OR nurse internship program

WhoDatWhoDare, BSN, RN · Jun 24, 2016

Good luck with this exciting opportunity.

I would encourage you to read some of the various posts here to get some pointers on how to adjust to the new role and what to expect. I'm sure you've heard lots of positive AND negatives on working in the OR, but be assured that it IS still nursing, just different from what you've been doing for the last 7 years.

Feel free to ask questions here, there are some amazing contributors here, e.g. Rose Queen.

-WhoDatWhoDare

Editorial Team / Admin · Jun 25, 2016

Welcome to our little corner of the world! I highly recommend you read my article Welcome to the World of OR Nursing, which can be found under the Articles tab on the OR forum homepage. Lots of tips there from me and many other posters. Take what works for you, find your own tips, and feel free to share those tips as you start on this next chapter of your nursing career.

Feel free to ask questions here, there are some amazing contributors here, e.g. Rose Queen.
-WhoDatWhoDare

Well, shucks, you sure do know how to make a girl blush.

SQueenRN, BSN · Jun 26, 2016

I've already read them! :up: Lots of good information.

littlemango · Jun 27, 2016

Hello!

WhoDatWhoDare and Rose_Queen, in your experience seeing new OR nurses being oriented, what seems to be the average amount of time a new OR nurse becomes accustomed to and more comfortable in the OR? I have been told the more orientation, the better... but I am assuming the orientation depends on the nurse.

Also, what is your opinion of new grads entering the OR? There is a possibility that I will be interviewing for an OR position in the future. Any tips on what I should emphasize during the interview?

WhoDatWhoDare, BSN, RN · Jun 27, 2016

what seems to be the average amount of time a new OR nurse becomes accustomed to and more comfortable in the OR? I have been told the more orientation, the better... but I am assuming the orientation depends on the nurse.

I can only say based on my own experience, but for me, it was literally around the 1 year mark that I felt competent to not freak out every day... That's not to say I feel like an expert. I still feel as I have sooooo much to learn, and isn't that just our way as nurses? Lifelong learners?

Also, what is your opinion of new grads entering the OR? There is a possibility that I will be interviewing for an OR position in the future. Any tips on what I should emphasize during the interview?

I am sorta biased on this... I started out in the OR. Many other OR RNs are the same... But there are many who have worked in other areas before coming to the OR. I don't think this really matters, as long as the person has the right attitude, is willing to step out of their comfort zone, puts the patient first, and willing to learn. I've precepted new RNs who left the OR after just a couple months because it wasn't what they expected, or couldn't handle the stresses, or any number of reasons... But I still remember the RN who came to us from the ICU with 10 years of experience, and even though I had high hopes for him, he left because in his words he couldn't get out of the ICU mindset. I don't want to come across as the preceptor who caused many RNs to leave the OR... I promise I haven't... lol... I was only 1 of many preceptors that these nurses had.

As for tips regarding what to emphasize, I would think that you would want to provide an example of a recent conflict that you were involved in and how you resolved it. Maybe discuss how you handle/react to stress. It might be helpful to ask questions about what to expect in the training you'll potentially receive and what the interviewers think are strengths of their current team members and what they are lacking... discuss how you could bring those lacking strengths to the team (if you can).

Good luck,

-WhoDatWhoDare

TL/DR....

littlemango · Jun 27, 2016

Hi, WhoDatWhoDare! Thanks for the interview advice! Also...

...that I felt competent to not freak out every day...

I'm glad you understood what I meant! :shy:

I spoke to the clinical nurse educator at the hospital I am attending for clinical, and she said the same about having the right attitude for learning in the OR. I've observed about five procedures (peds, OB, vascular) and there is certainly a large amount of information to learn... so I can see where learning new material can be hard for those who have experience working floors. That is part of the reason why I'd like to start my career in the OR right out of nursing school. Hopefully my memorization skills will come in handy!

Thanks again!

WhoDatWhoDare, BSN, RN · Jun 27, 2016

Hopefully my memorization skills will come in handy!

