LAM2010

No surprise that no other OR nurses are replying that their facility requires instrument counts on all cases, even superficial cases. VA nurses don't have to reply ?

This directive was made in 2014. Amended in 2023. Do all VA O.R.s know about it? If so, how do you handle new employees with O.R. experience who are shocked that we have to count instruments even on cataracts, blepharoplasties and carpal tunnels?

I work for a VA that required circulators to learn how to scrub. At the moment, that training is on hold for new-to-us circulators, because a lot of the experienced circ-scrub RNs still felt like the half-a**ED training we got isn't fair. Scrub techs go to school for 14 months or something, but RNs just learn on the job, on the fly. There's no structured program. I don't really mind that I learned that way, personally... I just have an attitude where I will admit my weaknesses and ask for guidance, and usually that's OK where I work since we are an educational facility with surgical residents also scrubbing in and doing surgery or assisting. Learning to scrub open heart surgery took a lot more time, though.

We had an OR nurse who was actually a NP, she just decided she liked the OR work. But after awhile she got a job as a NP for the anesthesia department. Also, our surgeons use PAs and NPs in their clinics but also bring them to the OR as assistants, like first assists. So those are ideas for later ?

- AORN guidelines or articles - Textbook - Alexander's "Care of the Patient in Surgery" - Berry and Kohn's "Operating Room Technique" Maybe some Elsevier modules on your facility's education intranet? Access research journals about the best prep to use for which sites -- Just some ideas

I got a job as an OR nurse as a new grad because I had done a management clinical with their director and so they got to know what kind of nurse and coworker/team member I'd be. You could maybe get a job at the facility that's not in OR, then try to get time shadowing one of their nurses, maybe.

Thanks for the responses. Someday soon I guess I'll have more curious questions about weird stuff we do. LOL.

Thanks for the replies. I agree, it sure does take up time. We're trying to standardize a "flow" so we can try to stay within our turnover times. It's stressful.

Yes, I am asking, ALL cases? Even cataracts. Is your hospital counting everything that touches the patient? Ours is making us.

I couldn't find anything anywhere else so I brought it here. ? I don't see a problem with it but some RNs have a problem with it because "it's not in their (STs) scope of practice". And then I wonder, "am I not informed enough about my scope of practice?" ?. I personally don't know what the big deal is but so many people are against it that I just wonder what they know that I don't. I tell people "it's a puzzle -- where do the cases go?" And I'm not good at it and don't want to do it. We don't even get charge nurse pay for it. Anyway, thanks. ?

I'm a surgical RN, I circulate and scrub. CSTs (or just STs) are now learning to run our O.R. board. where I work. Typically an RN has done it. A group of them rotate weeks, they do a week at a time. The "board runner" RNs were called "charge". So now that scrubs are doing it, they (the STs) don't make staffing assignments for the rooms (staff being RNs and scrubs). The assistant manager or manager takes their suggestions for that and approves or disapproves (so they say). Anyway, most RNs are not OK with it. I don't want to be a board runner so I don't care (at the moment). If I have a problem that is under the scope of an RN I will not take it to the board runner scrub. On those weeks the managers understand they're going to be acting as "charge nurse" (as I understand it so far). P.S. Our anesthesiologists and CRNAs do not ever run our board. ..... Just looking for thoughts from other people about it.

It will get better. 12 weeks is not enough time to feel 100% proficient. If you know your way around the O.R. and everyone's names, you're set! (Sort of, haha. You know where to go for help). The rest comes with time. Even 6 to 9 months isn't long enough to feel like you got this. It took me over a year. They SAID I'd get 6 to 9 months orientation but really, they threw me to the wolves after 6 weeks. Sometimes I still feel like a baby nurse and I've been doing it for 8 years. You get to a point where you can wing anything and if you don't know what an instrument is, they'll just have to deal with a 12-second delay, the poor babies....

Becoming an OR nurse (circulator, anyway) DOES have to be considered carefully. It's not easy and after orientation is over, you either love it or you hate it. I know how the OP feels; in my career there have been a handful of scrubs that gave me crap (I was a new grad BSN). But overall everyone was allright. Docs in private hospitals are a bit on the more entitled side than docs who work in teaching facilities or public or charity hospitals. I don't recall any nurses giving me crap. I don't ever recall an RN who was scrubbing refusing to count when I wanted to count (as if counting is difficult) (just an example), but plenty of techs have griped when I want to count and they don't feel that we need to. Not ONE RN who was scrubbing has ever even batted an eye about counting whatever the other one wants to count. Anyway... I've just been the type of person that can eventually get along with most people and I cut techs some slack with their chips on their shoulders; it's almost always a matter of them seeing that I know what I'm doing, I am a team player, I'm not out to get anyone, etc. PS I have also seen firsthand that OR RNs are better nurses with their educations under their belts (whether they started in the OR or started as floor nurses), when that knowledge is needed, and are needed for more than just being a go-fer. Disease processes, for one thing... Anyway, I hear you, OP. :)

Clinical Nurse Leaders or whatever they're called - My O.R. has one of those. She was a Clinical Facilitator until she got her degree, and now she is a CNL. I don't know if my brain could handle that right now, I'm going through a little burn-out ... Right now I also feel like a CNL is a person who is constantly having to find new ways to make our jobs more difficult, LOL. ...

