NurseSnarky

Great info! I'm also going to print it out. Invaluable information for sure!

I'm not sure how other SC's do it, but where I work (OR/PACU at times), only a couple of DC nurses do Phase I recovery (hence why I am pulled from the back sometimes). Otherwise the Admitting and DC go back and forth.

I'm not a CRNA...I'll get that out there now. I've wanted to pursue a degree in the field for some time, so I do know about the politics involved. I've also went toe to toe with a MD over what a CRNA can do, has done (i.e. history), and their huge importance (was told that CRNA's are nothing without an Anesthesiologist). My desire to become a CRNA is not the money. I've never sat down and thought it was unfair that an MD gets paid more. MDs get their feathers ruffled that there are so many CRNAs in the profession with many more on the way...it's the old boys club. But CRNAs have been around forever...surgeons wanted nurses to give anesthesia as they would give their undivided attention to the patient during the procedure whereas a resident wanted to pay more attention to the case and doc (1800s). As many of us know, a doc does not have to be present or even in the building or even on staff (small rural hospitals) in order for CRNAs to provide anesthesia care. If something goes wrong, it's the surgeon or another doc that gives orders for any problems. It would be the same if something went wrong if a doc was giving anesthesia...the surgeon then ICU doc would take over care. It's hooey plain and simple that an Anesthesiologist is required in some places...and I'll leave it at that. http://en.wikipedia.org/wiki/Nurse_anesthetist The history of the CRNA is fascinating to me as I used to believe it was always a physician's job to deliver anesthesia until I delved into the history of it. http://www.anesthesiapatientsafety.com/na_glance/history.asp Good info here: http://www.aana.com/brieflookhistory.aspx And finally a review on a must read book: http://www.amazon.com/Watchful-Care-History-Americas-Anesthetists/dp/082640510X/ref=sr_1_sc_1?ie=UTF8&qid=1323012985&sr=8-1-spell The book is available at the AANA website.

Sometimes the issue is being able to balance multiple patients with multiple issues. ICU gives you 1-2 patients with multiple issues. The ER? That's multiple pts, multiple problems in a short period of time. That's tough. I don't know...some posts are suggesting that "maybe" she's truly isn't cut out for nursing?? Those that weren't in my program didn't pass...even up to the very last day of the last semester. And then there's NCLEX. So she's working, she's passed school with flying colors, obviously passed NCLEX...she just hasn't found the type of nursing that fits her learning style. Book smart people learn differently. Well for that matter, people learn differently. She may need less patients in order to connect those dots.

I am glad you got the interview and you're going to shadow. Observe, take notes, ask questions when you can about the working environment, call requirements when you're off orientation, etc. Be friendly...make the OR nurses and scrub techs LOVE you as they will be the ones reporting your shadowing experience back to the director. I can completely relate to your OP and other posters. We were not prepared well in school and I brought this up over and over during school and during the exit interview. I also participated in a survey conducted by a major university researching the subject at the time. I was NOT popular with the program chair, but let's be honest. I went to a very good school, but the training was archaic (to borrow the term)! There was more emphasis on proper bed baths and back rubs, making the beds perfectly than on why is the BP high or low, what do we do...how do we prioritize SIX patients not only TWO? The most patients I was responsible for in clinicals was four patients...FOUR and all of them were being discharged AND it was the last clinical day. Up to that point? Everyone had 1-2. Usually one with heavy cares and meds and the other ready to go home (i.e. learn discharge teaching). I wanted to learn total care for the patient yes...but we basically were taught the CNA's position and not how to delegate those cares and focus on patient care on a real floor. My final preceptorship was a nightmare when it came to the end. I spent most of the time running after the best nurse on the floor talking 100 miles an hour and moving just as fast. I was lost and worked hard at home to be prepared for each day better than I was the day before. I was told "you're doing great" only to get to the final sit down with the clinical instructor and my preceptor and told I was not doing as well as I was led to believe. No I was not up to the preceptor's reality (she'd been a nurse for 20yrs and told me ALL of the time..."you'll get it, but realize I've been doing this for 20yrs!". Only to be thrown under the bus during the evaluation/end of preceptorship. I graduated with honors, but felt so ill prepared to hit the floor running. I was quickly hired and it just didn't click right away. I did not get fired, but felt floor nursing in any form was not for me (except for ICU). I came to PACU after almost a year in tele. I loved PACU (still do) and got my foot in the door in OR because of recovery. I just love the OR. It's just a different breed. Sorry for rambling on. But basically the OR sounds like it might be right for you. However....HOWEVER....it's not like ANYTHING you've ever done in Nursing School. You can observe for a day and it's awesome (for most), but doing it? It's a LOT of organization, it's knowing what you need to be doing and what you physically need for a case AND what each doctor prefers. KNOW this, understand this. If you've got the money to spend, buy Alexander's (doesn't have to be new) and read what you can to get the idea. Yes, you'll be orienting for 6mos and you'll have people to help you, but a program wants to know that you get it (the entire OR experience). There will days, oh there will be days that you will just scream WHY?! But when you're rolling out of bed at 4am rip roaring ready to go, you'll know it's for you. Even though you'll have six months to learn, you're still going to need to learn the basics quickly. So as many others here have suggested, get a pocket sized notebook and take LOTS of notes. Look things up at home, I still will watch videos of surgeries to see what something is for example. When you feel like quitting, push through it. It's hard to get into the OR...it's near impossible if you leave before a year is up. Also...OR nurses are OCD and a bit ADD/ADHD...if you feel that's you, go for it! But be relaxed and organized. Docs and others in the OR like calm, cool, collected even if you're falling apart inside. Move quickly and grab everything you need to limit your trips. Better yet, have everything in your room to begin with, but we all know that's not always going to happen. Always have a plan-B!!! And DO NOT CALL IN SICK during your first 90 days and better if you can go the six months. Haul your sick behind into work and get sent home. I know that's not always popular with everyone, but it's the reality of it. Kids, family...have a plan-B again...don't call in. Good Luck!!!

