Stacey30

You know you're an OR nurse if... ...you open your child's package of string cheese and let them pull it out as if it's suture. ...your hands are spotted with Dermabond to cover little cuts and painful hang-nails. ...students/observers wrinkle their nose and/or gag at the smell of burnt tissue and you don't bat an eye.

OR nursing isn't normally taught in nursing school because they want you to learn the basic skills necessary to become a nurse. Sometimes students get to follow their patient down to the OR if they happened to have a procedure scheduled during their clinical shift, but that's about all the exposure you will get. Med-surg would be valuable experience for any nurse since you'd get experience working with a wide variety of medical diagnoses while honing your nursing skills. Periop101 is a pretty expensive class to do on your own, I think it's around $1200. And I'm not sure if nursing students can sign up for it, I think you have to be licensed (may want to check AORN.org for clarification on that) Many hospitals offer it as part of orientation. I went through a 5-week OR fellowship/Periop101 class paid for by my employer. You could check and see if there are any OR fellowships being offered in your area. In any case, this was my first job out of nursing school so obviously you don't have to have prior experience to get a job in the OR. Good luck!

I work at a level 1 pediatric hospital OR (first nursing job out of school) and I love it. jdsmom pretty much covered the jist of the procedures we see except we also have opthalmology in my OR so we do lots of eye exams under anesthesia, eye muscle (strabismus), cataracts and cornea transplants. Traumas can be tough to handle, especially when the patient doesn't make it, I will warn you of that. But I can tell you that I work with a lot of nurses who came from adult ORs and they've never looked back!

I can understand why you may feel this way, because as a new OR nurse you do run your *** off at first. But pay attention to the experienced OR nurses around you and you should see that they're not running around nearly as much as you are. This is because over time you WILL convert those DPC's to memory and you WILL be able to anticipate the surgeons' and techs' needs. Setting up your room at the beginning of the day doesn't really take all that long. I look at the pick sheet on each case cart and pull all my suture, MIS stuff, etc for each case before morning report so that's less I have to do when turning over my room between cases. I also order all my meds for each case and pick up from pharmacy at the beginning of the day. You'll learn each procedure, and you'll learn how each surgeon does things during that procedure. You'll be able to anticipate when they might need more laps or suture. As for documentation? That shouldn't take you long to do. Charting takes me maybe 10 minutes tops. There are certain segments to the periop chart you can fill in before the patient even comes into the room (i.e. case attendance, cautery info) so that you can focus on that patient once they come through the door. You will develop the ability to multi-task, and you'll develop an "OR ear"- the ability to document while paying attention to the field and listening to your mumbling surgeon because let's face it, they're not gonna stop what they're doing and turn to you to ask for things. Last time I checked, multi-tasking is a big part of floor nursing too. So is organizing your time. I work in a pediatric hospital so anesthesia brings the patient into the room (I don't have to do a pre-op interview, but I do accompany patient to PACU for post-op report), this gives me time to help the tech set up the room. Like PP's said, once that pt rolls through those doors all your attention is on them. I assist my anesthesia personnel during induction. Since we're working on children, we use gas induction then insert the IV and put them deep with IV anesthesia (saves the kids and parents a lot of undue stress trying to place an IV pre-op). I assist with IV insertion, placing the BP cuff and pulse ox, and in the case of children toddler-aged and up I help with distraction techniques to try and keep them calm as they get the mask. This is the fun part. If it's a girl I might ask if she likes getting her nails done. If yes, I tell her let's paint your nails. I take her hand in mine and say now I'm putting the polish on. Can you smell the stinky nail polish? (this is where anesthesia switches the gas on.) This really helps calm my patient and makes induction a lot easier on us. If my patient is a boy then maybe he's flying a jet and he can smell the stinky jet fuel. I pay close attention to anesthesia monitors during the case as well. Intra-op hypothermia is a big issue nationwide especially with NICU patients, so I make sure the pt's temp doesn't get too low (or too high for that matter) by consulting with anesthesia before adjusting room temp or the Bair hugger. If you have a CRNA or anesthesia resident/fellow in the room who you watch like a hawk because you don't necessarily trust their competence, it is up to you to step up and call the attending into the room to assist them if they can't get the pt's sats under control. So in a nutshell, a good OR nurse can document, pay attention to the field, anticipate the needs of the surgeon/tech, monitor the patient's vitals/sats/co2, and document all at the same time. Oh, and keep med students/nursing students/other observers from contaminating the sterile field. If that's not nursing then I don't know what nursing is!

