Change into OR scrubs first thing when you get there, AFTER letting the charge nurse know who are, what school you're with, and such. This includes a long sleeved jacket. It's cold in there, you'll need it.
WEAR YOUR NAMETAG. To us, you're a suspicious looking stranger w/o your nametag. Cannot believe that this isn't a more enforced in schools to wear your tag.
Shoe covers are to be worn at all times when in the OR. Change them every time you go into another case.
Hats are to be worn at all times in the OR. All hair must be covered, and cover earrings as well. If observing in cases such as total joint replacements, spinal surgeries, or anything that's got a laminar flow air system that's running, you may be required to wear a second head covering that is a full hat that ties around the bottom of your neck (nickname a "hood" by some of the staff). The first hat should be covered completely by this hood.
Masks are to be worn at all times when in the OR room. They must be form fitted to your face and both sets of string tied, no exceptions. Change mask each time you go to another case. It is also suggested that if you are allowed to stand close to the procedure, wear eye protection.
Isolation masks that are for MRSA and VRE protection (the yellow kind typically) are NOT approved for OR level filtration. Do NOT wear those in the OR.
Sterility Rules:
The standard rule: if it's blue, don't touch it. Everything blue is sterile. Don't even reach over any sterile field for any reason (i've had this happen a couple of times, when a student pointed to something on the table and pointed OVER the field, and i wound up asking her to leave the room as a result, i could not risk a break in sterility. NO NO NO.) . If you have any questions about what is sterile, assume it IS sterile and treat it as such until you can ask about it.
Clear plastic in the OR is also sterile.
Radiation Protection:
You need to wear lead aprons and thyroid shields when observing OR cases with X-ray. While wearing the lead aprons, never turn your back to the X-ray machine. If no lead is available for you (which is typical on heavy case days), step out of the room during the X-raying, or stand behind someone who's wearing lead.
Misc. Rules:
Eat a good breakfast that morning. I don't mean an energy bar, i mean eggs, sausage, OJ and toast.
Don't lock your knees while watching. Step around a little bit, even if you don't have much room to move.
If you feel weak, step out. If you're in a total joint room and aren't "allowed" to leave, at least sit down. And if you are allowed to leave a TJ room, chances are you can't come back in, because of infection control.
If the smell is overwhelming (and there's a high possibility of this), bring alcohol swabs with you. Poke one inside of your mask when needed. VapoRub inside of the mask has the same effect, but the alcohol swabs are everywhere.
Always ask the permission of the pt., nurse, and doctor before going in the room. Do not just assume that you're allowed. Pt. privacy is always respected, first and foremost. The circulator is the pt. advocate. Always check with the nurse before interacting with the pt.
Ask the pt.'s nurse, then the pt. before looking at the pt.'s chart. To do so w/o permission could get you in a position where you will be asked to leave the room, and quite possibly the unit, for privacy violate (seen it happen more than once).
When talking to the pt., try to talk to them in a lowered voice. Privacy, again.
Do not take offense if the doctors don't talk to you. They are concentrating on the situation at hand.
On the other hand, there are plenty that DO like to teach.
If you're taking notes on anything, refrain from using pt. name, or MR number. Identify your pt. as, for example "56 y.o M h/o yadayada. It's actually best if you leave ALL names off your paperwork.
I don't suggest asking anesthesia questions until AFTER the pt. is intubated, the tube is secured and connected to the circuit, the anesthesiologist isn't touching the pt., and/or they have sat down in their chair. And ask if it's OK to ask questions about what they did/are doing. Don't just assume it's ok to do.
Also, before asking the surgeon any case-related questions before, during, or after the case, ask them if it IS ok to ask questions.
Chances are, when you're in a room, you have NO idea where to stand to watch. We don't even know where you should stand till the pt. is draped and everything is arranged. The safest bet is to stand up against the wall out of the way, and wait. Chances are, the circulator will point out a good place to stand.
OR staff will typically not talk to you during a case. We're trying to listen to what the surgeon says, and it's hard to hear a mumbling doctor when we're talking and listening to someone else.
A quick way to insult and alienate OR staff (tech or nurse, doesn't matter) is asking if they are a "gopher".
Assume that anything laying on the floor is filthy and dirty. If you touch anything that might have touched the pt., go wash your hands with soap and water. If the nurse tells you to wash your hands, do it. They're telling you to do so for your own safety (ex. we dropped a sponge on the floor, student picked it up, i immediately told her to wash her hands in a quiet voice, then told her why).
Never forget HIPAA! You may be required to sign an agreement for privacy before you are allowed to observe.
If i think of anything else, i'll add it on this post.
recently being promoted to deputy nursing supervisor. now i have to do more management works compare to being a scrub nurse. at times i feel down when i am not able to scrub up or to assist in cases anymore. being an OR nurse for the past 10 years ,my love is still to have my hand on the patient.
is there a way that i can do both at the same time and how can i divide myself in order to be able to manage th OR and same time to scrub too.
