The operating room (OR) offers a fast-paced, highly technical, and exciting nursing career. Nurses can start in the OR directly out of nursing school as a new graduate nurse. Training to work in the OR is typically a combination of classroom education that teaches the basics 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 is drastically different from floor nursing, and it takes time to learn the necessary skills and gain competency. New OR nurses are inundated with technical skills, knowledge, and training, which should all be learned before working on their own. Over time, nurses will develop an increased ability to remember nuanced details about surgical procedures.

Tips for New Grad Nurses in the Operating Room

Pocket Notebook, Scissors, and Pens

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

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

Trauma scissors are the perfect tool for a variety of 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

Understand You Will Have Multiple Preceptors

There is something to be learned from every nurse you work with in 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 on how to deal 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.

Pay Attention and Observe

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. There are many things that cannot be taught, but instead must be learned through individual experiences.  

Another vital skill in the OR is reading the energy of the room 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 that are 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 from simply observing what is happening and how other nurses respond to different situations.

Communication in the OR

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.

Organize the OR

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. 

Read the Preference Card

The preference card included details regarding the equipment and supplies needed for the surgery. Well-maintained preference cards are extremely helpful, as certain notes on the cards can be confusing to a new grad. 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 responsibility of the  nurse to take their own 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 that are not answered by the preference card.

Know Your 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.

Typically, new grad nurses are assigned to work with experienced scrubs who are 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, etc.) has a coordinator who manages the service and serves as 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, which means that 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.

It’s important to 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 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 is capable of making mistakes. Reminding yourself of this can help reduce the discomfort of speaking up when a mistake is made. 

At some time or another, team members will 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.

OR nursing 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!

More Resources

• What Do Perioperative Nurses Do?
• Top Tips for New Grad Nurses in the ICU
• What is Critical Thinking in Nursing?

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 is the owner of 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 NurseSplaneWrites.com or email her at [email protected].

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