3 days of circulating

So, I've been circulating for 3 days now and here's what my preceptor trusts me to do:
Pre-op interview, set up the room, count with scrub, poor solutions and medications, position the patient, prep, hook up the cords, wires and tubes to start a case, and the Time Out. That's a bunch!
So far she has been showing me the charting, though I can't do it since we haven't been trained yet.
She is really pushing me...but I feel that it's a good pushing. It feels good to actually start doing what I feel is the goal of this period of nursing in my life. Next week I will get to do another 3 days!
I've had several nice complements made and some think I am further along in the orientation process (they are very surprised when I say that I have only been circulating for 3 days).
So far, it's awesome!

Classes and a day of observation

This week was mostly classes, but I did get to observe circulating (as my primary focus) for a day. Having been in the OR for many years, I knew how hard my circulators worked. It was refreshing to see the PNDS (yep, it's actually a really good book) lay out each activity that nurses do in the OR for their patients. Still working on the assignment I need to turn in Monday, lots of busy work, but also a good review of all the things I will need to incorporate into my daily skills and tasks.

Week of hell is over

Well, due to events both at work and at home, this has been a week from hell.
The week started out with me making a mistake. Not life-threatening, but serious enough that I am now even more careful in certain situations.
The next day I almost ran out of the OR crying due to the belittling behavior of the surgeon. He was on a rampage, I was not the only person he lectured. I have never been so humiliated, nor have I ever cried in the OR. Tuesday I did. Not only was this surgeon a jerk, but he was also grabbing instruments from my hand, including scalpels. I felt rather endangered by his behavior. On the way out at the end of the day he "jokingly" said that "the rats were abandoning ship...I only partially mean that." Somehow that last comment really didn't help!
Wednesday it was the home life that just about killed me. Nothing to do with the family, that's all fine. It's the IRS. One, they lied to me about not auditing me, two they are taxing me at a higher rate than they should just because my son worked for 2 months in 2009...oh, yeah, they are also penalizing me and charging interest starting from 2009. I can't afford a lawyer, I already paid $400 to consult a lawyer to begin with on this whole issue.
Thursday in class was OK, except I feel this one nurse really must hate me. Anytime I say something in class she has to tear me down. It was also a long day since I stayed and put in a few hours training at the Writing Center .
Friday I was so tired and felt so beaten up I had no motivation to really shine on my last day of scrubbing. I tried. I did scrub in to give a lunch and breaks. I observed and tried the circulator to help in a big sports medicine case. I did set up several cases. I just could not muster the energy or enthusiasm to scrub in on any other cases.
Saturday was OK, except I was late to my Writing Center training. I stayed late, but feel that I benefited from watching one tutor respond to an online submission and spent the rest of the time reading material. After that I spent a great deal of time organizing rather than reading material for classes or my residency program.
Sunday I wrote 3 papers, read several articles, but I still have a great deal of reading to do. I have been tired, unmotivated and rather listless. I have to muster the energy to call the tax lawyer and ask if there is any hope of fighting the IRS, and  most important, ask for a referral to a good tax service: I will never prepare my own taxes myself, even through a software program. I am so tired of the IRS picking on me when I have no resources to fight back. I will pay for the service, I will pay for audit insurance and I will pay extra in taxes from each pay check from now until I die to avoid the IRS ever having a chance of auditing me again!
Next week I am in class 4 days, circulating or preparing to circulate on Wednesday only. It has to be a better week. Right? I really need a better week. Really.

