sugarik13

Just try the many different ones around the OR. Once you find the style and material you like you will get used to the feeling of wearing it. Don't tie it too tightly around your head and neck either...after I tie mine I slip my fingers in the mask along my cheeks and make sure I can get one finger along each cheek. This provides a vent for fresh air to come in. You can also play around with how much you pinch in at the nose. Feeling faint can also be made worse by not eating or hydrating properly. Some people don't eat well the first few times in an OR because they don't know if the sights might make them feel sick, but there is a lot of the OR environment that add to it...strange smells (bovied), wearing a mask (too tight), temp of the room (peds very warm)...etc I am so used to wearing a mask now I feel naked without it too. BUT, put a N95 TB mask on me and I feel like I am suffocating!

I started in the OR 14 months ago and have been off orientation since July. Since I am not a permanent member of any surgical specialty (I give breaks, then take over a room from someone at the end of the 7-3 shift) I am still trying to find my voice when I am in rooms with people I haven't worked with. Obviously I know all the RN's and surg techs, and I always introduce myself to a surgeon I have never worked with before. BUT, when it comes to surgical residents and PA's (med students too) I am not sure what is proper. They are supposed to leave their ID badges on the circulator's desk or write their names on the info whiteboard so I can include them in the chart, but they mostly forget or take for granted that since the last nurse knew their name that I do too. Before a case should they come over to me and introduce themselves? I mean, I am usually swamped getting supplies, opening up trays, setting up the room, dealing with the patient, etc and they just waltz in like the surgeon expecting gowns and gloves to be waiting for them too when I have no idea who they are or their size or preference. And then when I am trying to position, they take over from me, grab the foley and put it in, then tell me I can prep and they leave to go scrub! Mind you...I still sometimes at this point have not even gotten their names or titles! I guess, how can I run the room more without feeling like a slave/gopher to the residents and PA's and gain a little more respect? Seasoned RN's I see have more of a command of the room with the residents and PA's and I'm not sure how to get that. What exactly is the hierarchy in the room? I mean, I know we are supposed to be a "team" but the OR tends to have too many chiefs and not enough Indians. I think the attitude of the residents and PA's is that they believe they are "chief" when then the surgeon is not in the room, yet it is MY license on the line when it comes to patient care! Would appreciate any advice.

Thanks everyone. I did confirm with my nurse educator and she told me blood should NOT have been ordered. Just want to clear up any confusion...there was not any confusion about the consent or an issue in pre-surg. All the right consents were signed by the time the patient came to the room. And the surgeon was not arguing. When he asked to have 2 units of blood sent up I questioned the other circulator in the room (my preceptor for the day) and was told that I should still get them sent regardless of the signed refusal. My educator told me next time to remind the surgeon about the signed refusal and if HE or anyone else insists on ordering blood or trying to get me to do it, to bump it up.

Hey! Last week I circulated with another nurse (I am still on orientation). We had a patient who was a Jehovah's Witness, so along with a signed surgical consent there was a signed refusal for blood. I was told to have 2 units of PRBCs on hand in the fridge by the surgeon. I pointed out to my co-circulator that the patient was a Jehovah's Witness and had a signed blood refusal and showed it to him. I asked him if we should show it to the surgeon as a reminder. He said not to show it and told me to have them brought up anyway because when the patient is on the table it falls to the surgeon to make the call between saving a life and letting the patient bleed out. I thought that this was wrong but did what I was told and had the blood sent up. Thankfully we didn't need it, but I want to know for next time how to handle the situation.

I am 6 months into my first job as a new grad OR nurse. My CNS has me doing research on how to improve handoffs during surgery...scrub to scrub, rn to rn at breaks and end of shift, NOT OR to PACU. I have many articles from aorn and TJC's recommendations (SBAR, IPASStheBATON, etc.), so I am not asking you to do my research for me. I was wondering if anyone had a tool or checklist that works for them they could share. Advice for how to improve communication to reduce errors. I know a tool is only as good as the people who decide to use it, but at my hospital it is very inconsistent. I would love to help implement a short, useful (thorough) handoff report template. We already have a "sign-in" and "sign-out" time out form we read from that has a checklist that is supposed to be used, which is rare. I have thought about something small, like the tab from a surgical gown which everyone always has in their pockets for notes as a potential tool, but that would require the manufacturers to get involved...and cost money. Hang it on the wall? White board? What works for you? As a new rn I know any suggestions would surely help my own practice too. Thanks!

