New Grad Operating Room Nurse Success Guide

by | Apr 30, 2024 | Nursing Jobs & Interviews | 1 comment

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The operating room (OR) offers a fast-paced, highly technical, and exciting nursing career. Nurses can start in the OR directly from nursing school as new graduate nurses. Training to work as a new grad operating room nurse is typically a combination of classroom education that teaches the basic clinical skills of surgery and hands-on experiences in the OR with preceptors.

While it’s common for new grad nurses to feel intimidated in any unit, the OR can even be overwhelming for higher-level nurses. Surgical nursing drastically differs from floor nursing and bedside patient care, and it takes time to learn the necessary skills and gain competency. Every new grad OR nurse is inundated with technical skills, knowledge, and training, which should all be learned before working independently. Over time, you will achieve professional development, and increased ability to remember nuanced details about surgical procedures.

Remember that even as a new grad, you have the potential to be a nursing hero in the OR by providing exceptional care to patients during critical moments.

With all of that in mind, let’s discuss 10 critical tips for new grad nurses in the operating room!

Top Tips for New Grad Nurses in the Operating Room (OR)

Tips for New Grad Nurses in the Operating Room

Have a Pocket Notebook, Scissors, and Pens Ready

Three items are critical for success in the OR: pens, a pocket-sized notebook, and scissors. 

Pens can go missing anytime, so keep multiple pens in your locker or scrub pockets.  You will also need pens to fill out surgical checklists or paper documentation.

Trauma scissors are the perfect tool for various things – from opening difficult packaging to cutting off old dressings. Choosing a pair of scissors with a carabiner allows you to hook them to a scrub pocket so they won’t get lost. 

A pocket-sized notebook is an inexpensive must-have item for the OR. It fits into a scrub top pocket, allowing you to easily reference it throughout the shift and keep important information readily available. 

Examples of helpful information to include in the notebook are:

  • Phone numbers for calling the charge nurse and other departments
  • Emergency phone numbers
  • Surgical case-specific nuances 
  • Details on how to troubleshoot equipment
  • Personal notes about how to prepare for a case

Know You Will Have Multiple Preceptors

Another of our tips for new grad OR nurses is to be aware that it will be necessary to have multiple preceptors during your orientation experience. There is something to be learned from every nurse you work with within the unit – whether they have a few months of experience or several years. In larger facilities, it’s possible to work with different preceptors every day. Each nurse has a unique experience that can provide insight into dealing with specific situations or offer tips for completing a task. 

Having multiple preceptors is a gift because there are many ways to do the same task correctly. Once you are on your own, you will be able to choose the ways that work best for your personality and time management preferences.

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Familiarize Yourself With Common Equipment and Instruments

Familiarizing yourself with instruments and equipment is a crucial aspect of success for new grad nurses in the operating room. It involves becoming well-acquainted with the diverse array of tools used during surgical procedures. Common instruments include forceps, scissors, retractors, clamps, and needle holders, each serving specific purposes in different phases of surgery. Understanding their names, functions, and how they are handled is essential for anticipating the surgeon’s needs and ensuring smooth operations.

Additionally, it’s important to be proficient with equipment such as electrocautery devices, suction units, and various monitors that help maintain a safe surgical environment. Mastery of these tools allows you to assist the surgical team efficiently and respond quickly in case of any technical issues. For example, knowing how to troubleshoot a malfunctioning piece of equipment can be invaluable during a critical moment in surgery.

To enhance your familiarity with instruments and equipment, spend dedicated time in the OR, observing and assisting with various cases. Take advantage of opportunities for hands-on practice and seek guidance from experienced colleagues. Familiarity with these tools not only builds your confidence but also showcases your competence to the surgical team, earning you trust and respect in the high-pressure environment of the operating room. Remember, continuous learning and hands-on experience are key to becoming proficient in handling the instruments and equipment used in the OR, and these are crucial tips for a new grad operating room nurse.

Pay Attention and Observe

While a skilled nursing facility team provides excellent rehabilitative care, the OR environment offers a distinct path for new nurses seeking a fast-paced, surgical setting.

