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.

I have mixed feelings about this issue. Continuity, surgeon satisfaction, and efficiency often demand having people who've shown particular skill in an area in those rooms more often than others. I may be among the minority here, as one of the people who is drawn to ortho. My new hospital is currently fighting for survival, and among its competition is the surgery center co-owned by a large number of the physicians. Our case load is small right now, and we have a lot of doctors rotating through, so having staff who are super-skilled in the particular area doing those cases seems very important for earning future business from our new surgeons. As much as I appreciate the importance of being well-rounded enough to do things competently in all specialties, I've worked with staff who preach the virtues of being "jack of all trades" when, in reality, they're assigned specialty-to-specialty more because of having a hard-to-deal-with personality than anything. I totally agree with the previous poster who stated that doing something because you're good at it and like it is one thing--while doing something because you can't/don't want to do other things is a totally different story.

Have some bandage scissors, and some cast splitting tools handy as well. Our docs almost all use plaster; it's strange how different preferences can be. In our OR, we've got a nice Armstrong (I think?) rolling cart with: 2,3,4,6" Ace wraps and Webril 2,3,4,5" Plaster and Fiberglass rolls 3x15, 4x15, and 5x30 Pre-cut Plaster strips 2x15, 3x35, 4x(35?) and 5x(35?) Pre-made Fiberglass splints (packaged separately) We keep universal and elevating Arm slings on there, as well. Some of our docs have taping rituals (they like 1/2" or 1" silk tape that they criss-cross over the ace when they're done), so we keep that on there, as well. And, for water, we use the yellow plastic hospital basins with a plastic bag lining them.

Yeah, NoCrumping, I think the trick with most surgeons is just learning who you're dealing with. There are some who are more than respectful, some who you just need to shut up around, and others who actually deal better with people who throw their **** back at them (if they give it to you, give it right back to them). I used to work with an ortho surgeon who was as hot-and-cold as they come, but the fact that I stood up to him stopped him from continuing to treat me badly. I was a green nurse learning the OR, and one day we were doing an elbow procedure (an olecranon bursa excision or something). Unlike any other surgeon I've worked with since, he did the procedure on a single, regular arm board (instead of an operative arm board, double-wide, ya' know--not much room to work). Anyway, I nervously handed him a 27" suture, loaded on the needle-driver, and accidentally let the tail drop. He had me cut off what'd dropped below table level and proceeded to lecture me on why this was wrong, yada, yada. The next time I handed him a fresh suture, he grabbed it quickly out of my hand and, again, the rest of the strand fell over the side of the arm board instead of resting on the patient's arm. He threw the needle driver (loaded) across the room, yelling at me for another suture. The rest of the procedure required a lot of clamping and cutting and more suturing. EVERY single instrument that he asked for, I handed him with a sharp SLAP into his hand. I mean, SLAP. His assistant later told me that she could feel the bad vibes flowing his way. At one point, he turned to me, smiling, and told me that his hand was stinging. But the arrogant SOB NEVER treated me that way again and, in fact, seemed to get the hint that he wouldn't get away with messing with me as he did many others. I've worked with others since then, and showing them that you're intelligent enough to stand up to them sometimes actually wins their favor.

I worked somewhere that had a formula where your age plus years of service at the hospital added up to X number of years, and you were then off call. That really kept some of the people pretty loyal to the place--e.g. one nurse who'd started there at age 21 and was off call in her fourties. I worked at another hospital that just revoked their "20 yrs of service and you're off call" policy. This led to utter chaos. Most of their experienced staff has quit and gone elsewhere.

My hospital system implemented it on a hospital-wide basis for our brand new hospital before the rest of the system went live on this particular system. The software system, although not in its infancy, has a lot of "issues". And, in many ways, my hospital system was not ready with the IR support or infrastructure that we needed. I work in the OR, and I'd go back to paper OR documentation and paper charge forms in a heartbeat. And I think that, in some ways, it has been a pt. care and safety issue--orders placed by doc and being overlooked by nursing staff on the floors, taking time away from patients, documents that seemingly "disappear" in the computer system. It could be a real time-saver, but totally depends on how good the software, IR support, and hospital implementation is.

My first OR, in a small community hospital, used the hanging sponge counter bags. This is what I came to expect as the standard. I then got a job working within a large health system in a moderate-sized city. My OR used a kick bucket and people would hold the laps up by the strings, around each finger and then wrap the ball of 5 in a wrapper or enfold them all in the exam glove (peeled off carefully). The Ray-tecs would be carefully laid over the edges of the kickbucket and counted that way. The glove thing I personally found disgusting. There was a good chance that you'd end up with blood on your hand. And, if you ever had to question whether there had accidentally been a ray-tec stuck on a lap sponge, getting them out of an inside-out glove was also disgusting. At my new hospital within the same lg. system, we bought the hanging bags. It is MUCH safer, in my opinion, clearly displays them in the eye-shot of scrub, surgeon and anesthesia provider, less messy, etc. And, after all, it is 2006. In the age of neurotic med/fluid labeling, meticulous flash-sterilization logs, and other safety initiatives, anything less does seem a little crude.

