jdsmom

If you are willing to relocate, Banner Health in AZ runs periop programs at many hospitals, usually once or twice a year. It's about 5-6 months long. They are currently taking applications. I have been in the OR for 12 years and it has been a great career for me. I was trained at the facility where I still work. Good luck!

I have worked in a pediatric OR for 8 years now and really miss the interaction with patients and families. I deal with NICU babies and neonates on almost a daily basis and, as hard as it is to see a little baby fighting for their life, I love doing these cases. I have been thinking over the last year about transferring into the NICU. I realize it's a very different type of nursing than OR, but every time I'm in the NICU I feel like that is where I want to work. I have started talking with some of the NICU nurses to get a feel for what they like and don't like about their jobs. I have read through a lot of the threads and see a lot of great information here. One of my biggest concerns in my current position is just the lack of dealing with awake patients. Everything is rush rush rush, get them in, get them out. A lot of staff can be pretty callous about things, and that bothers me. Don't get me wrong, I give my patients the best care possible, but I definitely feel less compassionate and don't like the person I'm becoming here. Anyone have any thoughts on this?

I actually work as an RN in the operating room at a pediatric hospital. You are absolutely right to NOT sign it now or back date. Ultimately, the circulating nurse in the OR is responsible for ensuring the consent is signed and witnessed. Personally, if it was me in the OR with this patient, we could have intubated, stabilized the baby, and then got the parents on the phone to ensure they are on board with the broviac and then witness consent. The doctors would probably roll their eyes and say it's not necessary, but that's where I have learned I have to stand my ground. If they want to call it an emergency and document that in their op note (which is what is required at our hospital in order to perform a procedure without consent) then I'm good with that. Then it's on them. I have had to put my foot down sometimes about this, and they never like it, but my license is on the line. This situation sounds like a serious gray area that should be looked to ensure if it happens again that a proper process is followed so you can feel right about it. I think the Charge Nurse shows a horrible example by telling you to back date a consent. That's a serious violation of ethics.

Thank you for the feedback! I definitely like busy, and I think starting out in level 2 might give me time to learn without the stress of level 3 preemies and newborns. I appreciate you taking the time to respond :)

I have been a pediatric operating room nurse for 7 years and am feeling like I want to get out of the OR. In the population we serve I have seen infants and preemies all the way down to 22 weekers under 1 kg. Now, I know that OR nursing is very different from bedside nursing, so I would have a lot to learn, but I am thinking about transferring to a level 2 Nursery at a closer hospital. I am just tired of the rush, rush, rush of the OR and lack of interaction with patients and families. I did work in an adult unit for a year after nursing school, so I do have some sense of bedside nursing. Any thoughts, input, advice from anyone out there? Esp. if you were an OR nurse and left to do bedside? Thanks! Kristen

Unfortunately the OR can be a place where strong personalities can lead to problems like you have come across. I would not put much weight on this until you have a sit-down with the people involved. Most of the time these situations are not quite as bad as you feel they are and just require clarifying things. As someone who was new and now has experience and trains new people, I have seen a lot of different responses by staff. People who have worked in the OR for a long time have really had to earn their badges in many situations. It can be a very tough place to work and has a very steep learning curve. Give respect where it is due, but don't allow people to walk all over you. Respectfully and professionally confront the person you feel is the offender. Most of the time that will help. The fact that you made it through orientation is an accomplishment in itself so nice job! Be careful how you approach seasoned OR staff. Start by stating you respect their experience and appreciate feedback directly if they feel there are things you can improve of. Hope that helps! Keep your head up and keep striving to learn! The OR is an amazing place to work!

