Abby Suh

I did the opposite, and maybe it's just the particular surgery center I am at (I did mainly ortho - total joints/total revisions, instrumented and non instrumented spine (TLIF, ACDF, lamis, diskectomies), big foot and ankle (triple arthrodesis, fibular nails, TTCs, total ankles, usually with BMAC or bone autografts), and a lot of total shoulders)) but was also trained to do everything else for call, short on ortho cases, etc. At the surgery center a lot of the huge no-no's I was taught are just the norm. People open a sterile field (including for a total joint!) and walk out and leave the room entirely unattended, people walk right through the front door even when there are substeriles, until I told them I refuse to let them at least in my room, they were trying to provide lunches (like change out scrubbed personnel) during total joints, no one and I mean no one checks their trays (like actually put them on a couple towels on the back table and looks at the instruments for bioburden) or even look at their indicators in their trays, they don't really track FCOTS, so people aren't really rushed and people come in at varying times depending on their first case start. Just be aware, I had to train a scrub in the hospital who came from a surgery center, I did not understand why he did certain things and thought it was okay until I started working at a surgery center because everyone does what he did and thinks that's how it's suppose to be. There are things where it's okay that people do it differently but to me some of the things done "differently" are a risk to the patient, so don't be shocked if people in the hospital get onto you. I have noticed only people who previously worked in a hospital setting understand my concerns that I am seeing at the surgery center. A positive... probably will a flowing central supply or materials management. We're constantly out of things and essential things because surgery centers are cheap, like I found out I'm allergic to their brand of sterile gloves and have yet to see any replacement... and I'm 2 months in. We were completely out of hand packs, esmarks and Chloroprep sticks this week and 0 Vicryl CT-1 pop offs, they said it was some fluke but IDK we seem to be constantly out of something because they don't really order based on demand they order based on their current inventory. Also IDK if you had to, but they expect me to know how to run a large c-arm, and I told them... ya I can circulate, scrub and second assist on pretty much anything but we weren't running c-arms, we had rad techs. Sure I can figure out the mechanics of a c-arm but people go to school for this for like 2 years and I saw first hand why you need a rad tech. Basically me and the surgeon were just moving it around, moving the limb around, taking shots trying to find the perfect shot, where as if he called out he needed a certain shot a rad tech would just know the best way to get it... I actually am highly considering going back to the hospital setting because I actually liked taking call and having the ability to pick up. I don't like the overarching theme of being cheap at a surgery center including trying hard not to let people reach 40 hours a week. I'm not here for your profits, I'm here for the patients and I'm not cutting corners to save the big machine money.

There is a lot of mandatory checkboxes that are not booleans in the chart (meaning not a yes or no), that have to be checked in order to complete the chart (at least in Cerner), so I will go through in the beginning of the case after the timeout and check all those, I try to put my people in before the case but time doesn't always permit. After that, generally you're just adding times, specimens, implants, tissues, etc. so like things that should take you 1-2 minutes tops to throw in, if it's a time, it's one mouse click. I always look up the next one and see what paperwork is uploaded, again, like 1-2 minutes tops. Where I worked our computers did face away from the field, it was on a counter and no way to move it, because of that I never sat when I charted, if I sat it was because the case was hours and I was sitting and facing them. Generally all I need to finish is the handoff to PACU after and that was usually entering a name and a couple drop downs. Then I would start the process again, making sure stuff was in, throwing people in, go through the door to holding, get meds, then out the back door there to the ORs. Personally I did not interview the patient until before I rolled but this was a common practice in ortho where I worked because they were cut throat on turnovers, so it was always open, check vendor trays, interview and get the patient. In other service lines I would interview on my way back from PACU because they often wanted you to get them up to void and there's no vendor trays. This practice is probably frowned upon in multiple ways (technically some pre-charting) but I stay ahead and attentive, like my goal is to not be buried in the paperwork. I have scrubbed with nurses like that and it's really difficult, to the point the case is finished and I just need to help them out because they're drowning, and then they disappear in the PACU, when we're opening for the next one because they still have their specimen (that I ended up grabbing a specimen cup and putting it in for them) and they haven't entered it into the computer, or took it to the path room, cannot count because they're nose deep in the chart. REALLY BAD. I guess I should preface when I say 1-2 minutes tops entering things in... I type like 80 WPM. I see some nurses hunting and pecking slowly and not using some shortcuts. Where I work now is paper charting... pretty god awful with no way to get ahead either.

