Overwhelmed

OR nursing is a completely different world from anything you learned in school or did on the floor. Of course it's normal to be completely overwhelmed only a week in!

To help learn instruments, see if it would be possible to spend a day in the sterile processing department assembling instrument sets. Some facilities use a computer system that assists in assembling the sets by scanning instruments and also providing pictures of the instruments. Also, it may help to take a copy of the count sheet home- then you can try looking up pictures of instruments online, plus you have the added benefit of knowing exactly what's in your sets.

As far as documentation, that will come with time. When we first started with our EMR, it would take me about 30 minutes to document everything. Now, with the exception of times and additional charges that get added throughout the case, I can finish my documentation before anesthesia has finished putting in the central line and swan.

A few other tips:

If you can, get copies of the preference cards. Take them home so that you can look them over the night before. One of the great things about cardiac surgery is that most procedures have the same basis: positioning, prepping, instrumentation. There are only a few quirks for individual surgeons and a few differences when doing a CABG vs. a valve (at least with my surgeons).

Keep a pocket sized notebook available. Although I don't really carry mine around anymore, I had lists of important numbers such as the ICU, the anesthesiologist in charge in case I needed to call for help for the anesthesiologist in the room, blood bank, and any other important numbers. I also had a list of how long it took on average to get various blood products. I had a little cheat sheet on how to enter blood product orders in the new EMR. Then there was a small section dedicated to each of the surgeons where I could write down little quirks, such as Dr. X changes gown and gloves after taking down the mammary or Dr. Y prefers such and such radio station- the little things that don't matter quite so much but aren't on the preference card. You can also write yourself a mini-process for getting your day laid out, such as how you get your room ready when you first come in for the day, what questions you should ask during your preop interview, and so on.

Be aware that you may need to take things home and study at home. While it may take up some free time, it will be worth it in the end to be prepared. You may even want to check with your supervisor about possibly coming in 15 minutes early to help you get ready without feeling pressured for a week or so.

Realize that you will have good days where things click and bad days where Murphy's law applies. Heck, even after a decade in the OR, I still have those days where things feel like my first day- new procedures, new surgeons, so many things can throw a wrench in your progress. That's okay- learn from those days and shake it off.

It may also help while you are with a preceptor to take a day and focus solely on documentation, and then switch and focus solely on the patient care aspect while the preceptor handles the documentation. At my facility, when learning to scrub, we focus on steps: opening the chest and taking down the mammary, then when that is mastered adding in going on bypass, then adding in the next step, and so on. The same approach has been used successfully with new circulators in regards to patient care and documentation.

And as for that quote about it taking a year, yeah, that's true. So just give yourself time, don't expect yourself to know everything off the bat, and give the job a chance. OR nursing really is a unique specialty, and the teamwork you can find working with a small group of coworkers, surgeons, and anesthesia personnel can really be a benefit and make the job seem easy.