RNFANP

Since I work 4 days a week and the occasional weekend on call/rounding for an 11 day work week, I wear my hospital green scrubs everywhere. I'm also currently in the process of moving, so I have packed up all my nice clothes since I'm wearing scrubs 90% of the time anyways. The other 5% is PJs and the other 5% is leggings with a t-shirt. My green scrubs are so soft and comfy and I've actually noticed that one of my tops has a hole in it so it makes me a little sad (I really need to patch it up). Do I care what people think? Not at all. To be honest, if that means they get out of my way, I'm cool with that cause usually I'm in a rush to get in and out anyways. ?

Maybe minute clinics/urgent care?

I was in your exact position. Worked in the ER, did evenings (3p-3a) loved it but eventually the frequent fliers, poor staffing, and constant stress was weighing me down. Never got a break and got down to almost 100 lbs (best diet I ever went on!). It got to the point where if a patient wasn't dying or about to die, I did not care at all why they were there. I just wanted them to leave. I became mean. Finally switched out to the OR. It was a rough couple of months because I was new to the OR and there was so much to learn and it was very overwhelming. I almost went back to the ER because that was what I "knew" and I was good at it. Finally I got the hang of it and never looked back at the ER. I told myself I would pick up shifts, but I just couldn't convince myself to go back. I actually got a 15 minute breakfast break AND a 30 minute lunch break with opportunities to use the bathroom. I worked twelves and a lot of times we were done after 3pm, so I got to actually sit and relax! Yeah, it got boring sometimes circulating, especially if it was a long case. But I learned how to scrub, and be decent at it, so it was nice to change it up and scrub in every once in a while. Don't be afraid to branch out - it'll save your sanity. I took a paycut switching but it was worth my mental health. My depression got better and I actually enjoyed working with patients again. Most OR patients are lovely and they're so grateful towards you (except when they wake up wild but that's not their fault).

I've seen this from a couple of different sides. I worked ED and was constantly harassed by the ICU nurses - "I don't think this patient needs to be in ICU" or "why didn't you clean the patient up before transfer?!" (I did but I can't help it if they have a bowel movement or pee everywhere during transfer - can't stop in the hallway to do that!) or my personal favorite: taking care of a SVT patient "why didn't you empty the foley and count it?!" Um sorry I was making sure her heart rate was in an acceptable range? These nurses were also the ones who would somehow be magically gone when I arrived on the unit, leaving me to transfer the patient over myself, get them changed into the ICU gown (heaven forbid they be in the ER gowns which were different from all the rest of the floors - why I don't know) and get them hooked up to a monitor. Only then would they appear and ask if I needed help. Nope. I'm good. Moving to the OR, I saw at lot of hate from the OR towards the ER. "Why wasn't this patient completely undressed? Why isn't their consent signed? Why this, why that." I actually had to sit and explain to some of these people that sometimes the going to surgery patient may not be priority (if they're stable and just waiting to go) and that I may have a crashing patient next door that requires all my attention. I never complained when I went to pick a surgery patient up if they weren't completely ready. Instead, I -gasp- helped get them ready - grabbed fluids, got admission paperwork, signed consents, etc. It's all about people's attitudes. I think it's a grand idea to have people who complain the most about other departments go to those departments and see what it's really like. Many of the OR nurses who complained about the ER nurses would never survive an 8 hour shift in the ER. Moral of the story - haters gonna hate and you just gotta block that negativity from your life. You do you.

Absolutely it was better for me. I did clinicals on the floor/rehab and it was miserable. When I precepted in the ER for my final semester, I had zero skills other than taking blood sugars and giving PO meds. My time management was terrible and I wasn't really pushed to think critically during my previous clinical assignments. The ER brought me up to speed quickly - I learned IVs, how to access ports, codes, vent patients. I learned to figure out who needed my attention first and who could wait. I learned to think what my next step was going to be before I made it - chest pain is going to get an automatic ekg, 20g IV, troponins, etc and if they haven't had an aspirin they're gonna get one now if not contraindicated. I learned not to wait on the doctor to put in orders because I knew what they were gonna put in so I could go ahead and do it (with the exception of giving medicines without orders but I could go ahead and tell that Dr. "hey, they haven't had an aspirin. You want me to give them one?" or "hey, bed so and so is throwing up real bad. Can we get some zofran?"). I learned great communication skills. Now, someone on here who worked the floor might have had those same experiences and I'm sure that the floor would be hard for me in a lot of different ways that the ER wasn't but I'm just sharing in my experience. I think if you can make in the ER, you can make it anywhere. I got a lot of tough love in the ER and it's not meant for everyone with the variety of acuity and patients. But I loved never knowing what I was gonna get - kept things interesting. My advice is, if you can, shadow a day or two in different units. If you're looking to build your skills, go to the ER. You will do EVERYTHING! I got to help put in chest tubes one morning and it was awesome to see this guy's sats go from 60s/70s to 100s. Once again, I'm in no way, shape, or form saying that Med-Surg should never be considered as an option. It just wasn't my cup of tea. You'll find yours - just keep looking and ask to shadow in places you might find interesting to see if it's really worth going into

I always encourage my students and new nurses to go the the ER for a year if you can. You learn all your skills (IVs, NGs, foleys, etc.), your time management, and critical thinking skills quickly. I wasn't cut out for Med-Surg (I loathed doing clinicals there) but I really thrived in the ER - it can be a sink or swim sort of situation but I worked with some great staff and great doctors that were more than willing to teach. You'll get a lot of variety - one room can be a STEMI and next door can be a hot appendix with a gunshot or laboring person in the waiting room. I wouldn't have traded my time in the ER for anything!

