Senior Practicum in Operating Room

[awomul, BSN, CNA, RN]

I am graduating nursing school in 5 months and all that I have left is to complete my senior practicum and an online Community Health class. It's a very exciting & nerve-wracking time!

I was recently approved to complete my senior practicum in the operating room. I actually already work for this particular OR as a support tech. I also stayed PRN at my CNA job of 3 years just to keep my bedside skills fresh in case the OR didn't work out. I am very fortunate to have been selected by the team that hired me as they have been so extremely supportive in furthering my experience & education in the OR. My clinical educator is the same person that organized my new hire orientation so we know each other pretty well.

Now that context is out of the way, I was hoping to hear some tips to be most successful in my senior practicum. I rarely see practicum students at work, mostly just PONIs (PreOperative Nursing Interns), so I am not sure what they do that would be different than what the PONIs do. My preceptor is not yet confirmed, but will likely be one of the RNs I work with daily. How can I be most effective as a student in this practicum experience? What can I do to make a further/lasting impression on this team to hopefully be hired on as an RN someday? And was it a good idea to accept my practicum here, knowing the NCLEX will mostly test me on bedside-related clinical skills that are not directly pertinent to OR nursing?

TIA for your advice!

[Rose_Queen, BSN, MSN, RN]

I would definitely clarify what you are and aren’t allowed to do in the OR. In my facility, the circulator counting must be a licensed RN, so our externs/students are not permitted to count. They also aren’t allowed to dispense meds to the sterile field due to the number of hands the meds have to go through to reach the patient. They are allowed to help with positioning, prepping, foley insertion. They do not document (our system requires extra training for documentation in periop). 

Understand that there are definitely times to not ask questions (induction, emergence, counting, critical parts of the surgery). Make yourself a note and ask at an appropriate time. 

Eat breakfast. We’ll pick you up off the floor if we have to, but we’d rather not. 

Be engaged. Yes, there will be lots of purely observing time. Stay off your phone, don’t be sitting, etc. 

[awomul, BSN, CNA, RN]

5 hours ago, Rose_Queen said:

I would definitely clarify what you are and aren’t allowed to do in the OR. In my facility, the circulator counting must be a licensed RN, so our externs/students are not permitted to count. They also aren’t allowed to dispense meds to the sterile field due to the number of hands the meds have to go through to reach the patient. They are allowed to help with positioning, prepping, foley insertion. They do not document (our system requires extra training for documentation in periop). 

Understand that there are definitely times to not ask questions (induction, emergence, counting, critical parts of the surgery). Make yourself a note and ask at an appropriate time. 

Eat breakfast. We’ll pick you up off the floor if we have to, but we’d rather not. 

Be engaged. Yes, there will be lots of purely observing time. Stay off your phone, don’t be sitting, etc. 

@Rose_Queen Thank you! I will definitely ask them about my scope and do my best to learn visually vs hands-on when possible.

[kubelkabondy, ADN, RN]

I just finished my senior practicum in the OR so I can give you a few tips. I would recommend coming up with a list of goals that you want to work on while in the OR (maybe 2-3 per shift). Plan out what goals you want to work on each shift - starting with the easier ones in the beginning and then progressing to more complex ones as you move along. Be very intentional about this. Sit down with your preceptor at the beginning of or before your first shift if possible, and go over these goals and your plan of action. Make sure you and your preceptor are on the same page about what is allowed and what your preceptor is comfortable allowing you to do. I HIGHLY recommend working with one preceptor consistently, as opposed to having a different one each shift. Mine started that way because the managers wanted me to spend time in each surgical service (understandable), but the problem is it takes a whole shift just to build up trust and rapport with your preceptor, and they don't really have much reason to invest in your learning process if they're only going to be with you for one day anyway. Make sure you have a basic understanding of principles of sterility, and if you're ever unsure about something with regard to sterility, be sure to ask rather than risking contamination. Some good goals to start out with on your first shift might be initiating the time out, interviewing the patient in pre-op and transporting them back to the OR, and verifying patient information in the chart (allergies, H&P, etc.) before meeting them in pre-op. As you progress in your practicum, you can move towards working on more complex goals like positioning, skin prep, and foley catheter insertion. The AORN website has a list of 'RN competency verification tools' so I would spend some time looking over these if you need more ideas of goals to work on.  As someone above said, understand that you will be sitting back and observing for much of the time, especially in the beginning of your practicum, but you can still be actively learning things! Use this time to think of questions you want to ask your preceptor later, and make sure you write them down so as not to forget. Also use this time to familiarize yourself with the equipment. This may not be the case for you since you already work in the OR, but the surgical team is often wary about having a student in the room. As long as you don't contaminate the sterile field and show a willingness to learn and help out, you will earn their trust over time. Remember that your #1 priority should always be patient safety. Good luck to you. 

[kubelkabondy, ADN, RN]

On 12/14/2021 at 2:18 AM, awomul said:

And was it a good idea to accept my practicum here, knowing the NCLEX will mostly test me on bedside-related clinical skills that are not directly pertinent to OR nursing?

TIA for your advice!

It's definitely a good idea if you want to work in the OR as a new grad - having done your practicum there will show that you are passionate and committed, and it will set you apart from other new grads who are just applying because there was an opening. Clinical experience doesn't really help you pass the NCLEX all that much anyway - unfortunately, doing thousands of practice questions and reading the rationales is the only thing that can really prepare you. ?