I'm a new OR nurse on orientation and I'm learning to scrub and circulate (1 week scrubbing and 3 weeks circulating through each service). We are taught to scrub so that we can do so on days when techs are shorthanded, or in case we need to give lunches/breaks to techs, etc. Circulating still makes up like 90% of our job, but we can request more scrub time in order to get more comfortable with instrumentation and such and they're pretty good about accommodating whenever staffing allows.

If this is your first RN job in the hospital then it's unlikely that they'll let you do weekends only at first, as you lack the critical thinking skills necessary for the job. Traumas are most likely to occur on off-shifts, so it can be difficult for a preceptor to focus on a critically ill or injured patient while trying to teach you at the same time. My employer requires you to work for a full year before becoming eligible for the weekend program, you need to develop those critical thinking skills and be able to work with little to no supervision.

We do this as well. We document lot #'s in the event of a recall.

I have the 14th edition and this is what the Preface says: "The fourteenth edition of Alexander's Care of the Patient in Surgery has been updated to reflect new concepts in perioperative nursing practice and increased sophistication and complexity of surgical procedures. New to this edition, clinical chapters now include Ambulatory Surgical Considerations, Risk Reduction Strategies, and Rapid Response Team applications. Best Practices, featured in previous editions, have been updated, and retitled Evidence for Practice." It also said there were new chapters added on interventional radiology and workplace safety and Chapter 2 was refocused on both patient safety and risk management. So it depends on what you needed your textbook for. If you're taking The Periop101 class that's available through AORN.org website then you may want the newest edition just to be sure you're on the same page in terms of best practices currently used in the perioperative environment (and to help study for the final exam, which my instructor tells me only a handful of her students have passed on the first try). If you just want it as a reference guide then stick with 13th ed. Hope that helps!

Sure do, I interviewed twice for the OR position that I applied for (which I got, by the way!) and both times I was asked this question! So I used two different examples. Example 1: I completed my preceptorship on a GI/Gynie surgical oncology unit and one of my patients was recently admitted to the floor from the PACU s/p lap hysterectomy. The PCT was completing 11pm vitals when she notified me that this patient's temperature was above normal limits. I retook her temp myself and got the same result. The surgical dressing was still intact so I wasn't able to assess the site for signs of infection, but I knew that elevated temp could be a sign of infection which is a complication of surgery so I contacted the physician. He gave orders for IV acetaminophen and I continued to monitor her overnight. Her temp was brought under control. Example 2: I worked for an agency that provided in-home personal care to seniors during nursing school, and I was given a new assignment for a client with several comorbidities. We specialized in Alzheimers/dementia care, but we provided only nonmedical care to clients. So when I began working with this client I read through the notes that other caregivers recorded on this client so I could get an idea of what her daily routine is (care was provided twice/day for three hours each, not continuously, so I couldn't get verbal reports). I noticed in the notes that this client had been incontinent of bowel and that her stools were observed as being loose, mucousy, and bloody and foul-smelling. Her daily weights showed she was rapidly losing weight and she was having multiple stools per day. I knew from nursing school that these symptoms sounded like ulcerative colitis so I contacted my agency to verify that they were aware of these symptoms and that she should be seen by a doctor. She did end up being diagnosed with UC and given the proper treatment. Hope that helps!

