Planning a better experience for nursing students in the OR

[canesdukegirl, BSN, RN]

Yesterday was my first day back from a 3 day mini-vacation. I recently changes services in the OR, and although I love my new service, I still need a few days to get to a "comfort level" in how each doc does things, where the supplies are and what the preferences of the docs/staff are. While I was scrambling to get my feet grounded in my first procedure, the nurse educator walks into the room with a nursing student. He said, "This is Canes. She will look after you and answer all the questions you have about this procedure. She will tell you all about what is going on and what the roles of each person is during surgery." Totally dropped this poor student in my lap. I felt so badly for this student because the case was a complicated one, and I had A TON of stuff to do. She immediately starts asking questions while I am trying to chart. I told her that I have to concentrate on my chart first (which is laborious), and then I will answer her questions. Well, there was never a lull in the case. Things started to go south, and I had to in effect, push her to the side.

I am such a strong advocate of teaching, but the position I was put in was difficult. I had ZERO time to teach her, and I am afraid that her first impression of the OR was horrible as a result.

Can you guys tell me how I could have handled this better?

[elkpark]

Why isn't it the responsibility of the student's instructor (the school faculty member) to do all the basic "explaining" to the student??? IMO, it's really unrealistic and unreasonable of school faculty people to expect the working, busy staff nurses in a clinical setting to do their (the instructor's) job for them, and really unrealistic of the student (although I sympathize with the position s/he has been put in) to expect you, when you're obviously busy doing your job, to drop everything to answer her/his questions -- I would have saved my questions until you had some free time later on.

I've never done this to staff nurses when I've been a clinical instructor, and I really resent it when clinical instructors do this to me when I'm working in a clinical role.

Can you and your manager(s) address this issue with the school faculty? (Or the person at your facility/organization who is the official liaison with the nursing program?) I agree that the students need to have a better experience but (and I say this from having been on both sides of this particular fence at various times) it's the school's responsibility to make sure that happens, not yours. You are there, and being paid, to do your job, not your job and the schools' job.

Best wishes!

[Argo]

Unfortunately stuff happens like that and i would just have told the student to stand back, take it all in, write down what they have some questions about and tell them you will get with them after the proceedure is done so you can try and answer some of their questions.

I do not really like having students in my room when we have difficult CVOR cases going on but if I get one that is what I do. I give them a good vantage point to see the case and move on with what I have to do to keep everything safe for the patient. I have had to have a student do chest compressions before, I will use whatever hands I have around. It is also a good learning experience as long as they dont freeze up.... even experienced nurses freeze up though and get the "deer in the headlights look"......

I would not worry about it too much though.... People will either love or hate the OR regardless of what kinda situation went down in your room, if they could not handle the personality you have in getting your work done then they probably should not be in the OR to begin with....

[canesdukegirl, BSN, RN]

Thanks y'all. I just felt so badly for this poor student. She was obviously uncomfortable, and didn't know the very basics of which person held which role in the OR. I did feel that either the instructor or the hospital nurse educator should have been in the room with her in order to explain what was going on. It is SO hard for a student to even be comfortable in an OR, and I felt HORRIBLE that I was not able to give her the attention that she deserved. I was able to explain (while I was flying through the room doing 100 different things) what was going on in a very simplistic way. I was able to point out the anatomy that was exposed, but I wanted to explain WHY the anatomy was exposed. Didn't have time.

Should I write a personal note to this student? She really was given the shaft, and I don't want her to think that this is the way we treat nursing students at our hospital. When we had to convert our procedure to a much more difficult procedure, I was scrambling.

[Argo]

What service are you in now?

[elkpark]

Should I write a personal note to this student? She really was given the shaft, and I don't want her to think that this is the way we treat nursing students at our hospital.

I would not, and I wouldn't feel responsible about the situation. It's her school that's giving her "the shaft," not you ...

On the other hand, I would, as I mentioned earlier, take this up through whatever channels are available to you with the school that is dumping unprepared students in your lap.

Best wishes!

[To Help and Learn]

From my experience I can only speak from a student’s viewpoint. I remember when I was a student and we would get to leave the floor aspect of nursing for a day or two to check out other specialities. Well, I picked the OR for my day away from the floor and I watched a patient go through all the perioperative phases.

I can only speak from my experience and say that my clinical instructor was responsible for seven of us and we were all over the hospital. The clinical instructor could not be with all of us at the same time, so on the day I was in the OR I was introduced by the instructor to the staff and was told to follow the patient. From there on I was basically without a clinical instructor.

It is funny now but I remember my biggest responsibility was not getting close to anything that was sterile. I watched and took in all I could. I would wait to be spoken to, then I knew it was safe to ask a question.