Gotta watch those scrub techs

A tech was showing me a trick one of the surgeons had taught her to help differentiate Lidocaine and Marcaine on her field at the same time (this is in addition to the required labeling). I thought it was clever. Then I mentioned that methylene blue should be used with caution for patients with renal impairment and the surgeon immediately wanted new Lidocaine, and told the tech that methylene blue should only be added to non-injectables.
I felt sorry for the tech, 'cause the warning is for severe renal impairment. We administer methylene blue all the time when working near the ureters to help visualization. A little bit of methylene blue in Lidocaine is not likely to cause an issue in a patient with healthy or mildly impaired renal function when it is being infiltrated, not even delivered intravenously.
Also, techs from out of state have experienced a different scope of practice than we enforce in Washington state. Some other states allow counts, dispensing fluids and medications to the field and even suturing by surgical techs. Washington is quite restrictive on the practice of surgical techs and techs from out of state sometimes want to practice outside of these restrictions, since they have safely done so elsewhere.
I have one more week of scrubbing, then I will be back in class for a couple of days and then we start our adventure in learning the role of the circulating nurse. I can hardly wait. It is exciting and a bit scary at the same time, and I think I am ready.
I think upcoming blog posts may contain a bit more substance into what it is to be a perioperative nurse. I'll be learning the new role, with theory to consider while caring for my patients. It will be a tremendous growth period.
On another topic, finally road the scooter into Seattle (and back). I hadn't had the opportunity to scout the route, so it was quite an adventure. I almost ended up on I-5 without intending to, then I did end up on I-5 without wanting to be there. I got off right away, then realized that I had no idea how to get back on route, and I was running out of time. I considered the 5 miles I would need to be on I-5 to get to the exit I normally take, then went for it. It wasn't as bad as I thought it might be. There are more motorcycles on I-5, I think, than on our smaller freeways on the Eastside. Drivers kept their distance, didn't cut in front of me or follow too closely, and the wind buffeting wasn't as horrible as I have encountered on previous jaunts onto the freeway. I still don't think I will repeat that experience any time soon.
Coming home was another adventure. I kept heading north and east until I managed to find my way to the UW main campus area. From there I kept following the shore of Lake Washington and found myself going through Sand Point. Eventually the road took me to Lake City and I was finally in territory that I felt more comfortable in. I have driven to and through Lake City many times, I knew my way home from here! I now also know a better route to get to Seattle when I need to ride in because my carpool is telecommuting.
BSN school is going well, but I do have to not let one of my group members get to me so much. She talks non-stop, quickly, asks questions but doesn't really give you time to respond before she talking on the next topic. It's only another 7 weeks.

I'm crazy, just ***ing crazy. It's OK, you can admit it!

Just signed the hire paperwork for yet another job and pull on my time. I am now going to be paid to help my fellow nursing students to write their papers.
It's has many advantages, which makes my insanity explainable: it will look good for my petition for waiving 2 English composition credits - back in 1985 English 101 was only a 3 credit class, now it is a 5 credit class and that's what I am supposed to have, 5 credits; it will also look good on future applications for nursing faculty positions that I have instructional experience through the writing center on campus.
So, it's OK, you can admit it, I am crazy! And I am excited and a little frightened that I may not be able to do all of this. I am determined, though, to do my best for my patients and students.

Week 1 back to full time scrubbing

Spent the first day of the week with a nice fellow, fairly new himself. He was able to give me an idea of how things work in the outpatient surgery center. Got to scrub a couple cases (ENT) that I think went well.
Tuesday worked with my preceptor for the first time. She was way behind when I caught up with her, so I stood back and watched until the case was well under way. The surgeon was not the most pleasant individual and I felt really sorry for his resident and intern. After the first case my preceptor and I had a little more time to get to know each other, then she would set up the case and let me fly. The surgeon was still rather unpleasant, but I believe I did a good job.
Spent Wednesday and Friday back in the outpatient setting. Scrubbed independently, set up lots of cases, did lunch reliefs. On my way to making friends with staff, and showing that I know what I am doing as a scrub nurse. I even knew a set better than my preceptor and the surgeon at one point (broken hardware removal case). That, of course, comes from working in SPD and talking to the vendors of orthopedic trauma instrumentation and just being good at figuring out those ortho instruments.
The more I am scrubbing, the more I am thinking about what service I want to eventually be part of. I really like being able to do any surgery. I really like vascular - it's easy to understand that you need to open the vessels, clean them out, close them up... General can be good - cut out the tumor, reconnect it, close it up. Neuro can be good (if you have the nice surgeons), though spine surgery is frustrating because you can't see a darn thing in the tiny deep hole in the back. Cranies are fascinating because you get to see that most important of organs that makes us who we are, the brain. GYN and GU are OK, but they don't excite me. I have had so much of ENT and Eyes that I really don't care for it any more. Besides, pulling snot out of peoples noses just really makes me nauseous. Ortho, on the other hand, is awesome. Complex instrumentation that I get to play with (assemble and disassemble). Immediate results as the plates and screws are placed and the bone fragments are aligned. Power equipment.
I know, it's just carpentry for the human skeletal system...but it makes sense, you have to make a plan, measure out the pieces, make your cuts, place the hardware, check your results and finish it up.
I am glad that I am only working 32 hours a week right now. With school the reading work load is intense. Just wait until we are done with this scrubbing rotation! Then I think I will be overwhelmed with reading, trying to soak it all in so I can be the best OR nurse I can be.

