spineCNOR

Hi MeiLana, The reality is that most surgeons in private practice will want an assistant who can "pay for themselves", i.e. they want to be able to bill for the assistant's services and therefore cover the salary costs of the assistant. So your best options would be a surgical PA or NP/RNFA, depending on insurance reimbursement in your state. Being an RNFA only would limit you to the OR (which i fine if that is what you want to do). At least one school that I am aware of (UAB School of Nursing) has a distance assessible acute care NP/RNFA option, there may be others.

First of all, I don't think this is a case of "beggars can't be choosers". Even though you are already on the OB floor as a tech(?) being a nurse will be different, with a whole different set of responsibilities and accountability. If you like the unit and staff staying on the unit would make for an easier transition. You already know the staff and unit norms, so learning your new role would be less stressful. Transferring to another unit later would always be an option.The real question is what are your intermediate and long- term goals? Do you want to return to school to prepare for one of the advanced practice roles (NP, CRNAS, etc)? Do you plan to remain at the bedside for the foreseeable future? (and either option is perfectly fine - you have to decide what is best for you and your situation). Every hospital needs good OB nurses but any unit will give you an opportunity to make a positive impact for your patients. Even if you take a job on the postpartum unit you can always ask to cross-train to L&D, nursery, etc.Good luck to you, whatever your decision!So, I do not have any answers, you just have to decide with your head and heart what is the best choice for you.

I currently work in staff development in a large academic medical center OR. Trying to develop a more structured/organized orientation process. If any of your hospitals offer an internship or fellowship for new hires with no operating room experience please share your experiences: 1. How many sessions do you offer on an annual basis? 2. What is the length of your program? of the didactic portion? of the clinical portion? Does your facility offer Periop 101? 3. Is there a limit to your class sizes? 4. Do you have designated classroom space for education/training/labs? 5. Can inexperienced nurses start work at any time or can they only start when a fellowship/internship class starts? Many thanks in advance!

I am currently a student in a DNP program, so I am not unbiased. While I agree that the DNP does not have the academic rigor of a PhD I am not aware of any one-year DNP programs (but I certainly can't say they don't exist. The program I am attending requires 40-ish hours, about the same as the MSN.) I see the DNP as being similar to other healthcare practices doctorates, such as the PharmD and the Physical Therapy doctorate. Some people who have attended those programs have chosen to pursue PhDs due to their interest in research and I imagine that will be the case with some DNPs as well. Given that healthcare is growing more complex by the day I do think there is a place in nursing for a practice doctorate. One of my professors described the DNP role as being a "superuser of evidence-based practice". Does a nurse need a DNP to use EBP? Of course not, but having a broader knowledge base does help. One of my MSN professors used to say that the purpose of graduate education is to enable a person to see things "from the 30,000-foot level". Do you need a graduate degree to see things from the 30,000 foot level? No - but it does help!

I work in an academic medical center and it is generally the custom that the nurses and residents are on a first-name basis (except when in front of patients where the nurse would address the resident as "Dr. ____". If it is acceptable for the residents to address nurses by their first name it should be all right for the nurses to address the resident by their first name.

I'm sorry to say that any place there are intruments there are problems with instruments! I agree with Sandra about the accountability factor, having the CSS techs sign the sheets. Another thing- does your facility using intrument tracking software? There are various systems (my hospital uses SPM) and all the intruments trays are sets are barcoded so that they can be tracked. Now this has not totally eliminated issues, but it does help. Another thing, if you have trays that are esecially problematic (one with a lot of specialty instruments, etc) it was helpful for our OR to have an OR person from that particular service to do a brief inservice for the CSS staff to go over the instruments and stress how important complete trays are to patient care. I think many CSS people don't really realize what an important role they play in patient care, for some people helping them to understand the importance of their role is a motivator.

I do know that both the University of South Alabama http://www.southalabama.edu/nursing/dnp.html and Samford University http://www.samford.edu/nursing/academics/dnp.php in Birmingham Alabama have education tracks in their DNP programs.

Will you be expected to cover other specialties when you are on call? If so, you certainly need at least a brief rotation through those areas.

Interesting question! "Back in the day" before same day surgery became so common it was not at all unusual or OR managers to expect their nurses to do pre- and post-op visits. I don't consider checking up on a patient post-op a HIPPA violation, but it wouldn't hurt to run it by your manager first. After all, this is one way to evaluate the effectiveness of the patient's intraoperative care. As long as you keep in mind that the patient may be tired and not interested in having a visitor most patients and their family members don't mind a very brief visit.

