Starting as a new Nurse anywhere can be extremely intimidating. This is especially true in the surgical arena. It's not exclusive to Nurses, but to anyone new to the Operating Room environment: Medical Students, P.A. Students, Surgical Technologist students, and even Medical Rep Trainees. It is completely normal to be anxious. Here are some tips to help bolster your confidence - particularly if you're brand new to the Operating Room.
Respect the Sterile Field - The single-most important thing to watch for in the Operating Room is the Sterile Field. This aspect of surgery separates the O.R. from almost all other types of work environments. Instruments, supplies, and draped areas are considered to be sterile after being cleaned, then subsequently steam sterilized under high heat and pressure (or chemically sterilized). If a person is not scrubbed in and sterile for surgery, then caution must be taken to avoid getting near or touching these areas of the room. Sterility, Patient and Staff safety will always dictate actions made in the O.R. A break in sterility can have the potential to negatively affect the outcome of the surgery.
A patient may acquire an infection and other complications (i.e. sepsis - a system-wide infection with a high mortality rate if not caught and treated immediately), or may require subsequent surgeries (revisions with biopsies), or could even lead to the death of a patient. It could also lead to the non-reimbursement for the procedure per CMS guidelines due to a HAI (hospital acquired infection) or SSI (Surgical Site Infection) being acquired within 30 days of a procedure, or being named in a lawsuit.
It's safe to expect the surgeons and staff to remind (possibly yell at) you not to come too close to the sterile field, cross a certain boundary, remove attire near, walk too fast around, open room doors too often, or even open instruments, supplies, and implants improperly thereby causing an increased chance of contamination. Don’t take it personally, as it should be in the O.R., patient safety and sterility come first. Bottomline, respect the blue areas (some drapes and gowns are green), give yourself some distance, and you'll be fine.
Scrub Attire - You will be expected to wear clean provided scrubs. Often times O.R.'s will provide their own scrubs and a locker room to change. Dedicated O.R. shoes are also required for use in the Operating Room to prevent the tracking in of mud, dirt, and unwanted microbes into the surgical areas. A surgeon's cap, bouffant, or scrub cap must be worn in the O.R. at all times. A surgical mask must be worn in the sterile core and Operating Rooms while a procedure is being setup or in progress. Make sure to remove and secure any jewelry such as rings, ear rings, cell phones, watches, etc., particularly if you will be scrubbing in. This is to prevent any potential Junior Mint moment (a Seinfeld reference) and allow for proper scrubbing of one's hands.
Surgical Instrumentation, Equipment, Implants, and Supplies - Because instrumentation, equipment, implants, and supplies can be highly specific to a particular size, material, and usage. Many of those new to the field find the names, settings, and sizes of these items to be a foreign language. Names and settings include a 4-0 Chromic on a P-2 needle, 25 cut, 25 coag, 15 on bipolar, Bier-Block cuff, a 22mm cortical locking partially threaded screw, size 5 left with 1mm offset, Balfour Retractor, Tecnis Symfony Toric ZXT300 22.5 diopter IOL. But trust me, this lingo will become second nature.
Basic Operating Room Department Layout - O.R.'s are linked to the Pre-Op / Admitting, and Post-Op / PACU.
Within the O.R. department itself you will find: the Control (Charge) Desk where the O.R. and flight board of rooms, cases, and staff assignments are managed by the Charge Nurse, an Equipment Room with lasers, laparoscopy towers, table attachments, I.V. poles, endoscopes, ultrasound machines, positioning equipment, a Sterile Supply / Implant Room, Sterile Core, Sterile Processing Department (SPD), Manager and Director Offices, Locker Rooms and clean scrub machine / shelves with clean scrubs. Sterile supplies and peel packed instrumentation (individually sterilized wrapped instruments) will be located in various locations throughout the Sterile Core.
Staff Personalities - An old book on the Operating Room, whose title eludes me at the moment, refers to the Operating Room as "the Crucible." As I've had the privilege of working in different O.R.'s, this description couldn't be more true. With a wide array of surgeons, assistants, and staff, comes a wide array of personalities, backgrounds, and experiences. Rarely will you find a workplace with more laughter and tension (as surgery can be tense at times). Naturally as a newcomer, you may often find you are the new center of attention, whether you like it or not.
There will be intermediate and expert level staff who will selflessly teach and share their time and advice to help you succeed. I had a wonderful group of Nurses and Surgeons, a few in particular, who blessed me in such a way. God bless them in all their endeavors. However, expect that there will also be veteran nurses or staff that will be overly critical, unfairly judgemental, and almost seem to not want you to succeed. They have either forgotten what it was like to be entirely new to the O.R. Or they may have issues at home. One friend who is a wonderful counselor always said, "hurting people hurt people." And so there's always the sage advice of having thick skin, or turning the other cheek. There's also a time and place for sharing your frustrations with those you trust. Often times they will share similar struggles that they've had and how they've dealt with it. Then there's a time and place for confronting that person directly about an issue, and even a proper time to speak with your manager about an individual, or how the training is or isn't coming along. As an aside, when paired with a preceptor (another name for a mentor), sometimes the preceptor / preceptee relationship isn't the best, and another preceptor may be the solution. You have the ability to share with your preceptor your feedback, but don't be afraid to let your manager or educator know your concerns as well.
Scrubbing Process - You will learn how to perform a full surgical scrub of your hands and forearms using a scrub sponge soaked in either hibiclens, betadine, or with a 3M product called Avagard. Here is a link to the Johns Hopkins Medicine Tutorial on the basics of the scrub. The steps and methods may vary depending on who is teaching you. However, the basic premise of the scrub is to utilize the mechanical friction of the "scrub" to physically loosen microbes on the skin's surface then rinsing them off; along with utilizing the germicidal effect of the solution on the remaining microbes.
REMEMBER - Have the following items on BEFORE beginning the scrub process: surgical mask, protective eye wear, lead apron (if there will be x-rays during the procedure), helmets attached to the hip holstered battery (for total joint procedures), and booties if it is an arthroscopy or messy procedure. Also remember to already have your gown and gloves opened in the room and ready for you when you scrub and re-enter the room. Keep in mind, this process will be slow at first. With repetition however, the scrubbing process, like everything else, will become muscle memory and second nature.
In sum, listen carefully and stick to whomever you're paired with (as you're often paired with someone to start). If he or she stands somewhere, you stand there. If he or she asks you to sit here, you do so. You get the idea. Be confident, but always remain inquisitive and teachable.
"Surgery is simple. We cut to repair or remove the problem, achieve hemostatis (slow / stop the bleeding), and then close. Don't make it more complicated than that." - O.R. Yoda "Whenever you learn a new procedure, don't learn from step one on up. Build on the steps you already know then nothing will seem as overwhelmingly complicated." - L.S.
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