You have to be highly organized and able to multitask in this role. Skills you need to work in a hospital. You would have a leg up as far as a non-nurse receptionist in that if an important piece of info comes in you will know to get that to one of the other medical personnel in the office asap. You're a new grad....have you passed boards yet? It's a good position if you are waiting to takes boards and maybe they'll hire you in the back after you've passed(?). Some offices like a nurse who can do all of the roles of the office in case someone calls in sick, vacation, or the place gets very busy (which Mondays & Fridays can get crazy and having an extra person up front who knows what he/she is doing is GREAT).

Oh boy! I had one too. My instructor seemed to be "okay" but a little distant with me. I was not her favorite. She showed me my written review one day and it was excellent across the board (maybe midway through clinicals)...the very next week I had a BAD clinical day and it was due to crummy organizational skills. I was struggling a bit up to that point with organization (I didn't really "get it"), but that day was pretty rough. Clinical instructor blew a gasket right there and then. She was former military and she'd had enough apparently. She dressed me down, said I'd NEVER make it as a nurse and I went home in tears. Next clinical day she shows me the review with EVERYTHING scratched out that was positive and she had written everything I'd done wrong on that single day. She didn't get out a new sheet or put in the date in question with feedback...just scratched out the positive. WHOA!!! So now I had a second day of tears on the way home. So I made a "brain" to use in order to improve my organizational skills...used it for the rest of nursing school and when I started working. I was asked by instructors and managers and coworkers for copies of it. It would make any military proud...lol! Anyway I presented the "brain sheet" to her and implemented it and she was so happy and impressed (with IT...still didn't warm up to me). Made rest of clinicals with her smoooooth! BUT she never tore up the scratched out review. Just added I made the brain, used it, and improved greatly by the end of clinicals. My lesson was to find out why and try to fix it. There are some that will just have it out for you (because there were other students that were less organized than me the entire time and didn't get it or fix it and she singled me out to rip me a new one...but I will always thank her for it and I still do!). And I agree...prove 'em WRONG!!! I was struggling and then I was overkill organized...lol! Eh I guess you can never be TOO organized.

I've worked both. Cath Lab is a different pace than PACU. The patient is awake, groggy instead of out. So it's like recovering a heavy MAC. You do groin checks, pt has to remain flat so you will be giving pain meds. Pulling lines/sheaths can be unnerving until you get the hang of it because you do have to hold pressure for awhile...used to be 20min, but it depends on what doc uses. I would go for it. Whenever I see "no call"...I'm on it!

I second the University of Iowa. I've worked with SEVERAL students in their final rotation of clinicals over the past several months and they really know their stuff. Anesthesia has even hired one and he hit the ground running. It's just and excellent program and turn out top quality CRNAs.

I worked in a hospital that was "color coded" as well and I strongly believe it's a great thing to do. Nurses wore white, navy, or a combo of the two...and on special holidays we could wear prints or printed jackets. Techs would wear burgundy, unit secretaries wore scrub pants and polos. Housekeeping also wore scrubs and polos if I remember right...in yellow I want to say. There was no confusion by the docs as was stated above. They knew white or navy would be a nurse. Hard to see our name tags from a long distance or from behind. The patients also did not have any confusion. We introduced ourselves and the techs also introduced themselves. We were also not limited to a certain brand. It created a professional environment as well. Then I worked in an ICU where everyone had to wear burgundy scrubs supplied from the hospital and no other color was allowed. Patients would always ask the tech questions intended for the nurse. It was confusing and yes, the docs also got confused unless they had been there long enough to know who was who.

