FlyOR

You know you're an OR nurse when you hand people stuff that they murmur under their breath unintelligibly that they want. You know you're an OR nurse when you figure out you've created a "sterile field" around whatever vegetables you're chopping/ washing on a cutting board. You know you're an OR nurse when you require "read back" for every damn question someone asks. You know you're an OR nurse when someone says "Eww Pus" and you want to see from where and how much. You know you're an OR nurse when your kid comes to you with a good size cut and is bleeding and you say, "aw that's not much, put pressure on it". You know you're an OR nurse when you finish your dinner before anyone else has made a dent in theirs.

I thank you all very much. I feel a bit better about my struggles with this mess. I guess my "keep your mouth shut" policy is really the best one, amazing how that one always works. I will explore the Al-anon meetings, I think it would help my spouse and the rest of us. Many thanks! Happy Thanksgiving!

Ahh. In this case, I am going to have to admit to not doing my homework. Jeepers, I know better! I guess I just thought that no one would come here and admit that they loathe a mentally fragile individual who happened to be in their sphere. And, as a nurse, I guess I thought I should have a better grip on this. Please forgive the any assertion that nurses aren't human too. Not what I meant to do. How do you handle this though? So far, I am trying to keep my mouth shut, because nothing I have to say is helpful. There's no way to cut this person off, the only thing I can think of is to try to facilitate an escape pod for their immediate family. I think this person has had wayyyyyyyy too many chances, and sometimes if people do not get to rock bottom can they finally heal?

I haven't done any psych nursing since nursing school. At the time, I actually did very well at it, and it was a definite option, however, I decided it was too much like my previous job and I wanted something different. Here's what I would be grateful for- some tough love advice. I hope this is useful for other nurses, and I really do not know who else to ask. I recognize that mental illness is indeed an illness, and has all kinds of pain, suffering and maladaptation. I was always able to retain the "unconditional positive regard" with my patients. I saw their suffering, their distance from their families, and how it decimated their life and I tried to help. I know it's often the result of biochemical imbalances, genetic disorders passed on, and maladaptive responses to life. I know all this. However. I find that a person close to my spouse, whom he cares for a great deal is apparently mentally ill- bipolar and an alcoholic. I have never liked this person, I have always found them infantile, selfish and with that ever present "poor me" mien that is inevitably irritating- and that was before it was discovered that they were an alcoholic. This person has done a lot of destructive things, and currently is causing a ton of pain in my spouse's world. This person has a family and is currently destroying its fabric. I am finding it really hard to do anything but despise this person, and I realize that, that fact is indeed a character flaw on my part. Please help me re-acquire the nursing regard, the constructive way to see this person. Slam me for not seeing what I should see, I really want to be constructive and help, not be judgmental and a silent source of negativity. If this person had not really hurt those that I love, I guess it would be easier, but as a nurse, I find my loathing unacceptable. I would be grateful for an experienced psych nurse's view on this. Thanks.

Pick up the newest edition of Periop standards and read it cover to cover, almost everything about being an OR nurse is in there, and it will give you the knowledge as a base while you pick up the rest. With already having training in how to move/ handle a sterile field, you do have experience. A lot of being an OR nurse is hearing and seeing; hearing what the scrub/ surgeon need and seeing every single thing that is happening to the patient. I think that if you show them that you're willing to learn, willing to help and can take criticism you'll do fine, but you really need the basic knowledge behind what we do, so that you can ask good questions and think critically about every patient. Examples: Positioning Anesthesia meds and allergies Diabetics and their needs in the OR Obese patients and normothermia ETC. Good luck!

Bravo! What a generous post Esme! I wish I had seen that when I was in anatomy! Just a suggestion, if you google "cardiac animations" or really any animations, you can get some good stuff. Sometimes the visual is the trick for certain learners, it helped me during my NCLEX studying. Hope this helps and I LOVE the backed up toilet analogy!

You know, I have thought a lot about prayer when I am at work, mostly because I am doing the praying. Sometimes, I have been in cases that have been so dicey, that I have thought that one of the the reasons I drew it, WAS to pray. I think that at any institution, framed properly, prayer can be there, just like at any institution, the absence of anything religious can be there. Like the old adage, it isn't what you say, but how you say it. This is an OR board, we are with people the moment before they or their loved ones are cut open. Choices, to pray or not to pray should be given gently, but not done away with.