I currently work in a pediatric OR and have worked in adult OR as well. The anesthesiologist is the one who runs a code, or even a rapid response. Most times the anesthesiologist will notify the surgeon that something is not right and ask them to stop whatever they are doing and try to correct the situation. Our OR requires all RNs to be ACLS certified (because we are combined with the adult OR as well) and PALS certified for the pediatric side. Any hospital who does not train their RNs to be ACLS or PALS certified is asking for trouble and poor outcomes. I have been in a few codes and felt well-prepared to handle them. Every time the anesthesiologist is the lead and everyone directs their attention to them for instructions. Most of the time the surgeon and surgical team scrubbed in do what they can to keep the sterile field sterile and wait for instructions from the anesthesiologist. Sometimes that means getting prepared to close quickly so they can get the patient off the table, or possibly doing internal compressions depending on how serious the situation is. I have not worked in an environment with CRNAs, but I imagine that if things start looking concerning you would notify your anesthesiologist STAT and get them in there to help. A good anesthesiologist or CRNA is pretty in tune to how the patient is doing and is proactive when warning signs arise.

Congratulations! I have precepted a few new grad RNs...first, the O.R. is entirely different from the floor and what you probably experienced in school. Expect a huge learning curve. There will be times when you think you will never "get it" but you will! There are several things you are ultimately responsible for, which would be good to review. Patho and A&P are not going to be the most helpful up front. Deebaxster's suggestion is excellent. There are a couple of books that will help you with learning different surgeries/procedures and the positions and necessary considerations. Alexander's Care of the Patient in Surgery is great, VERY in-depth though. Pocket Guide to the Operating Room is a great condensed version. AORN Standards and Recommended Standards are helpful as well. You may get these books checked out to you in your internship, so don't spend a lot of money on them. If you get a good deal on older editions, go for it...nice to have. The operating room is an area where you have to really pay attention to what can injure your patient...not just meds, but things like wrong-site surgery, nerve injury due to positioning, skin integrity, burns, and many more. Take notes, ask lots of questions, jump in to the best of your ability! I LOVE the O.R.

Hello, I have worked in the OR for 2 1/2 years with all peds experience. I had worked with adults prior only in telemetry. If peds interests you, I would say start by reading some on developmental stages and how they apply to O.R. experience, anything you can in pediatric surgery, and memorize vital sign ranges for the different peds ages. Peds is going to involve a lot of appendectomies, cholecystectomies, hernia repairs, orchiopexies, cystos, hypospadius repairs, circumcisions, bronchoscopy for foreign body removal, I & Ds of abscesses and wounds, broken bones, and shunts, crani's and cranial reconstruction if you have neuro at your facility. Plastics will have cleft palate repairs, lac repairs (dog bites), and reconstructive surgery. Of course, tonsils and ear tubes are also frequent. That is the majority of what we see. The bigger cases are going to be neonates (preemies and full-term) with serious anomalies that require ex laps, bowel resections, crani's, PDA ligation, broviacs, laryngoscopies and bronchoscopies for respiratory problems or GERD. Some of the bigger cases I have seen are ureteral reimplants, crani for tumor resection, lobectomy, Nissen fundoplication, liver resection, total lung resection, cranial reconstruction for synostosis, Roux-en-Y, colectomy with pull through, spinal fusions, laminectomy with tethered cord release, and I am sure more, but can't think of any. The biggest thing physically is airway and reserve. The smaller kids, less than 5 or so, don't have much reserve in terms of blood or oxygenation. The smaller they get, the less reserve they have. It would be a good thing to get PALS certified before going into a peds OR. Developmental considerations are the 2-year-old that won't let go of their mom or dad and you want to try and make the experience the least traumatizing as possible. You have to get creative with how you do things...I have seen anesthesiologists walk kids back to the O.R. holding their hands, trying to give them as much control over the experience without giving in too much. It is a fine balance. Some kids are just fine, but you have to prepared for the kids where their parent gives in to everything, so they will expect you will. Kicking, screaming, punching, biting, yelling at you. You distract, distract, distract, stay calm, and sometimes have to really hold them down while they go through mask induction. That is the other thing. They typically don't start IV's in kids less than 10 years if they are not already in the hospital. That means you have to be prepared to get an IV fast if the kid goes into bronchospasm or laryngospasm on induction. Good IV skills are a major plus. Imagine trying to get IV access on a 1-2 kg baby...not easy! I will say, I absolutely love it! OR is rewarding, but peds OR is very rewarding. You can really make a difference for some of these kids and their families. I look forward to going to work every day and have a great time there. Peds surgeons and anesthesiologists are typically pretty easy-going, but they need to know that you can take care of a peds patient, especially if things go south. If you want to go into peds OR, start looking for opportunities now, the best thing to help you is experience! Good luck!