Initially enjoyed it, now bored with it, I started to scrub and second assist so doing that has definitely switched it up for me, hoping to get my RNFA next January (eligible but I don't think the program starts until like March or April). It gets really stale because for the most part it's very front loaded and back loaded and you have varying amounts of time where you don't do much especially if you and your team prepare. I only worked at a level 4 rural hospital and mainly did same day orthopedics with the occasional end of day fracture, I+D or amputation, and now work in a surgery center only doing total joints and smaller ortho stuff, so it's all super routine and predictable. When I worked in the hospital I did other stuff but it still felt very front loaded and back loaded and very predictable. I don't have any of those "unexpected" exciting trauma or emergency moments. The most that happened was a patient coded during a TFNA in my entire career thus far. Scrubbing has definitely refreshed my interest and it helps you be a better circulator too. Having not gone to scrub school it is a challenge, because you are learning a lot of instruments as you go or in your own time learning. I also learned to scrub on total joints, so the curve was quite steep LOL. Knowing what all the instruments are or if they are struggling and just start spewing descriptions really helps having scrubbed because you can find stuff faster or be able to figure out what they need and get it based off stuff they're spewing out. It has also massively helped me understand suture - different needles, what they're used for, etc. Some nurses learn in time too passively but this knowledge will come way faster having to touch and prepare the back table and anticipate the surgeon.

Unfortunately I still end up bored often. It's probably a fault in me, but I prepare every morning by coming in early, so I already got stuff lined up (aside from meds) for all day or the day before if we finished early. Could make a list to stock but never could do it as we were not allowed to leave the room like that. Occasionally had people who were out and you could pass the list through the cabinets and they'd bring it back. I also chart insanely fast, would look up the next one, and then yes I would stand near the field and watch, talk to the surgeon/team, reps, etc. but I also cannot stand still so I still would get extremely fidgety and bored especially if the surgeon is a no talking type (have one of those now... no music, no talking, dead silence, and watching him work like this is quite painful tbh). Anterior hip replacements are my favorite for a reason, because you get to work the Hana bed. I have gotten to learn to scrub and second assist which definitely helps, but man, some spine and foot and ankle you exchange standing and watching the field to standing behind or next to the surgeon holding a wire driver empty or karrison, or holding a retractor. Totals are nice because they're extremely fast paced usually.

Some scrub techs and assistants can seriously be like this and it's not okay. I have been able to learn to scrub and second assist (cannot first assist... yet), and because of how I have been treated as a circulator, I do everything in my power to not be like this. I make sure everything + anything that may be needed is in the room, if we have to put it back... so be it but at least it's there. I started and still primarily do total joints and any good place has rules on not leaving the room once draped, so this became mandatory anyways unless you wanted to be calling out for someone to get you something which is incredibly annoying. The whole trash can thing and such... like that kind of drove me mad myself, so I will just kick and drag stuff around scrubbed in and have become incredibly good at it. Sometimes I will ask/ throw the trash and apologize or be made fun of when I miss the trash can because I'm no basketball player, worst case I just leave it on the end of my table. I've also been sprayed by a pulsavac and such, it does happen, kind of just laugh it off. Honestly some scrubs, assistants, and surgeons are really needy, others are rude, but it also comes down to you as well, with more experience learn the surgeon's preferences and the people in the room's preferences and you will run and be asked to do less... because you already have it and you're 2 steps ahead of them at all times. That's always my goal.

Recently learned that while going RN > RNFA is already a pain in comparison to CST > CSFA, that basically a CSFA becoming an RN doesn't automatically assume the title of RNFA. Basically you have to what every OR nurse that wants RNFA has to, 2 years as an OR nurse, then an RNFA program and get the CNOR before you finish the program. Basically you're better off being an RN and keeping up your CSFA certification until you can do your RNFA if you want to (it will be time and money to learn and do stuff you already know as a CSFA). Not sure if you could function as all 3 roles in a similar fashion to an RNFA that can scrub or if it's a conflict in being an RN and CSFA. There's also a small chance that an experienced CSFA salary would be more than a "new grad" OR nurse's.