I agree with other posts. Do you have an older neighbor with grown kids who could come over for 1-2 hrs in the morning, feed kids and help get them ready and put them on a bus or drive them? A local college student...maybe a senior in HS near you who can drive? There are websites that let you search for different types of domestic help - sittercity.com and care.com are 2 I know people have used (not sure where you live or if they cover your area). Do you have a local community center that does before care and will bus the kids to school? Good luck.

Thanks for your reply. I actually am in a teaching hospital. Level 1 trauma university hospital with attached nursing and medical schools. Good or bad?

Thanks for your reply. While I like the OR, I have always felt a certain amount of apprehension in accepting the position (the only one offered to me as a new grad). I always thought it would be difficult to go to another unit with having had the traditional "nursing" experience. I am also not your usual 20-something graduate. Nursing is a 2nd (3rd if you count raising kids) career for me so I don't really feel like time is on my side to play around and travel between units every few years. I know the L&D nurses circulate their patients. I really feel like I am missing the critical thinking, assessment, etc..all the skills I loved going to school for.

I started OR nursing as a new grad in December '12. I was torn between the OR and L&D, but was only given the opportunity to interview for OR, even though both units were hiring (it was because I did some periop rotations during school). I am grateful I have the job and took it for that reason, but I am not positive the OR is really my passion. I like what I do most days, but I can't help thinking maybe L&D might be a better fit for me. Here are some things I miss from clinicals and wish I got to do more of...1) med admin 2) assessment/critical thinking 3) IV's 4) patient care. I am on OR orientation until July and I'm not sure how long to wait to try to pursue L&D in my hospital, which I have heard may be easier now that I am an employee and will bring OR experience with me. Can anyone give me an honest idea of what to expect and whether or not a move from OR to L&D is wise. Thanks so much!

I started OR nursing as a new grad in December '12. I was torn between the OR and L&D, but was only given the opportunity to interview for OR, even though both units were hiring (it was because I did some periop rotations during school). I am grateful I have the job and took it for that reason, but I am not positive the OR is really my passion. I like what I do most days, but I can't help thinking maybe L&D might be a better fit for me. I am on OR orientation until July and I'm not sure how long to wait to try to pursue L&D in my hospital, which I have heard may be easier now that I am an employee and will bring OR experience with me. Has anyone worked in L&D and can give me an honest idea of what to expect and whether or not a move from OR to L&D is wise. Thanks so much!

Can anyone tell me why most hospitals have trended away from 12 hour OR shifts in favor of 8 hour shifts? All of the hospitals in my area hire for 8's (usually M-F with a wknd rotation about every 4-6 weeks). Most hire either 3-11p or 11a-7p (in my hosp it's called a flex shift which is used to cover the 7a-3p workers meals and breaks). I personally HATE the 8's as it is much harder to get any time off (when you work 12's you automatically have days off built into your schedule), is more days of commuting, more gas $, etc as I live 40 min from work. Yes, I know 12's are longer and more exhausting but I would prefer the extra days off. I requested a change to 12's or 7a-3p in my hospital but I fear it will take YEARS to get either and there is a long list of people looking to siwtch ahead of me and nobody is leaving...we just came out of a hiring freeze that lasted for many years. My hosp does not allow part time either. Any suggestions? Please don't tell me to be grateful for a job...I am. I just would like to flexibility in the OR that others seem to have on the floors...we are all paid the same...we are all nurses!

I am a new grad with a BSN and landed my first job in the OR. My advice is this...consider the very real possibility of NOT into a BSN program right away. They are VERY competitive. Have a back-up plan. Apply to all the BSN, ADN and surgical tech programs available in your area within a reasonable distance. Your career path might be dictated by default. If you really want the OR I would accept whichever program you get into and can work your life around. Many BSN programs force students take the same schedule of classes and will not let you go part-time, which might not work for your situation. ADN or surgical tech programs might be more flexible. This will add time to your path, but if working in the OR as a nurse is really what you want, you need to be flexible. Many of the nurses in the OR in my hospital started as techs...some have their ADNs, some have their BSNs. Working in the OR is very rewarding, as a scrub or a circulator. Good luck with whichever path you take.