I can sprint pretty good down the OR hallway in them. I would never be without my Danskos either. My legs and feet don't ache at all. They are not for everyone, but 99% of the OR staff and docs wear them. When I worked on the floor and while I was in school I also tried Birks...my feet, legs, and back hurt so bad. Same with tennis. I own a lot of Danskos...oy!

gr8ape...holy cow! I would give my first born for ancillary staff! LOL! I do work ASC, and I "thought" I knew how it was going to be (i.e. in the interview, "you know how same day surgery works, right"...ummmm, sure! Not so much after all). Now I can set up a shoulder case and tear it down. I am one of two nurses who sets up the beach chair - not so complicated as much as it's a clumsy piece right? I've moved beds around here, there, and everywhere!! PITA! Clean up in OR5...start truckin' down the hall for the mop! No one's coming to help. I help or at times pull my own cases for the next day. That was WAAAY new to me! It can be crazy can't it? It's a good crazy though.

I have never looked down upon a MA, a CNA, or ST because they are not a Nurse. I don't think anyone has implied that MAs are idiots...I think the gripe is that some (not all) think a monkey can do an RN's job. And that SOME present themselves as Nurses when the title is earned by taking the required classes, earning a degree, and passing a very tough exam. Then and ONLY then can we call ourselves Nurses, but really you don't even FEEL like a Nurse until you've worked as a Nurse. So the title is revered and held in high esteem to many of us. If you want to be called "Nurse"...earn it the way the rest of us did. If you choose to be a MA, then be prepared to stand behind the title and career you chose to pursue. Be honest and be respectful.

cardiac/telemetry floor is my vote just because it gives you a great start for critical care if you choose to go that direction. When I worked tele, we had to take the critical care class and talk about gaining knowledge! And if you decide to work med/surg you're ahead of the game imho.

LOL! I just CRINGE when I hear that as I scan the half empty room! ARGH!! And there are some that just want ALL of the other's toys from the playground in the room. I know who they are and my coworkers will always get on me for bringing everything but the kitchen sink in for "just a ____"...uh, huh. BTDT. If it's present in the room, it seems that it's not wanted. Oy!

Don't forget the doc's stash! I also have the size issue (need smalls, none available)...so I've raided the men's locker room many times. I know you've already been to work today, but I agree about emailing/contacting the manager.

I agree...and don't do pop if you don't have to have it. Water, water, water. Mid-morning I'll have a quick sip of 100% OJ with no added sugar. Oh and I forgot, I also second the Naked juices. Some Starbucks will sell them, so I ask them to blend it with ice to make a smoothie.

Breakfast...it really is the most important meal of the day when heading into the OR. I can oh so feel it if I've not eaten well. Don't be stingy on that btw...eat a healthy BIG breakfast with the protein and whole wheat natural bread (no high fructose corn syrup)....and oatmeal with nuts was always a fav of mine with scrambled eggs on the side. Work up to that if you're not used to eating it. I'm glad you're going to check things out with your doc...good idea to r/o other problems. And think WATER is so underrated!! I drink TONS of water during the week when I'm working. Bring a tumbler/cup with the straw and keep it filled all day! I ALWAYS wear my compression socks (don't do hose) and I'm never without my Danskos. They are worth every penny and then some. I always breath out of my mouth if it's a smelly case...I've made the mistake of taking a "sniff" here and there, but I usually just "shut off my nose" if that makes sense. Heat plays a HUGE factor and people always ask why it's so cold in the OR. Bottom line is, scrubbed-in personnel's comfort. I work with a ST that will wear the vest mentioned earlier if she's in certain rooms that are either long cases or the room is hot. :redpinkhe I think the bottom line is to not be a hero and take care of yourself. Hopefully between the advice you've received here and talking to your doc, you'll be able to get through this. If you will need to be in the OR before your doc appt. ask to be in SHORT cases and not in hot rooms. If you are able to observe and sit periodically, do it. :)