Memorization is a great skill to have, but learn to continue developing your critical thinking skills.... that skill will serve you better than just memorization... It's not something you have 100% starting out... It takes time to look at the booked case and decide what equipment you'll need, to look at a patient's lab value and determine you might need to anticipate having blood during the case and then asking the doc whether they want some in the room so you can order it and making sure preop does a type and screen.

-WhoDatWhoDare

littlemango · Jun 27, 2016

It's not something you have 100% starting out... It takes time to look at the booked case and decide what equipment you'll need, to look at a patient's lab value and determine you might need to anticipate having blood during the case and then asking the doc whether they want some in the room so you can order it and making sure preop does a type and screen.

Understood. I hope the year's time in orientation will help me with this. (If I get the position!) :x3:

Regarding booked cases, how early in advance are you able to view them? Per recommendation from one of the threads here on allnurses, I bought Maxine Goldman's Pocket Guide to the Operating Room, 3rd Edition in hopes that it will help me to review cases prior to receiving the patient the day of surgery. I expect there to be hours of studying after each workday as well, and I'm sure this guide will help me. I love it because it is so easy to read, even for a newbie like me.

However, I was speaking with my periop professor about the book, and with the guide being from 2008... we were wondering if there was a more recent alternative, if you, Rose_Queen, or any seasoned OR nurse can suggest any?

Editorial Team / Admin · Jun 27, 2016

hellomango, the typical thorough orientation for an OR nurse should be at least 6 months. Are there some who are ready to be more independent earlier? Absolutely. Are there those who need the full 6 months and sometimes more? You betcha. A structured orientation program seems to serve orientees much better.

When I started at my facility, we did the AORN Periop101 program. We seldom had any nurses chose to leave within the first 2 years. Of the 2 who did, one decided OR nursing was not for her and the other needed to move away from an abusive ex-husband. However, we then stopped doing Periop101 and went to a program the facility developed. It was nowhere near as effective and we lost over 50% of the nurses who completed it. We've since gone back to Periop101 and have greatly improved our retention.

As for new grads, I personally prefer new grads to nurses coming from elsewhere. Fewer bad habits that we needed to break and easier to mold into what we, as a department, wanted to see in our nurses. We've just had better luck with the new grads in my facility. Many of the experienced nurses coming from other units ended up leaving to go back to those units. The ones who stayed the longest are the ones who entered the OR as a new grad... including yours truly.

It truly does take at least a year to feel comfortable and competent in the OR. And if you change specialties like I have, you'll get to experience that fish out of water feeling again! Although with the new specialty, it didn't take quite as long since I already had the basics down.

Ability to view cases that are scheduled ahead of time, that can vary on the facility, its booking policies, and the surgeons who operate. Generally, our elective surgical schedule is pretty set the day before, with the exception of our cardiac surgery schedule due to the need to sometimes bump an elective for an urgent in house patient. When I was in orientation, the assignments for the next day would be posted around lunch time, with a copy of the schedule with it (in a locked, badge-entry only break room, so no HIPAA violation). Sure, it might change a bit, but it gave people a pretty good idea of what cases they'd be involved in the next day.

Books. Boy, do they outdate quickly! The guide you picked up, if it's from 2008, it's likely going to be missing a lot of the new advances in surgery, such as robotics, newly developed minimally invasive surgery (did you know heart valves can be implanted without opening the chest now?), and things like that. The so-called "OR Bible" is Alexander's Care of the Patient in Surgery. It's big, it's dry, but it covers a heck of a lot. If you're going to be scrubbing as well as circulating, you might want to check out some of the books used in surgical technology.

littlemango · Jun 27, 2016

Rose_Queen, thank you for responding!

At the teaching hospital I am hoping to interview for, I was told by one of the circulating nurses that orientees go through all of the specialties for the first three months, and following this, are able to select a specialty they are interested in and continue their orientation there. Is this the same at your facility?

