Mountain

When I was updating my former blog, I was a staff nurse at big trauma center in the suburbs.  I have since taken on the challenge of being part of a leadership team assigned the daunting task of improving a surgery department in bad shape.  And when I say bad, I mean REALLY bad.

Little Trauma Center's OR has not had a leadership team in over a year.  How they have been managing to run things is nothing short of a miracle.  The staff had been getting by, but unfortunately, the quality of care suffered and patient safety was being risked on a daily basis.  There are issues regarding practice (training, best practices, AORN standards), process (lack thereof), and the overall disorganization that is apparent when you walk through the department.  Needless to say, there is a lot of work to do!

The Chief Nurse Executive was finally able to bring in two strong nurse leaders to fill the roles of Director and Manager.  And now, the frontline leadership (me being one of them) is trickling in.  Reinforcements are on the way!

When you take a tour of Little Trauma Center's surgery department, it is easy to make a mile-long list of things that need to change.  Left and right, surrounded by painful reminders of the lack of leadership, I think, "We can fix that..."  All we need to do is prioritize, right?  Hmmmm...  Maybe.  I don't know.  The only thing I can say with any confidence is that we will do our best, but it won't be easy.  Between the size of the To Do list and the staff that needs to be on board with the changes, this is going to be one tough mountain to climb.



I'm putting on my gear, saying a prayer, and will begin the ascent...

I'm Back!!! And with a post --- Your First Job in the OR

Hey there...  It's me, MB.  I'm back from the "dead."  You might remember me from the now-defunct "Livin' Large" blog.  I've taken some time off and feel like I'm ready, once again, to share stories about my life as an operating room nurse.  This time I'm in management (assistant manager).  (Scary, huh?)  So let's see what happens in this new adventure!

Towards the end of my writing in "Livin' Large," I felt my posts were taking on an overly negative tone.  I wasn't happy in my job and it showed.  This time around, especially now that I'm in a leadership position, I'd like to stay positive and forward thinking.

So here we go...  The next adventure begins!

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Every now and then I sign in to a nursing forum or two just to get a pulse on what's happening "out there."  What are the issues that OR nurses face?  What are the questions that are asked over and over?

It's that time of the year where many new grads are either studying for boards or getting ready to start their first job in the OR.  After surviving nursing school and boards, their nerves are a little rattled.  Anxiety begins to build about the "Real World."

Here is my advice to them...

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To the new grads starting in the OR:


You studied your butt off, graduated from nursing school, passed the boards, interviewed for jobs, and accepted an offer to start your nursing career in the Operating Room.  Phew!  Now what?

Before you embark on any journey, make sure that you pack some necessities:

• Pen - "What is a nurse without a pen?" said my nursing professor.  This drove me nuts, but she was right.  We are always jotting something down even when we have computer charting.
• Notebook - Unless you have a photographic memory, take notes on everything that you're learning.  Even as a seasoned OR, I'm still taking notes.  Lots of them.
• Highlighter marker - This is for highlighting stuff in your notebook (for further study, etc.) and for highlighting important info on the OR schedule (latex allergy, right versus left appendage, special equipment, etc.)
• Comfortable shoes - When you are assigned to scrub a case, there is usually no sitting.  When you circulate, there might an opportunity to sit - but trust me when I say you could be running all day.
• Hard candy (individually wrapped) - Just in case your lunch relief is late or there is no lunch relief!  You don't want to be hypoglycemic during a procedure.
• Pocket calendar - Write down your schedule, call, classes, etc.
• Scissors - For opening packages, boxes, cutting bandages off, etc.
• Locker organizer pouch - You can fill this with emergency items like "feminine needs," contact lens solution/container, ibuprofen, candy, makeup, ponytail holders, brush, etc.

Hospital Orientation
The first day on the job is not in surgery, but in a conference room where all the new hires from every department get the Corporate Orientation.  You find out about the hospital's mission, values, etc., fill out paperwork, then on to the important stuff like when you get paid, direct deposit, benefits enrollment, and parking.

Nursing Orientation
The rest of the week is typically the Nursing Orientation for the hospital.  This may last one to two weeks.  Some of these classes are not applicable for surgical nurses.  Your supervisor might have the option of picking and choosing which classes you need to attend.