Director of Surgical Services (currently vacant) Nurse managers for CVOR, General OR (everything accept CV) and PACU/Same Day Admissions (Endo is not under Periop services) Charge nurses run the board on each shift General OR has team leaders for the different specialities. In CVOR a scrub nurse for each surgeon serves as the team leader.

Why hello! I am an OR nurse, origianlly a diploma graduate (hospital school of nursing). Went back to school a few years ago for a BSN & MSN so that I would have more career options (I was working as a staff nurse at the time). I now work as an educator in the OR, so there were different career and money advantages for me. It really depends on where you work. Most places in the US prefer or require a bachelors for a managment or educator postion. My impression is that it is basically the larger hospitals and academic medical centers that require a masters. I'm sorry, I don't know anything about education preferences/requirements "Down Under".

Exactly -- I agree that is is probably best not to worry about learning instruments right now. Honestly, the best way to learn instruments is to see how they are actually used. Alexanders is a great text, and it does have some info on instrumentation-care & handling, and the main categories (grasping, cutting, etc). That will give you plenty of information for right now. Good luck in school!

It is very important to be familiar with your state's boards practice guidelines, i.e. what is in your scope of practice and what is not. It's also important to be familiar with your faciltites policies, especially those involving patient safety. One concern is how to properly escalate concerns about patient safety, i.e., if you express concerns to a doc or your manager and you don't feel the situation is resolved what do you do next?

I recommend Alexander's Care of the Patient in Surgery by Jane Rothrock. This is a very comprehensive text that covers the basics and well as the various specialties. It's a little pricey, but well worht it, especially for OR newbies. Alexander's on Amazon Best wishes in your new job!

you can read and print out Home Study articles here: http://www.aorn.org/journal/homestudy/default.htm even if your aren't a member. I hope you enjoy your OR clinical experience!

First of all, gratulations on your upcoming graduation! I know nothing about Cleveland, but I do know that The Cleveland Clinic is consistently rated as one of the top hospitals in the country. You owe it to yourself to at least check the facility out.

Here is a university hospital web site that offers basic perioperative nurse education, however not for any sort of CE credit. And ditto to the above advice, more hospitals today are willing to train nurses who don't have previous OR experience. http://www.health.uab.edu/show.asp?durki=71239

Lu Ann, I suggest checking with Employee Health at the hospital where you want to work. I can't imagine that you would put patients or coworkers at rish as a circulator, but that would be a decision your employer would have to make.

Ditto to what Imjamie said, and brush up on positioning--when I took the exam there were several very specific questions on potential pressure points and so forth, i.e. lateral malleolus NOT ankle. Know sterilization parameters, for prevac, gravity, EtO gas, Steris--what temperature for how long. Know you standards and recommended practices. If you brush up on the above you should do just fine on the exam.

where I currently work, a university medical center, a physician is required to mark the site in preop. It's usually done by a resident, rarely by the attending. The policy is currently being revised, and will allow RNFAs to mark the site as well. In the for-profit community hospital where I worked previously, the same day admissions nurse marked the site in preop. As far as I know, the State Board here does not address this issue, and it is up to each hospital to make it's own policy.

where I work they are classified as OR Care Techs or ORCTs, a variation of the Patient Care Tech title.

you might want to check with your Steris rep, but I think the "Just-in-Time" refers to the fact that items sterilized in the Steris cannot be stored for use at a later date, like things sterilized with steam, EtO, Sterrad, etc.

In the 2 OR's in town I have worked in some surgeons wear them, some don't. Some that do expect the scrub nurse to wear a spacesuit as well, some don't. Just guessing I would think most don't require the scrub to wear one. If there is a difference in the infection rate between the 2 groups I am not aware of it. Neither place has laminar flow rooms.

all the above, plus flexibility--it is important to be to "go with the flow" and adjust to changing situations. Being attentive to details is VERY important in the OR (of course it's important in other areas of nursing as well). Of course being able to prioritize and be organized is important too.

For those of you whose hospitals employ RNFAs what is the criteria in terms of education and credentials? Does the hospital require that RNFA have completed a course? be certified? Are RNFAs in your facility typically salaried or hourly? Do they participate in setup of the room, and turning over rooms, or do they just come in when the patient enters the room? My hospital's job description is quite vague--states that RNFAs "should have a BSN" and "should have completed a FNFA course" Thanks in advance!