Thanks for the comments. I am not sure how to go about advocating for myself and asking for a regular preceptor, which I think would be good for me. I don't know how it would be received because I have asked for things before from my educator who decides my daily schedule and been turned down (ex. getting to see a particular procedure, getting to work with a certain person I learn well from, etc). I'm not sure if it is to put me in my place. I am really trying to see the big picture and figure out the method to her madness. In my hospital orientees spend about 3 weeks in each service rotation (GU, GYN, general, ortho, neuro, etc.). It's unknown until I come in whether I am scrubbing or circulating, or if I am even in the service I am supposed to be in. For example, I am in the middle of my GU rotation (my first service) and have just started to feel comfortable with the procedures and equipment, but was put in GYN for the day and felt like a fish out of water. I was made to feel like an idiot when I didn't know where to find some things I have never seen or used before. Just frustrating.

Not trying to be mean, but please don't to tell me what I learned in nursing school, since you were not there with me. I did learn sterile technique in nursing school. And I learned how to use sterile technique to put in a foley, suction a patient, and change dressings. I also took a course in perioperative nursing at the ambulatory surgical center of my nursing school's affiliate hospital where I had education and experience in sterile technique, scrubbing, and circulating. AND I did my senior rotation in the perioperative unit. And I have a Bachelor's Degree in Nursing. I think it makes me qualified enough to put in a foley catheter without being made to feel like an idiot.

I am new to the OR but I can spot bad practice a mile away. I was told yesterday by the circulator I was working with that I should tuck my scrub shirt into my pants because of "skin sloughing" only to watch her prep a patient 10 minutes later with no gloves on! Um, doesn't skin slough off your hands too? In our ORs there is a main door with a smaller one next to it that latch together (to increase the doorway to allow beds in and out). In some rooms the doors need to be physically closed together in order to latch, otherwise the smaller one stays open...wide open. I am the only person who EVER shuts this door! People think there is nothing wrong with surgery happening in a room with a door wide enough to fit a person open...HELLO! People are just too damn lazy to open and close a door and people are so used to it being open they think nothing of it! I have found the OR to be the land of control freaks who believe the way they do things is the ONLY way to do them. Period. Since I am new I am not offering advice, but in my hospital the circulator preps the patient. Since I work in a teaching hospital, there are usually residents and/or PA's who scrub in with the attending...sometimes I have seen the residents or PAs prep. Never the scrub person though. I have seen preps run the gamut from just blobbing on betadine with a sponge stick, to widening circles of chloroprep with reaching over the patient. I was taught by my educator to scrub the incision area 20x and then expand my prep area, but I am always scrutinized by the circulator I am working with and usually told I go too slow, or don't need to get "too crazy." In lithotomy the head of the bed is always moved to the foot. And I was told to tuck patient arms using the sheet under the body, not mattress. I don't think "it's you." I think many people have just allowed bad practice to become second nature and nobody speaks up. And it is very discouraging to constantly be advised on these boards to just grin and bear whatever I see or am told to do, and then do it my way when I am on my own. Why am I not allowed to question what I see by the person teaching me? And isn't this where bad practice comes from? I mean, if you follow people around for 6-9 months who have bad practice, and you are constantly told to do it their way in their OR, then by the time you are independent you have adopted these bad habits into your practice and they become hard to change, and some of these things newbies may not even know are bad practice. Such a shame. And people wonder why HAIs and SSIs are on the rise instead of the decline...

I am new to the OR. I have taken initiative and asked to put in foleys on my patients when I am circulating if they are ordered. Usually the nurse I am circulating with (a different one each time as I don't have a set preceptor) hovers over me, questioning things the whole time. The questions are insignificant and have nothing whatsoever to do with the actual foley insertion, they just question why I am not doing it the exact step by step way THEY do it. They nit-pick where I put the lube and how I soak my cotton balls with betadine, to the point where they get annoyed and ask "why do you do that" or "who showed you how to do that?" More often than not they are questioning things that have been shown to me by nurses I worked with on different days. Some have even gotten impatient (when I am doing nothing wrong) and put on gloves and try to take over. That just ends up with extra hands in my way, an increased chance of contamination, and me doing it how THEY say. I can understand if they see me violating aseptic principles, or if I can't find the right hole, or if I am about to contaminate something. Putting in a foley is a skill we all learned in nursing school. I have done it independently MANY times as a medsurg/capstone student with my preceptor watching and saying my technique was good. I have no problem doing things the way the regular nurse in the room likes them done, but I get annoyed when they don't let me insert the foley in the way that I am comfortable, and try to get me to do it their way. It seems foolish to question me over things such as soaking cotton balls vs. dipping and lube staying in syringe vs. being squirted into the tray. I wouldn't mind them saying "I have found it works better if..." or "maybe next time you should try this..." As long as the foley gets inserted properly using aseptic technique, isn't that the most important thing? Now instead of having my own way, I find myself doing it the way whichever nurse I am working with does it which is usually awkward. Concentrating on doing it THEIR exact way usually makes me forget something, and then they are quick to point out that I forgot a step. I wouldn't have if I had just been allowed to do it from start to finish myself. It also takes me longer because I spend time trying to remember their exact sequence so I don't get berated. The bottom line is...everyone has a method, and I'm trying to develop my own, but I know what works for me and what doesn't. How can I advocate for my autonomy in foley insertion without stepping on their toes and having them take over?

