Questions from a new-grad ER nurse wanting to switch to OR

[CAguyinMO]

Hey all. I'm a new-grad RN (graduated from nursing school last August) with six months' experience in the ER now under my belt. I work in a very busy, extremely high-acuity 50-bed ER/level II trauma center. It's been a fairly good experience, in that I've learned a lot in just the six months I've been there. But I realized early on - and I'm more convinced than ever now - that the ER is not for me and what I want to do is work in the OR. I did a very short OR rotation in nursing school and loved it, but I was recruited early on for this ER position, and I went with it, thinking it'd be a great move for me. I wish now I'd gone to the OR. I work for a large health care company in St. Louis that allows employees to take another position after six months of employment, and I'm very strongly considering doing that sooner rather than later.

I've talked to several people in nursing and health care and told them I wanted to move to the OR, and each of them were fairly dismissive, saying OR nursing was incredibly boring, that I'd very quickly lose all the skills I'd developed in even six months in the ER, and that if I ever wanted to do any other kind of nursing, I'd have a lot of trouble with an OR background. So my question is fairly simple: Is this true? Is the OR *really* that boring? Do you all feel as though your skills have atrophied that much that it would be difficult, if not impossible, to do something else in nursing if you wanted to?

Any input, advice, or counsel would be greatly appreciated. Many thanks!

[Rose_Queen, BSN, MSN, RN]

OR nursing is boring: A day in the OR is like a day anywhere else- it has its ups and downs, its slow times and its crazy times. As for boring, well, there are days I'll take boring over coding the crashing pediatric trauma patient whose parents didn't make him put on a seatbelt but then there are other days when I get tired of appy after appy after appy (how many people in my area even still have an appendix to take out?).

Losing skills: Yes, you will probably lose some skills. I haven't started an IV since nursing school- either the patient gets one in the ER, on the floor, preop starts it, or in the case of peds, anesthesia does it after masking the kiddo down. However, you will also learn a lot of skills. Positioning to avoid skin breakdown/nerve injuries, sterile technique (not that you wouldn't learn it elsewhere, but sterile technique is absolutely mandatory and emphasized in the OR), and several others.

What you can gain: An understanding of anatomy that textbooks/pictures/diagrams can never truly convey. Besides, how many people out there even really have textbook anatomy? Focused assessment skills. You only have about 5 minutes to get to know your patient while they're still conscious, and in that time you have to assess: knowledge of their procedure, mental state (would they benefit from some "happy juice" before we head to the OR?), allergies, history, what do we need to watch out for in the OR (knee replacement means no bovie pad on that side, etc.). You also learn how to gain someone's trust in that short little time. OR nurses are also very good patient advocates- the patient is unable to advocate for him/herself.

P.S. How many of those you talked to were actual OR nurses or had been OR nurses at some point? Not to slam other nurses, but unless you've really spent time in the OR as more than an observer, you can't really know what OR nursing is all about. Just like I wouldn't expect myself to know more than the bare basics about med/surg nursing or ICU nursing or ER nursing as I've never done more than nursing school clinicals in any of those areas.

[CAguyinMO]

Hey, Poet. Thanks for the fast reply, wise words, and honest thoughts. FYI, I talked to 4 different folks about this, only one of whom was previously an OR nurse. (I work with her now in the ER.) So I realize that's just one RN's an opinion. However, I did also talk to a good friend of mine who's director of cardiac services at a big hospital in Milwaukee. He oversees the cath lab, and he told me his team has a lot of OR nurses apply to work in the cath lab, and according to him they've said similar things about OR nursing.

Frankly, what I've heard from these 4 people hasn't really dissuaded me from very likely trying to move into OR nursing at my hospital. I've read many of the posts on the OR nursing pages here, and it seems like a LOT Of the OR nurses who post here really like their jobs. That says a lot.

Thanks again.

[marowediva]

I am a nurse with 19 years experience, 11 years and counting spent working in the O.R. The O.R. is not for everyone but if you like a fast-paced environment with something new to learn all the time, then this is for you. In the O.R. there are specialties within specialties and there are so many things to learn at first that sometimes it can seem overwhelming. I suggest that you shadow an O.R. Nurse and Scrub Tech to see exactly what they do.

