cinn05

question: how do you handle more contaminated areas within your prepping area? the following are specific subquestions: 1. do you prep the umbilicus first or last in an abdominal prep? 2. do you prep the lady parts first or last for a perineal prep? 3. what do you think about the need to change into new sterile gloves after a lady partsl prep and before inserting a foley? i think aorn recommends prepping contaminated areas last but this is not how i was taught and i never saw anyone do it. any thoughts? thanks!

The gyn onc I worked with insisted on using Hibiclens and nothing else for lady partsl prep. This was for every patient every time. He was very emphatic so I did. What else could I have done? I know of no good solution.

When I interviewed for an OR position after only having worked in NICU, the manager broke it down like this. She said OR nursing was not only a specialty but was like no other kind of nursing. She said if you like bedside nursing, the OR is not for you. She really wanted me to think on it and insisted on me shadowing in the OR before making a decision that would involve a 6 month orientation period. There is minimal hands-on patient care... the nursing involved is much more big picture oriented despite the fact that the knowledge you need is incredibly detailed. You definitely have to be able to not only work with a wide variety of personalities and job descriptions, but do so face to face in an immediate setting under all the stress of high expectations in situations that are sometimes critical to the well-being and life of the patient. You have to be able to be confident in your skills and role and be able to stand up to other team members - especially with more training and education than yourself (read DOCTORS) - to enforce policy and principles that ensure the safety of your patient. Perhaps a downside that I haven't heard mentioned is this: I feel like I'm losing some pathophysiology knowledge and meds knowledge after being in the OR a while. However, I have definitely picked up some other patho knowledge in certain specialties after reading a million H&Ps. And I have definitely lost some skills such as IVs, lab draws, etc. and it's been forever since I've had to insert or maintain NG/OG tubes. However, I'm excellent with a Foley. :) I do think the best aspect is having only one patient at a time and usually seeing an immediate positive effect from your work every day (vision corrected, pain relieved, cancer removed [or not found!], faces reconstructed, mobility restored, etc.).

It depends what your goal(s) is... which may not be clear to you until you actually experience the different areas of surgery. I transferred from NICU to OR and it was a sweeping and dramatic difference. Going from an ICU environment where there was hands-on care and a lot of personal responsibility for patient welfare to transitioning to a much more interdependent and collaborative sort of care took a lot of getting used to. That said, I would recommend starting out in a hospital with a bigger OR/ER/census because then you will truly get a wide smattering of cases. I had a 6 month orientation which barely felt enough (but was). In the hospital I was in, there were 2 floors dedicated to OR. On one floor, RNs were assigned to a specialty (after going through orientation and kind of learning and being exposed to all specialties). On the other floor, RNs were expected to be able to circulate all specialties on that floor after going through orientation. At a smaller hospital, you may not even be exposed to some specialties and especially not to some emergent/trauma cases because at least in our area, it was the community hospitals that transferred any type of trauma surgery to us. They didn't want to touch it. So, think about your goals. You'll figure it out.