"Witches"...yikes! I worked PACU Phase I for over three years and I really loved it. I had no time to knit or surf the internet because if I didn't have a patient or one coming in I would be trying to help the OR nurses or anesthesia. Also it was NOT boring at all, it was very rewarding and it's more than pushing meds. It is critical care and it can get hairy sometimes too. You're responsible for bringing people back and doing it safely and to help minimize their pain...safely. It's a lot of pharmacology knowledge and knowing the half life of not only pain meds, but of the anesthesia meds...s/s, side effects, what to do if something happens and then there is the cardiology aspect. What happens when a bp is sky rocketing - is it pain, pt forget bp meds or what if the bp is bottoming out? LOTS to think about FAST and react FAST. There's a lot of autonomy there and you work very closely with anesthesia and develop a lot of trust with them. Now the OR...I LOVE the OR now that I'm a FT circulator. I do not think it's boring at all either, but I work in a fast paced, run and get things done OR. I've been asked a lot lately what I like more PACU or OR (OR was always my dream job, but wound up in PACU first). I LOVE PACU for different reasons and I'm lucky I get to help out if things are busy where I work because the other OR nurses do not have PACU Phase I experience or ICU & Tele background. With that said I really love OR now. I'm comfortable where I'm at right now and that helps. Now I will say I thought the Phase II/Discharge/Outpatient nurses can be a bit cranky in past places I've worked. That's a whole different breed of nurses IMO. I couldn't do that job...lol! Not my cup of tea.

I see this sometimes...yikes! Most just take off their watches, rings, and place on the desk with their cell phones.

Leave them at home...I put mine in my scrub pocket once. Went home late on a Friday night only to wake up Saturday morning realizing they were in my POCKET!! I called an ED friend, laundry hadn't been taken luckily and she kindly dug through the laundry and found my rings. NEVER again! I also was broke of the habit of wearing watches in the OR (little germ magnets). I also knew a nurse who lost her diamond at work too...fell right out of its setting. Can't remember now if it was ever found.

You tell the charge or ask a coworker if they can get you out to go. Many (not where I work) have two circulators to a room and you can run to the bathroom if needed. Now not so easy if you're the only OR nurse around. I've worked late where only the recovery room nurses were in the building and they know zilch about the OR...so that was a moment that I would just have to wait. Usually we get a break before the last OR nurse would leave so it's really no issue. I honestly had the worst time getting to the bathroom as a tele nurse. Loooong 12hr shifts with only one or two pit stops.

Stop the "no news is good news" mentality. I do like some acknowledgment during Nurses' Week. Nothing was acknowledged where I worked...not even a printed or handwritten "Happy Nurses' Week" flyer...nothing, nada, nil. In contrast...the doctors got fancy boutique cakes, expensive umbrellas (have yet to see ONE used), candy (which they gave to the nurses), and a fancy lunch...all on "Doctors' Day".

EXCELLENT (as usual) Canes...#9 is my biggest pet peeve I think. I am a quiet circulator as I'm trying to pay attention, etc. We had a med student recently who was a CHATTY Cathy and the surgeon was getting more than annoyed. I could see he was about to blow. So in between cases, I told her she had to keep quiet...no offense, but this surgeon doesn't like a lot of chatter unless he's asking the questions. Just the way it is. She seemed so offended (as she'd been in other rooms and talked and talked...on & on and no one told her it was TOO MUCH!). I just told her like it was and that was that. She was in the room for a short bit longer, quiet as a mouse and then left all bummed out. It's not social hour IMHO. She wanted to talk about school things and her personal life at a regular tone non-stop. I also had some med students who were shootin' the business as I was bringing in a patient and this gal was nervous. I whipped around and gave them a look and then put my finger up and shushed them. They were stone silent every time a patient came into the room and was being put under from there on out.

I get my lunch everyday (albeit late lately)...I get my breaks 99% of the time and if I have to get out to go the bathroom or whatever, I ask someone to give me a potty break. No one wants a crabby, half starved, full bladder OR nurse around. No, no, no. OR nurses are BUSY. Those that don't understand, it's hard to get what we do. It's not just one patient and one doc. Depending on the schedule, the doc, the room, it's a lot to do in a very short amount of time. I may have several patients in an hour! If I'm running from room to room, several patients and docs in a short period of time and that's not counting anesthesia too. I have to remember each doc's preferences and the anesthesia too. I have to take care of the patient's needs, the families needs all in a very short period of time. I have to have my room READY and that means having all of the right equipment, is it working, the patient in the right position, the right meds drawn up, the right gloves for the right surgeon and it's all thrown off kilter if we find out we have a latex free patient at the last second...new gloves, make sure all items picked for that patient are latex free, etc. All of us could go on and on. I am glad I get a lunch and my breaks. I worked the floor 12hr plus shifts in the past and with a full bladder and hungry...no more thank you. I work hard and I'm always moving, so they know we need fuel to keep up that fast pace.