Surgery Orientation
When you finally get to the surgical department, it is up to your nurse educator to come up with a plan for you.  This can vary from hospital to hospital.  My orientation as new nurse was set up like this:

• Week 1 and 2:  Intro to Surgery, computer based training, classroom training, training videos.  A general overview of everything that you will eventually experience "hands on" is shown during this time.
• Week 3:  Focus on Sterile Technique, Developing your Surgical Conscience, How to Scrub, How to Glove and Gown, time down in Sterile Processing to set up trays/learn instrument names for a basic tray, and learning the Basic Setup for a simple General Surgery case.  This is all HANDS ON.
• Week 4 and on:  Begin rotation through all the specialties in the OR.  Assignment to first specialty (6 week rotation).  First three weeks to scrub, last three weeks to circulate.  Depending on how well you're doing, you might be able to move on.  If not, an extension may be granted for this first rotation.  
• Rotations through the other specialties last two to four weeks.  You are meant to get an overview and enough experience to step in as a backup.
• Once you have finished all your rotations, you can either request a team assignment or your supervisor will pick one for you.  Personally, I think General Surgery is a great place to start, especially if you want to be handle traumas.  You will have an orientation schedule for that team which will be up to the discretion of your Team Leader and/or Manager.

Survival Tips

You will face a lot of challenges during your first year as an OR Nurse.  It can be really overwhelming trying to learn the instruments, setups, or everyone's name for that matter.  Just take one day at a time and remember that every OR nurse had to start somewhere --- exactly where you are.

More tips for your back pocket...

• Your first priority is the PATIENT.   This idea guides your day.  Never forget that.
  
• Listen.  No matter how much you think they know or don't know, everyone has something to offer in the way of teaching.  You will see different ways of doing things.  In the beginning, it's best not argue.  Just listen and say, "OK."  You can take the best of what you learn and incorporate that into your practice.
• Take Notes.  Start with all the important phone numbers:  the control desk, the charge nurse, your director, your manager, the nurse educator, all the OR suites, the overhead page, the lab, pathology, etc., etc., etc.  Write things down that will jog your memory on setups, surgeon preferences, how to handle specimens and all the little things that come up.  Write down questions as you think about them.  You might forget to ask when an opportunity comes up.
• Be Professional.  When you're in an OR be sure to introduce yourself to your colleagues - nurses, techs, PAs, physicians.  Most people appreciate the gesture.  It might even help deter them from calling you "nurse" or acting as if you are invisible.  Even if others are unprofessional, continue to behave in a manner in which you can be proud.  Should any issues arise and management gets involved, at least you know you handled yourself as a professional.  Back this up with your notes (see "Take Copious Notes" below).
• Take Initiative.  Read about the procedure ahead of time if you know what your assignment is.  This doesn't always work since assignments can be moved around, but try anyway.  It can help put you at ease.  Ask your preceptors for immediate feedback.  What did I do well today?  What do I need to improve?
• Be Helpful.  One way to win people over is to show that you're willing to roll up your sleeves and help them out.  If you're free, offer to grab blankets when a circulating nurse brings the patient into the OR or help the staff clean up after a case.  This helps you build rapport among your co-workers and could open doors of communication.  Just watch out for people that might take advantage of you.
• Avoid the Rumor Mill.  The OR can be like high school.  People talk about each other or what's going on with management or whatever the topic du jour.  Don't put any value on what you hear.  Do yourself a favor and don't participate.  Everyone has their own version of the truth and it's usually FAR from the truth.  You are busy and you have work to do.  Stay away from the poison of the grapevine.
• Eat Lunch.  When you are given a lunch break, take it.  You might not realize exactly how much energy you are burning.  As a nurse, you need to think clearly so try to avoid hypoglycemia and dehydration!
• Find a Mentor.  Pick someone who loves to teach and who will help give you perspective as you go through the trials and tribulations of an newbie OR nurse.  Believe me, there will be plenty of time that you need someone to help you get back on track.
• Take Copious Notes.  Document interactions or situations that you think might be inappropriate in file on your home computer or somewhere at home.  These are for your eyes only and can come in handy should any issues arise.  Sometimes you might be stuck with a preceptor that for some reason you don't get along.  Write down details of your interactions and what's not working in terms of your learning.  If there are issues with your orientation, document it in your notes.  Physician or staff behaving badly?  Write it down somewhere.  If things get bad for you at work, at least you have covered your ass - which is the best lesson I ever learned right out of college!  You can then go to the management or up the chain of command to find resolutions.
• Don't Panic - Just Breathe.  You might be thrown into new situations where you are on your own.  Take a deep breath and don't panic.  Remember to prioritize and at the top of that list should be PATIENT SAFETY!!!
• Utilize Your Resources.  Identify experts in the all the specialties or those rare nurses who seem to be so well rounded and know a little about all the services.  For example, if you are a General Surgery nurse thrown into an Ortho room, call an Ortho expert who can help jog your memory on where to get the casting material or where certain trays are kept.
• Keep Your Sense of Humor.  Sure, surgery is pretty serious, but that doesn't mean that there is no laughing in the OR.  If people feel comfortable joking around with you, they are more likely to open the door to building a positive professional relationship.  At the end of the day, if you can find something to laugh about, you're in good shape.

 Good luck and welcome to the OR...