Time to leave the OR? Options

[Silver_Rik, ASN, RN]

I am a new grad (Dec 2019) who is 8 months into an OR circulator nurse internship (let's call it 6 months because we lost 2 due to Covid-19) at a major (800+ bed, level 1 trauma, 30+ ORs, high acuity) hospital.  I have had some struggles and been put on write up for performance, but the past month I've felt like things were really clicking and improving.  

This week I had a progress meeting with my internship coordinators, told them I thought things were going much better, and they pulled out negative feedback and told me "we don't think you're a good fit for the OR and should be thinking about working elsewhere"  though later amended it to "not a good fit for our OR" because it's such a high complexity / demanding facility.  

I want to vent a little here, but don't take that as I'm not open to advice.  I want it, even if it's not what I want to hear.

Let me start by saying I am not the most confident person. I know what I'm doing but then I hesitate or ask a question about something and my competence is questioned.  

On a day to day basis most of my feedback from my preceptors / resource nurses is positive.  I'm frequently told I did a really good job, and that they are seeing a lot of improvement.  However, the positives never seem to make it back to my evaluators. 

I think most (not all) of the criticism has been valid, but lacking in context.  I point out a string of successes and improvement and they act surprised, "we've never heard about this" and then bring up something I did wrong two months ago.  For example, my ability to perform a particular skill was questioned.  I said that I have done this multiple times the past few weeks successfully and without assistance.  The coordinator pulled out a report from several weeks ago that I made a mistake and someone had to step in and help me.  

I've found that when my resource person trusts me enough to step back and let me run the room, their trust is usually merited and I do fine; but when they think they have to step in all the time, and constantly be over my shoulder and correct me they're usually right, too.  

I hear "everyone of us makes mistakes, we've all made that mistake" and then still have it reported.
"It takes at least a year" to feel like you even have a clue in the OR, but told if I exhibit honest trepidation about handling more complex cases until I have more experience they don't feel comfortable giving me that experience
But I think the worst is "every nurse in the OR has their way of doing things, and you will figure out what works best for you," then work with nurses who think their way is the only right way, even if not a single other nurse in the hospital does it their way.  They never appreciate being told that nobody else I've ever worked with does things their way.

So, I'd like to be where I am and make it work.  I tried to get a meeting with my OR manager and I feel like they blew me off (this actually bring up another issue I might append later, but will leave out of the initial post) just to tell my side and get another opinion.  I think they will take the side of the internship coordinators, but I want to say my learning style is not the same as others, and if you can put enough trust in me to let me work I can do this.  Unfortunately, I think it might be too late.  The disciplinary process for work performance is already under way.  

If I leave, it's been suggested I might find another unit in the same hospital - though I'm pretty sure I'm in a time crunch because if formal disciplinary action gets to a point I don't think another unit will take me.

I'd be up for trying OR again at another facility to prove that I can do it, but fear that with less than a year of experience and failing in my internship, nowhere else will take me.

There are plenty of nursing jobs around here, and I think I'm a recent enough grad to hopefully not be pigeonholed as OR if I want to go do med surg or psych or whatever.

In my shoes, what would you do?  
 

[Rose_Queen, BSN, MSN, RN]

First, do you like the OR?

Second, your internship coordinators may be correct in their amended statement about the complexity not being a fit yet. You may indeed find you flourish at a facility that isn’t as complex. We’ve done that with some new grads who were hired directly into the cardiac team and floundered- but in the less intense/complex specialties they flourished. 

What resources are you giving yourself? Do you keep your own notes in a pocket notebook to help with the things you struggle with?

What resources do the management/education team have to offer you? Is there the ability to do some mock situations with those things that are a struggle?

Consider what it is you like about the facility, the specialty, and your feelings. That can help guide your decision.

[Silver_Rik, ASN, RN]

2 hours ago, Rose_Queen said:

First, do you like the OR?

Second, your internship coordinators may be correct in their amended statement about the complexity not being a fit yet. You may indeed find you flourish at a facility that isn’t as complex. We’ve done that with some new grads who were hired directly into the cardiac team and floundered- but in the less intense/complex specialties they flourished. 

