Precepting new staff members in the OR

It is never easy to be the new kid on the block, especially when learning the vast amount of information needed to function efficiently and safely in the OR. Following are a few tips on how to precept a new staff member.

Precepting new staff members in the OR

I was excited to start my first day in the OR. Full of optimism and nervous energy, I found my way to the staff locker room, looked through the lockers to find my name and started to change from street clothes into fresh new scrubs. "Um, can you please move your stuff over so that I can get dressed?" asked the nurse next to me. Nurses were chatting, some were laughing and others were complaining about the previous day's cases. Although there were at least 30 women crammed into the locker room, not one staff member met my eyes, and no one asked me who I was, if I was a new, if I was an observer or if I was a student. The only indication that my presence was even acknowledged was the comment that the nurse next to me made as I hastily gathered my shucked clothes from the tiny bench that we shared.

I gathered with the rest of the staff in the hallway for the daily briefing. I looked around for my preceptor, and found her chatting with her co-workers. I stood with the other 3 new staff members during the briefing. I expected the NM to give a brief acknowledgment to the new staff members so that we could introduce ourselves, but it didn't happen.

The rest of the day was met with more of the same; no introductions by my preceptor, no greeting of 'welcome to our unit', no sense from the staff that they were even curious about their new teammates. Being from the South, manners mean a great deal to me. Making a new person feel welcome has always been a priority for me, no matter if it was in school, a new job, or moving into a new neighborhood. Although I found it odd that the NM nor the preceptor of our small group made a gesture to even introduce us to the rest of the staff, it didn't bother me a great deal. This was work. I figured a 'get down to business' mindset was the norm in the OR. I figured correctly!

The OR is a different beast. You almost need a passport to enter this foreign place. Expediency, efficiency, protocol and keeping in mind the ever present time crunch are the main priorities in many ORs. A new staff member, a new grad or even a medical student oftentimes find themselves overwhelmed by the seemingly hundreds of little unspoken rules: don't speak unless you are spoken to, don't sit down, don't address the docs until you become involved in the case, don't ask questions when your preceptor is busy, don't ask what is going on during the case, and DON'T TOUCH anything! New members are relegated to standing in the corner without much guidance, and constantly worry if they are in the way. It is an awkward time.

How many of you guys remember feeling this way when you first started your OR career? I am raising my hand while jumping up and down, sounding like a monkey, "Oooo, oooo, ooooo! ME!"

I swore that I would NEVER make someone feel as uncomfortable as I did when I first started. As many seasoned nurses do, I lapsed into a comfort zone at work. When I had a student with me, I went about my duties (mindful of the time crunch) and didn't explain to my student what I was doing, or the rationale of my implementations. I just wanted to get the job done. The day I found myself saying, "Stand right here and watch. DON'T TOUCH anything!" was the day that I knew I needed to re-focus.

I sought out the Nurse Educator and confessed. I told her that I felt so badly for brushing off my student and shared my vow that I would never do that to a new staff member. I told her that I loved to teach, but because I am so OCD, I didn't think that I would make a wonderful preceptor. I asked for some guidance.

She laughed at me and said that she wondered when I would finally realize that I loved to teach.

She gave me some great pointers that I want to share with you all

  1. Communicate with the NE so that you know to expect to teach during your shift. The NE will usually let you know, but there is nothing worse than finding yourself scrambling to get your case set up and the NE interrupts you in mid-stride to tell you that you will be precepting a brand new staff member. With no experience. While the anesthesia staff tell you that they are rolling back with the patient. And you haven't counted yet.
  2. If you are OCD like me, get to work early to plan your day. Get all of the little stuff done to allow more time for teaching.
  3. Ask your orientee what they know, what they feel comfortable doing, and what they would like to focus on.
  4. Introduce your orientee to the surgeon and the rest of the team.
  5. Explain what you are doing. Offer a brief description of the surgery and instruct your student to read about the procedure when they get home. USE the resources that the NE has to offer; that is what they get paid for.
  6. Never forget what it feels like to be new. It is never comfortable.
  7. If you offer a kind word, a new member will never forget it. If you ignore them or treat them like a second class citizen, they will take longer to feel as if they are part of the team, longer to feel confident, and longer to be a productive staff member. Don't assume that they know the etiquette of the OR; give them a quick and dirty run down of what to expect. If we KNOW what to expect, we can conduct ourselves accordingly.
  8. Take time at the end of the day for a "hot wash". Ask your orientee what their challenges were, what tasks they felt comfortable doing, and develop a the plan for the next day.
  9. LISTEN to your orientee. If they say that they feel comfortable doing XYZ, then LET them do it. Stand back, or step out of the room and observe from the door if you must.
  10. Encourage your orientee to write down the events of the day when they are in a quiet place. A journal is helpful. Go over the journal with them and offer guidance with the most challenging experiences.
  11. Always encourage. Never berate. Most adults respond to positive reinforcement.

Sometimes we get caught up in the tasks at hand, and don't give priority to the students or new staff members that rely upon us to learn the expectations of the OR. A well thought out plan in conjunction with our Nurse Educators fosters an effective learning experience that preceptors and orientees feel good about. Guidance and compassion are the tools that we can use to develop confidence in our new staff members. Watching them become assertive and effective is a wonderful reward for the preceptor.

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canesdukegirl

About canesdukegirl, BSN, RN

OR nursing/Trauma Surgery, Nurse Management

1 Article   2,543 Posts

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Very nicely done. Thanks for writing.

Good points to consider regardless of the department one works in.

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"New members are relegated to standing in the corner without much guidance, and constantly worry if they are in the way. It is an awkward time."

My very first time in the OR as a student nurse, I decided to move to get a better look at what the surgeon was doing without first asking permission. I got my butt handed to me because of it :lol2: (I was getting a weeee bit too close to the sterile field for his liking. I knew not to touch it, but I had never been told how far away from it I was supposed to stay. Woops). After that, I just stayed in the corner of the room and watched. Oddly enough, though, I found everything everyone was doing to be so interesting that I was very content with just dejectedly standing there.

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