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Med surg tele, very heavy pts. We get 6 at night. Recently they've been cutting staff so now we sometimes take 7. This is very unsafe imo but they are more concerned about the budget than safety.

ER never calls to give report. Half the time transport doesn't call to let us know the pt is coming. I have never spoken to anyone from ER. I'm shocked this actually happens! I'm on med surg tele.

Why can't they keep their beliefs to themselves?

I'm currently a med surg tele nurse with almost a year of experience on this floor. I have 6 pts per shift, all of whom have varying levels of acuity. Sometimes I'll get heavy surgical patients, basic medical diabetes and cellulitis-type pts, and even psych (DTs mostly and suicide). I feel like I'm a med passer and that's about it. Sure, I spend time with my pts and their families, bonding and what not. But when it comes to taking care of acutely ill pts, the others tend to get left behind. I really liked being with one of my pts tonight. He is very sick, dialysis and surgical pt. Wound vac, foley, PICC, tube feed, g-tube, HD accesss cath, infusing heparin and 0.9. I had to manage all his lines and tubes, checking the meds, flushing them through the PEG, etc. I really enjoyed that and I had to put a lot of thought into what I would do and prioritize. He was only 1 of 6 patients, the other 3 demanding pain medication and getting angry with me because I couldn't bring them their pain med immediately. I'm getting sick of this, quite frankly. I don't know if it's pt ratio, short staff, or acuity that bothers me the most, but it's getting to be tiring. I like working with fewer patients that are really sick. I feel like I have a chance to use critical thinking skills and assessments that I feel I lack on my current floor. I like managing lines and tubes, and working with technology, on a more independent basis. I have a very limited view of what an ICU nurse does, but it's always something I've been interested in. What kind of qualities make for a good ICU RN? I'm thinking about applying and doing a transfer as soon as I'm able, but I feel like I have more learning to do to prepare myself to be successful. Any advice or suggestions for how I should proceed? Thank you in advance!

Thank you all for your advice! This week I am going to shadow a CRNA friend of mine and get some tips from her, so I'm definitely excited for that. I would like to get a job in ICU as soon as possible, but with my limited floor experience, I'm not sure if I'm ready for that yet. I'm having difficulty juggling med pass, families, post-op care, etc. for 5-6 patients. Granted I work nights, so it is not typically as hectic as days, but I'm not sure if I'm in a place to transition to ICU yet. Plus, my floor experience totals only 2 months, and that's probably not long enough. I know most ICUs require 1 year med/surg (at least). I don't mind spending extra time getting the "right" experience so I can be successful. I know that ICU can be quite different from med-surg/post-op, and if I am having a hard time juggling 6 patients now, how will I be able to take care of 1 or 2 with multiple complex issues? I've heard from other nurses that have had a hard time in med-surg felt more comfortable with ICU. Maybe I'm one of those people? But I digress. I will definitely review meds, contact my alma mater, and look into re-taking classes. I'm not happy about that, but I know it will be worth it in the end. After all, I've already taken the classes so I know what to expect. I plan on only taking one at a time, and if I'm giving myself a 4 year goal, I'm sure that will be sufficient. I digress again! Thanks again for the support and advice, I really appreciate it :) I am always willing to learn more and I am very receptive to suggestions (and maybe some harsh truths when necessary!)

After spending a year and a half in the OR as a circulating nurse (right out of nursing school), I became very interested in anesthesia. I left the OR to eventually pursue CRNA school as my "end game", and I'm now on a very heavy post-surgical/telemetry med-surg unit. I plan on going to the ICU after at least 1-2 years on this unit (or sooner if possible). I also plan on doing at least 2-3 years in ICU/SICU. After reading all the requirements at various schools, the amount of requirements is a little overwhelming. I'm concerned I won't have the grades (even though none of my required classes have been below a 2.7-3.0). I'm tentatively planning on applying to CRNA school in 4-5 years. Most of my experience should be in ICU, and I will try to get there asap. I'm also realistic and know that I might not get accepted at all. I'm just wondering what I can do now to help increase my chances of acceptance and ultimately success in a CRNA program. Is there anything I can start now (like studying or researching certain topics) on a med-surg floor that will benefit me and make me stand out? (Or even increase my chances of getting hired in the SICU, since that's my first step anyway.) I'm not afraid or intimidated by hard work; I graduated from a very difficult BSN program, and I passed my NCLEX on the first attempt. My nursing school actually offers a nurse anesthesia program, which I definitely plan on applying to. There are only a couple things I know I must work on (CCRN certification and ACLS/PALS). Would it be a good idea to begin studying for that now or should I wait until I have ICU experience? Where should I even begin? Thanks in advance for your advice!

