Pursuing a new career in OR

WhoDatWhoDare, BSN, RN · Dec 18, 2016

Good morning, and congrats for getting the call for the OR Position.

I work in the Cardiothoracic team in my facility. You may want to ask during the interview what for the specifics for your facility will be, but I will try to elaborate what it might look like based on my experience.

Most of us work 10 hour shifts (0645 to 1715), with 1 day off during the week, and no scheduled shifts on weekends. I take 1 day/week of call (1700 to 0700 the next day) for emergent cases (type A dissections, emergernt CABG's, lung transplants, bring backs for bleeding) and 1 weekend every 6 weeks.

In regards to exposure to radiation, this is where it might be more helpful to get specifics for you facility, because while there is no exposure in a typical CABG case, at my facility, we also help cover the vascular room where they use it for angiograms, aortagrams, and fistulagrams. Additionally, we are in the cathlab as backup during TAVR (transcatheter aortic valve replacement) cases that are done percutaneously under fluoroscopy. We have an open setup in the event we must open the sternum because something gets dissected. Lastly, during days we don't have any CT cases available, we are tasked to other services, that include ortho or urology where c-arms are used regularly.

I say all of that not to discourage you, but rather give you some insight in order to know what questions to possibly ask when you go to your interview.

Good luck,

WhoDatWhoDare

Editorial Team / Admin · Dec 18, 2016

I am just curious if anyone knows what being pregnant and working in open heart would look like?

That would depend on the facility and its expectations. Will you scrub and circulate? Only circulate? If you scrub, you will be on your feet for hours at a time with no chance to sit down. You will be leaning over a table or a patient with that big belly in the way. It can be done, but it won't be comfortable. You will have a chance to sit if you're circulating.

Is there radiation exposure in open heart?

Depends on the types of procedures done. We do TAVRs in our hybrid OR. There is always a cardiac surgery team on standby for a femoral approach and a team scrubbed if we do a transapical, transaortic, or transsubclavian approach. We also do hybrid cases where we will do a MIDCAB one graft LIMA to LAD and then the cardiologist will come in and do stents. Because it's a surgical case, the OR team doesn't leave until the patient does. Our cardiac team is also responsible for TEVARs, where stents are being placed to deal with aortic aneurysms. Also involves fluoroscopy. However, all radiation exposure comes with requirements including wearing full lead (either a one piece that covers from neck to knees or a two piece that does the same and also covers the back plus a thyroid shield) and monitoring of exposure. Our policy states that as soon as an employee who experiences radiation exposure during the normal job duties knows she is pregnant, she must inform the radiation safety officer who will then issue a second dosimeter to be worn under the lead at waist level to specifically measure radiation exposure of the fetus.

Ive read a lot on here but looking for a discussion more specific to CABG. I really want to pursue this opportunity, but i also don't want to make a foolish move or become a part of a team that I will then be slowing down. I understand that surgical nursing is long hours and very physical. Right now I currently do 12s, which are really 13, and my job is pretty physical. (Also lots of combative patients) Am I thinking to much, shall I just go with life here?
thank you for your time!

It's not just CABGs you'll be doing in cardiac ORs. You'll also have valves, aortic aneurysms/dissections, minimally invasive procedures, and depending on the facility possibly lung surgeries as well.

In my facility, we all work scheduled 8 hour shifts. We are then on call for finishing scheduled cases or emergencies. We do not have a second shift cardiac team and our second shift main OR team does not work any cardiac cases. On average, I cover 60-100 hours of on call per two week pay period, depending on whether it's my weekend or not. We cover every 4th weekend.

Definitely have a list of questions ready for your interview. Ask about the radiation exposure. Ask about the call. Ask about the average of times people stay late. I may be scheduled to work 40 hours/week, but between low census time and/or getting called back in/staying late, I don't think I've ever had a simple 40 hour work week- it's either less or more. You may still be working 12 hour shifts, but you'll be working more days per week.

birdie22 · Dec 31, 2016

It totally depends on the facility/hospital you work at what shifts you'll be working, how long they'll be, what your call schedule will look it, and if you have to only circulate or also scrub. Dont worry about "slowing them down", they will orient you to everything and if you need more time, SPEAK UP. dont worry about people judging you for it. the OR is a whole new language, you'll often question yourself "why did i do this!" its definitely an adjustment period filled with self doubt. but totally worth it. if you like the technical, science, detailed side of nursing, you'll love it. seeing the human body up close and personal in the OR when people are totally dependent on your skills and knowledge is really awesome.

Definitely ask questions during an interview. then ask to shadow a nurse, and ask them the same questions - see if you get a different answer than what management told you. often times management might try to sugar coat a situation like "oh we only do 1-2 call shifts/month" but really they are short, etc., so everyone is doing 1-2 calls/week. remember, you're also interviewing them while they interview you. ask as many questions as you can think of - what kind of cases, does the heart team only take call for cardiac or other services, what does the heart team do when there are no cardiac cases, will you be trained in the other services, how long is orientation, etc.

Regarding pregnancy, like everyone else has said, you wear protective lead during fluoro/x-ray cases, and hospital usually give people a monitor to watch the levels that you are exposed to. ive never heard about anyone having a problem.

good luck with your decision!