In the beginning, there is so much to learn, and a preceptor cannot tell you every single thing you need to know to function on your own. Therefore, it’s critical to be observant and watch how other team members behave and function. Many things cannot be taught but must be learned through individual experiences.  

Another vital skill in the OR is reading the room’s energy to grasp what is happening at any given time. Is the patient stable, and are people talking about the surgery? Is the room completely silent except for the beeping of monitors, indicating a serious moment? Is the room a flurry of activity as the teams try to stabilize a crashing patient?  

Other things to notice include:

  • How team members walk around the sterile field
  • The process for starting a surgery
  • Actions that the scrub personnel take to help understand what surgical items are used for
  • The personality of the surgical team – is it serious, personable, or education-focused?

As with any professional nursing job, it’s important to stay off of your cell phone in patient care areas. While many providers in the OR use personal cell phones to communicate, new grads on their phones are perceived to be not paying attention, and a negative reputation can arise. 

A great deal of information can be learned in the OR by observing what is happening and how other nurses respond to different situations.

Be Adaptable

Being adaptable in the operating room is one of the most valuable tips for new grad nurses in the operating room. The OR environment is dynamic and can change rapidly. Cases may involve unexpected complications, varying surgical techniques, or different surgeon preferences. As a new grad operating room nurse, it’s crucial to embrace this adaptability. This means being open to learning new procedures on the fly, adjusting to different surgeon styles, and efficiently problem-solving when faced with unforeseen challenges.

It’s about being flexible in your mindset and actions and understanding that each surgical procedure may require a unique approach. This adaptability not only enhances your ability to provide optimal patient care but also helps you integrate seamlessly into the surgical team, earning the trust and respect of your colleagues.

Furthermore, being adaptable also means being resourceful and quick-thinking. It’s important to anticipate potential issues and have backup plans in mind. For example, if a specialized instrument is unavailable, knowing alternative methods or instruments to achieve the same outcome can be invaluable. Additionally, being adaptable means being receptive to feedback and continuously seeking opportunities for improvement. Embracing change and being willing to learn from every experience will not only make you a more effective OR nurse but also contribute to your growth and success in this challenging yet rewarding specialty of nursing.

Note the Communication Tendencies and Styles

The OR is often considered a difficult place to work. Surgical nurses serve as advocates who speak up for patient safety. This includes telling physicians when something is wrong, notifying the team that the sterile field has been contaminated, and communicating any information that may be concerning to another co-worker. 

During particularly intense moments, surgeons and other team members may not be focused on being polite or taking the time to explain what is happening. After all, the primary goal in these cases is to save a patient’s life. Many new nurses can be overwhelmed by the directness and intensity of communication in the OR. Over time, nurses will adjust to the communication style and no longer perceive certain tones as a personal offense. Naturally, learning to communicate tactfully is one of the most important tips for new grad nurses in the operating room.

Learn the OR Organization Game

Before setting up the OR for an assigned surgical procedure, it’s important to remove any unnecessary equipment. Make sure to untangle cords, as they create a tripping hazard and can make it difficult to move equipment. Additionally, declutter supplies left from previous cases and focus on the required items and equipment for this particular procedure. Dispose of used items promptly and efficiently.

✨ Major ✨Tip For a New Grad Operating Room Nurse: Read the Preference Card

The preference card included the equipment and supplies needed for the surgery. Well-maintained preference cards are extremely helpful, as certain notes on the cards can confuse a new grad in the operating room. This also offers an opportunity to ask a preceptor questions. 

Keep in mind that nurses cannot solely rely on a preference card, as it may not have all of the necessary notes needed to be successful in the case. It is the nurse’s responsibility to take notes in their pocket notebook. Knowing what to write comes from the daily experience of completing procedures and learning from mistakes. This allows the preceptor to focus on questions not answered by the preference card.

Top Tips for New Grad Nurses in the Operating Room (OR)
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Know Your Operating Room Resources

Being on your own in the OR for the first time can be initially intimidating. It’s important to know who can help you when a situation occurs, such as when a surgeon asks for something, and you don’t know what it is or where it is located.