LOVE Ortho! Great big femur fractures, drills, plates, screws, Jackson table and the satisfaction of "fixing"! Like General, but only at certain times. General surgeons can be mean )&*()*&(&& s. Cases are great, just who you're working with. Urology, can't say I love the cases, but our urology team is made up of very very nice people. Pleasure to work with them. Eyes? Snooze. Especially after lunch. Except for ocular plastics, I do like that. That's the great thing about the OR! So much you can do!

Using the argument "you knew it when you took the job" applies only so far, and likening pregnancy to various diseases doesn't hold water. Pregnancy is a life event, not a disease. There are two lives affected and protective policies benefit not just the pregnant woman but the employer. From a purely economic point of view, it is in neither the employee or employer's best interests for the pregnant person to experience complications from the environment of the OR. Exhausted pregnant workers are more likely to take disability, use sick time, and terminate emploment. None of which is free for the employer. There are also valid and real liabilities for the employing institution. Imagine a day in court where a lawyer can prove fetal harm due to Xray and bone cement? You do not want me on that jury. Add to that is the inconvenient reality, oft discounted by employers but certainly germane to their bottom line, the expense of training and growing a productive OR nurse. It takes a year to bring an OR nurse to function. Optimal productivity is estimated at 3-5 years and rises from there. Losing an otherwise productive employee because of a nine month window of decreased (arguable) productivity is stupid. Finally, NURSES ought to know better and take better care of one another.

Yup, these responses are pretty typical of what I have seen in nursing. I come from outside the healthcare industry and I have been pretty appalled by how it deals with pregnant workers, especially considering the previous and continuing prevalence of females as nurses. The OR is a physical and high stress environment, with quite a few dangers to a growing baby. The data shows that more needle sticks and exposure happens to OR workers than other healthcare workers. Radiation exposure is not monitored nearly well enough, with wrap around lead rare in some facilities because "it's expensive". Bone cement is a known danger and I am glad my facility doesn't require pregnant workers to be exposed to it. AORN standards are primarily for standing surgeries, sitting is basically frowned upon unless absolutely necessary, such as eyes. Standing all day is tough on anybody much less a pregnant body. Even the maternity leave is appalling. I was able to take up to six months post partum, as that is industry standard in my other industry. The last three month are unpaid, but at least they're available if you want them. It allows for the best case breast feeding advocated by "health experts". Unless you're a nurse, of course and need to pump every two hours. Good luck getting that from your unit. I remember a nurse that returned to work after having a baby and the breaker came in to do breaks for us. The breaker asked me to go first because, gesturing at the other nurse, "she takes too long". I asked why and she made a face and said "she's pumping". I fixed my eyes on her and said, "let her go first, she can have my time". Nurses need to start taking care of eachother. The brutal atmosphere so often prevalent in healthcare needs to change. As it stands nurses are still predominantly female. Females get pregnant. Recognizing this and adapting for it is just common sense. Finally, be advised that depending on your job, if you are physically unable to do YOUR job, you probably qualify for unemployment, unless your facilty makes another position for you.

When I was in nursing school, I just kept repeating to myself "shut up and learn". I think that helped me in orientation. Nurses who teach tend to like to teach, but it can be pretty thankless when you have someone who doesn't want to be taught, or is more about their ego, than taking care of the patient. Here's what I decided: 1. criticism is your friend. If someone cares enough to give you criticism, say thank you. It may hurt, you may think you don't need it, but say thank you and try to figure out how to use it. 2. If some one rechecks or confirms your work in the OR, which I WILL do if I am relieving you, don't take it as an affront, be happy that I am confirming your good work. I want you to do the same to me, because if I miss something, I damn well want to know about it. 3. Lose any and all attitude when it comes to counting. Yes, I know there is no way that you will lose a lap pad in that incision. My chart requires two counts. If anything goes wrong in the case, I don't want any aberrations in my charting. If you ditch your drapes after just counting the sharps, I have to dig through the trash to confirm the second lap count and guess what? Now I KNOW I don't want to work with you again, and you're not a team player. Good for you asking the question.

Rather than PRN can you switch to part-time? At least that way you might have it easier dealing with the mandatory OT. Also, try going out of the box, can you work a weekend day? One night and a day? Sometimes you just have to start asking the right questions. Finally, if you can tough it out for another six months, you will probably have more options. The cold hard facts: -You don't have floor experience, so that will be a tough transition, which isn't something that sounds good for you right now. -OR nurses are expensive to train. Get to your two full years, get your CNOR, and you'll be able to get a PRN gig somewhere. Look at the back of the AORN journal, there are a lot of openings for OR nurses, hospitals just do not want to pay to train them. Often, there are jobs that are not advertised, but a unit will jump on an experienced OR nurse. I know mine would! -You'll have more leverage if you tough it out. 1.5 years isn't a lot in OR nurse years. Two years is better. Your hospital is short sighted, they'd be better off keeping you in some capacity. You're trained, you know where everything is, you know your surgeons, and frankly, they haven't gotten their money's worth yet. Usually it takes three years to recoup training costs. Not to mention, if you're a good employee (which I am sure you are) whydo they want to gamble on someone new? Look for another gig, then if you find one, go to your manager and state your case. If they're smart, they'll realize better to keep you in some capacity than lose you to a hospital that did not pay to train you. Best of luck!