A good day for me, but sadness creeps in

I am sorry to hear of the death of Steve Jobs. His vision and commitment to innovation and quality will be missed.
On the other hand, I had a great day at work. It's all coming back to me. I even know the instruments and their proper use better than the surgeons! :)

American culture is

American culture is...

We are separate individuals.
We love our freedom.
We have the right to privacy.
We strive for equality of gender and race.
The nuclear family is more common than the extended family.
We wear what we want.
We focus on the future, rather than the past.
New is better.
We make our own destiny and decisions.
We are responsible for our own actions.
We believe human nature is good.
Time is valuable...time is money.
We believe in achievement, action, work, production and materilism.
We practice forthright communication.

I am from poem

I am from...my experiences

OK, this is not directly related to my experiences of being a Perioperative resident nurse, but it's my first assignment for this quarter in the BSN program that I am doing simultaneously with my residency. Might answer some questions, might generate some! Enjoy!

I am from Seattle, Washington.

I am from where I can hear the airplanes taking off and landing.

I am from the pink house on the corner.

I am from daddy built me a playhouse.

I am from “Where is daddy?”

I am from “He won't be coming home any more.”

I am from Hawaii, a haoli, a mainlander.

I am from the mainland, but speak pidgin like a local.

I am from sun, surf and sand.

I am from exploring hills, rivers, waterfalls and forest.

I am from volcanoes, pineapple and sugarcane.

I am from mangoes and bananas picked right from the tree.

I am from swimming in the ocean in the rain or sun.

I am from lightning strikes on the sea horizon while watching the stars.

I am from the Eastside, south King county, Kent, Auburn and Renton.

I am from Nelson Middle School and Lindbergh High School.

I am from marching band and pep band.

I am from football games and basketball games.

I am from living with grandparents.

I am from helping at home.

I am from the Eastside, north King county, Bothell, Woodinville and Kirkland.

I am from a daughter and a son.

I am from a domestic partnership with Steve.

I am from enjoying the drive with family and music

I am from surgical technologist school.

I am from Snoqualmie Hospital, Auburn Hospital and Overlake Hospital.

I am from Group Health in Redmond and Bellevue.

I am from Nursing school at Lake Washington Technical College.

I am from flying around Mount Rainier, Boeing, Snoqualmie Falls and Snoqualmie Pass.

I am from the Pacific Ocean to the West.

I am from hikes up Tiger Mountain to see it all.

I am from flying to Oregon and Nevada, alone in a single engine plane.

I am from visiting dirigible hangers in Tillamook

I am from Harvey Field in Snohomish.

I am from lighthouses on the coast.

I am from storms washing buoys ashore.

I am from fresh seafood all year.

I am from cherries and berries in spring, apples in the fall.

I am from crisp Autumn walks, photographing the vibrant colors.

I am from 300 days of rain, making the air clean and the plants green.

I am from riding along the Sammamish.

I am from walking 60 miles in 3 days.

I am from rock concerts.

I am from sleeping while the party goes all night.

I am from iPods, iPads and iPhones.

I am from books that line the walls of my halls.

I am from xBox games and Macintosh computers.

I am from gadgets, gizmos and other compact useful items.

I am from the operating room.

I am from masks, hats, scrubs and gloves.

I am from instruments, patients, procedures and surgeons.

I am from equipment, solutions, sponges and supplies.

I am from tables, gurneys, ring stands and sterilizers.

I am from patient advocacy, patient safety and patient healing.

I am from scrubbing and circulating.

I am from new roles and new goals.

I am from American values.

I am from individuality, freedom, privacy, and equality.

I am from being responsible for my own actions.

I am from achievement, production, and work done well.

I am from learning anything I want to learn.

I am from my experiences.

I am from Lisa RN.

Week 2

To recap what I learned this week:

