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.
Specializes in ICU, PICC Nurse, Nursing Supervisor.
this is good stuff marie, thanks for posting. i was seriously thinking about or after graduation (rn).. i would love to be able to observe/precept with you ..you sound like know your stuff...
Hi...Student nurse here...what is the difference between a circulator and a scrub nurse? Are there programs that we can apply to become an OR nurse? I am really intested in this area. Thanks for all the advice and information. Have a wonderful day!:studyowl:
Specializes in Cardiac Telemetry, Emergency, SAFE.
Hi...Student nurse here...what is the difference between a circulator and a scrub nurse? Are there programs that we can apply to become an OR nurse? I am really intested in this area. Thanks for all the advice and information. Have a wonderful day!:studyowl:
A circulator is the person that checks/assesses the pt in preop, brings them back to the OR, prepares the Pt for surgery, and then stays in the OR through the case to chart and get things the Scrub people may need. A Scrub nurse/surgical tech is the person/people at the field that are scrubbed and sterile and are assisting or have the table of instruments. Facilities usually do have specialized training programs for the OR. Check in with the places in your area. :)
i work in the OR and its always cold, but u get use to it very fast.
i would add, dont bring anything in ur pockets like ur keys, valuables, wallet, money, etc, always keep that locked up in your locker because u dont want to lose it and u dont want to have any metal or anything on you. Also, dont bring your school bag or what not into the OR area unless you are allowed too. this is a sterile temperature controlled and atmosphere controlled area. I will see doctors bringing soda and food into the area, but not into the room. This doesn't mean you can bring your bottle of water or what not with you tho.
If they do let you get dressed in a gown or what not and your in the room and for some reason you are near the sterile environment, you always pass a person back to back because the back of a person is where the germs would be and the front is the sterile area in most cases. for instance, if your sterile and the doctors sterile, you dont walk right by infront of him because your letting your germs brush away onto him or onto his hands. Also always keep your hands up if they let you put gloves on, dont cross them on your chest unless u got a sterile gown on, or dont let them hang down or be below your belt. Im sure you see this on tv all the time where you see them walking around with their hands up like there nuts. same things applys.
when you are wearing eye protection, make sure u get a mask that keeps the steam out of your eye protection glasses because many times people put on a regular mask and when they put their glasses on, they steam up from their breath. there are specific masks that prevent this from happening, and they are usually lined with a plastic on the inside to keep the moisture in.
oh and if it starts to smell for whatever reason, like bile or just some uncontrollably disgusting smell, it will happen lol, the nurses might have some mint stuff to get rid of the smell. i am not quite sure the name of it, but its a mint bottle that u put on your finger and then swipe on your mask and keeps the smell from intoxicating you. if u cant stand the smell, ask if the nurse has some mint for your mask, they usually will kno what u mean.
also when u have perfume and what not, do not spray it all over your scrubs or what not, its nice to smell good, but u dont need to overkill us and especially the patients. many patients are sensitive to things and the last thing we want is your patient breaking out or being anaphylactic because u got some weird perfume or cologne on. you can wear deoderant tho. some cases will ask that u not, but usually it will specify if their an abbi patient.
Last year when I had OR rotation, I just automatically did what you suggested so as not to get in the way of ANYTHING. I was so surprised to hear of a few fellow students who did the exact opposite and got thrown out of the OR!
Hello and nurse OR of Portugal, and experience and emegenci cirurgery:welcome:
Thank you for an excellent post. I have been a surgical RN for the past 5 years. We seem to have more and more students each day. We have Med Students, RN students, LPN students, scrub tech students and high school allied health students. And no, we are not a teaching facility (smile). It is wonderful that they can come to surgery and observe, but sometimes it can be a little frustrating. Like you pointed out, they never know where to stand. The back wall is an excellent place at least until the patient is draped and everything is passed off to the circulator. Afterwards, the nursing students tend to migrate to the CRNA. 9 times out of 10 they go up to anesthesia and ask them how they got into anesthesia school, where they went to anesthesia school and how long they had to work in ICU until they could apply. Although I encourage everyone to further their education, let's focus on the one you are working on now (smile).
im an OR nurse for three years now here in my country and the US tradition is so different from where im working. i know all the other sterile techniques and stuff and were all practicing it here though your setting is very ideal and are all "by the book." its nice to have read all your tips. it gives me better picture of an operating room setting in the US. makes me better prepared going there.thanks a lot! hope to read a lot more about these things. and hope ill be able to get a chance to be an operating room nurse when i get there because i sooooo love being a scrub and circ at the same time. tnx a lot!! good day!
im an OR nurse for three years now here in my country and the US tradition is so different from where im working. i know all the other sterile techniques and stuff and were all practicing it here though your setting is very ideal and are all "by the book." its nice to have read all your tips. it gives me better picture of an operating room setting in the US. makes me better prepared going there.thanks a lot! hope to read a lot more about these things. and hope ill be able to get a chance to be an operating room nurse when i get there because i sooooo love being a scrub and circ at the same time. tnx a lot!! good day!
I wish I had known this thread existed before my OR rotation for the semester (first week of Feb.) I had an awesome time, however, and followed your advice basically without even knowing it.. I just stayed away from the blue and kept myself out of everyone's way. Biggest thing to remember is that it's an OBSERVATION; I treated it that way, asking questions when appropriate but mostly observing procedures. I found that most nurses and doctors I met were eager and willing to discuss their roles and the procedures at hand. Thanks again for the advice, though. I'm thinking about becoming an OR nurse after a few years of Med-Surg and some critical care experience. :redpinkhe
txspadequeenRN, BSN, RN
4,373 Posts
this is good stuff marie, thanks for posting. i was seriously thinking about or after graduation (rn).. i would love to be able to observe/precept with you ..you sound like know your stuff...