I once pulled my sterile mayo over an undraped patient. Everyone has dumb moments. The fact that you realized it and immediately reported it says that you are where you should be. Sterile conscience is just that, a conscience, and the people who would scare me are the ones that won't say anything or worse just let it go. Hopefully your OR has a good "there but for the grace of God go I" vibe. Every OR should have a zero negatives policy toward a mistake and just focus on rectifying it. If you're like me, your head is thrumming with self recrimination, but if you're like me, you probably don't remember other staff's mistakes, so they probably don't remember yours either. Be kind to yourself.

I don't know if this will help, but I treat a day in the OR like an athletic event. I make sure I go to bed early, prepare everything I need the night before and kind of block out life for those eight hours. I eat protein at about 0630 and then a second protein breakfast during my break. (I joke that I have become a hobbit-what no second breakfast today?) I wear Danskos, compression knee highs and if you can elevate one foot on a stool or the bed, it helps your back in a long standing case. (FYI, never touch the bed if there's a microscope involved, you'll get hissed at by everyone, for good reason.) I also have found after three years that if I keep myself physically fit, I weather work days better. Finally, if you're going to see something that might gross you out, look at it purposefully. I remember one case that if I was going to lose it, it would probably be that one, so I made myself stare at it, and then I shrugged. Okay, gross, let's fix it. Hope this helps.

You've been given a lot of good answers, but as someone who is still relatively new to healthcare I see the circulating nurse in the OR as the minimum. Surgery is the cutting open of the human body. The patient has no defenses except those that the team provides. That requires knowledge and expertise. Being a patient advocate is not just caring, it's knowing your stuff so you can see danger coming. I know plenty of nurses that I don't exactly like, or think are kind people, but I would have my family member with them in the OR, because they are hell on wheels for their patient. Expertise = safety. The OR is a team, there's a surgeon, anesthesiologist, a scrub tech and the circulating nurse, at minimum. The surgeon and the anesthesiologist have their responsibilites and often they are very much in their own head. Knowingly or not, they rely on me to catch what may be outside their present view. That's why I am there. Effective safety protocols have layers and I am the last layer. Without my education, how would I know what often simple dips and rises mean? Everyday I tell myself that my goal is to be THE nurse that I would want my family member with. I want someone who will assess, observe and check all throughout the case and sorry, but I want them licensed and responisible. At the end of the day healthcare is very elitist at heart, especially amongst doctors. Whether or not you are listened to and respected rests on your expertise and that requires education and experience and THOSE allow you to call STOP and be effective.

I only wear a wedding ring, but it means a lot to me, so I leave it at home. I've tried tying it to the string in my scrubs, only to almost throw it in the laundry machine. I've tried safety-pinning it to by scrub top, same thing. When I forget and leave it on, I put in on the key ring that is attached to my badge, and that works, but I don't like it, it's rough on the ring. I know a surg-tech that lost her diamond ring somewhere during the day, and it broke her hearrt. In the final analysis, any kind of jewelry is a potential bacteria catcher, and I take care of precious people. Just my humble opinion.

Go back about twenty pages and start reading this OR board. Read all of the posts you can and then start formulating questions. New management thinking on the OR has a lot to do with error trapping, checklist compliance and basically having the guts to say STOP when you see something out of order. The OR is no place for the shy or reticent. Are you a good team player but emphasis on the PLAYER. Can you take heat? Can you keep quiet while enduring an insufferable co-worker who is safe but should live on an island by themselves, all the while keeping your patient safe? Do you mind being corrected? A LOT? The OR has a huge learning curve, can you sustain being stupid for a year or more depending on how many specialities you have to learn? Do you have a strong sense of self that will allow you to say "I just contaminated that set up that took you almost an hour". These are the things that are day to day in the OR. Despite what your management might say, there is a lot of biting your tongue and soldiering on. Did you ever do the "some assembly required" at 3am of a toy that a sadist designed? Well for some surgeons that is what they're doing with the human body and they get cranky, frustrated and will snap. It's not personal, it's the ******* colon. Some ORs are great days, others you will walk out swearing to look for something else. What management wants to know is if you have a flexible enough personality to roll with it and not become a problem/ whiner or just not be an asset. If you think your personality can thrive in a fast paced high stress environment, think of examples from your work that will exhibit these characteristics, all the while remembering that you are a nurse and you are there for someone's grandmother/ mother/ father etc. This board helped me get my job, it'll help you too. Good luck!!

