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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.

There are a lot of nursing skills that you will lose when you go to the OR and are no longer at the bedside, as with any specialty. That doesn't mean that you can't re-learn them though. If you want to try the OR, go for it. I work with plenty of new grad RNs in the OR and they're doing just fine. Keep your unused skills fresh by reviewing them periodically and look for opportunities to use them whenever you get a chance. There are a lot of nasty people that work in the OR, so hopefully you will a good environment to work in; Your co-workers can definitely make or break your time in the OR!

Definitely have an attorney look it over for you before deciding. I am in a similar situation and I may be seeking legal counsel as well. Long story short, I signed a 2-year commitment to my unit with a penalty of 5k if I break the contract. In addition, I will never be able to work for this health system ever again; I will be permanently banned from future employment with them. Had I known this before signing (the contract doesn't say this at all - I found out verbally from someone else), I wouldn't have accepted the position at all. Now I'm stuck for 2 years and I hate it. Please, other nurses perusing this thread, do NOT sign a commitment contract! There is no guarantee you'll be where you want to be in 2 years, and then you are screwed. Good luck, OP!

I think the best way to deal with people like this is to handle it directly. When I was new, I always introduced myself to the surgeon and let them know that I am new and still learning. Sometimes it was my preceptor that introduced me; sometimes the docs care, sometimes they don't. Always read the preference card, and take some personal notes for your own use, such as his/her positioning quirks. That shows that you are learning, and a lot of surgeons recognize this. Even if you don't think they're paying attention to you, they are. Show them that you are learning, that you care, and are dedicated. They will trust you more with time. Sometimes the docs will just yell anyway and snap at you. It happens to everyone, even to the doctor's "favorite". Surgery is stressful, and not everyone handles stress the same way, so just be aware of that. Do not take any of it personally, and don't let them intimidate you.

In my OR, the RN does none of these things. It's always anesthesia. The doctor's don't care if the circulator is an RN or not, since we are not very well respected anyway.

I feel like this every single day. I am new to the OR, so maybe that has something to do with it, but a lot of people just ignore me or respond rudely. People know I'm new, and I get some pretty harsh treatment as a result. I hate it. My OR is the only one I know of where people are regularly treated like garbage, no matter their role, unless you're a surgeon and bring big bucks to the hospital. Ethics? Nope. Professionalism? Nope. Only a few "good" people exist, and I feel like my place of employment is toxic. I want to go elsewhere. It's pretty sad that I have less than a year experience, and already I feel burnt out and fed up. But I digress. To your point, I don't think there's anything we can or cannot do to be respected. People are going to feel however they do regardless. All you can do is give it your best every day, advocate for your patient, and be yourself.

"Doctors are coddled to" - oh YES! That is definitely true for me. I'm in the OR and the surgeons are pretty much allowed to treat others however they want, including techs, residents, and students. Most of the docs are great, but there are a few that are awful on purpose. I understand that some surgeries are higher stress than others (i.e., thoracic vs. lap chole lol), but sometimes the attitude is completely unnecessary. I'm very glad I don't work on a unit like the one in this article. Yikes!