Oh yeah, hoods too :) also a lot of our attendings have accents so you have to get used to that as well!

I had to buy Alexander's Care of the Patient in Surgery as part of my Periop 101 class. I have not yet picked up the pocket guide yet but plan on it. Right now my biggest challenge is trying to develop my "OR ear." There's a lot of white noise in the OR, plus with everyone wearing masks it can be hard to hear the scrub or the surgeon ask you to get something so I always find myself saying "huh?" LOL. I'm thankful to have gone through this fellowship because it's helping to give me a strong foundation for what I need to know as a circulator (learning basic instruments and sutures can make your head spin!) based on the AORN standard. Some pros of my fellowship are that we practice opening sterile items, gowning and gloving, etc in the classroom setting so you don't feel completely useless at clinical and focusing on one patient at a time is great. Some cons would be not knowing where in the heck everything is, being assigned to a different service and preceptor every day (this may not be the case for you, but in the institution where I'm doing my clinical and will end up working at I will work in all the services except heart because they're specialized), and becoming familiar with the supplies and instruments needed for each procedure. Obviously none of this stuff is something you can learn overnight that's why I said try to set yourself goals to work on each week!

Congrats! I'm 3 weeks into an OR fellowship program (it's basically Periop 101) and am loving it. There is SO much to learn though! Get yourself some spiral-bound note cards so that you can take notes as you go (especially since surgeons might like to use different things for different procedures that their preference cards won't reflect!). Also try to set yourself goals each week as to what you want to accomplish, e.g. "This week I will become comfortable with positioning my patients" etc. That's all I can think of for now since I'm still a newbie myself but I hope that helps! Oh, and until you're comfortable moving around the sterile field, stay away from anything blue! LOL

I just began an OR nurse fellowship program for UPMC in Pittsburgh. It's 5 weeks long and takes you through Periop 101 and counts toward your 6 months of orientation. I have both new grads (must be licensed already) as well as seasoned RNs in my class. I saw they've got another OR fellowship rotation beginning in June on UPMC's careers site as well.

You both made some good points. I had orientation today and I explained my situation to the HR lady. She said it wouldn't be an issue if I get offered L&D and accept it since obviously it's a permanent position whereas the fellowship is considered temporary. I'd just have to give the usual 2 week notice. They're supposed to be sending out offers next week so we'll see what happens.

First of all, I'm thankful to even have this as a dilemma since it's so hard for new grads to even find a job, let alone a specialty. I recently interviewed for two awesome specialties. One was for an OR fellowship for new grads (totally awesome opportunity!) and the other was for LD (my dream job, they rarely take new grads here!). Since the fellowship starts May 6 (it's a 5-week Periop 101 class) they were moving quickly to choose candidates and get them registered. The Unit Director for LD, however, is taking her time. This facility does a whopping 10,000 births per year, specializing in high risk births and many of these patients have comorbidities. There's also an OB ICU on the unit. Because it's such a fast-paced, stressful environment they have all candidates shadow on the unit for 4 hours to make sure it's really something they want to get into. I recently heard that burnout is common on this unit but I know that can happen anywhere. I've already received an offer for the fellowship and was given a deadline in which to accept/decline. The UD for L&D went on vacation (figures!) so isn't making a decision until after she gets back (she's out til May 3). I didn't wanna risk being totally out of a job if I declined the fellowship only to discover that I didn't get the LD position, so of course I accepted it within the deadline. I'm still really excited about it, but if I get a call for LD I'm wondering if it would look bad if I were to back out of the OR? I plan to become a CNM one day so LD fits with my long-term goals. By the way, the fellowship doesn't guarantee employment at the end. But halfway through the course we will be given a list of OR openings that we apply for internally (so not considered a new hire) and we interview for them. They've placed every fellow that have gone through the program though. A part of me also worries about the potential for burnout if I were to receive an offer for LD and accept. Ahhh what to do! Both positions are at hospitals within the same health system. Sorry that was so long!