Start OR Monday, Any Advice?

canesdukegirl, BSN, RN · Oct 3, 2010

Congrats to you for graduating, passing the boards and landing a job in the OR! Way to go!!!

First, get up early and eat breakfast. Preferably something high in protein. I usually wake up at 0430 and take my time getting ready for work, because when you get there, you are hitting the ground running. It is nice to have some extra time in the morning to "center" yourself. If you have some TED hose, put those on. You shouldn't wear the same shoes outside of the OR that you wear inside the OR, so if you have a pair that you can keep at work, do so. Your preceptor will tell you this. Also, I wear a tank top under my scrubs so when I bend down, I don't give a free show to everyone. You can't wear anything that shows outside of your scrubs (like long sleeves). You may want to bring a hat with you because when your day ends and you take off your OR cap, you will have seriously deranged hair.

Bring with you a small (little bigger than your palm) notebook to make notes. Have a pen and some scissors in your back pocket every day.

Make note of the numbers that you will be calling often (like PACU, pharmacy, x-ray, surgical path). When you get your badge, you will want to tape these numbers onto the back of your badge so that you won't be fumbling around looking for the numbers.

I understand your being scared, and I remember that feeling! Just keep a couple things in mind when entering the OR: stay at least a foot away from the sterile field. When walking near the sterile field, NEVER turn your back to it but rather always FACE it. Don't walk between sterile fields (like going between a draped pt and the back table). Don't sit down unless your preceptor does. Don't be afraid of the docs. Be confident on the outside even though you are shaking on the inside. Be attentive to the surgery itself, and only ask questions to your preceptor. Most of the time the docs don't mind your asking questions, but they have to get used to your being there first. When they get used to you, you can ask questions when they are closing.

Don't get involved in the whole "anesthesia v. surgery" hoopla. We are all there to take care of the patient. Don't EVER EVER EVER forget that the patient is your main focus, not the surgeon. It is easy to switch your focus to the needs of the surgeon when they are in your face. Provide your hand for the patient to hold when they are being induced. They are scared, and their biggest fear is not the surgery but rather the fear of not waking up. Stay at the bedside and assist anesthesia with induction. When they are putting in the ET tube, they may ask you to pull the stylet, but this is something you will learn from your preceptor. Also, make sure that PRIOR to induction, the pt has a safety strap on. You would not believe how many times I have seen a surgeon pull off the strap to look at the proposed incision site and then leave the strap off.

When your patient is emerging from anesthesia, they may be wild. Speak to them in a soothing voice, tell them that the surgery is over. Have some warm blankets to put on them. The OR is cold, and the patient is wearing only a thin gown. I remember when I had surgery, the WORST part of waking up was not the pain, it was being FREEZING cold. Patients that have a hx of ETOH or drug abuse will likely wake up swinging, so be prepared for that. When you are trying to hold down a wild patient, hold them just above the knees. Pediatric patients will wake up wild, then go back to sleep, wake up wild, go back to sleep. They wake up in stages, and sometimes it can be a long emergence. I try to cut off half the lights in the room to make it less stimulating for them.

Your preceptor will go through the "flow" of the day. They will show you how to read a preference card, a pick sheet, and where supplies are located. Be helpful in getting supplies for your preceptor when you can. Write everything down that your preceptor tells you, because you will forget. There is SO much to learn.

At the end of the day when you go home, review in your Alexander's text the surgeries that you saw that day. It will help you to understand what you saw and reinforce the learning that you were exposed to.

Come back to this site often and tell us what you learned! Don't be afraid...be EXCITED! I am excited for you! Good luck. And remember...confidence.

brownbook · Oct 3, 2010

You'll be meeting a lot of new people, use whatever trick you need to remember people's names.

Don't be afraid to say "I'm new here I don't know." (Adding, "but I will find out" might sometimes be appropriate.)

Don't be afraid to ask questions, even stupid ones. But also prepare ahead of time, have some basic knowledge. There are dumb questions and there are DUMB questions.

I used to imagine a "force field" glowing around the OR table that I had to stay away from.

LauRN · Oct 3, 2010

Congrats!!

I too am a new grad starting in the OR in 3 weeks. I am excited and nervous, but can't wait to get started. I have been skimming through Alexander's while I wait to start.

I'm interested to know how your first week goes. Good luck on Monday!

And thank you canesdukegirl for your advice! :)

Susan317 · Oct 3, 2010

I've been an OR nurse for 17 years,the first year is the worst it does get better. My best advice is to listen alot. Ask questions of your preceptor quietly,surgeons dont like background noise,because then its not about them. Again listen a lot and then you'll learn when to speak. It's like learning to play a game with no written rules,that's why you have to listen so you too can learn how to play.