Tips for New Operating Room Nurses
Transitioning into the role of an Operating Room (OR) nurse, whether a new grad or an experienced nurse changing specialties, can be overwhelming. Sometimes, those nurses wonder if they made the right decision in accepting the job. Here are a few tips that can help make that transition smoother.
Welcome to the world of OR nursing! Now sit down, buckle up, and hold on (Tips for new OR nurses)
So, you were offered that coveted OR position and accepted. Now, you're wondering just what it is you've gotten yourself into, or maybe you're a few days or weeks into your orientation and feeling overwhelmed. Well, here's a few tips to help you get started on your new career as an OR nurse.
Understand that OR nursing is different from any other specialty of nursing you may have been exposed to in nursing school or in your career as a nurse. As such, it is going to take time to get comfortable. Many will say that it takes at least a year to start feeling competent and confident in your abilities. Don't expect yourself to get everything right off the bat- it's going to take time and there is a steep learning curve.
Understand that there are going to be good days and bad days. Don't be too hard on yourself if you have a bad day- we've all had them, and even still occasionally have them as experienced nurses. The bad days might be those where your patient doesn't make it off the table or those where just when it felt like everything was clicking, it all feels like your first day again. Even experienced nurses have those kinds of day: new equipment is purchased, new procedures are developed, and we have to learn from point zero how use/do everything.
It's okay to feel overwhelmed. You've got a lot to learn, and it probably feels like too much at once. One of the tricks that helped me was to break the learning into chunks: spend a certain amount of time focusing on learning how to set up rooms and get them ready for the case. Then moving on to focusing on prepping and positioning. Some time spent focusing on implants. Another few days spent focusing on circulating while my preceptor did the documentation. Then, focusing on documentation. Finally, putting it all together and functioning as the primary circulator. Breaking it up into chunks made the learning seem much more manageable, easier to retain, and less intimidating. Find what works for you, present it to your preceptor, and go from there.
Depending on how your orientation is set up, you may work with one preceptor per specialty or a different preceptor every day. Both have arrangements have good points and bad points. Working with one preceptor helps with consistency, both in what you are learning from them and ability to provide thorough feedback. However, working with multiple preceptors allows you to see more than one person's routine and figure out which one (or parts of both) works best for you.
Feedback is important. So is goal setting. For each week of your orientation, set yourself a goal. Work with your preceptor in meeting that goal. If it's required, get written feedback on a weekly basis (or as the requirements state). Get verbal feedback daily from your preceptor. What did you feel you did well vs. what you need to work on as well as what did you preceptor think you did well and what could be improved.
Preference cards are your friends. If you are able to find out the day before what cases and surgeons you will be assigned to, try to get copies of the preference cards ahead of time. Yes, this will involve some work on your end during non-work time, but it will make the following day go much smoother. The preference card will have information such as positioning, equipment needed, prepping, etc. This can help you walk into your shift knowing what you need to start your day and assist with time management.
Keep a small, pocket-sized notebook handy to write down useful/important information. My notebook for my current position (that I have so well memorized that I don't actually carry it around with me anymore) has a list of important phone numbers such as blood bank, PACU, service line coordinators, charge anesthesiologist, and so on. It also has a cheat sheet for how to order blood products and intraop lab tests. And then there is a section for each surgeon I work with where I can write down little idiosyncrasies: preferred radio stations and things like that that wouldn't appear on the preference cards.
There are a lot of instruments and sutures used in surgery. You may want to look into some books, websites, or apps that have images of instruments, what they are used for, and any alternative names. It can be confusing when someone asks you for a kocher clamp when everyone else calls it an oschner. Yep, 2 names for the same instrument- and that doesn't include surgeon pet names. You may even find it helpful to spend a day assembling instrument sets in the sterile processing department to learn what instruments are called and which ones are in which set.
Understand that when someone goes off, it's almost always at the situation and not directed at a single person. Surgery is routine to us, but it can still go real bad real quick. It's not uncommon to see a surgeon suddenly start using some impolite language (we have a few that could make a sailor/truck driver blush). Now, throwing instruments and directing personal tirades at staff is not okay, and a good management team will support their staff and ensure corrective action.
These are some of the tips that have worked for me throughout my OR career, which has included some specialty team changes from general/vascular to neuro to a hodgepodge of everything and on into cardiac. Hopefully you will find them helpful and others will add tips of their own to the list.