I think you handled the situation fine. If anything next time let the student know what you told us in the original post about getting to your “comfort level”. Also let the student know that with OR nursing things do not always go as planned, but you will do your best to give them a good overall picture of how things are done in the OR.

Do not be so hard on yourself. I am sure you gave the student a good experience even though you were not expecting them. If you have a good relationship with the nurse educator let them know that next time you would like to be asked, not in front of the student if it would be fine that you have a student that day. This way you would not be put in a bad spot and if you are in your “comfort level” then it would be a better experience for all involved. If you still feel badly about it then maybe contact the student and let them know what you are telling us now.

[Rose_Queen, BSN, MSN, RN]

Where I work, we know the day before that students are going to be joining us for the day. They are actually assigned to work with a circulator who knows in advance. They meet them in the surgical waiting room at the beginning of the shift, and have that half hour before the first case is supposed to be in the OR to talk to the student before becoming involved in patient care. We've never had students just "dumped" into the OR, although there have been times where we get add on or emergent cases on patients already in the hospital who have been assigned a student nurse. In those cases, we first get the OK from anes/surgeon, then have them come down before the patient for a quick crash course from the charge nurse (don't touch anything blue, save questions for when the circulator is obviously not busy, etc).

[njmomstudent]

I am a nursing student and was just in the OR for a standard procedure. I had issues with the doctor that made me extremely uncomfortable, but thats a different issue. As far as your question, it should be understood what happens in the OR beforehand. There are basic rules and you did nothing to make her uncomfortable. Stand in the corner, watch, stay away from the sterile field, speak when spoken to, and write down questions to either ask or RESEARCH later. If she didn't understand that, then its lack of preparation on the schools part (and hers--I researched my OR observation thoroughly before attending and what was expected of me). Jeez, she would have run out of there crying hysterically if she had my experience LOL.

[canesdukegirl, BSN, RN]

Thanks for the frank reply, NJ. I realize that these students are both fascinated and awkwardly uncomfortable in the OR. I strongly believe that learning and the retention of learning commences only when the student feels a degree of "safety"...and by that, I am referring to Maslow's hierarchy of needs, with the bottom level being "safety". One can only build upon that foundation, no matter the circumstance.

It was obvious to me that the student had ZERO prep time before coming into the OR. She told me that she knew that she had to stay away from anything blue, but then when I was trying to get past her, she turned her back to the sterile table and almost contaminated it. She had no idea what the anesthesiologist's role was, did not know what a circulator was responsible for, and clearly had no understanding of abdominal anatomy. I would expect a student to know the basics of abdominal anatomy, but she could not identify bowel. I went through the basics with her and showed her what the liver looked like when they were retracting, and pointed out the omentum and the small bowel.

I almost wish that students would scrub in instead of just standing there to observe, because they can actually be up close to see and touch. They would get to handle instruments and learn the basic set up for a belly case. Our ST students of course scrub in, but NONE of the nursing students that have come through have been able to scrub in. Only observe. When I was in school, we scrubbed in for 2 weeks.

I think that I will have a chat with our nurse educator. They know well in advance when students are expected to rotate through, and they will generally put a student with me. However, I can get to work a bit early if I KNOW that I have a student with me that day. I can get my own work prepared to a degree and that in turn will allow me to do some teaching.

A student should never come away from a learning experience feeling out of place to the degree that this student surely felt. I accept that part of my responsibility as a nurse is to teach students, and I take that responsibility seriously. Perhaps I should be more proactive and obtain a schedule of the students rotating through so I can avoid this last minute scrambling.

[idahostudent2011]

At our school one of the days is the etiquette in the OR. The Scrub Tech instructor comes by and give a talk about what it is like in the or. She discusses where to stand(against the wall untill the nurse moves you), listen to the nurse, don't touch blue, and whatever goes on in the OR stays there. Don't talk unless talked to and enjoy!

I was glad that they did that because a lot of the students were very nervous about going to the OR. I don't really understand why the schools don't prepare students before going to the or, it is very frustrating for the staff, even though we really do like students in the or. To canesdukegirl, you did what you needed to do at the time, and it was the schools responsibility to prep students not you, especially in the middle of a difficult case.

[suanna]

Sounds like you gave a realistic view of what it can be like in an OR some days. Students are never going to get "educated" to OR proceedures in the 1 or 2 cases they get to observe. At the hospital I work for, OR orientation is 4 to 6 mos full time. All the student is going to get is a glimpse of true sterile technique, and a feeling for anesthesia induction/recovery. Sure- it would be nice to be able to spend as much time as you need to walk them through every aspect of the case, but that is just not going to be possible-or necessary for the students level of understanding while viewing one case.