Also, do you find that new grads that go through PeriOp101 find the material easy to understand with little nursing experience? What is the format like? So far in my periop elective course, the information is coming naturally to me- very easy to understand however there is a tremendous amount of information. It really is the basics, but I'm sure learning through this elective course will help me in the long run.

I've heard of Alexander's from my professors and saw it on the AORN's online bookstore, so I will see to it that I will have it in my hands before interviewing. I'd like to impress the clinical educator and OR manager, and I'm sure having a basic knowledge of the major surgeries will help me in accomplishing this. I'm sure they will expect that I won't know everything, as I am still very, very new to perioperative nursing. (I also am a student member of AORN and have been receiving their journals through the mail, so I've been keeping myself updated with some of the articles so I can possibly mention them.) I've also bought a surgical technology book from my local community college that explains (with pictures) the basics on aseptic technique, scrubbing in, and specimen collection to mention a few. I've been reviewing it here and there, as I hope to scrub in the event that surgical techs are short.

At this time, I am between the idea of starting in the OR or starting on the medsurg floor I currently work in at the same hospital. Some OR nurses I've spoken to that started in other specialties have told me to start on the floor first in order to develop the organizational skills. Others have told me to start in the OR. I've been unsure as to whose advice to listen to, but I am happy you, Rose_Queen, and WhoDatWhoDare have given me insight as to what practicing OR nurses' perceptions of new grads are, and now I am hoping that the interview with the OR at this hospital will go through successfully. The current program I am hoping to interview for is for graduating seniors in nursing school who would like to have practicum there, but in return must sign a contract to stay on the unit for 2 years following graduation. I was told that I am possibly the only one hoping to end up in the OR for this cycle, and I'd like to take this opportunity to start gaining experience as soon as possible.

I'm very passionate about this specialty! If I am able to get in, I don't see myself changing specialties in the future. :)

Editorial Team / Admin · Jun 28, 2016

Rose_Queen, thank you for responding!
At the teaching hospital I am hoping to interview for, I was told by one of the circulating nurses that orientees go through all of the specialties for the first three months, and following this, are able to select a specialty they are interested in and continue their orientation there. Is this the same at your facility?

Nope, in my facility the only specialty that is truly separate is cardiac. The orientees rotate through all specialties for the full 6 months, then have 3 months solo where an experienced nurse is available for up to 3 orientees at a time as a resource. While they may spend the majority of their scheduled shifts working in 1 or 2 specialties, we do not cover specialty call and those on call are expected to be able to do anything that rolls through the doors (with the exception of cardiac because we cover our own call).

Also, do you find that new grads that go through PeriOp101 find the material easy to understand with little nursing experience? What is the format like? So far in my periop elective course, the information is coming naturally to me- very easy to understand however there is a tremendous amount of information. It really is the basics, but I'm sure learning through this elective course will help me in the long run.

We have some pretty awesome department educators who have actually spent time in the OR nurse role. The current format of Periop101 is online modules; I'm probably dating myself here, but when I took it, the format was PowerPoint slides. Between the educators, the mix of classroom time and hands on time that allows them to put things together, most orientees have no trouble grasping the information.

At this time, I am between the idea of starting in the OR or starting on the medsurg floor I currently work in at the same hospital. Some OR nurses I've spoken to that started in other specialties have told me to start on the floor first in order to develop the organizational skills. Others have told me to start in the OR. I've been unsure as to whose advice to listen to, but I am happy you, Rose_Queen, and WhoDatWhoDare have given me insight as to what practicing OR nurses' perceptions of new grads are, and now I am hoping that the interview with the OR at this hospital will go through successfully.

Just like with any other new grad/student who asks whether to start in a specialty or in med/surg, you'll find a wealth of differing opinions. I'm of the opinion that med/surg is a specialty in its own right (and it even has its own certification!) that to state every nurse must start there is a bit of disservice to recognizing it as a specialty in its own right. Not every nurse has what it takes to be a med/surg nurse- I know I for sure don't, and had I been forced to start there, I probably would have ended up leaving nursing due to burnout.