You know, we always have this debate where I work, and I've been putting the belt under the Bair blanket and then I just keep my eye on the Bair blanket to see if it's slipping (it never does). We do have metal belt clips, and I've never felt one get hot. -- However, last week I noticed that when the belt was placed over the Bair blanket (directly on it), all the channels were filled with the warm air, above and below where the belt was. The belt did not appear to be impeding that air flow.

Can you ask to observe in the O.R. where you work? Everywhere I've worked will let a nurse observe in the O.R. If not on your own scheduled shifts (if you ever have slow days, lol...), maybe on an off day? Then, you will have your face in there. Ask questions while you're observing, if the nurse is up for it - a lot of times even the surgeons are happy to explain what they're doing. :) You could maybe shadow a circulator. I got my first job in the O.R. right out of nursing school because in my last semester of nursing school, I followed an O.R. assistant director around for my Leadership class. And she happened to believe in training fresh nurses who weren't already trained elsewhere who had "habits" that would be hard to break -- because OR nursing is a different "flow" than floor nursing. It may be a "process" to get into the O.R. but that is a start...Good luck :)

Sometimes people think "throwing you to the wolves" helps you learn. Looking back, it helped me, LOL. Although I would never do it to anyone I was in charge of... When I first started in the O.R. I was also just out of nursing school, and for the first 6 weeks they led me through orientation and told me I was doing well, then suddenly they told me I should be more advanced than I was, then the next day I was circulating arthroscopic surgeries by myself that I was never oriented through (I was orienting through the inpatient stuff - ortho scopes were outpatient!). I was out of my mind! But after a few days I was at least comfortable enough in the department to wing it... I wouldn't recommend it and hopefully you can go to your manager and tell him/her your concerns. And the anesthesiologist is not your boss -- ignore him. I've had some be snotty to me in the past -- I always got backed up by MY bosses if there was an issue... Anyway.... I was thrown to the wolves in my first weeks and while it was chaos... personally for me, I appreciated it much later. You WILL learn your job one day. I know it seems like you won't. BUT - with them throwing you in like this and not having anyone to at least be a "point" person to help you, I believe you should address that with them. Good luck! :)

I just applied for this type of position in my own facility. I haven't been able to get a hold of the people in the department to ask them about it (I am really busy as an O.R. nurse), no one's answering my emails, but I went ahead and applied for it anyway. What could they expect out of an applicant who does not have "informaticist" experience? I have the ability, I just haven't worked in informatics nor do I have a degree. But I've worked on the charting and information systems every day. It's been a field of interest for me, but I haven't tried to go back to school for it because I am not ready to go back to school (I graduated with a BSN almost 7 years ago and I still get nauseated by the thought of any type of school! - unless I know it will immediately benefit me). Was hoping for some insight, maybe someone here will answer me faster than the week I've waited for anyone to email or call me back at work. :) Sounds like a busy job, since no one has time to answer me there, LOL. That's OK with me!

I leave the room. I go do something else. I can also speak from experience, I was a new nurse (never worked anywhere but an O.R.), and after about 6 weeks of "you're doing great" they decided to tell me, "Oh, we're extending your 90-day probationary period another 30 days because you're not taking enough initiative", etc. I cried the whole 30-minute drive home after that day. However... when I came back they immediately threw me into arthroscopic cases (I didn't have a lot of experience in there because the regular ortho nurses liked to have them all the time) in outpatient surgery by myself, because we suddenly got so short-handed they had no one to pair me up with. And that instant I was like "these people are yanking my chain...". I was never paired with anyone again, either. I thought, "If I'm so terrible, why are they OK leaving me alone suddenly?" And I knew even if I didn't know everything about circulating a certain kind of case, I could at least fake it til I made it. :) I hate to throw people to the wolves, as they say, but that's my M.O. when I precept. It's how I learned best. You take some time being embarrassed, hearing comments, seeing people roll their eyes, etc. But I'm still alive and kicking.

I did apply. Haven't heard back, however... I just learned that I have to be employed here 90 days before I can apply for another position in the system. :/ So... I will have to wait.

Thanks everyone :)

Hmm. Maybe I can job-shadow... What you describe sounds like the job description they gave me. Thanks turningred, very helpful. :)

Yes. I did take that post as her personal perspective, thanks :) Sometimes MY job is boring - and I get to run around and do different things. But even that is getting monotonous. My patients are asleep most of the time. Sometimes I feel like anyone could do MY job, although I know some specific things that need a nurse's skills. The techs think we just do "data entry" when we're charting a case... sometimes it seems that way but in every chart there is something I have to critically think about. Anyway.... thanks... this feedback is great.

Thanks for the responses. I am just sort of burned out. I don't want to take call anymore because we want to move more than 30 minutes away from work, and I don't know what other area of nursing I could stand besides OR nursing. I am OK with boring things, lol.

It is worth it to hang in there a little while longer! There will be a time when over night one day it will be like 'Aha!' I guess I can't 100% guarantee you will feel that way, but I would feel up-and-down for awhile, and then one day I felt like, "I am fiiine." :) It is realistic to expect that to take a year. List all the PROS of working in the OR, and the CONS.... That might help :)