For interventional radiology, what types of procedures do you do exactly? Did you go through a "periop 101" lecture/clinical type program before you started on this unit? I'm afraid I'm not too familiar with the types of procedures you do, as I am relatively new to the OR myself. However, I can tell you that we have very strict rules for maintaining sterile technique in the OR, but each unit that does invasive procedures does things a little differently. There are a lot of procedures where things need to be super strict, but not always. I'll get into that in a minute, but let me address your specific concerns first. When opening a sterile item for the scrub to either take or add to the field, definitely say something as soon as you notice a break in technique. It's OK that you didn't say something this time; Sometimes no one is around to catch these breaks and they go unreported, especially when you're the only one watching. ("You don't know what you don't know", or so they say.) Part of the scrub's responsibility is to make sure they don't break technique either, so it was quite literally out of your hands at that point. You cannot blame yourself for what someone else does or doesn't do. The doctor you mentioned that might have contaminated something when he moved the lead shield. Was he scrubbed in? Are you sure the screen was sterile (e.g., came wrapped in a sterile pack of some kind with a sterile indicator strip)? Without getting into too much detail, remember that only sterile to sterile is allowed to touch (and non-sterile to non-sterile). Sometimes items are designed to have sterile protection on only certain areas, but it depends on the equipment and its use. In some procedures, strict sterile technique is not always necessary. For example, the other day I did some cysto cases, which were mostly kidney stone removals and stent placements. We prepare the sterile field just like for surgeries, but we don't need to wear masks, eye protection, or shoe covers. In surgery you do, especially if you are scrubbed in. In surgery, the C-Arm has its own sterile drape that must be applied prior to it being introduced to the field. In cysto, there is no sterile drape for the x-ray device. As another example, you have to wear sterile gloves and maintain sterility during a foley insert or trach care, but you don't need to wear a mask or gown for that either. So it really does depend. A good rule of thumb is "when in doubt, throw it out". If you think you might have possibly contaminated something, do not use it. Just get a new one, whatever it may be. Don't be afraid to speak up! If someone gets mad at you for doing your job, don't take it personally. Surgeons especially are great at yelling at people, but 9 times out of 10 they do it because of stress and pressure, not because you're so absurdly dense! Pointing out a break in technique can be very intimidating as the new guy, and I have had moments when I was afraid too, and beat myself up just like you did. Comfort comes with time and practice. Remember that the patient's safety and care comes first, over your own feelings of pride. I don't like being yelled at either, but YOU are the advocate for your patient when they are under anesthesia. The patient is relying on you to speak up for them, since they cannot. This is an important role that is your number one priority, always. The absolute best resource you have for this type of thing is your hospital's policy database and the Association of PeriOperative Registered Nurses (AORN). The AORN has absolutely everything in great detail listed for you, which are evidence-based recommendations for best practices in surgery. If this is the first time you're hearing about the AORN, it is likely that you are not being trained as a circulating nurse in the OR just yet. Someone in the surgical services department will be able to give you a better answer than the one you received though, so maybe you just didn't talk to the right person. The OR front desk at my hospital has a copy of the AORN's standards. It's a big ol' book that anyone can reference at any time, no questions asked. Find out where yours is. I hope I helped somewhat and didn't confuse the heck out of you lol If you have any more questions, feel free to ask. This is good for me too so I can check my own knowledge

I second the primer suggestion. That and a setting/finishing powder would really help, in addition to a setting spray. Go to Sephora and ask them for help. They will match your foundation, hook you up with a primer, and anything else you may need. They also give free samples so you don't have to keep buying and returning stuff. Sephora's return policy is awesome, but getting free samples is such a time saver! For primers, Hourglass and Dr. Feelgood by Benefit are two of my favorites. Hourglass makes one for oily skin. Dr. Feelgood also mattifies, and helps minimize pores and fine lines. MAC's Prep and Prime Skin is fantastic too, available at their website and Macy's, Nordstrom. The former can be found at Sephora. Foundations can make a big difference too. When you choose one, try to use a cream or stick. That type has better staying power d/t how it's made. Liquid and tinted moisturizers are worthless for coverage too. MAC's Pro Longwear foundation is good. Kat Von D, Bobbi Brown, Make Up Forever's Mat Velvet (although a liquid, it's thicker than most and has great staying power), and Cover FX are equally excellent brands. Lastly, set your face with a finishing powder. MAC has great ones, but all high-end brands are about the same efficacy-wise imo. Finally, you can set your entire look with a few sprays of a setting spray. Urban Decay's All Nighter Long-Lasting Makeup Setting Spray is my favorite, MAC's Fix Plus is awesome too, and it smells so nice! For oiliness, try using a moisturizer for oily skin. Murad makes a great one. That will help keep the oil down as well, and thus improve your staying power. I love makeup and looking nice, even if it's just for work. I had cystic acne very badly and my face is quite scarred, so I totally understand where you're coming from. Good luck!

If you want to find out if you passed or failed, go to https://www.nursys.com/ Click on "Search Quick Confirm". Follow the instructions and click search. If you have/earned a nursing license, it will show up there. (FYI: Per the website, the only states that do not participate are AL, HI, and OK.) I have known people that didn't get their results from Pearson Vue for a while, but their name showed up on the BoN.... And then they got Pearson's. If the BoN says you have a nursing license, you have one ?

The Kaplan content videos are worth a watch. They will review nursing content, a 'quick and dirty' review. The other videos are a review of the practice tests with a detailed walk-through for each question. They explain the method used to answer the question correctly, explain in detail the rationale for each answer. There are 8 videos in all. (The 7 QTs and 1 readiness exam = 8.) Be sure to review every single question and the rationales for each answer - even if you got that question right. Why? Because that will allow you to see if your thought process was correct for answering that question. Maybe you got a question right because you had a hunch and got lucky. Thus, it's better to go through all the rationales. It takes time, so be sure to give yourself enough of it. Good luck!!