IsseyM

I logged into my acct after 3 years and read some of my posts. It's funny to read some of my old posts. I was such a nervous Nelly when I first started. Here is a post I thought I would share with the newbies. Good luck & wishing you all the best! I learned how to circulate through numerous preceptors. Some would hardly make me do any circulating and some made me do it all. You're main job is patient safety and comfort...along with making sure your doctors, anesthesiologist and scrub have everything they will need. Making sure the patient is transferred safely. Safety straps are on. Patient is kept warm. All monitors are on and VS are visible on machine, even though anesthesia is mainly focused on this. You may help anesthesia intubate patient, you may not. Some are pretty self-sufficient and don't want help, but always offer. Here are some tips i hope you find helpful. Tips for a circulator before you bring patient into the room. *Make sure your OR bed is locked and safety straps available! (For body and arms) *Make sure your OR bed is in the right position for the type of surgery you're going to do. (Lap Chole. The C-Arm machine needs to fit under the table without the metal part being in the way) (If doing lithotomy or jacknife be sure the bed is positioned to where its supposed to bend) Also some doctors want cassettes on the table in case they want to do a flat plate x-ray, some don't care. Its good to have them on for big bowel cases. *Make sure all your suction units on the walls work, have enough suction cannisters and tubings available in room. *Make sure all the lights work. *Make sure your room is stocked with supplies you will need throughout the day. (All different kinds of prep solutions, dressing supplies, lap sponges, xray detectable sponges, suction tips, towels, drapes, gowns, gloves, sutures, ties, lighthandles, positioners-like gel rolls etc, etc.) *Make sure you have some kind of warming unit in the room (Baier Hugger or Warming Blanket Unit) *Make sure your bovie machine works and that you have grounding pads. *Make sure that your anesthesiologists checks their machine and cart to make sure all drugs and supplies are available, so you won't have to run or call out for it during the case. *Have step stools available in your room, especially for the short doctors. *Have 3-4 pillows availabe in the room. You never know when you're gonna need em. I like to put 1-2 pillows under patients knees, especially if they have back problems. *If doing a Laparoscopic procedure which requires insufflation of gas into the belly. Make sure you have a full tank of gas. I've had to change out numerous tanks (what a pain), thank goodness they were not during the case. *Check your preference cards and read over them 2-3 times. Sometimes you'll miss an item and then realize it was on the card and end up having to run or call for it during the case. If it takes forever to get it the doctor will have a fit especially if he knows it was on his card. *If you're unfamiliar with any of the equipment have someone give you a quick inservice on it, or ask if someone can come in during the case to help you with it. It took me a few times to get used to the Laparoscopic monitor because i wasn't sure how to turn on the gas or take the light off, increase pressure or flow. *Make sure you have a sitting stool for yourself. Haha. Its nice to have a seat during the case, you really don't have to be on your feet all day. Tips for circulating during a case: *Make sure your scrub person has warm irrigation solution NaCl. *When giving medication to the scrub person, make sure you look at the bottle closely, tell them what medication you are giving them, some want to see the bottle and check the expiration date!!! Also make sure your scrub person labels their medications. Some doctors will through a huge fit if they don't see anything labeled. *After the patient has been draped and cords are being tossed off the sterile field. Always hook up the bovie (make sure the grounding is hooked up also), suction or other electrical equipment first before you do anything. Don't stop to answer the phone or run to get anything. One of the first things a surgeon will use after the patient has been draped is the knife, (or local injection) then the bovie. For Laparoscopic cases I like to hook up the bovie first, then the Laparoscopic camera, light and insufflation, then suction. But sometimes they throw off the Laparascopic first and the bovie cord second. You can do either or. *Watch how many sponges your scrub person is going through. Its nice to notice when they only have 2 or 3 more left, you can ask them if they need another package. This includes sutures/ties/hemoclips. If you notice they go through supplies fast, have them available so you can quickly open it to them when needed. Keep track of supplies you open and your charges. *Pay attention to your patients IV fluids. When you notice the bag is getting low ask the anesthesiologist if he/she would like another warm bag. Sometimes no one pays attention and the bag ends up going dry. *Make sure your patients extremities stay on the OR bed. There have been a few times I caught the leg slipping off the table because of the SCD machine. Or arms fall off the armboard because they were not strapped. This is why I like to use arm straps. *Pay attention to see if doctor may have to switch sides. If doctor is using a headlight you have to unhook him and switch and if he's using foot pedals you just have to move them where he can reach them. *Pay attention to the case. Listen to what the doctor is telling his assistants, residents, medical students or scrub. This helps me out alot because it can put me one step ahead. *If there are specimens make sure to ask the doctor what the specimen is and how he would like it to be sent. Also make sure if it is to be sent right away that you write your extension number on the card so the pathologist can call back to the room for results. (However, there could be a different policy depending on what hospital you work at) One time I forgot to write the number and the doctor was asking about the specimen, if I sent it and what was taking so long so I had to call the lab myself. *If you're not sure what type of dressings the doctor will use then ask. I personally like to ask when they're starting to close, that way I have time to gather all my dressings supplies and have them readily available to open. With ortho cases (broken bones) I like to have them available earlier. Circulating takes practice and repetition. I didn't think I could ever do it by myself but now I am. You will have many different cases but circulating duties are pretty much the same for each one, the only things that change are the instruments, supplies or anything you will need to call or run for I know there are so many other tips but this is all I can think of for now.

