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.
Specializes in Telemetry, ICU, Resource Pool, Dialysis.
Those are great tips, Marie! It all just reminds me of the very first surgery I observed, my very first semseter of NS. It was a CABG. I got the primo position at the head of the table, standing on a stool. The anesthesiologist then proceeded to string lines and cables all around me until I was pretty much roped in. I had a great time at first until I realized I was trapped. Then I started thinking about what would happen if I passed out, fell, and took out all those lines on my way down. Longest 5 hours of my life!
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!
I know that a lot of students in my clinical groups don't know this stuff (the instructors don't tell us and sometimes the OR nurse we are with doesn't or can't either).
When I went to my first OR observation, the circulating nurse pulled me aside before the first case and gave me a basic synopsis about what would get me evicted from the room. At first, I was really intimidated by her, but after she and the rest of the team got past the busy prep period and had observed me long enough to trust that I probably wasn't going to do something inappropriate, they were great! I learned so much from what they shared about their roles. :Melody:
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 supicious 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 covers, 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 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.
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.
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 everythign 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 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.
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.
Thanks for all the great advice. I hope they do make this a sticky.
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.
If the case you're watching is posted as I and D or "Incision and Drainage", it has a high chance of being rank.
Plus, if necrotizing fascitis is involved... get the little wintergreen bottle, ASAP. Yes, some don't like the wintergreen smell, yet it is the better alternative & does mask the foul odor, IMHO.
:uhoh21:
RosesrReder, BSN, MSN, RN
8,498 Posts
great tips thanks for sharing.