Tips for Surgical Nurses


Surgical nursing is not for the weak of heart. Some people are just not cut out to be an OR nurse.  But for those of you who are, here are some tips:

Whether you just accepted a position in the OR, or you're well into your surgical nurse orientation, these tips are bound to help you.  Hold on to your seat. It could be a bumpy ride!

Surgical nursing is completely different from any other specialty you may have experienced. Not much time is spent on surgical nursing during nursing school clincals. But that doesn't mean that there's no training involved in OR nursing. In fact orientation to the OR can be anywhere from 6 months to a year.  It's actually the longest orientation of any specialty. And if you're feeling a bit overwhelmed about working in the OR, have no fear! That feeling is totally normal. Most nurses don't feel truly comfortable in the OR for at least a year.

The Operating room is a strange environment that seems very weird at first.  There's a certain mysterious element because the only people who really know what goes on in surgery are the folks who work there. Most patients have no clue, because they're given Versed before surgery and can't remember anything about their experience afterward.

You have to understand that when you're new, you will have more bad days than good.  There's a massive amount of information to learn and skills to practice and perfect.  Most of the skills you'll learn will be unique to the OR.  So, regardless of what you've learned anywhere else, learning the ropes in the OR is completely different.

The worst days are when your patient doesn't even make it off the operating room table. Be prepared to question yourself and wonder if you could have done something different that would have helped the patient survive. Death is never easy, but you must look at it as a learning experience just like anything else in nursing. Unfortunately, people die, and it's the circle of life.  Sometimes we don't understand it, but realize that maybe it's not for us to understand. 

I remember once when I was working in a level one trauma hospital in surgery.  A 16-year-old patient came in with severe injuries from a motor vehicle accident. We transported her immediately to the operating room, but we were unable to save her. We placed towels and an Ioban over her incision and took her to the recovery room for her family to say their goodbyes. 

 It was completely heartbreaking to watch her family as they received the news, and her mother was laying over her body and screaming. The entire surgical team just stood there, and I looked over at the anesthesiologist and he was in tears. He said, "I hate this job sometimes." One of the people from organ donation approached me as the family were still mourning and asked me if they could talk to the family.  I won't repeat what I said to him and I realize that they had a job to do, but I was furious that they approached me about that at such a delicate and sad time.

There was also a case when a patient was transported to the OR with a gunshot wound to the head.  He was 19-years old. It was incredibly sad.  He was intubated, and we were just there to take his organs.  He was obviously brain dead.  As I was prepping him for surgery, I couldn't believe that he was really dead. I saw that he had something still clutched in his hand. It was a picture of his girlfriend. She had broken up with him, and he had committed suicide because of it. 19 and his life was over. To look at his body, all you could see was a small wound on his temple. Such a shame. Once we were finished collecting his organs, the vent was turned off, and he was pronounced dead. You must learn to deal with things as a surgical nurse, and you have to learn to separate them from the rest of your life or you will certainly drive yourself crazy. In surgery, the minute you think you've seen it all you are always mistaken when something else comes through the doors that is worse that what you've already seen. 

For the first six weeks that I worked in the OR I was totally overwhelmed and wondered if I had made the right decision on multiple occasions. The most challenging part of your day will be finding things. Everything has its place in the OR. Everything is labeled so that it can be easily located during a case. You can't leave surgeons waiting long when they ask you for an instrument or another supply. This can be very stressful on a newbie.

So I suggest that in your spare time you familiarize yourself with the supply room, the instrument room, and the sutures.  There is a lot to learn. But there are also certain things that are used during most cases. You'll learn all those things first.  Major and minor instrument sets are used most often during general cases, so memorize the location of these instruments and learn what each instrument is called in the set.  Initially, you'll feel like you're on system overload with way too much to learn. But if you learn a little bit every day, before you know it you'll earn your wings by scrubbing a major neuro case. 

Try to learn in increments, This will make learning a lot easier. Once you get the hang of sterile technique, move on to setting up rooms for cases. Then you can focus on prepping and positioning. Take full advantage of your preceptor. Learn how she does things and duplicate it. If you don't understand something, ask. Always be open to constructive criticism from your preceptor. They can tell you what you did wrong and what you did right. Set goals for yourself and let your preceptor know what they are so she can hold you accountable for meeting them.  Surgeon's preference cards are your bible.  Always study them before a case. If you can make copies of them the night before, so you can take them home and study them that's even better.  Once you get used to each particular surgeon and their preferences, it will become second nature to you.  But when you're new it's a good idea to read them ahead of time. It will make your day go much smoother.

Keep a notepad in your pocket for taking notes on important phone numbers.  Surgeons often have preferences that are NOT on the preference card. For example: Some surgeons like it colder in the room than others. Some may work with a stool.  Some may like country music while others like jazz. Writing down these preferences will help you be more prepared for each case. Surgeons are people too, and they can get pretty unpolite in a hurry, especially when a case isn't going as planned. Being prepared to deal with their demands is imperative. Some surgeons do get verbally abusive, and this should never be tolerated. You should report this type of behavior to your superiors immediately after the case. 

When you're new to the OR other nurses can be a bit mean. Surgery is a busy environment and most OR nurses are always in a hurry. They don't have a lot of time to spend dealing with new people. Nurses tend to eat their young anyway, so surgery is no different.  Surgical nurses also have a reputation for being very leery and dubious of new-comers. They're very territorial and not always the most welcoming bunch. Stay humble and help whenever you can. Once they see you're there to stay and you've built your skills up, they'll respect you and you'll become part of the team Once you are accepted, surgical nurses are extremely loyal and good-natured. 

Surgery can be exciting, invigorating, interesting and fun. But it can also be stressful and exhausting. They say "once an OR nurse always an OR nurse. I think that's a pretty true statement. You can take the nurse from the OR, but you can't take the OR out of the nurse. Also a true statement. Even though I no longer work in surgery, I will always be a surgical nurse. Some people are just not cut out to be a surgical nurse. You'll know whether you are or not, fairly quickly.  Don't be too hard on yourself. It takes time to learn how to be a surgical nurse. I hope these tips help you to ease into the environment in the OR, and I sincerely hope you enjoy working there as much as I did.