I'm currently looking for a NP job (new grad) but I've had interviews at a variety of places. One was a liver transplant inpatient unit, a Urology clinic (seeing outpatients), a Nephrology clinic (seeing outpatients), a GI clinic (seeing outpatients with ability to see inpatients), an ICU inpatient only, and a Cardiac clinic (outpatient and inpatient) and hoping to interview with a cardiothoracic surgeon (possibly doing inpatient, outpatient, and assisting in the OR). I think a lot of changes are coming to the landscapes of NPs. I see a lot of hospitalist and inpatient positions open to Acute Care NPs only and I definitely think we are welcome in any specialty (excluding women's health most likely). My local ER/Urgent Care only hires FNP because of peds/OBGYN but I would think in some more academic hospitals and cities that have women/children's hospitals would be more receptive to AGACNP.

9 times out of 10, the CRNA has got the problem covered if it's a patient crashing issue. When there's a problem, they have control of that ship. I just do what I can to help them (grabbing supplies, crash cart, etc. per their directions) The MDA will always appear and honestly, so will any free CRNA. You're never alone in the OR - scrubs can break sterile and the surgeons can fend for themselves if it's that emergent and there's no free staff. In the OR you learn to read the room and if I'm scrubbing and feel like things are gonna go south (like your simple laparoscopy is threatening to open), I alert my Circulator to go ahead and grab stuff and have it nearby. If I'm the Circulator, I'm paying attention to the dynamics and grabbing supplies in anticipation. That's just part of learning the job like you would anywhere, OR or otherwise. Yes, the ED prepared me to think ahead but it didn't teach me what trays I would need for an emergent GI bleed versus an emergent hysterectomy. But this is just my experience and everyone will have a variety of experiences of how things are done.

Our CRNAs usually start the first IVs of the morning and then from then on it's the Pre-Op nurses. Most of our OR nurses don't start IVs but I've thrown in quite a few in the back as a Circulator (during emergencies/to help out if the CRNA is busy) just to keep my skills. As for full body assessments, I don't do a comprehensive exam but mostly looking at different IV sites, tubes, and most importantly any skin issues. We have to document if there is any skin issues, just as a way to cover that those issues were present before surgery and could not be claimed as injury from surgery, positioning, etc.

Honestly, it really just depends on the person. I came to the OR after spending a year or so in the Emergency Room. For the first 6 months, I felt like an absolute idiot and almost went back to the Emergency Room where I knew what I was doing and felt comfortable. The OR is such a different beast that I think even with floor experience, it is going to be a steep learning curve. Also, where I work, a majority of our RNs have never been outside the OR. They were new grads to the OR or had come from different surgery centers with absolutely no floor/ICU/ER or other experience. They are terrific OR nurses and I would want them on my team any day of the week. Then there was the case of a nurse who came from us from the floor and unfortunately the OR was just not a right fit for her, despite her experience. All in all, do I think people should have more than just OR experience to make them well rounded - absolutely! I encourage any students that come through to go through the ER right out of school - you learn all your skills, critical thinking, and time management (I personally could never work the floor, it would kill me ?). But! I do think that new grads can be properly trained right off the bat in the OR if there is a support system in place to help them grow and thrive.

I just graduated with my Adult Acute Care NP/RNFA. Been an OR nurse for 5 years, did Emergency Room for about a year prior. If you're not going FNP route where you have to do certain clinicals, the best advice I can give is choose your clinical sites wisely (I did Vascular Surgery, Emergency Medicine, and Internal Medicine) and start networking with the surgeons. It's been incredibly tough to get a job being a new graduate (still searching but some leads) and I had one doctor pointedly tell me he didn't like that I only had OR experience in the last few years, so be aware that non-surgical specialties may prefer floor/ICU/ER nursing experience. However! I was able to upgrade my position in the OR to RNFA and receive that pay, so if you go NP/RNFA route, ask your manager to upgrade you as soon as you're done and get that extra money and experience! Overall I did not have a problem with the didactic portion of school and honestly, even though we checked off on procedures such as LPs and Intubation in class, I hardly ever needed "physical skills" other than assessment and the occasional pelvic exam! You're still using your assessment skills in the OR. You may not be doing head to toes, but you're definitely assessing airways, levels of consciousness, and how the disease processes might affect the patient perioperatively. I lived on Pocket Guides and Drug Books so as long as you're reading and understanding the material and how to apply it, you'll do just fine!