Best wishes as you embark on the next phase of your nursing career as an OR nurse!Last edit by Joe V on Jun 14, '18
About Rose_Queen, MSN, RN Guide
Rose_Queen started her nursing career over a decade ago in the OR as a new grad. She has experience in multiple surgical specialties and currently works in cardiothoracic surgery.
Joined: Mar '06; Posts: 14,253; Likes: 30,721Jul 29, '15Thanks for the article. I'm starting a new grad OR fellowship in less than a week. I'm SO nervous.Jul 29, '15The timing on this article could not have been more perfect. I've been a nurse for almost 20 years (ICU/ER/Trauma) and am recently 5 months into my new cath lab/IR position and I am seriously doubting my decision to transfer. I was at the top of my game as a Trauma nurse ...I am a TNCC instructor, I lecture and teach medical students & resident physicians, and I precept paramedic interns & new grad nurses. My colleagues often commented on my expert skills, but suddenly I am feeling as if I made the wrong decision entirely b/c I feel like I know absolutely nothing. My facility has a cath lab/IR that has several different specialties (IR, Neuro, Vascular, Pediatric EP, Adult EP, cardiology) and I would be a better nurse if I could stay and learn all that I can, but its been a very rough road and I am thinking long and hard about transferring out. Its not in my personality to quit when things get rough, but this has been more than I had ever bargained for.
To make matters worse, the staff I work with is hostile and the bullying is well into full force (which is unexpected b/c I work at a very well known teaching facility) and there are days when I go home feeling like the worst person in the world. It's safe to say I am being hazed and bullied and I am not the only one who has suffered the same as I know other excellent nurses have left for the same reason. I come home angry, bitter, and worn down. My health has deteriorated and I'm beginning to wonder if its worth it all to stay and endure a job that makes me so miserable. My supervisor has been very supportive and is well aware of the difficulties in such a transition, as well as the well known bullying atmosphere, but she is limited in what she can do b/c no one else will come forward and complain.
If anyone else has had the same experience or has any advice or feedback I would sincerely appreciate it.Jul 30, '15Thank you Rose_Queen for writing this article. It helps me to mentally prepare for my up coming OR training.
Now I am doing the Peri-op 101 class and it is making me feeling overwhelm already.
There's so much to learn as an OR nurse.Jul 31, '15Rose_Queen, you seem like a mentor here in the operating room section, and I appreciate it very much. I have been in orientation, classroom-like learning for the past 3 weeks and this coming Monday, I will be scrubbing in for the first time in colorectal cases. I am very nervous but again, thanks for all your help.Aug 1, '15Operating Room nursing can be overwhelming even for a seasoned OR nurse. Find an approachable colleague that you feel comfortable confiding your distress and questions to b/c they will be a valuable resource to your enthusiasm to see it through your training. Even after 10 years and 12 ORs later (I was a travel OR nurse for half of my OR experience) I am constantly learning. It's also okay if you find that it isn't right for you whereas ICU was a great addition to my RN experience, but I just knew there was no niche there for me. Be kind to yourself and know OR staff is a tough crowd but some are tougher than others. One thing to keep in mind is a Lap Chole, is a Lap Chole whether you are in Florida or California. Most patient positions are the same as well although surgeon preference for positioning devices will differ. It's tough learning every position, machine and utensil however, if you stay in one OR you will remember the surgeon's preferences so well you will come to a point that you have memorized the pick ticket. The pick ticket/preference card is your key to a successful surgery (and running shoes)!!!Aug 1, '15Still a student and have not chosen a focus area yet, but have loved all my OR observation experiences. OR nurses as a group seem to be excellent teachers. Thank you for these tipsAug 1, '15These are excellent tips, Rose_Queen! I've been an OR nurse for 33 years & will agree, those of us who are well-seasoned are sometimes tough on newbies, but remember: it's a very fast-paced, stressful place. Surgeons' tempers run high, & it trickles down onto us, then to you folks! But again - do NOT take it personally! 30 years ago, I was in YOUR shoes being chided by a grumpy RN! Just keep your cool, & chalk it up to experience. And yes, keep a small notebook in your pocket always! Take lots of notes: anything that helps you remember things, like important phone numbers (charge nurses, OR aides, front desk, lab, pharmacy, etc), quirks of certain docs, special equipment needs, anything that you think is useful information! Try making a copy of the preference cards for cases you will be responsible for the next day, & study them well! Just know that NONE of us know EVERY THING in the OR. It's always changing with new technological advances. Make it a point to learn which of us specialize in what services; keep our phone numbers handy too. Don't ever be afraid to ask go help, whether it's about dome instruments/equipment, procedures, positioning, medications, etc. I'm in Neuro: call me if you need help, even if in @ home! After about a year, you'll feel more comfortable if you just give yourself time, & communicate! In another 5 years, YOU may mentor a nurse who is new to the OR! Welcome to our world!Aug 2, '15Good luck to those of you going into a peri-op 101 course. I loved mine, it came very easy to me. The nurses weren't always nice or helpful but the ones that were made my experience better.