I can still scrub, gown and glove with ease...but the arms do need some conditioning.
I can still open sterile supplies with out contaminating the sterile field.
I still know my instrumentation, but I can still be surprised when someone calls a dressing forceps a Debakey forceps.
I like the new alcohol based scrub, but it will take some getting used to the process taking about 30 seconds!
I can drape a Mayo stand in about 2 seconds, without contaminating the drape, my gown or gloves. It can be fun to watch others struggle with this particular piece of equipment...but my demonstration helped many understand why they were struggling and it become easier for them.
I still remember how to load needles and blades, I still remember how to properly hand them to the surgeon. I will have to teach myself to not expect them to hand it back to me (MUCH safer!).
I enjoy scavenger hunts...but wish my companions would remain focused on the task.
I love the friendly helpfulness of my new coworkers!
Every OR has a fire extinguisher.
I am much more familiar with where all the OR rooms are.
I think the new building is supposed to be a smart building and has very few fire pulls.
Reading policies and procedures can be very educational, but I find much of the information the same as the previous places I have worked.
Tidbits of information from policies and procedures can complete that scavenger hunt!
I now have so many things hanging from my collar that I fear my shoulders will start hurting from the weight.
I learned a great deal from the breast surgeon who came in to talk about his specialty, why it's done, common causes for surgical intervention and why it is so important to keep the specimens labeled correctly. Don't guess!
I learned more about positioning for laparoscopic procedures.
I learned that I was hired about 1 month too late to be able to get tuition reimbursement for Fall quarter.
I learned the stairs from Tully's lead to another way into the locker room area.
I learned more about SCIP, SSI prevention, organ and tissue donation policies, medication and solution identification, pressure ulcer prevention, patient ID verification, latex allergies and back injury prevention.
I learned that my ability to stage a pressure ulcer is pretty good, especially considering that I have not had much experience in my practice.
I learned that I still hate the OR floor for it's hardness.
I learned that while I am uncomfortable setting up the sterile field for advanced surgical procedures for surgeons I have never worked for, I can still work off another's set-up and impress those who don't realize that this is not my first day of scrubbing.
I learned that I still like vascular surgery and find scrubbing a AAA exciting (especially since it is day 1 of scrubbing at this employment).
I still know that the OR is exactly where I should be as a nurse!

The first week

What I learned in the first week of my residency program:

1.    OR nursing is where I am supposed to be.

2.    I have an atypical learning style for the OR, but I am pretty balanced (flexible and adaptable) in my learning style - it will work for me!

3.    The body has 3 natural defenses against injury and infection - the skin, chemical defense (inflammation) and immune response (cellular defenses).

4.    The (major) skin layers are - epidermis, dermis and subcutaneous layers (I also know that the epidermis consists of 5 - or 6 - layers depending on function and location on the body).

5.    There are 3 types of wound healing - primary, delayed primary and secondary.

6.    3 stages of wound healing - inflammatory stage, proliferative stage and remodeling

7.    Many things affect wound healing (nutritional status, how the tissue is handled, length of surgery, immobilization...the list is really long)

8.    Complications of wound healing are many, but the most important are those that lead to poor outcomes (infection, scar tissue, hematoma...)

9.    The 4 surgical wound classes are:
I: Clean - no entry into GI, GU or respiratory tracts, no previous open wounds, no signs of inflammation or infection, no breaks in aseptic technique
II: Clean-contaminated - Controlled entry (with no spillage into surgical site) into the GI, GU or respiratory tracts, no inflammation or infection, minor breaks in sterile technique.
III: Contaminated - spillage from GI, GU or respiratory tract into surgical wound, traumatic wound less than 4 hours old, inflammation present, infection not present
IV: Dirty - traumatic wound more than 4 hours old, inflammation and infection present, fecal contamination, purulent drainage.

10. Hemostasis can be achieved through mechanical, chemical or thermal methods

11. Suture comes in natural, synthetic, absorbable, non-absorbable. If a suture is not available stay within the category and look for a needle that is in the same group.

12. The number one method for preventing infection (anywhere, anytime) is to utilize proper hand washing. Can't say this enough!

13. The OR is dangerous, it has many chemicals and pieces of equipment that require training to make sure the user and patient remain safe. If in doubt, ask questions!
Also, the electrosurgical unit is great for "mad-science" demonstrations! :P

14. I know my surgical instrumentation, I know how to take care of it, inspect it, and prepare it for use! :)

15. I know how to properly decontaminate and process used surgical instrumentation, including terminal sterilization and sterilization for use at the surgical site.
16. There seems to be a lot of concepts that come in 3s!

17. There's a bunch of nice people in my cohort!

18. And so much more!

This will be a spot where I will post some (appropriate) thoughts and feelings about my perioperative nursing residency. I will try to keep whining and *****ing to a minimum and share some of the more important/interesting details of what I am learning (about periop nursing, and myself).
If you don't like what I say, remember that I am only expressing my own opinion, and not representing any facility or organization, and PLEASE let me know WHY you don't like what I said. How can I learn to be a better person if I just change how I think because someone doesn't like it. I need to know why what I feel and think bothers others before I can make a reasonable choice to keep my opinions or change them. :)