I graduated December 2023 and now have been working as an OR nurse for 10 months. Don't let anyone tell you can't do what you want to do. I literally did everything in my power to make sure I got to be where I wanted. I did a 10 month nurse externship in the float pool which helped me in clinical and then 10 months as an anesthesia tech in the OR, I also shadowed surgeons and built connections in various OR's in the area. I actually ended up interviewing at one of my clinical sites because I was connected with the board runner through school. Got offered the job on the spot, also not in a new grad residency and they support my career goals (RNFA). I'd love to end up back in California but for all the education I require I have to commit at least 5-7 years where I am. I love where I work but do not like Tennessee.

For me it was learning the whole and not just my role. You're likely going to be precepted by circulating RNs unless you learn to scrub, then it could be RNs or CSTs. I really learned a lot with my nurse AND with my scrub. Even now any time I do something I do not know, I lean on my scrub to help me out. Learn in small chunks like prepping, positioning, charting. On their own, it's all not bad, putting them together was the challenge, especially the charting combined with the rest, charting is very time sensitive because many doctors and the board runner use the "in room time" and "start times" to help know when to send for the flip room or for the surgeon to know when to come to the room. It's important to find the balance of getting the time in and attending to your patient and your team. In some surgeries, you are an active member of the surgery even circulating so it's important to learn any shortcuts or ways to speed up charting or you'll be catching up in the PACU. (An example is during an anterior hip replacement you're to run the Hana bed). Keep either a notebook or tablet to take notes. If you're learning to scrub take pictures of the back table and Mayo. For total joints most vendors have technique guides to help you understand too. My main thing for all (when I was in nursing school and in the OR)… don't stress! Stress does not help you, try to remain calm and just do.

Honestly as someone with EDS, no more than any of my other jobs. I had carpal and cubital tunnel surgeries due to doing a desk job and being a gamer for so long. My main issue is I run into things. Like today I scratched/hit my back on a computer rack mounted on the wall because the cysto room is so small. I have tripped in hall once, got a "suture wrapper" cut, etc.

I know this post is old, but an update to all this: I graduated nursing school December 2023, started a job in the OR in January 2024 and first went through orientation to circulate, went on my own after 4 months (they do not have a residency, it's individual), now 8 months in, I'm learning to scrub too. Total joints are overwhelming... all the nurses learning to scrub are learning their service line. There's a nurse who started a little before me who learned general and vascular... me it's all ortho LOL.

I got back, but they offered me an assortment of med-surg floors and I declined. I ended up getting an OR nurse job elsewhere.

I'll be real, granted this was during COVID, the only company I have ever applied for an interviewed with that was out of area for me, they video interviewed me and I know from watching people's videos before COVID, they paid for airfare/hotels. I think the issue with Vanderbilt is they have a massive amount of local applicants. This company probably has more out of state and even international applicants than they do local applicants. Like there is a ton of state community colleges (and now they accept ADN nurses into their residency), a ton of state and private universities, and private for profit colleges in metro Nashville and around it. From their stand point, they got so many people applying and their point "if you want it bad enough, you will figure it out, if not we get a ton of people lined up". Luckily even now... they conduct video interviews for everyone, and this is even coming from someone who lives in Nashville. In all honesty, my ideal world would be go home, but I can't, my partner refuses to move to California. For me career wise Vanderbilt is the best option for me because they are a level 1 and they have the most thorough Perioperative residency (I have talked to pretty much every hospital in the area). I definitely know I need at least 2 years, but long term I don't know how long I can drive downtown, even if it means transferring internally in Vanderbilt's system.

I believe all new grad residents across the board start at $31. (MODERATOR EDIT OF NAME) emails even right after you initially apply are very transparent about the pay.

IDK what department you interviewed for, but a majority of my classmates applied to Vanderbilt and most have gotten their offers and they all weren't internal. Most applied to Peds, NICU, ER, and ICU, etc. I'm still waiting myself for the adult OR, but applications for experienced nurses without OR experience are still open until Saturday and interviews are still going. They told me not to expect anything until late September or early October.

Nope. It's so scary having to wait. All my classmates have heard back, so it's nerve wracking.