I read this post of yours quite a while back and put it in the back of my mind until...TODAY. My first OR experience (since LPN school) of my RN program. And don't ya know...this post was the FIRST thing I thought of as soon as I walked on to the floor! Though my OR rotation is strictly observational, I really enjoyed it the nurses were some of the nicest ones I have met! I work in the ER now and have never considered doing anything else, but after just a few hours today I am considering maybe checking into the OR internship at my hospital when I graduate!
Kids,,,I hope you're taking note!!!! Just kidding,,,sort of.....
I've been in the OR for nearly 30 years. Over the course of a year, we have student RN's, paramedics, LPN's, physical therapy, xray tech, PA's and interns, come thru, just to name some....not too bad for a small rural hospital. One thing for the "veterans" listening in.....remember gang, you were there once too... How were you treated, like some sort of insect, or with some dignity, for trying to become one of them.
I, for one, love to see students in the rooms,,,any chance I get to teach someone a little bit about my world, cool!!!
Now, kiddies....yes,,EAT BREAKFAST!!! it really helps!!
Don't be afraid to ask questions, but remember there's a good time and there's not. If I'm too out of breath from doing CPR, probably not a good time to ask a question!!
Rember, we're working in the real world, you in the text book world, they don't always agree. Is one more right than another,,not sure, hard to say at times.
Like Marie says, "it's blue, it's sterile" STAY BACK!!! I like to see no less than a good arm's reach. Don't even think about reaching over.
Another good rule....you're going to fall, fall backwards. Better yet, don't tough it out..you don't feel good, let someone know, and let them get you out safely. You can always come back later. Hard to do if you have a head laceration and a date in the CAT Scanner for a concussion from passing out and crashing into a bovie!
And teachers....are you out there too!!???
Give the kids some basic info. You don't have to be an old OR nurse to prepare them. Maybe give 'em a little scavenger hunt type sheet. You know things to look for. Who's the RN, the docs, the tech's, what's there role, how do they interact. How do they communicate, etc.
In our OR we talk to the instructors routinely. They tell us what is going good for them, we tell them if we've had problems with any students, etc.
I want these student well trained...think about it. They are going to be taking care of us some day!!!
Give the kids some basic info. You don't have to be an old OR nurse to prepare them. Maybe give 'em a little scavenger hunt type sheet. You know things to look for. Who's the RN, the docs, the tech's, what's there role, how do they interact. How do they communicate, etc.
And that's why i thought to post this. We got directions on where the OR was in the hospital, we didn't get ANY other instructions, nothing. Therefore we got to the floor and didn't have a clue what to do or wheree to go.
Thank you all for the great tips. I observed my first surgery, a scheduled C-section, without any formal education from my instructors. So, your tips saved me and I had a great time in the OR.
Marie, I have printed your excellent post to share with students who come to my OR. I get both nursing students and high school students who are in a program for those interested in health care careers. This will be perfect to hand them when they arrive.
Of course, all of these students are interested in the surgery itself, the anatomy. But it's also a great opportunity for us to educate them about the different roles in the OR, particularly the RN as both circulator and scrub nurse.
We all know we could use several thousand more of us so we could all have better schedules, less call, more breaks, fewer vacation restrictions, etc! So I always make sure to give these students my standard presentation on perioperative nursing in hopes of snagging some new recruits to our ranks!
Do not try to help out. Sometimes it seems like there are not enough people helping and you could do something. A small error can be a big one in surgery. We had one student who wanted to help plug in the bovie cord. When it was thrown, it did not make it off the sterile field and that is where she grabbed it from (again stay away from blue). We had to reprep and drape.
We had one student who wanted to get the specimen. She was so excited, she did not wait for me to pass it off the field, and she grabbed it off my back table. When we all said no and you need gloves, she immediately placed it back on my back table. Fortunately we were closing so I worked off the mayo for the rest.
I am going to start my last semester of assoc. degree RN in January and hopefully graduate in May 07. I did my first OR rotation this semester and loved it more than any clinical so far. I used to think I wanted to be a L&D nurse until my OR rotation. I am undecided if I should try to go straight into OR or work a while in Med/Surg or another area first for experience. Any suggestions from some experienced nurses in this area would be great.
This forum is the truly the best thing that could happen to an up and coming future nurse; thanks for all of your suggestions and experiences they are truly enlightening.
I'm excited - I've arranged an OR shadow experience next week where I work. I have no clue if it will interest me - but I get to see what this area is all about. It will no longer be some strange mysterious place in the hospital lol. I'll let y'all know how it goes - I'm going to try to remember all of Marie's good tips :)
I would suggest that if time permits, you call the OR and ask if there is anyone that could give you some tips on rules and regs. and maybe a brief tour before you show up to observe. As for the perfume mentioned in another post, please don't wear it to work!! So many people, patients and staff are allergic/sensitive; it's better saved for your personal special occassions!
irynn
6 Posts
recently being promoted to deputy nursing supervisor. now i have to do more management works compare to being a scrub nurse. at times i feel down when i am not able to scrub up or to assist in cases anymore. being an OR nurse for the past 10 years ,my love is still to have my hand on the patient.
is there a way that i can do both at the same time and how can i divide myself in order to be able to manage th OR and same time to scrub too.