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You know, I earn a good salary. It took me 30 years to get here, but the truth is, I have no complaints about my salary. And I'm "just" a staff nurse (by choice). I have hundred complaints (a day!) about working conditions, both labor related and physical conditions And about the corporate nature of medicine. My nurse-colleagues agree with me on this. It's NOT the money that's the big problem. I work in a university hospital, and it is still an extremely corporate mentality. PR is their biggest concern, because they think that telling the public that their staff does community service, or that their staff has advanced degrees or that we have every available surgical robot will foster public admiration for and loyalty to the institution. At the bottom line, patients care about the CARE!

Hi, Lu. I have been an OR RN for 30 years after having worked a few years on surgery and oncology inpatient units. I think it is a mistake for OR programs to accept new grads. We have a program in our OR, and just accepted new grads for the first time. They educators have decided they won't accept new grads again. The "interns", as we call them, had a tough road to navigate. Yes, the skill set in the OR is unique, and yes, we are not respected as "real nurses" by some peers in other specialty areas. We have fought that marginalization of our professionalism forever. The truth is, we care for patients immediately after meeting and interviewing them for only 5 or 10 minutes. After that, they are asleep, and all the information we have is what we've been able to glean from that brief initial interview and the chart. That requires an ability to connect and establish trust quickly with patients and their families, and sharp assessment skills. Assessments must be mentally translated to care plans immediately. In addition, the ability to prioritize needs and to delegate tasks within the OR is key to efficiently facilitating a case. The OR is a "tough room", where it is necessary to stand up for your patient's needs in the face of impatient and/or rude and/or angry docs. (It can also be a place of quite satisfying professional relationships with anesthesiologists and surgeons.) The pace is extremely rapid. It is very demanding, physically and emotionally. It can be very satisfying work. I believe that at least a year on the general patient care unit provides the new grad with an opportunity to "get her legs under her". That is, to further develop the skills and judgement that began in school, gain confident and reliable assessment skills, and gain overall confidence in herself as an RN who can function independently and oversee techs and assistive staff. I do not mean to discourage you from perioperative nursing. Rather, I encourage you to enhance your chance of success by building a stronger foundation after graduation before you attempt to join us in this tough specialty. Best of luck to you, Linda

Thanks for the followup. Have a great weekend.

Thank you for sharing that info. Makes sense. Linda

I wrap them in a pillowcase. (Wrap the case around it rather than putting the gel roll or IV bag inside the case to avoid losing it in the laundry.) I never use towels because they leave ugly marks on skin. We still often use IV bags - I'm unaware of AORNs position against this...anyone care to summarize? Thanks

Dansko Professional (closed back). No question.

Our policy is similar - termination even for looking up your own record. This is no joke. The sad thing is that protecting patients' privacy has always been our ethical responsibility, but it took a huge bureaucratic action to get many to take it seriously....

I'm so sorry you are dealing with this stress. It happens to so many of us and any nurse who makes a med error suffers internally about it. I made the same error, in reverse, recently. I, too, was sick at heart even though I knew the patient wasn't harmed. I had an extremely anxious pre-op patient for whom I heard the doc order klonipin, which made perfect sense to me. He'd actually ordered clonidine. I so wish we had a generic names only policy at our hospital. One of my clinical sites when I was in school 29 years ago had such a policy, and it surely helped clarify things. Try to relax and get your confidence back. You know you are a good nurse. Good luck to you. Linda

We do the same.

You absolutely did the right thing. No question. Good for you. The pharmacy must verify any meds brought from home. Basic safe practice.

Scrubs from home, laundered at home, changed into at the hospital. Any hat/cap is OK.

OR Dude: We have some pretty obnoxious reps in our OR too. The "boys' club" atmosphere between the ortho reps & surgeons, in particular, gags me... Back to your point: I think you should use your "chain of authority" and first report this rep's behavior to the appropriate service clinical coordinator. If s/he is unresponsive, then go to the OR Nurse Manager. It is their responsibility to coordinate matters with the vendors, and therefore to address this guy's/woman's unacceptable behavior in the OR. I think you'd be out of line to go directly to the rep's company on your own. Hope you are successful. Linda

Thanks for the link. I'll check it out.

PS: This idea is insulting and ridiculous. Absolutely unfair to our less senior colleagues.

OK, I'll admit my ignorance. What the heck is AIDET????? And may I add that if I see one more acronym at work I'll pull my hair out:banghead:

They do whatever they want, whenever they want to do it. If they want to start before our 0730 start of business, they allow them to post an early start & the staff assigned to that room must come in early to do the case. If they post a 6-hour spine for 4pm, that's business as usual, and if there's not enough scheduled staff there, the call team comes in to finish the schedule. The docs' lounge is fully stocked with beverages, snacks and hot meals - oh, and a vibrating leather recliner (swear it's true...) from which to veiw the large plasma screen permanently tuned to ESPN or Fox Oh, how I miss the more egalitarian, collegial atmosphere of a teaching hospital.