Head to toe basically. I start out with any neurological stuff, previous head injuries, seizures, strokes, deficits. ENT problems. Thyroid issues. Heart problems, pacemaker, HTN, Cholesterol. Lung problems, asthma, COPD, smoker. Abdominal stuff, diabetes, kidney, reproductive organs. Any previous surgeries, metal in body. Take medications for anything. Do they use drugs. Last time NPO, last void. If they will need a catheter I explain about that. And I do mention cold room and how they have to move from stretcher to OR bed but will be covered up with warm blankets. I used to explain hooking up leads not anymore. Then I complete interview with if they have family & if they have any questions. Is this what you're looking for? I'm sure i forgot somethings. LoL. I know some nurses that hardly do a preop interview. Some only ask procedure, allergies, metal in body, last NPO, last void while some do a full blown interview covering more than necessary.

Take the OR. You will have lots of training before you're on your own. I think I had 9 or 10 months training. The first year was tough. I've been in the OR for 5 years and I'm thinking about going to ED. LOL! I Only because I don't want to be stuck in OR the rest of my career. I'm getting kind of bored with it and need a change; however, I do like the OR most days. Also you can make lots of money with taking call especially if you join the heart team or transplant team. Those people take a TON of call. Good luck!

You're focused on one patient at a time. Great team players. If its a rude obnoxious patient, they're knocked out. I don't have to call doctors in the middle of night for orders or questions and get yelled at. 95% I get a lunch break and potty break.

Thanks Maggie. I know i will have alot of studying to do. I almost feel like a new grad again. lol.

Right out of nursing school I went right into the 6 month perioperative program at my hospital. I've been in surgery for a little over 5 years but i'm starting to get bored and burnt out with it. I have lost alot of nursing skills. We don't start IVs or give drugs, anesthesia does. I am super nervous and scared because i forgot alot of my drugs and normal doses. I don't even remember how to read EKG strips!!! I have always been interested in the ED. I had a choice when i graduated and wish i would of chose ED. You use so much of the skills you learned in nursing school. I am thinking about talking to a nurse recruiter and switching over to the ED, but i'm not so sure if the ED will hire a nurse with no ED experience. If they don't i don't know what else to do. I can't think of any other type of nursing i would be interested in. I was just wondering how long is the orientation for new ED nurses average. any other recommendations. Thank you.

Ortho case. Resident was messing around with screw and i think he said something like, "Push it in more so I can get a better view of head."

Curious to know if anyone experiences OR burn out and has even considered leaving the OR to try another area of nursing?

I like babies and kids but not in the OR. I prefer adults. We have a main OR that accomodates all services and we do alot of peds cases, big cases. For one, i can't stand those hot ol rooms. Our peds surgeons like the rooms to be 80 freakin degrees for the neonates/infants. I feel sorry for the people scrubbed in cuz you are sweatin the whole case and if you forgot to put on deodorant that day, pepe le pew, no thank you. I also don't care for the high acuity or intense cases, but thats just me. If you like peds, then go for it. We need more peds OR nurses, not too many i know.

Yup, i've had the same thing happen to me too! That is too funny. Just last night i had a dream i was late for work. In the dream I could see the charge nurse and my crew getting ****** off and wondering where i was, i was thinking "OMG i have to get to work" I woke up panicking and looked at the clock and it was 1000am. I freaked out thinking i had to be at work at 0645 but it was my day off today. LOL!!!

It sure does! LOL!

Haha, yes i do. Seems to be when i had a very stressful or bad week though and like you said its usually with me running around like a chicken with head cut off. I've also had dreams of not being able to talk in the OR when i wanted to, afraid of being yelled at, me getting in trouble, doing surgery outside the hospital instead of inside the room, and a bunch of others i can't remember. The 1st 8 or 9 months was the worst, i often had nightmares about the OR. Now its mainly having dreams of not moving fast enough, its like everything i am doing is in slow motion...very frustrating.

Hi QHnurse, i could of written the same post myself. I have been a circulator in the OR for 2 and half years. I am also quiet and too nice. I am somewhat shy and lack self confidence. It took me over a year to get to know some of the surgeons and anesthesiologists, i mean like be able to conversate with them. I still feel like i walk on eggshells almost everyday because i am afraid of getting yelled at. I sometimes feel like i'm in a emotionally abusive relationship with some of the mean surgeons. Some of them can be so nasty and make you feel like you're the dumbest thing on the planet. I also cringe when i know i have to be with them all day. I like to do a good job and put alot of pressure on myself to do the best i can but i also realize i am only human and i do make mistakes. It was really really hard the 1st year for me. I also had co-workers who shared the same feelings as i did. Some of them very timid and shy but still in the OR. Many of us talked about quitting the program, we vented to each other everyday how much we hated the OR and which surgeons we ****** off. Actually we still vent to each other. I do like surgery though especially open belly cases. I don't know why but i do like the blood and weird stuff. There are some days i just love the OR and don't want to do anything else and there are days i can't stand it and think about leaving. You definately do get tired of dealing with BS in the OR, i usually just vent to my co-workers and friends. I go to the gym to deal with the stress. I also take the time to do things i enjoy, taking care of ME. As far as how to handle dealing with the mean surgeons i'm still struggling with that but i have realized to not take it personal because most of the time they are mad at the situation and not you. Anytime you need to vent or discuss anything come here, it helps. Good luck!

Yep, we do the same also.

Most of the OR staff work five 8hr shifts the 0645-1515 shift. But we do have 10hr and 12hr shifts. I was working the 8hr but now i work 12hr. 12hr days are hard but its nice having all the other days off.