We have preop RNs that check in the patient. When the pt arrives, the preop RN is the one that receives them. They start IVs, get a height/weight, toilet, give preop meds, abx, make sure an NP/PA or resident does the H&P, obtain surgical consent, allergies, NPO, medication hx, verify ID/MRN/DOB, correct surgery/site/side, draw labs, orders, CRNA has their own interview: Verify ID/MRN/DOB, correct surgery/site/side, airway assessment, allergies, NPO, questions regarding anesthesia. OR RN prepares OR and has their own interview: Verify ID/MRN/DOB, correct surgery/site/side, check signature on surgical and anesthesia consent, ask for metal/implants in body, any PMHx that would be relevant to the procedure or positioning. OR RN and CRNA bring the pt to the room, and the rest seems pretty standard.

OR definitely has pros and cons. I won't repeat a lot of the great posts here so far, but some things that haven't been mentioned already are your nursing skills - You won't use any of these in the OR. CRNAs do the meds, blood, intraoperative monitoring, etc. Preop does IVs, meds, vitals. The RN in the room does computer charting; setting up equipment for use during the surgery; positioning and prepping the patient; counting with the scrub; dropping meds on the field (local and double antibiotic for irrigation, most often. We don't actually administer medications); setting up the room with whatever the surgeon prefers for that surgery; place Foleys (CRNA places NG/OG tubes). The only real nursing-specific thing that we do is positioning with regards to making sure the patient is free from nerve injury/damage and pressure sores/skin breakdown. We do skin assessments (but not like how you do a typical head-to-toe in nursing school, it's mostly focused) too, but that's essentially it. I think in the OR, you either love it or hate it. The RNs in the room are amazing at what they do; it's a very special skill set that no other unit or nurse does. Not everyone is cut out for the OR and that's ok, it doesn't mean you suck or you failed at anything. There are some ORs that have their circulating nurses do a lot more than tech support/running, but mine is not such a place. If you're interested, see if you can shadow for a few days, rotating through the different specialties if possible. You need more than just one 8-hr shift and 3 surgeries to get a good feel of what the RN does, in my opinion. Some doctors are notoriously difficult to work with, regardless of their specialty. So it would be prudent to see the good, bad, and the ugly

Wow. Just... Wow. I feel for you, trust me. I am in a very similar situation. First, do you get a morning break? At my facility, we get an AM break, lunch at 11, done by 3. We do 35-40 surgeries/day, though some weeks are lighter than others. In my state, we are actually entitled to getting two 15-minute breaks, but we're usually lighter in the afternoon so we can often self-break. Morning can be hectic, but there are some real break Nazis at the desk that make sure we all have had one (STs and RNs). Orientation was 6 months. The first 3 were classroom, with a couple days observing in the OR. Then we slowly transitioned into the OR, practicing skills in the classroom (opening, setting up sterile fields, gowning/gloving, etc.) and then we started doing more in the OR. During the entire 6 month orientation, we were 1:1 with a preceptor at all times. During our last month or few remaining weeks of orientation, we were left alone in the room, but our preceptor was right outside the door or easily reached if we needed her. She came in periodically, helped with turn overs, etc. Spending "a few hours" in the OR does not accurately portray the role of the nurse in the OR, and all the responsibility and politics involved with that. It's tough work. I've been on my own for 9 months, and certain cases are still overwhelming. So. Let me be clear when I say that you need to make a decision that is best for YOU. Fully weigh your options and make a decision in sound mind. With that being said... I signed a 2 year commitment contract with prorated $$ to pay back if I break the contract. In your situation, they have not upheld their end. Therefore, the contract is not valid. You do not have to be held to the same expectation if the other party didn't do what they said they'd do. Talk to HR or an attorney for clarification, your state may be different. Do you have documentation that can support your claim? Get some. My training was adequate, but the environment is toxic. For reasons of confidentiality and personal privacy, I am not going to detail my experiences publicly. However, I have weighed my options and I am getting out as soon as I can. My mental and physical health are suffering due to my place of employment, and I simply cannot do it any more. I am one of a handful of other RNs that will be leaving for the exact same reasons, all of us with different years and areas of experience. It sounds like your place is just trying to get as many circulators as possible, with no regard to how adequate their training is. It doesn't seem like your managers or educator(s) have your best interest in mind; they don't sound supportive or even safe. That's a problem. My advice? Apply elsewhere and go on as many interviews as possible. Don't rule anything out: med-surg, ICU, ER, etc. Whatever is an open spot that meets your criteria, go. If you find a good fit somewhere else and they offer you a position, quit and don't look back. If your manager has a reputation for ruining your career options on other units within that hospital, go outside your system. If you can't get out of your end of the contract (which I find unlikely unless there's some crazy fine print somewhere), then bite the bullet and pay back the money. It's only money, and once it's paid off, it's done; Think of it like a credit card. What price do you put on your health? Your ethics? License? Time with family and loved ones? My OR experience has taught me many things, one of which to advocate for myself because no one else is going to. Good luck!!

In my OR, the circulating nurse or whoever is assisting with the surgeon (resident or medical student with supervision/permission) will place the Foley. We have Surgical Technologists ("scrub techs") but not "OR techs", per se. Scrubs have gone to school and are certified. Everything else mentioned is true and applies for my facility as well.

