I will never forget my first day on orientation in surgery. Total information overload – I had a deer-in-the-headlights look that everyone could see from a mile away. I watched a surgeon do a knee scope and I remember thinking, “What have I gotten myself into??!” My anxiety level was sky-high. I’m pretty sure I questioned all of my career choices at that one moment.
But! It got better! The first case was scary, but every case after that built a little bit more confidence and I learned a little bit each time. It wasn’t long until I was off orientation and running rooms on my own. Although, my first case on my own didn’t go so great… but we all start somewhere!
Sometimes other nurses forget they were new once, too.
The other day, I overheard an “experienced nurse” (been in the O.R. for less than 2 years) being very hateful and criticizing a new O.R. nurse. But the complaints that this nurse had were all things that were part of the orientation process! Some one has to teach you before you know these things! I stepped in and defended the new person. What’s considered “common sense” in the operating room isn’t so common if you’ve never been taught it.
So today I want to try to help you out a little bit. Provide a few helpful insights. And, hopefully, we’ll cover some things that others think are “common sense” so you’re well-prepared and set up for success. 😊
#1 – Don’t touch anything blue! (that’s the sterile field – don’t contaminate it)
If you’ve been in the O.R. for even 20 minutes you already know this. It’s the first thing everyone tells you. But it’s also good information to have ahead of time. So if you’ve gotten a job in the O.R. but you haven’t started yet, please remember this.
#2 – When in doubt, throw it out
This is a common rhyme used to remind everyone that if you think it’s contaminated, or you’re not 100% sure that it’s sterile – toss it and get a new one. It’s always best to know for certain that the instruments and supplies that you’re using are sterile. You don’t want to risk your patient’s safety.
#3 – Learn the meaning of “surgical conscience”
According to OR Today, “surgical conscience is about much more than just using good surgical technique or not taking shortcuts. It’s about consistently exhibiting ethical behavior and promoting patient safety all the time, in every circumstance—and doing the “right thing” in a surgical setting even if nobody else is watching or is aware that patient safety has been compromised, however minor or insignificant the compromise may appear to be.”
This is SO IMPORTANT! Learn from the beginning that we do the right thing – every time – regardless of who’s watching. So if you contaminate a back table that’s already set up, own up to it. Everyone might get angry because of all of the work and expense involved in a new set-up, but not speaking up is unacceptable.
#4 – Keep a notebook! 
I say this all the time, but it’s a necessity. Preference cards are great, but let’s be honest, they’re not always right. Especially in rooms where the same nurse and scrub always work together. One day the nurse is sick and the nurse who has to fill in is blind-sided by the fact that the pref card hasn’t been updated in 10 years. It’s no fun for anyone. So take notes. That way the next time you work with Dr. OCD you’ll look like a pro because you remembered exactly how he liked his prep stand set up.
#5 – Show up to work on time
Don’t come strolling into the OR at the last possible minute before you’re considered tardy. Chances are the nurse you’re working with that day has already been at work for 30 minutes – if not longer. Find out what time the nurse usually gets there and try to beat her to work. That way you can see ALL of the tasks that go in to getting started for the day. You miss out on so much if you’re not there from the very beginning.
#6 – Pay attention to your room’s ‘atmosphere’
Does the surgeon like loud music and lots of conversation? Or is it so quiet you can hear a pin drop? Chances are, if it’s an O.R. that’s painfully quiet, the surgeon doesn’t want to overhear you talking about your weekend plans. If you notice that you’re the only one talking, or the only one who isn’t whispering, act accordingly or shut-up. It will save you from the embarrassing moment when the surgeon’s had enough and you get flame-sprayed from the field.
#7 – Wear supportive shoes
Don’t come to work in Crocs. And don’t try to hide the fact that you’re wearing sandals under your shoe covers. Find a good, supportive shoe that will be as comfortable in 8 or 12 hours as it is in the morning. I see lots of nurses in Dansko’s, but just as many, if not more, wear a comfortable tennis shoe. I’m an Asics girl. They’re the only tennis shoes I wear. I’ve dealt with foot pain in the past, so I use an orthotic insert to help as well.
#8 – Stay off of your cell phone
I say this all the time. You can’t take care of your patient if you’re on your phone. You also can’t learn what you’re supposed to be doing in a room if you’re on your phone while the nurse you’re working with does everything. I’ve seen this so many times. It makes the experienced nurse angry and makes the new nurse look really bad. So please, put your phone away during cases. It’s best for patient safety and best for your orientation experience.
#9 – If you have questions, ask!
I see this all the time, too. Orientees don’t understand something, but they won’t just ask what’s going on. You don’t know everything yet, questions are expected! But if you don’t feel comfortable asking the nurse you’re assigned to, seek out a team leader, manager, or nurse educator.
#10 – Expect some O.R. humor
No matter how demanding someone is, do NOT run out of the room to get them a sterile set of Fallopian tubes. I promise, the only one stressed out about them will be you when you can’t find them. These kinds of jokes don’t happen everywhere, but I’ve heard stories of other nurses’ experiences during orientation. And if someone does have a little fun, remember that the O.R. is full of people with a weird sense of humor. 😂
Hopefully this list will help you out.
There’s plenty more that you have to learn, but if you remember this list, you’ll be starting out set up for success. Remember, you can do this!
Here’s to another successful day in the O.R.,
Melanie
Experienced nurses – What other helpful tips do you have? Share them in the comments below!