JLynnOR

Hey--hugely valid concern. Glad that I saw this post!! My hospital system began a recycling program several years ago and has won awards for it. Legacy Health System in Portland, OR. I've worked at three hospitals throughout the system--two of the ORs had big blue plastic bins in the corner with plastic bags for recycling that were only emptied as needed. Other place took out the recycling every case. All clean packaging, wrappers, foil from knife blades and suture, saline and H20 bottles, blue wraps, etc. thrown in the OR receptacle, bags sent to the central sorting facility, sorted in the sheltered workshop run by the health system and sent accordingly to the city recycling place. There have been news articles on this, and the hospital system has saved impressive amounts of waste in terms of tons recycled as well as millions on medical waste disposal. Legacy's PR info related to their waste reduction http://www.legacyhealth.org/body.cfm?id=1891 Info from the organization "Hospitals for a Healthy Environment" on a conference featuring "our guy," Tom Badrick: http://www.h2e-online.org/teleconferences/ConferenceDetails.cfm?Date=2007-09-14&teleconfid=380 Hope this helps.

I'm a nice person, too and I had similar feelings when I started in the OR 7 years ago. And I did gain a lot of assertiveness that now is second-nature to me (I love how the OR shattered my "fear" of doctors). I absolutely hated the culture of "horizontal violence" of the OR in which I started. One of the docs told me early-on that the nurses "ate their young" in that dept. and I found him to be very right!! Luckily, I was young and ended up making a move across the country--away from that OR; got to new ORs, new experiences, and a lot of young nurses who were equally frustrated by some of the nasty experiences they'd had. When you become one of the experienced nurses, I trust that (from your sentiment) you'll never purposely sabotage someone. However, NEVER forget the sense of being "an outsider" that newbies often feel. Make things less socially awkward for those newer than you. It feels really good to get to the place where you've "made it" and you feel like an insider. And I do love the affirmation of docs acknowledging that I'm doing a good job, and I love the feeling of belonging (without any malice toward others). I just try to acknowledge the frustrations of the newer people, include them in conversation when appropriate, and work on their knowledge/experience needs in a respectful and constructive way. They have to "get it" to ultimately succeed in the OR. But there doesn't have to be any harshness in the process. You can be instrumental in helping to build a culture of respect and consideration in your OR by getting to a place of personal and professional comfort in the OR and then being a model of professionalism toward the new people in your dept. Good luck, and hang in there.

I've seen both ACNP and FNP--mostly FNP. There are more FNP programs scattered across the nation, so that has some bearing on the prevalence of FNPs. I've heard (or read on this board?) that ACNP's don't necessarily have the Peds training in their programs--I'm not sure if this is true. The docs I've talked to, however, have wanted someone who can see kids too. My experience with surgeons and NPs is that surgeons don't really have much experience with them--they're used to PA's. So, unless an NP has some background that allows them to negotiate for more $$, in my area they seem to make about what a PA does. A large Ortho group in my area starts their rookie PAs at a salary of $65,000-ish and the range extends up to $120,000.

You guys are awesome. Thanks so much for the encouragement and tips.

Your best bet would be to ask this in the Operating Room Nursing section under Specialty Nursing. Usually nurses in the OR have to do a little of everything, even if neuro is your passion. The other thing would be to go to NP school and then work for a neurosurgeon assisting in surg and seeing pts in the office. General OR nursing would be a step in the process. Hope this helps.

I currently work in surgery, and am in FNP school. I've worked with several NP's who work for surgeons, assisting MD in OR and seeing patients in clinic, etc. It's not as common for NPs to fill this role as PAs--if you've had work experience in a surgery setting it is more likely, since NP school often does not include a surgical rotation. There is misinformation out there. MDs may not know all of the details about what NPs can/can't do. If you don't have an OR nursing background and want to work as a mid-level in surgery, I'd personally advise PA school (or, depending on surgical specialty you want to work in, getting OR experience prior to NP school). Then, know your own skills and sell them to your potential employers accordingly. Refer to the PA vs NP differences forum for addt'l details, and know that NP surgical jobs (like PA surgical jobs) are not a gravy train. Especially CV surgery. There are often long hours per day/week, long procedures without pee or food breaks, lots of responsibility, and a lot of on-call time (no drinking, limited reliable plan-making depending on how much they work you on call). Ortho has many of those same traits and is equally or more physically demanding. Whatever you do, be your own advocate within your educational prep, fill in your knowledge/employability gaps, and be assertive about your skills with potential employers! Best of luck!

My immediate reaction to the thread title was "Ooh, those is fightin' words!" I've hearded nurses who should know better say equally insensitive and false things about scrubbing. (I often like scrubbing more, but that doesn't make it any less challenging). I agree with the poster who said that this statement is often uttered due to bitterness about compensation. The sad matter is that, yes, many ST's go to school for 2 years and many RN's go to school for 2 years. This makes many techs bitter that they're not getting paid the same. However, nurses do ultimately have more responsibility. One tech I work with (when not complaining that he doesn't get paid enough) laughs and says, "Yup. I'm not a nurse. I don't deal with all of the P's: Paperwork, phones, pagers, poop, puke." Unfortunately, if ya' want to make the money, you've got to take the good ($$) with the bad (nursing school being a broader prep for a professional practice, "wiping butts," [a reason I've heard techs list as why they didn't go to nursing school] and more legal responsibility). Back on topic--I wouldn't be caught dead saying that either is consistently easier or harder. Anyone saying differently about either role is just stirring the pot!

