Soooo, you're observing in the Operating Room (O.R.)...

[Marie_LPN, RN, LPN, RN]

A couple of tips and such to help:

Dress Code:

• Give some serious thought into what attire you will wear into that dept. if you're allowed to wear something other than your clinical outfit on your OR day. I wouldn't have even thought to mention this, except last Friday, we had some airheaded student who wore a belly shirt, very low rise jeans with rips in them, with her G-string 4 or 5 inches above the waistband of her pants, and, yes, stilettos. This was our first impression of this student. She looked like she was ready for amateur night at a club in Richmond.
  
• About perfume: it's called cologne, not marinade, so make the scent a minimum, not something that people can taste. Pts. are sensitive to things like that.
  
• 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 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 must 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 operating rooms. 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, things can splash, even on the simple cases.
  
• 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. (It's, what, September 4th, 2006 right now, and we've already seen 8 students attempt to wear these masks in our ORs. We don't even have them on our floor, so who knows where they came from.)
  
• If the pt. is suspect of TB,you will be required to wear the N-95 respirator mask (). Where i work, we actually recommend that students avoid a room with a TB pt. though (the less people in the room, the better).

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 more than once, 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 had lead on).
  
• Do not fold the lead apron in half or drop it to the floor. This breaks the lead, causing it to be ineffective.

Misc. Rules:

• Eat a good breakfast that morning. I don't mean an energy bar, i mean eggs, sausage, OJ and toast.
  
• Anything of value has a habit of growing legs and walking off from the locker room. I recommend only bringing a couple of pens, your nametag, and a notepad, and leaving your other clinical things out in the car.
  
• No food in the OR. Yes, the docs might be dragging their coffee cup in, but as the rule goes, do as they say, not as they do.
  
• Television is not reality. Just because the actors do certain things on their shows doesn't mean it's correct technique. (and probably the biggest reason why i can't stand any of the medical dramas)
  
• 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 on 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. (Already, in Sept. 2006 at our facility, this has had to be reinforced)
  
• 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 violations (seen it happen more than once).
  
• When talking to the pt., try to talk to them in a lowered voice. Privacy, again. No one else needs to hear about Mr. Smith's 'rhoids, and it's probably safe to say that no one would want to either.
  
• 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 arrange. 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 scrub 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 great way to insult and offend OR staff is ask if they are a "gopher." Or say "This is boring" over and over. Think about it, how would you feel if someone came to your job and said "this is boring" for 8 hours?
  
• If you're there with a fellow student, be careful of your conversation. Keep it clean and professional. I say this because yesterday we had 2 students from the same clinical group describing in a normal tone of voice the prior weekend's frat parties, and let's just say it was overheard how one of them made a few football team players "happy" that night, and made me suddenly feel the need to brush and floss my teeth.
  
• 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.

[mand1]

Thank you for that info, just what I needed before I go back to my placement after xmas holidays. On a surgical placement at the moment and will be following a patient through admission, theatre and discharge. I am really excited, just praying that I dont do something stupid like break the sterile field or faint

[Keepstanding, ASN, RN]

Marie,

I am not an OR observer, but have been long ago when in nursing school.

Your information is so good ! Thanks so much for it. You always add a nice touch to this forum !:kiss

LPN 90

[Marie_LPN, RN, LPN, RN]

More tips:

• 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.

[Marie_LPN, RN, LPN, RN]

Marie,

I am not an OR observer, but have been long ago when in nursing school.

Your information is so good ! Thanks so much for it. You always add a nice touch to this forum !:kiss

LPN 90

Thank you.

I'd hope this would become a sticky. I've seen so many students that had no idea what to do or where to go for their observation and their instructors didn't help. I thought this might give a little bit of a headstart on it.

(Which reminds me, i got another idea for another forum suggestion.)

[MIA-RN1, RN]

this post is great! Takes me back to last year around this time when I was the first one in my med-surg clinical group to get the dreaded OR rotation lol. I was so scared going in and your advice would have been such a help!

I ended up enjoying myself and learning tons but I was so worried going in.

It was FREEZING in the OR and it wasn't until probably 5-6 hours in that the circulating nurse offered me a long-sleeve gown to wear (I hadn't even known that I could have one)lol

[following_faith]

This could not of come at a better time! In a couple weeks-I get to do the OR observation and I had no clue what to do/not do, expect..etc. The only thing we were told was that what happens/is said in the OR stays in the OR.

Thank you! I am going to be SO prepared now!

[MMARN, BSN, RN]

I gotta say, the tips are wonderful, but IT SCARES THE CRAP OUT ME!!! :eek: :eek: I'm afraid I will faint, touch something I'm not supposed to or just simply screw up! Phew!!!!

[CRNAhopefulguy]

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.

other than that, have fun.

[NewEnglandRN, RN]

Thank you, Marie :icon_hug:

What an excellent post. I wish I had that information BEFORE I passed out in my first OR rotation Fortunately, I have had three more and LOVE it.

Thanks again!

[not now, RN]

A couple of tips and such to help:

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.

When I was in my second sememster I was watching a procedure...dear God I can't even remember what it was. Anyway, the doctor had already started and forgot to put on his lead. Since I was the student and just standing there with lead on he would stop, walk around behind me (not close enough to touch), let them X-ray and then walk back around me.

[Marie_LPN, RN, LPN, RN]

Some doctors won't wear the lead, because the Velcro on it is shot, or if it's a long case, they'll just stand behind someone. That lead holds in heat, and it kills your shoulders if it's not padded.