How are the people you work with? Are they team players? Do the cliques help non-clique co-workers? Do they cause drama or throw people under the bus? If you don't feel comfortable with your co-workers (on a fundamental level, not on a personality level), then this particular OR might not be for you. Be aware and open-minded, but strongly consider the behaviors of your colleagues. Some aspects of the OR will get easier with time (i.e., multi-tasking, time management, communicating with doctors/surgeons, knowing where things are located and what resources are available to you), but there are some aspects that might not. If you have poor management and a lack of adequate education or training, that is not your fault. That can be a HUGE unhappiness factor, and that is not fair to you as a new nurse and a new OR nurse. Try to make an appointment with your educator or manager as soon as you can and discuss your concerns with them. That is their job and they should be more than willing to accommodate. You will be stressed, you will cry, and you will hate everything sometimes. That much is normal and true for any nursing position, not just OR. However, if you have no support from coworkers or management, if the people are awful, and it's not a positive environment, that is not normal and its not fair to you. You might want to consider other possibilities if you can't make it work. The OR is not for everyone, and that is perfectly OK. I have had a similar experience, although I'd argue that mine has been worse in comparison. I will not be staying in the OR. Best of luck to you!

We only have 1 team on Saturdays and Sundays, all shifts. If the "weekend team" needs a break because doctors have been doing lap chole after lap chole, the call team will be called in to give them a break/lunch, etc. Instead of standing up to the doctors, they just keep pressing on because they know they have a call team. Some people allow themselves to be pushed around by the doctors, and will call in the call team to work the shift just to appease the ortho doc(s) that wants to run 2 rooms simultaneously. If you work all night, you have to work your regular shift whenever you are scheduled. No exceptions. Sometimes they will let you go home and sleep, but if they're short that day, then you just have to deal with it. Your schedule is pretty awful, but mine is arguably worse. Everything about my facility is terrible lol [Edit for spelling]

I agree completely with this post, OP. I was one of the disillusioned new nurses that thought going to the OR would be a valuable experience, but it is nothing like I thought it would be. We are not respected at all in the OR, and the surgeon turns to the CRNA for patient-related info, not the RN. Many in the OR (techs and RNs) have a God complex and they won't hesitate to back stab or throw you under the bus if given the chance, as long as they get what they want. Anyone can be a circulating nurse, and you do not need to have an RN license to do that. Many of the bedside nursing tasks can be performed by the CRNA (and at my facility, the CRNA is the one that does it). Can anyone with minimal training... Insert a Foley? Yes. Straight cath? Yes. Hook up all the unsterile equipment? Yes. Position the patient? Yes. Prep the patient? Absolutely. It does not take a Bachelor's degree or an RN license to know how to do any of that. The only thing you need a license for is Pyxis access (though techs used to be able to do that at my facility), blood administration (most of the time the CRNA checks it with another CRNA if available or even the anesthesiologist), medication admin (antibiotics, anesthesia drugs), and ordering labs or meds. That's pretty much it. I disagree with RNs being eventually phased out of the OR. The AORN is a very powerful organization and lobby for perioperative nursing as a whole. As long as the AORN exists, RNs in the OR won't go any time soon. Yeah, but anyone can do that. Half the time the doctors don't care and will drape anyway.I'm glad that there are so many OR nurses that love their job, and truly find value in it. I think that one of the most important things in life is loving what you do, and nursing is a career worthy of love! There are plenty of nurses in my OR that are happy with it, and that is wonderful for them. I truly believe that, I am not being condescending at all. Unfortunately that has not been my experience, and I will be returning to the bedside as soon as possible. I miss starting IVs, pushing meds, spending time with the patient and their family, doing head-to-toe assessments, reading EKGs, and reporting critical values to the physician, etc. OR nurses simply do NOT do any of those things. Bummer.

I've inserted a foley on a male patient, without resistance and no blood in the urine return, etc. When I removed it later, there was blood on the end. The balloon was fully deflated, and I don't think he had any documented prostate issues. I charted that, told the doc, and that was it. Sometimes people have really unexpected responses to things (procedures, meds, treatment, etc.) and there's no way to tell what that response will be. Bank this experience in your memory and learn from it, and try to find something positive in it. Next time you have to remove a Foley, deflate the balloon twice (just to be sure), take your time, and provide comfort to your patient. (Pre-medicating is a good idea, if there's an order.) Now you know exactly what could happen with a "difficult" Foley d/c, and you can use that to better prepare for the next one.

Interesting to see what they do at other ORs... Mine is going for the level 2 trauma cert, and we were told that "anyone" can do trauma and you don't need any special skills or experience. They said all you need is a blade, prep, drapes, and hemostats (over-simplifying, I'm sure). The new people that just finished the peri-op program are already taking 24 hour trauma call, in addition to our regular call team. We don't have specialty call, other than hearts; Everyone does everything. Our "trauma call" consists of 1 RN, 1 scrub, and 1 CRNA that must be able to be in the OR within 30 min. People have had low morale and bad attitudes for years, looooooooooong before we started doing trauma call. Not sure how anyone can fix that - at your place or mine.