If you're like most facility leaders, you're looking for a nurse with at least 1 or 2 years of OR experience when hiring a new RN. Sure, there are benefits to going that route, but have you considered hiring a new college grad or a long-time RN who earned her stripes, say, in the ICU?

RARING TO GO New nurses have to learn the ropes, but are eager to learn and pitch in to help wherever they're needed.

Recent nursing grads
Advantages. Nurses fresh out of school are still in the learning phase of their careers, so they're used to being taught new things as you mold them into the type of staff member you want and need for your facility. School nursing programs rarely include curriculum about OR nursing. That means new recruits are clean slates who will have plenty of learning to do, but that can work to your advantage. They're like sponges: eager to soak in all the lessons you're willing to impart.

Challenges. New nurses obviously haven't yet applied their degrees in real-world practice, so there will be some growing pains as they learn basic nursing concepts, familiarize themselves with your processes and procedures and understand how to prioritize their responsibilities — before you add in lessons on the specifics of OR nursing, including how to use numerous surgical instruments and platforms.

They likely haven't had any professional experience, and nursing is a difficult profession to enter as the first job of your career. New nurses therefore have to be taught the importance of being on time and prepared to work hard on a daily basis. They must also understand that the staffing schedule is made to meet the needs of your facility and patients, and not to accommodate their personal lives.

Drug Diversion a Concern Among Facility Leaders

When filling a surgical nurse position, who would you rather hire?
a new nursing school graduate 9%
a nurse with perioperative experience 85%
a nurse who's never worked in the OR 6%

SOURCE: Outpatient Surgery Magazine
(www.outpatientsurgery.net), InstaPoll, November 2017, 342 respondents

Set clear, up-front expectations with novice nurses. Explain the implications of their actions with respect to not only what your policies mandate, but also the workplace culture and how that might impact their relationships with peers. For instance, they might be considered on time according to your facility's policy if they clock in at 6:30 a.m., but if they're not dressed and back in the ORs helping to set up by 6:45, their peers will consider them late and resent their behavior.

The bottom line: You have to work with new nurses to help them maintain focus on the processes of care. Surround them with experienced nurses who are willing to teach — and are good at it.

SOLID BACKGROUND Veteran surgical nurses might need to change past habits, but they can get up to speed quickly.

RNs with OR experience
Advantages. These nurses come with a background of surgical knowledge, so orientation is typically smooth and completed quickly. They need to learn the specifics of how things are done in your facility — what equipment you use, the preferences of your surgeons — but already know, understand and can speak the language of surgery. They'll experience a learning curve as they get acclimated to new types of procedures, but they know what they don't know and are aware of how to get up to speed with little or no guidance. They also embrace new experiences and are typically earnest learners.

Challenges. Not every OR works the same way — especially when nurses are transitioning between inpatient and outpatient environments — so it can be challenging to get nurses who come from other facilities to meet the standards you've established. Nurses who have worked in other surgical facilities might need to break old habits and create new ones.

The pace of outpatient surgery can also be jarring to nurses who are used to working in inpatient ORs. It's a good idea to have nurses with inpatient experience shadow a current member of your staff for a day so they can see firsthand what the job entails before accepting a position. You also have to have honest conversations about your case volumes and the types of procedures you perform. If you don't share that information during the interview process, nurses with surgical backgrounds will make assumptions based on what they've experienced in other facilities.

SOLID BACKGROUND Nurses who have worked in other clinical areas have mastered patient care skills, but might need to adjust to the unique demands of surgery.

RNs without OR experience
Advantages. These RNs understand the processes of nursing and have real-world working knowledge. If they're seeking to change the focus of their career, there's a good chance they're trying to fulfill a passion for working in surgery. I've interviewed nurses who've worked for years in other clinical areas who said they wanted to transition to the OR because they were unable to land a job in surgery when they first entered the workforce and are looking to fulfill a career goal. That's promising and welcome feedback to hear during an interview.

Challenges. In many ways, nurses with experience outside of surgery can be the most difficult to orientate to the OR because they must change their preconceived notions about basic nursing practices. For example, sterile technique in the OR is much more involved than it is in other patient care areas and, in some instances, nurses have to relearn basic practices they've been performing for years. They're also used to being the expert in their previous clinical spaces and might have been the veteran nurse who oriented the new hires. In your facility, they might be told what to do by nurses with fewer years of overall nursing experience. That dynamic can cause friction, so be upfront during the interview process about the differences in how they've been accustomed to working, the makeup of your current staff and who they will be reporting to.

Tell nurses with experience in other clinical settings that you're going to teach them the reasoning behind what they'll be asked to do. That's important for any staff member to understand, but it's particularly important for this group of nurses, who often don't fully realize the extent of the relearning they'll endure. OSM