I wish you the best with your interview. If I were you I would dedicate a good afternoon to reading at least fifty pages of this site. That is what I did prior to my OR interview and they were impressed with how much I knew, the questions I asked and what I already understood about the unique OR dynamic. Every single thing came from the pages on this site. Everything thing is here for you, you just have to go through the pages and read the posts. There is no substitute for learning about the OR other than actually doing it.

I try to preserve my patient's modesty as much as possible, however untying the gown is necessary not only to prevent pressure from knots, but if there is a lot of positioning necessary as well as transferring, I need to see everything in order to prevent harm. Example: residents who forget to unplug Pulse oximeters, IVs that can get tangled around the patient, leads can somehow make it around patients' necks, it's amazing what can happen during a transfer. Also, older school anesthesiologists like to watch the chest rather than the monitor, for them it's more accurate. Somewhere in a consent for treatment is the option for a foley, hence our facility's rule of no underwear. If for some reason a procedure goes long, you can't risk a distended bladder, it would be bad nursing care. Trust me, going under drapes to put in a foley is the LAST thing we want to do, but if the patient's well being is at risk, under we go. As for bruises on elbows, I'm not sure how that happened. We either tuck the arms, palms facing thighs and thumbs up or they go on padded armboards palms up.

Oh please. I am still googling stuff two years later. I know nurses with ten years that google stuff, nevermind pronouncing it. This surgeon is a twit. Are you at a teaching hospital? Because if you are, I find that as long as I choose a non-stress moment, most surgeons are willing to explain things to me and some seem to like the questions, it shows I am interested and vested in what they're doing. Next time you work with the guy, choose a quick moment as say "Hey Dr. Smith, I am not sure about this procedure, do you say it like this?" That'll probably shut him down. Humility is always a winner, and it never bites you in the tookus.

Having 2 RNs in the room is a wonderful day. You always have an extra pair of hands and an extra active critical thinker. I find that RNs pitch in and get the work done efficiently and expeditiously. No lines are drawn at what's your role is, where by virtue of a tech's more narrowed scope, you just don't get that. There are really good techs, but I've never hand them remember a warm blanket without being asked or plug in compression boots for me when I am doing something else. They don't know to perk up when the heart rate goes up and you're close to extubation, so you might need an extra pair of hands to hold down a two hundred kilo-er. It's a no brainer, two RNs in the room and the patient gets better care, but not cheaper care, which is high on a hospital's list of needs.

Want that! Want that!

I agree. My facility wants you to get certifications but really doesn't help you do it, nor do they pay for it. I have noticed that most OR jobs do usually state CNOR preferred etc. Given the state of the economy, as well as the desire of Magnet facilities to have certfications on the roster, I just wondered if it gave an edge. That said, I am getting it for me. I love the OR and want to be as good as I can be. I've just been thinking about my future lately and you can't really ask OR co-workers about job changing and how it works, whether some things are important enough to switch for and the adjustment time required. It's almost like starting over when you switch jobs, new computer systems, different methods, different doctors etc. However, as I said, sometimes to get where you want to be you have to change. Thanks very much!

That the amount of liability for even small decisions is huge. That co-workers, doctors, everybody anywhere near something going bad will look for ways to blame you and not themselves. Corollary: NO ONE HAS YOUR BACK. YOU HAVE TO PROTECT YOURSELF AND BE SMART. That seniority is a BIG deal in nursing, and time off at holidays and summer will be hard/ impossible to get for YEARS. The money----you EARN every CENT. Frankly, it's not enough. That you should savor the good moments to help you get through the bad ones. That the job will kick your can for a LONG time before you get used to it. (Still waiting) Whenever you get busy and it's a choice between anything that seems important and being at the side of the patient, ALWAYS CHOOSE THE PATIENT. CHECK EVERYTHING ALL THE TIME. ALL THE TIME.

So basically 2-2.5 years. That's kind of what I thought too. Would you say that the CNOR would add to that, meaning would you be competitive with a 6 year experienced nurse who didn't have the CNOR? Like I said, I like where I am, but sometimes to get to where you want to be, you have to move jobs and I value all of your advice and shared knowledge! Thanks.