I have never seen a 2:1 RN to patient staffing pattern. The common rule I've seen over the years is that there is never only one RN working alone in PACU even if there is only one patient. There is always a second nurse for backup in case of emergency. The typical staffing is 1:1. Perhaps it is this minimum of 2 nurses on duty that you've heard. I think your anxiety over this situation is justified. ACLS is certainly appropriate, but PACU RNs need to also have detailed understanding of different anesthetic agents & their side effects. Most have critical care backgrounds and/or specific PACU training programs. Post anesthesia care is a recognized clinical specialty. I have been an OR RN for about 25 years and was a strong clinical nurse on the floors prior to that, but I would not work in PACU, except as an extra pair of hands in a pinch, without formal training. The liability is huge. Patients deserve fully trained nurses in the appropriate clinical area. Best of luck in your new position.

absolutely. when money gets tight, nursing is the first area targeted (both staff & leadership, to be fair). i have been in this industry long enough to have been through crises like this at least 4 times. i never panic anymore, because it always blows over eventually and so far i can count on my hands the number of weeks in almost 30 years that i haven't had all the work i needed. i have always been a staff nurse. that said, i worked at a place in new england that went through a tough time around 12 years ago. their brilliant solution was to offer irresistable early retirement packages to staff who were close to retirement, but not quite there. so...we lost our most experienced staff, the hospital erased their top of the scale salaries and benefits, and you guessed it...within a year we were hiring completely inexperienced rns and training them ourselves to be or nurses. what a bargain! you can imagine the stress of working on a unit with a hugely disproportionate percentage of inexperienced staff. so, if your institution comes along with an early retirement windfall and you don't qualify, you may want to head for the hills rather than deal with the consequences down the road. good luck to everyone during these uncertain times.

"]don't do it. take care of yourself. good luck to you & your family.

Hi, and congratulations on your upcoming graduation!:balloons: RNs play a very real nursing role in surgery. It takes very little time to pick out even a very experienced OR nurse who has never worked on the floors. Experience on the floors is very valuable. Experience on the general patient care unit gives the new grad a solid opportunity to hone skills in assessment, time management, leadership, effective communication with docs, and the big one - confidence. RNs in the OR have struggled for years to be accepted as "real" nurses. Strong "real nursing" skills do make a difference in a perioperative nurse and in the care patients receive. You do have patient contact in the OR, and a valuable skill is being able to make the most of the small window of time you have with the patient while they're still awake. Strong assessment & communication skills are essential in that regard. If you are able to get a handle on the patient's knowledge and intelligence levels, you will be able to more effectively provide pre-op teaching and reassurance. Going through the history & physical and labs quickly & confidently will enable you to assess and plan efficiently. The list goes on. I've been in the OR for almost 25 years now & am still always glad I spent 4 years on the floor first (one as an RN, one as an LPN, and 2 as an aide). So, yes, take that year on the floor to get your legs under you and your confidence up. Then come join us in surgery because we always need more interested, motivated nurses among us! Good luck. Linda

I respectfully and strenuously disagree, Babyshark! It takes very little time to pick out an RN in the OR who has never worked on the floors. Experience on the floors is very valuable. To say the two are like Chinese vs German devalues the true nursing role RNs play in surgery. Experience on the general patient care unit gives the new grad a solid opportunity to hone skills in assessment, time management, leadership, effective communication with docs, and the big one - confidence. RNs in the OR have struggled for years to be accepted as "real" nurses. Strong "real nursing" skills do make a difference in a perioperative nurse and in the care patients receive. Invest in yourself, Brandy. As a perfectionist, you will likely fit well in the OR. As a perfectionist, you also will likely be glad later if you've spent a year strengthening your basic skills and independence before joining us behind the big double doors. Best of luck to you, Brandy. Linda

You said: I kind of feel like my hard work to get my BSN was not worth it since a tech with half the training can do virtually everything I can in the OR. A floor RN has many more responsibilities than a tech, but not so in the OR Don't sell yourself - and the rest of us- short. Every day, with every patient, you make assessments and plan your care accordingly. Techs don't have the education to assess patients.

I like the idea of the door locking open mechanically, without an electric mechanism. This could be a more economical solution You're absolutely right - these beds are becoming more enormous all the time. Regarding the comment about the opening door contaminating a back table or draped scope, I have to say that the sterile field should not be set up so close to the door in the first place. Sorry - not trying to be bratty, but I was taught not to place the table near the door. Thanks for your input, everyone. I'll keep collecting comments and will pass them on to the committee that approached me to poll you here.

Thanks for answering. Linda