The OR team will collaborate with you to understand the surgeon’s plan of care and ensure the operating room is set up accordingly for the specific procedure.

Typically, new grad nurses are assigned to work with experienced scrubs considered experts in their specialties. Scrubs are an excellent resource for identifying and locating surgical supplies and instruments. 

Each service in the OR (ex., orthopedics, GYN, general, neurosurgery, cardiac surgery, etc.) has a coordinator, with good leadership skills, who manages the service and is an expert regarding the surgeons and their preferences. The coordinator can answer specific questions about surgeries in their specialty.

The charge nurse is the board coordinator, meaning they manage the surgical schedule and troubleshoot issues. The charge nurse knows where all of the staff are assigned and can send unassigned staff to help out when necessary.

Here’s another one of my tips for a new grad operating room nurse in the operating room: Never be afraid to ask for help! Surgeries can go from calm to chaos at the flip of a switch, and even seasoned OR nurses can become overwhelmed. It’s important to ask for support when needed, as it can make a significant difference in patient outcomes.

Nobody knows everything about every surgery. Knowing your resources and who to ask for help is a critical aspect of OR nursing. 

Everyone Makes Mistakes

As our final tip for new grad nurses in the operating room, remember that everyone makes mistakes, even amazing nurses. As obvious as this statement may seem, it’s still an important reminder. From anesthesia and the surgical team to nurses and scrubs, everybody in the OR can make mistakes. Reminding yourself of this can help reduce the discomfort of speaking up when a mistake is made. 

Sometimes, team members accidentally drop a sterile item or contaminate the field. Again, mistakes happen to everyone! As the safety advocate, it’s in the patient’s best interest to speak up as soon as contamination is recognized. This allows for the situation to be remedied as soon as possible. Never let a mistake deter you from continuing to pursue your OR career.

The OR nursing journey is an exciting, stressful, and fulfilling specialty. It takes some time to master the skill set, but the effort is worth it in the end!

Final Thoughts on Tips For a New Grad Operating Room Nurse

For new grad nurses in the operating room, prioritizing patient safety, clear communication, and a structured, organized approach are crucial. Mastering aseptic techniques and becoming proficient with surgical instruments and equipment are fundamental for seamless procedures. Adapting to the dynamic OR environment, staying composed under pressure, and fostering teamwork are key skills. Continuous learning and professional development are essential for long-term success in this rewarding field, and for obtaining more career growth opportunities.

Embarking on a career in nursing is an incredible journey, and the operating room (OR) offers a dynamic and challenging specialty to kickstart your path in healthcare. Care for patients goes beyond the physical. As a new grad operating room nurse, you’ll also be a source of comfort and emotional support for patients undergoing surgery.

Don’t forget to learn your preference cards and take notes for yourself! Before you know it, you’ll have them memorized and will be teaching another nurse new to the operating room. As a new grad operating room nurse, your career journey in the fast-paced and demanding OR environment is about to begin! We hope you enjoyed this blog post of tips for new grad nurses in the operating room!

More Resources For New Grads in the Operating Room

About the Author


Blyss Splane BSN RN CNOR is a certified operating room nurse with years of experience scrubbing and circulating. She was an orthopedic surgical specialty coordinator for the OR at a level 1 trauma hospital. Now she travels as an OR nurse in the southeast. She owns Nurse Splane Writes, creating content for healthcare websites and blogs. Blyss is an avid reader and spends her time pursuing a healthy lifestyle. She can be found at

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    1 Comment

    1. Kris Streb

      This article is great! I have 4 new grad nurses starting this month. I have communicated many of these things to them and it has been repeated by their initial preceptors. However, I am going to print off this article and have them read it as well. It is good for them to recognize the stages of shock and the realities of OR nursing. It can be a wonderful place to work, but it takes time and it is a very different environment from the rest of the hospital and from non-nursing careers. I think it helps to let them know, “this is normal for OR”.
      Thanks so much!
      Kris Streb BSN, RN, CNOR (Peri-operative Educator)


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