Four Ways to Gain Confidence in the OR

Functioning as an RN circulator in an OR full of surgeons and support staff can seem very overwhelming for a novice nurse. However, the room can and will run smoothly with confidence. Confidence as a new nurse in the OR does not necessarily mean that you need to have the answer to everything. (Working in the OR, you are always learning something because techniques and best practice are constantly evolving.) Confidence comes in knowing who your resources are, being able to speak up and ask clarifying questions when they arise, effectively communicating to ensure everyone is on the same page, and staying organized.

Knowing Your Resources

Knowing your resources in the OR can help during stressful times. You should keep a list of useful phone numbers with you to use as a quick and easy reference tool. These numbers should include:

• Charge Nurse (for example, for communication about delays or patient concerns)
• Charge Anesthesiologist (for example, for patient concerns or status changes)
• OR Front Desk (for example, for scheduling questions or room delays)
• Sterile Processing/Clean Workroom (for example, for instrument concerns or kit contaminations)
• Service Line Coordinators/Clinical Coordinators (for example, for service-specific questions)
• Preop (for example, for patient arrival status, room delays, or if ahead of schedule)
• PACU (for example, for announcements of surgery end times or communication of equipment or patient care needs, such as nebulizer treatments or orthopedic positioning devices)
• Lounge Areas (for example, to reach staff if a concern arises)
• Radiology/OR Radiology Technician (for example, for if fluoroscopy is needed in a case or there are equipment issues)
• Orthopedic Technicians (for example, for casting or immobilizer needs)

Speaking Up

Confidence also can be demonstrated in speaking up for patient safety. One way to do this is to watch traffic within the OR to ensure that there are no breaks in sterility; this is especially important in an OR with multiple providers. If you see something, speak up. Be confident in your tone and do not question what you saw. For example, you can say, “I see your suction hanging low on the drape; here is a new one,” instead of, “Is your suction a little too low on the drape?” Safety is a top priority not only in the OR but also in health care in general, so you should use phrases, such as “I have a concern for patient safety” or “I have a safety concern.” No one should question you if your intention lies with being safe. Speaking in this way will also let other team members know that you are paying attention and being alert.

Communication

Communication within the OR is essential no matter how many people are working within the suite. Having a huddle with everyone in the OR before any case is a good idea to make sure everyone is prepared. It is important to have everyone present from the surgical team (or teams if more than one service is participating) and anesthesia. If they are unable to be physically present, being on the phone also may work. Examples of things to discuss during a huddle include equipment needs, supplies, positioning, implants, specimens, the procedure order when there are multiple providers, and medications.

An RN circulator acting as a middleman between multiple providers and team members can easily become very overwhelming and add to confusion. When communicating with providers and surgeons, it is reasonable to suggest that they discuss the plan with each other; the huddle is one opportunity for them discuss their portion of the case. You also can use other methods of communication, such as a whiteboard, to help keep everyone on the same page. This allows for a central location for sharing information among all surgical team members. The whiteboard can list information, such as allergies, medications, patient weight, retained items, and tourniquet time.

Staying Organized

Every OR nurse has a routine that they have developed over time to help them stay organized. In order to create your own routine, it may be beneficial to develop a checklist (see sample checklist). This checklist can help you set up your room for the day, guide the huddle, and organize patient care information. When preparing, organize your needs for one case at a time to ensure everything is available. Once the case begins, it can be challenging to organize yourself, so doing it before is helpful. Meticulous organization will not only help you build confidence but will also help you communicate better with the team.

AORN Resources

AORN members can access:

• Team Communication | AORN Guideline Essentials
• Team Communication | AORN FAQs
• Speaking Up: Voices From the OR – AORN Journal
• Redesigning the Perioperative Huddle to Improve Culture - AORN Journal
• Encouraging Interdisciplinary Preoperative Communication With a Virtual Huddle - AORN Journal
• Daily Organizational Safety Huddles: An Important Pause for Situational Awareness - AORN Journal l
  

If your facility subscribes to eGuidelines+, you can access:

• Room Setup at a Glance | AORN eGuidelines+
• Team Communication Guideline | AORN eGuidelines+