I don't know that the inference was that OR, ER, PACU or L&D aren't overworked, maybe just that they're more rewarding or feel more appreciated. I'd personally recommend getting ICU experience right off the bat. Many systems offer internships that allow you to get into the ICU. Most PACU settings require ICU experience, many ED positions either require or look kindly on ICU experience, etc. I would say that many of the specialty areas seem to garner more loyalty among their nurses--OR, ED, ICU, L&D, PACU, NICU, etc. I worked on the floor for a year before going to the OR, and did find the experience worthwhile. But, as a whole, floor nursing is very thankless. But, as to your initial question about what OR nurses do: Circulating nurses: 1. Are responsible for coordinating supplies and services to make the surgery run smoothly; Along with the scrub, we make sure that all of the needed instruments and supplies are open or available; We coordinate with pharmacy, central sterile, the supply dept, x-ray dept, etc. 2. Are responsible for making sure that the patient is ready to enter the OR--the consents are in place, they're NPO, don't have jewelry, etc. and double-checking to make sure that none of the patient's significant info has been overlooked (pacemaker, allergies that are applicable to surgery or post-op course, etc.) 3. Are responsible for assisting anesthesia with induction of anesthesia, blocks, IV starts, line placement, etc. 4. Take part in positioning the patient, pre-operative prep like applying SCDs; we put in foleys, do the surgical skin prep, etc. 5. Paperwork 6. You get to be the gopher during the case. (Depending on how well you know the procedures, how competent and organized your scrub is, and how "needy" the surgeon and anesthesia person are, this can range from being fun to EXHAUSTING.) 7. Helping to get things finished up--applying tape, slings, casts, immobilizers, 02 for transport, transferring monitor components and prepping patient for transport to PACU, ICU, etc. Scrubbing is something that will really depend on where you work (as to how much you get to do it). Being the sterile, scrubbed-in person and functioning proficiently in that role is a huge skill and is acquired with time and experience. I love to scrub (especially Ortho), but my current job doesn't affort much opportunity for me to do so. A nurse I know said this week that she'd rather scrub because "scrubbing is easier". And that is often not true. There are some times when it is very unpleasant to be the circulator (sick patients or needy Drs requiring tons of work on the part of the circulator), and there are times when scrubbing is also very demanding. Again, scrubbing WELL is a huge skill, and many who scrub aren't as good as others at planning ahead, being kind to their circulator, and keeping their surgeons happy without too much fuss and muss. I love the working in the OR, and think that it's a great part of the nursing world.

Have you applied for the internship? One of my co-workers applied for it a couple of weeks ago, was in-line/ready to go for the job. Someone applied for it internally the day before the internal deadline, getting it by default, because SWWMC is union. This doesn't really have to do with what you're asking. But my co-worker was pretty bummed. :) (The program sounds like a cool one.) I work in Vancouver, at SWWMC's new competitor. I've heard good things and bad about the work atmosphere, but the stuff don't relate to their ICU and is probably a dept-by-dept thing. I'd suggest going for a union place, as I currently work for a big non-union system in the area and that DEFINITELY has its drawbacks. (That's a totally personal choice, though.) As for well-reputed work environments: I've heard great things about Kaiser's hospitals in the area; Prov. Portland Med Ctr. is well-reputed with physicians and nurses; and Legacy Emanuel seems to have won the loyalty of a lot of its staff. The advantage, obviously, is that living and working in Washington holds a significant tax advantage over commuting and working in OR. Hope that this helps.

RNFAs and PAs are not even equitable. RNFAs are not mid-levels. They may be able to bill in some places for assisting, but they do not have prescriptive authority or the same primary care training that PAs/NPs get. As for thinking that NPs are too noble to get involved in surgery, as this would be such a waste of "health promotion" and "illness prevention" duties...if that type of idealism and holier-than-though thing is what does it for you, great. But there is nothing wrong with wanting to be involved in the surgical aspects of care, make more money, whatever. As an intelligent OR nurse, I'd be the first to admit that you don't use a lot of your nursing skills working in the OR. But you do learn an entirely new set of skills. When you then go to NP school, and begin to learn/strengthen the skills needed to function/thrive as a mid-level, you've now got two huge skill sets. The only way that the PA-centrism (present in the minds of many physicians, and in surgery settings as a whole) will be lessened is by a bunch of intelligent NPs proving that we can function as capably in surgical settings as PAs (with the added bonus of our autonomy).

(Before I posted, I didn't realize that there were four pages of posts on this. People on pages 2, 3, and 4 said what I was going to say--and better! Oh Well.) The scrub is always supposed to have things labeled, even (as a previous poster mentioned) saline and water. If you're a non-OR-trained person, it might seem wierd. But we have double-checks in place that often seem a little redundant (labeling ad nauseam, repeating the med and concentration when we give it to the surgeon, etc.) The biggest issue that I see in the situation outlined by the original poster is the fact that they weren't labeled. And, the surgical tech or scrub nurse is to repeat the med and concentration to the doctor as the med is handed. "Quarter-percent Marcaine with Epi" If this wasn't done, the staff was not using the double-checks that are supposed to guard against error. Many surgical techs have 2 years of training. Their training isn't as comprehensive as the training we've gone through as nurses, but it isn't like some other "tech" positions in which a person with a high-school education comes in off the street and receives a little on-the-job training.