What resources are you giving yourself? Do you keep your own notes in a pocket notebook to help with the things you struggle with?

What resources do the management/education team have to offer you? Is there the ability to do some mock situations with those things that are a struggle?

Consider what it is you like about the facility, the specialty, and your feelings. That can help guide your decision.

Thanks for the reply.  It’s helpful.  I have more to say in response but no time right now. Be I’ll try to soon.

[GadgetRN71, ASN, RN]

I honestly would start looking at other ORs. It’s sounding like they are unreasonable to begin with, because it can take up to two years before you are 100% comfortable. And, you are working in a large place with high acuity cases. 
 

 

[Silver_Rik, ASN, RN]

17 hours ago, GadgetRN71 said:

I honestly would start looking at other ORs. It’s sounding like they are unreasonable to begin with, because it can take up to two years before you are 100% comfortable. And, you are working in a large place with high acuity cases. 
 

 

I talked to my service manager and she said she felt I can be a good OR nurse, but would be better off developing my skills and confidence in a facility with a more stable, lower acuity, case load vs a level 1 trauma / large university hospital.

 I went to a job fair at another hospital in town, interviewed with their OR manager, and was offered a job:  RN circulator, primarily on their orthopedics team.  That’s been one of my favorite areas to work but I’ll be going from mostly trauma (I say if you got rid of car wrecks, ATVs, and ladders we wouldn’t have any work) to mostly new hips and knees.  It’s smaller, tighter, and they send their major traumas out to my old place; but their ORs looked as well equipped and up to date as what I’m used to.

I start right after Christmas 

[Hoosier_RN, MSN]

1 hour ago, Silver_Rik said:

I talked to my service manager and she said she felt I can be a good OR nurse, but would be better off developing my skills and confidence in a facility with a more stable, lower acuity, case load vs a level 1 trauma / large university hospital.

 I went to a job fair at another hospital in town, interviewed with their OR manager, and was offered a job:  RN circulator, primarily on their orthopedics team.  That’s been one of my favorite areas to work but I’ll be going from mostly trauma (I say if you got rid of car wrecks, ATVs, and ladders we wouldn’t have any work) to mostly new hips and knees.  It’s smaller, tighter, and they send their major traumas out to my old place; but their ORs looked as well equipped and up to date as what I’m used to.

I start right after Christmas 

Congrats and good luck!

[GadgetRN71, ASN, RN]

On 12/15/2020 at 10:25 AM, Silver_Rik said:

I talked to my service manager and she said she felt I can be a good OR nurse, but would be better off developing my skills and confidence in a facility with a more stable, lower acuity, case load vs a level 1 trauma / large university hospital.

 I went to a job fair at another hospital in town, interviewed with their OR manager, and was offered a job:  RN circulator, primarily on their orthopedics team.  That’s been one of my favorite areas to work but I’ll be going from mostly trauma (I say if you got rid of car wrecks, ATVs, and ladders we wouldn’t have any work) to mostly new hips and knees.  It’s smaller, tighter, and they send their major traumas out to my old place; but their ORs looked as well equipped and up to date as what I’m used to.

I start right after Christmas 

Excellent, congratulations! I think you’ll find having a solid orthopedics foundation will help in the long run. My two specialties are Ortho and Opthalmology and it’s been beneficial, since those are two specialties that people avoid like the plague for some reason. 

[Rose_Queen, BSN, MSN, RN]

42 minutes ago, GadgetRN71 said:

My two specialties are Ortho and Opthalmology and it’s been beneficial, since those are two specialties that people avoid like the plague for some reason. 

Eyeballs are just ... ew! 

[RNBSC]

On 12/20/2020 at 8:47 PM, GadgetRN71 said:

Excellent, congratulations! I think you’ll find having a solid orthopedics foundation will help in the long run. My two specialties are Ortho and Opthalmology and it’s been beneficial, since those are two specialties that people avoid like the plague for some reason.