Overwhelmed

Editorial Team / Admin · Jan 18, 2015

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.

Nurse Sasha · Jan 19, 2015

Be patient, OR is very different and everyone takes time to adjust and learn! I borrowed a text book from one of our CSTs to study at home when I started in the OR, and it was so helpful to learn the instruments and read about suture and surgical procedures. When I started in OR 28 years ago, we had realitively little special equipment to learn to operate. Today when precepting a new circulator, I suggest they get a little pocket notebook to write themselves some reminder cheat notes for new equipment and phone numbers. Join AORN and attend your local chapter meetings - this can be a very helpful networking and learning opportunity for you. The AORN monthly magazine is a great resource that is part of your membership. Association of periOperative Registered Nurses website is a good resource also. Hang in there, it can take up to a year but one day you will click and feel that "I'm home" moment! Good luck!í ½í¸·

schnookimz · Jan 19, 2015

I have been in the or seven months now. It was terrible at first. I had NO CLUE what anything was or where it was or what it did. One of the nurses told me that eventually things would just kind of click and I shouldn't worry. It took at least two months before ANYTHING made sense. Just stay calm and give it more time. Now at 7 months in, I sort of get it. I can do a lot on my own. Sometimes I have questions, but I know the basics and where to get the answers I need. You'll be fine!!!!!

nurse482488 · Jan 21, 2015

Thank you so much for your responses!

Travel_RN_0714, MSN, RN · Jan 24, 2015

Welcome to the OR. Been in the Operating Room for over 10 years and I still learn something new EVERY day. It just takes time. Stick with it. Once you have worked in the OR, you won't want to work anywhere else.

sop832 · Feb 18, 2015

Haven't been on the site in a while,so forgive the late response. PLEASE cut yourself some slack! You're brand new to the OR, and you're starting in the heart rooms and you're feeling rattled?I guess you are! You have to give yourself some time to get your feet under you. Please tell me that you have a preceptor, and you are not on your own. I had 5 years of General OR experience, and it took me a year before I scrubbed on my own. Are you only going to circulate? If so, you should ask if you can n back-scrub a few times. There's no better way to get a grasp on what happens at the field. If your surgeons are open to questions, ask lots of them. You will make some mistakes, just try to learn from them and ask for help when you need it. Try to be a little easy on yourself

nurse482488 · Mar 9, 2015

Thanks for all of your responses! It seems to be getting better, I'm approaching 2 months in the OR now. There are still days where I get frustrated over little things that I did wrong. I hope it will continue to get better.

Nveesee · Mar 11, 2015

Thank you everyone for your positive responses! I'm a new nurse and have been in the OR a month now and today I really needed to hear some optimism to boost my confidence. Some days things go smoothly and I learn a lot, and other days I feel like I'm back to square one. It's tough being new!

nurse482488 · Mar 11, 2015

It's great to know there's other new people out there along with me! I had an awful day today where I just wanted to give up and find another job. I agree, it sure is tough being new!

LeLeRN2b · Mar 18, 2015

Hang in there. I had an interview w/ the nurse manager in the OR unit, and she said it usually take 2 years to feel confident. I wanted to start my residency in the OR b/c I knew it will be a lot of info to retain. However, Just try to take it one day at a time. Good luck..

LeLeRN2b · Mar 18, 2015

Wow. Hang in there new nurses..What made u want to give up? Are you doing floor nursing? Is your work load hectic? Hope u don't mind me asking. Thank you in advance. I'm getting nervous b/c I will be starting on the night shift in a surgical unit..