I have been an O.R. nurse now for 10 years, that's hard to believe! No matter what path you choose in Nursing, there are going to be speed bumps, challenges, unruly physicians, and "mean girls".
In my personal opinion, new graduates should not go directly into a peri-op 101 course. Why you ask, once you get in the operating room, that's all you know. The skills you learned in nursing school aren't utilized as much. You may put in 100 Foley catheters in a year but you will lose other valuable skills. Many O.R. nurses lose the ability to perform an assessment. Many no longer know the medication names or classes and why their patient is taking them. Some are so focused on computer documentation that they forget everything else.
I came to the operating room after 6 years of med-surg nursing. That helped me tremendously. I know what those patients experienced post-op, this made me a better OR nurse. In polling my colleagues that worked in other places and those that only did OR nursing, I found that the "team" part of nursing is more prevalent in those with floor experience. They have no problem asking for help. That's the culture of floor nursing. The peri-op nurse is is used to 1 patient at a time. 1 room, 1 CRNA, 1 MD, 1 assistant or PA. It's a great scenario, she or he is in charge of their room, the focus is only the case they are working on. Over time they get into a routine and for some, if someone puts an orientee with them, their entire day is ruined.
I am not discouraging new grads but think about it, long and hard. I went from med-surg, to O.R., to teaching. I still do O.R. Nursing part-time but the clinical skills I used, in med-surg, help me in the clinical setting with my students. If I had gone from school to the O.R., I probably would not have gotten this job. I would have had no hands on patient care except for in school, which we all know is limited.
Think about your future, if the O.R. is where you want to be for a long time, go for it. If you are unsure, those positions will always be available. Make yourself more marketable and try other areas 1st. You will be glad that you did.Aug 3, '15Kimlilly07, you stated: It's tough learning every position, machine and utensil however, if you stay in one OR you will remember the surgeon's preferences so well you will come to a point that you have memorized the pick ticket. The pick ticket/preference card is your key to a successful surgery (and running shoes)!!![/QUOTE]
I just wanted to comment on your suggestion that says the new OR Nurse should stay in one OR. The theory being that by working with the same surgeons, & always/often doing the same types of surgery, you only have to learn those particular surgeons & what they like & do. I'm not sure where you work, but in both medical centers I've worked in, we had to take call, even with routine night shift staffing; & we had to take weekend call even with a dedicated weekend staff. Emergencies happen, often while the regular staff is already operating. With that in mind, the potential exists that you may be required to do many different types of surgery, with many different types of surgeons!!! Therefore I would discourage anyone from simply staying in one room because it's easier to learn a few procedures done by the same surgeons repeatedly. If you'll be taking call, you need to be familiar with many, many types of surgeries, services, & surgeons, as well as a lot of instruments & equipment (or as you said above, many machines & utensils). I've been an OR Nurse for 33 years. I specialize in Neurosurgery, however, having worked in an Orthopedic surgery center for 7 years, I also do a day or two in Ortho. I've done practically everything except open heart. I can circulate & scrub just about anything, & was evening shift charge nurse in a busy medical center for 10 years, so dealing with emergencies helped me hone my organizational skills, plus learn to prioritize, gather any instruments & equipment which will be used as all as those that may potentially be used. I always keep a cart outside of the sterile core door into my OR with all of the possible instrument sets/equipment "just in case...." So don't try to limit yourself just because it's less to learn; instead, tell your charge nurse (or OR Nurse educator who may be orienting you) that you need to get into as many types of cases as you can, in order to be able to perform your job in the highest standard. You'll feel more confident & in control when on call or working an "off" shift. Plus, in the long haul, if you relocate & need to apply for a new job, having a diverse knowledge of all types of procedures & keeping up with new equipment will make you more marketable (especially having an edge over less experience nurses). Good luck to you!!!Last edit by Spiker on Aug 3, '15 : Reason: spelling
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