Outpatient surgery to hospital circulator

[Nursegal2020, BSN]

Hi there!

I have been an outpatient operating room circulator for 4 years now, mostly in orthopedics. I enjoy the outpatient life, however, the higher pay and benefits of working at a hospital are very appealing to me. The only thing that I am hesitant about switching from outpatient to the hospital is dealing with sick patients in critical care situations. I worked in the ER during Covid and that basically scarred me forever LOL. I went from the ER to outpatient life after a year of working in the ER in 2020. I feel like I have my circulator skills down, at least in the orthopedic setting. However, because I am outpatient, our patients tend to be healthy, and there are very minimal emergency situations. Anyways, I'm wondering what the environment is like working in the hospital OR as a circulator. The hospital I'm interested in is not a trauma center and does very minimal pediatric procedures. How is the hospital OR stress when it comes to emergencies? Is anesthesia always there to help? I am worried about being alone and ill-equipped in those situations. I do have experience in code situations etc and tend to handle those well, but I get VERY anxious if that is a constant in the environment I am working in. 
signed, 

an anxious nurse. 

[emergenceRN17, ASN, BSN, RN]

Hi there!

I work at a community hospital as a circulator. I love it. Day surgery, endo, and pain clinic.  Anesthesia is always there should a situation arise.  Which part of the country are you looking at?

best

k

[Nursegal2020, BSN]

I work in Central Oregon! God I love anesthesia. Glad to hear you enjoy it! I love circulating at my outpatient ortho center, just the money isn't there..

[Abby Suh, ASN]

I did the opposite, and maybe it's just the particular surgery center I am at (I did mainly ortho - total joints/total revisions, instrumented and non instrumented spine (TLIF, ACDF, lamis, diskectomies), big foot and ankle (triple arthrodesis, fibular nails, TTCs, total ankles, usually with BMAC or bone autografts), and a lot of total shoulders)) but was also trained to do everything else for call, short on ortho cases, etc. 

At the surgery center a lot of the huge no-no's I was taught are just the norm. People open a sterile field (including for a total joint!) and walk out and leave the room entirely unattended, people walk right through the front door even when there are substeriles, until I told them I refuse to let them at least in my room, they were trying to provide lunches (like change out scrubbed personnel) during total joints, no one and I mean no one checks their trays (like actually put them on a couple towels on the back table and looks at the instruments for bioburden) or even look at their indicators in their trays, they don't really track FCOTS, so people aren't really rushed and people come in at varying times depending on their first case start. 
 

Just be aware, I had to train a scrub in the hospital who came from a surgery center, I did not understand why he did certain things and thought it was okay until I started working at a surgery center because everyone does what he did and thinks that's how it's suppose to be. There are things where it's okay that people do it differently but to me some of the things done "differently" are a risk to the patient, so don't be shocked if people in the hospital get onto you. I have noticed only people who previously worked in a hospital setting understand my concerns that I am seeing at the surgery center. 
 

A positive... probably will a flowing central supply or materials management. We're constantly out of things and essential things because surgery centers are cheap, like I found out I'm allergic to their brand of sterile gloves and have yet to see any replacement... and I'm 2 months in. We were completely out of hand packs, esmarks and Chloroprep sticks this week and 0 Vicryl CT-1 pop offs, they said it was some fluke but IDK we seem to be constantly out of something because they don't really order based on demand they order based on their current inventory. Also IDK if you had to, but they expect me to know how to run a large c-arm, and I told them... ya I can circulate, scrub and second assist on pretty much anything but we weren't running c-arms, we had rad techs. Sure I can figure out the mechanics of a c-arm but people go to school for this for like 2 years and I saw first hand why you need a rad tech. Basically me and the surgeon were just moving it around, moving the limb around, taking shots trying to find the perfect shot, where as if he called out he needed a certain shot a rad tech would just know the best way to get it... 
 

I actually am highly considering going back to the hospital setting because I actually liked taking call and having the ability to pick up. I don't like the overarching theme of being cheap at a surgery center including trying hard not to let people reach 40 hours a week. I'm not here for your profits, I'm here for the patients and I'm not cutting corners to save the big machine money.