Depending on how long you have for the assignment, the term "sterile conscience" is applied to the individual staff member's desire to protect the patient from harm by making sure that things are always sterile. You can read about this, I believe, in the Berry & Kohn's OR nursing text; I'm not sure whether Alexander's ("Care of the Patient in Surgery") mentions this term. To the non OR person, this concept may sound like a no-brainer. However, there are often times in which it is very unpleasant to deal with the consequences of the rules of sterility--lots of work, re-gowning people who've brushed up against stuff, completely having to tear down a sterile setup and re-sterilize instruments because of a torn back table cover or wrap or an unchanged chemical sterility indicator in a tray, etc. If people don't have this sense of "sterile conscience" they could look the other way and let things go unchanged, not sterile, and result in patient harm. Another ethical concept of relevance in the OR setting is the phenomenon of "horizontal violence" among nurses. There's an AORN article on this in, I believe November of 2003 or 2004...there has been much publicized about the phenomenon within nursing at large. It is the concept of nurses "eating their young" or really acting unprofessionally, backstabbing and acting unduly mean/harsh toward one another. This is often a problem in OR settings, and the AORN article lists possible reasons. Otherwise, the general ethical principles of nursing apply very fully--beneficence, nonmaleficence, justice, etc. Hope this isn't too late to be helpful!

Wait a minute--you were in podiatry already? (Reading is fundamental) You're not new to sterile technique in the OR setting, so you've got such an edge. My words of pre-encouragement are still applicable to you. The other reflective part of my little paper is how much I thought it "bit the big one" (not a term in the paper) to be good at something (for me, OR) and so green at something else (ER). At one point in my initial misery, I felt a bit like a petulant child--mad at myself and internally pouting, like "Oh my god, I hate this. Why did I do this?! [Even though I CHOSE it] Another group of nursing theory type of people (Davidhizar, Gigen, and Reed) said, "Keep your perspective. You are in school by choice. No one is doing this to you." As a professional back in school, humiliating as it is to admit, this statement has often met me where I'm at. Anyway, enough babble. Best of luck in your new career!!

Remember this a couple of months from now: It is grueling to start any new specialty. Period. So when your current excitement (and desire to do always do a great job) clashes with the intenseness of being a newbie, DON'T GIVE UP. You sound totally eager to learn. Keep it up, keep your OR goals in mind, and hang in there. I'm a 7 yr OR nurse, and am writing a paper for the end of my RN-BSN program, mentioning the nursing theory of Patricia Benner (she studied the transition from novice, advanced beginner, competent practitioner, proficient pract., expert practitioner--nursing "professional socialization"). Check out her stuff online--her stages are right on (encouraging when you're learning, growing). I recently did 120 hours of clinicals in the ER and the beginning was so frustrating!! I found myself thinking, "Benner never said how frustrating it is being a newbie!!" But while being a beginner is frustrating, you don't stay a beginner for long. So keep that in mind. Best of luck to you!! The OR is a great place!!

I am an OR Nurse of 7 years, love it, wouldn't want anything other specialty within staff nursing (except that I'm in NP school). Love ortho, love fast paced stuff, and scrub pretty much everything but big vascular (working on that one now) or OH. I've recently joined the staff of a Level I trauma center that earns that designation four times over. They see the ****. I'm wondering if any of you have any tips for, basically, a "Trauma virgin"? I buddied up with the trauma team yesterday and ended up (was glad for the experience) in a balls-to-the-wall case on a 12 yo patient. Two teams working simultaneously on the head and the belly. I kept my cool and did an awesome job scrubbing the crani but am a little scared of the belly/chest region. I'm looking for trauma tips or any commiserating RNs/techs out there with comments! Thanks, Jenny

I know of one Ortho NP and one Neuro NP. Neither went through any specific training programs, although the Ortho one was an RNFA first. I, too, am interested in becoming an Ortho NP and was excited to learn a few wks ago about the UNC Ortho Residency Program for NPs. I think that you need to have a strong knowledge of the physical challenge that Ortho presents, some time at least observing in the OR during Totals, and I'd recommend networking with Ortho professionals in the region that you want to work. What doctors have told me is "NP vs. PA doesn't really matter--If you're good, we'll hire you!"

I've worked in two states in which our OR owned mini C-arm machines run by the doctor. The nurses don't run the machine--as others have said, we just turn it on, get it ready to go, and print the pics at the end. For those of you who also do this, are your doctor-taken images stored in an imaging library? We'd tried to have this happen for our mini C-arm images and there was a ruckus about the fact that they have to have a radiology dictation? Curious.

We have two scrubs for Total Hips and Knees (this is in addition to a PA, and somehow all hands manage to stay busy). Sometimes I'd really like to challenge some of the Ortho docs and ask them, "Have ya' ever heard of an Alvarado?" as they don't use them on knees. Seems archaic to use a sandbag taped to the bed (and a person's not-so-spare hand) to hold the leg in flexion. This is 2006. Do they think that OR staff are free$$?

If not being a "real nurse" means cleaning "code browns" less than twice a year, count me in!! In all seriousness, the roles of all members of the interdisciplinary team are shifting and blurring all of the time. Just because people in other roles can do it (EMT's, etc) doesn't mean that it's not a "real" nursing duty, in my opinion. OR nurses are responsible for patient assessment, patient advocacy, and can be held liable for their duties perioperatively. To me, that's "real nursing". And, as an OR nurse, I know that I'm in a highly-specialized role in which my skills are well-utilized, my talents and knowledge are respected by the physicians I work with (even if they expect me to work like a drone), and I make a good living. If at any point I choose to transfer to an area of nursing less desirable to me (as in more "grunt" nursing tasks), I can do so.