As for the technical aspect of this job, don't let the title "Scrub Tech" mislead you. There are many O.R. Nurses that know how to scrub and assist just like the scrub techs do. Furthermore, the O.R. Nurse actually has to be proficient in troubleshooting the machines and equipments that you use in surgery when it malfunctions. Many times I had to figure out whether it's the instrument, the equipment (generator, light source, monitors, drills, etc.) or just plain operator error(surgeon, technique, etc.) that is causing the problem!!

In my facility, we chart in the computer so we have to learn how to work with it. There were times when I feel like throwing the computer on the floor/trash because it is so slow or the screen freezes. So, really, working in the O.R. as a nurse is more technical than some people think.

One advantage I like working in Surgery are the days off. There are many different shifts in the O.R. that you can work depending on your lifestyle/schedule. I picked five 8-hour shifts, 7-3 pm, Monday-Friday to coincide with my family schedule. I'm off on weekends and holidays unless I'm on call which is maybe 4-5 times a month. Some of my coworkers work four 10-hour days, three 12-hour shifts(7a-7p, 11a-11p) five 3p-11p and some work just weekends. Also, if you need to make money, you can take as many calls as you can handle and get "time and a half" and on-call pay on your salary!!!

As a nurse in the O.R. we advocate for the pt. who is asleep and vulnerable. If you ask me we have a bigger responsibility than RNs on the floor because surgical patients are not able to complain or press the button when something is bothering them. Their insides are wide open while the surgeon is dissecting and manipulating their organs. It is up to the O.R. Nurse to make sure that all appropriate actions are taken to maintain the pt's pre-op status. Anything can happen even in a fairly-controlled environment like the O.R.

Some RNs will most likely tell you that it is not real nursing. However, it is a matter of opinion. I say put these same nurses in the O.R. and see if they can function?! It is a totally different kind of nursing care - different but equal to other specialties.

I really enjoy working in the O.R. I knew even as a student that I will be an O.R. Nurse someday. Now, I am even a CNOR (a nurse certified in the O.R. specialty). I hope I have given you a better view of how it is working in the O.R.

[RNPinkShoes]

Someone saying that OR nursing is not 'real' nursing.. is like saying floor nurses are just glorified butt wipers.

Sure, being on the general floors, you get to utilize a lot of basic skills learned in nursing school.

HOWEVER, there are tons of wonderful and unique nursing specialties. Diabetic nurses, wound and ostomy nurses, OR nurses, ect..... even though they may let go of some of those nursing 'skills' used on the floor, we get to focus on that one area of patient care and really MASTER it.

OR nursing is unique, and different. It is very technical. We handle a lot of equipment (many if not handled right can seriously harm patients), and instruments. We still do patient care, but yes, much different than on the floor. We still do assessments, and take care of patients while under anesthesia. We stand up for them, catch surgeon errors (a lot), and make sure they are receiving the best care possible. We still do basic nursing skills such as applying dressings, put in foleys, mix medications, I put in IV's (usually in kids when anesthesia is busy), chart, and I am always aware of patient status (it's not just the CRNA's job). I make sure everything has been done pre-op before I bring the patient to the OR (there are many times I catch abnormal lab values that hadn't been followed up on, or orders that have not been carried out or written). I have to be familiar with what meds the patient is on that may hinder certain procedures (ex. if I see a patient is on Flomax, I need to know the surgeon is aware before peforming cataract surgery in that it may hinder eye dilitation and increase risk of complications). I call codes, do chest compressions... tell me again why I am not a real RN?

Being on a general floor makes it easier to transition to another general floor. But transitioning into a specialized area is difficult for a nurse working on the floor, just as going from a specialized area to floor nursing is difficult.

Am I making ANY sense at all? lol

[ShannonRN2010, BSN, RN]

Granted...I am new in the OR, but everyday has been exciting for me, esp. coming from a strong med/surg background. At this point, I can't even imagine going back to floor nursing!