months isn't long enough to feel like you got this. It took me over a year. They SAID I'd get 6 to 9 months orientation but really, they threw me to the wolves after 6 weeks. Sometimes I still feel like a baby nurse and I've been doing it for 8 years. You get to a point where you can wing anything and if you don't know what an instrument is, they'll just have to deal with a 12-second delay, the poor babies....