Heard that many times. It's a cop-out from someone who either doesn't know how to teach, or is a lousy teacher. I have found, BY FAR, the best nurses to learn from (and the ones with the best practice) are the true old-school peri-op nurses who learned by doing the same procedures over and over again. Hands down. They still are out there. I know because I worked with them while a nursing student on a medsurg peri-op rotation in a Level 1 trauma center. They were ALWAYS willing to stop, help, and explain. And after all, in an area like the OR, where having good technique is essential for ensuring positive patient outcomes, isn't "see one, do one, teach one" a rather spiteful and irresponsible way to initiate the new nurses to your "team" regardless of whether it was how you were trained or not? Having vindictive nurses as teachers, forcing their newbies to go on scavenger hunts and wild goose chases for supplies they don't yet know, not answering their questions, all while prolonging the amount of time the patient is being left under anesthesia seems to go against the nursing ethic of non-maleficence.

I am a new grad who landed an OR position in a Level 1 trauma teaching hospital with 20+ ORs running at any given time. I too am overwhelmed and having trouble adjusting to the attitudes I encounter from older, more seasoned members of my nursing "team." Some are downright vicious and there is, quite honestly, no reason for it. Period. Yes, to be an OR nurse you need to have a "thick skin," but having a thick skin doesn't mean allowing yourself to be made to feel stupid, worthless, and inferior. EVERYONE was new to the OR at some point. Nursing school does not prepare you to be an OR nurse so it is a totally unique perspective of nursing. It is actually more of a trade. The more experienced nurses don't realize that the training programs for new OR nurses now is quite different from how they learned. Peri-op nurses used to do everything from checking in patients to set-up of instruments to scrubbing AND circulating to patient recovery. They did the same procedures over and over and over until it became second nature. Hospitals today don't do 5 appendectomies back to back, or cholies, etc. In the same OR in one day I will circulate on a lap chole, followed by a mastectomy, then an adult circumcision, and finish with an irrigation & debridment. All much different types of procedures but you are expected to know how each set up is unique. It is unreasonable. I can go through a general surgery rotation for 3 weeks and not see the same procedure more than 1-2 times. Every case is much different. I spend most of my day just figuring out where the supplies I need are, because they are scatted about. PLUS, I don't know exactly what I am looking for even looks like half the time! Because I work in a Level 1 trauma hospital that also prides itself on being a "teaching" hospital, you basically get whomever they decide to stick you with for the day. Yes, it teaches you flexibility, but I am really tired of hearing from each nurse I am assigned to "You'll develop your own way of doing things eventually, but today you're in my room so you need to do it my way" even if I am the one charting under my license #. I have a wonderful educator who tells me "I am showing you one way to do something, but there are many others. Find the way that works best for you and do it the same way each time." MUCH DIFFERENT way of teaching! The problem with a teaching hospital is that management expects EVERYONE at any given time to teach a newbie. Some people don't WANT to teach. Others don't know HOW to teach. I believe preceptors should be volunteers who are trained and I know many hospitals do just that. My other educator isn't the best teacher, but she always tells us how ****** the more seasoned nurses can be in the OR and to advocate for ourselves. If someone is speaking to us in a way that is not acceptable, we should come and tell her. Easier said than done! The bottom line is (according to me), is yes, you need to put in your time, but you need to find a voice and not let yourself be abused. If you would not let yourself be treated in a certain way by your parent or spouse, you should not tolerate it from a co-worker, even one with more seniorty. One day they will want you to work a holiday for them, or switch a weekend with them at the last minute. Payback is a *****.