How often do you have cases where your patient is awake during surgery? We use a safe surgery time-out process where we timeout just before incision, and typically the patient is under general anesthesia. While this situation is difficult, it is ultimately to protect the patient. I would suggest that you include a description of the time out process and the reason behind it to your patient prior to coming to the O.R. if they are going to be awake. This might help in case something like this comes up. Tough situation for sure, but I would rather have a surgeon upset with me for involving a manager, etc. than having a wrong site event or something of the like. My Sr. Mgr would always say, "You have the power to stop the surgery until you are sure it is safe." If your administration does not provide this kind of support, you do not work in a safe environment and I would consider finding work elsewhere. I don't think there are any rules against singing the time out, maybe that would be an option? For sure, talk with the doc after in private so they know what is expected the next time this happens. Hopefully, they will ultimately respect you for standing your ground :0)

After reading through the posts, I have a couple of thoughts... 1. High standards are AWESOME! They can never be too high...however, approach is EVERYTHING. There is an RN on my floor that scares me to death, intimidates me, and rolls her eyes at me all the time. The thing is, I get she is an awesome and experienced nurse, but why do you have to treat other people like that? She does this to everyone! You can get your point across better by not being rude, mean, or short. You know? 2. My 2nd thought is that we all have heard that "health care changes rapidly." Are we so tired of that or what??? The problem is we can't change policies and ways of thinking to keep up with "health care changing rapidly!" I think that is where the overworked part comes from...too many different people thinking their way is the best way to run a shift, but no consistency whatsoever. Sometimes it seems like organized chaos! 3. I agree with another post, some RN's went into this thinking good money, good schedule, and that's it. This is a job you have to really understand, want, and have a passion for. Nursing school is COMPLETELY different from being on your own on the floor, and everybody expects probably more from an RN than is reasonable. That is just part of the job, and you have to be willing to work through that. I would love to see nursing schools institute more preceptorship time at the end of the program, similar to that of student teaching. This would only happen AFTER you get your license so that your preceptor RN does not hold all the risk. All in all, things need to change in nursing, but the fact is that there is little money to make changes and a lot of resistance because of the complexity of it all. The best thing you can have is have a great attitude and treat others with respect...demand that of others as well, don't be a door mat and don't let people treat you like dirt. Being positive can be contagious...it just takes one person to start! BTW, I LOVE MY JOB! RN for a year, starting in peds periop next month!

Graduated last May with BSN. Been working a step-down tele for about 7 months. Not real keen on the 5-patient load and have been thinking of moving to ICU. I feel like I would do better with less patients and more complex issues than trying to manage 4-5 almost critical patients. Anyone have similar issues in Tele or transferred to ICU from Tele after such a short stint?

Grab it while you can! You will feel inadequate in any first job as a new grad. I graduated in May and have been working in Tele for 4 months and still feel like I am inadequate. I am sure your instructor would not recommend you if she had any doubts. I saw a lot of school nursing handbooks online at Amazon too. I am trying to get into school nursing, but kind of difficult in my state :0) Good luck!

I know how crushing it is to work so hard and feel like you will never get where you are trying to go, but I think you should stay the course and keep trying. I have a cousin who has a degree in finance that is trying to get into the nursing program. She is 1 prereq away from applying, and someone talked her into going into Health Care Admin. She started the courses and absolutely hates it. I think that if you want to become a nurse, it does not matter when that happens. You may have to be creative in finding ways to do that if you need to be financially independent, but it will be worth the wait if this is your heart's true desire. I would not recommend changing your plan unless you think HCA is something that would suit you better. The good thing about waiting lists is that you will eventually get in. Some of the competitive programs make you start ALL over from square one each time you don't get in. Try to find the positives in this and move forward with a positive outlook