How to be an O.R. Nurse

You may have noticed that I haven't written a post in a while, and I have a very good reason. For the past 6 weeks I have been working very hard at my REAL job. You see, as lucrative as this blog is, the $16.64 I have earned since its inception last May isn't enough to allow me to quit my day job. We all must face the fact that there are times when the need to eat overcomes the need to provide entertainment. 

At the end of February I embarked on an eLearning development project that would normally take my itty-bitty company about 4 months to complete. We were given a little under 6 weeks to get it done. All through the project, I couldn't stop thinking about that sign you often see in places like the cable TV office and auto repair shops -- places where cranky people work who want to make it very clear they aren't about to listen to your shit:

But in my line of work the customer is always right, so we put our noses to the grindstone and got the job done. 

MY REAL JOB

In case I've never adequately described my day job, twenty years ago I started a little company that makes computer-based training for hospitals. We teach doctors and nurses how to use the systems they rely on in their jobs to look up test results, enter orders and document care. As you have no doubt noticed, clinicians spend a whole lot more time on the computer than they do with you, the patient. Somebody has to teach them how, so I figured it might as well be me. I assure you it is a much more lucrative profession than blogging, which is why it commanded all of my attention over the past few weeks, leaving all of you to amuse yourselves, doing God only knows what.

One of the biggest deliverables of this latest project was Operating Room Management Training and I found the work so fascinating that I thought I should share it with all of you who also have an appreciation for being fascinated. I'm a Registered Nurse, and that's my cred for convincing people I can do this work better than anyone else. But the fact is, the only time I ever spent standing up in an OR was in nursing school. Every nursing student has to do an OR rotation, during which you follow patients from pre-op, into the OR, and back out to the Post Anesthesia Care Unit, or PACU. I thought being an OR Nurse would be pretty cool because the operating room always looks like a fun place for clever banter and sexual innuendo on TV shows like M*A*S*H and Grey's Anatomy.

M*A*S*H OR

Grey's Anatomy OR

Given that expectation, my experience in the OR was a pretty big disappointment. There was zero humorous banter and it was about as sexy as a gas station bathroom. Being an OR nurse is a little like helping a disagreeable, meticulous person organize a meat locker using only tongs and chopsticks while wearing a Halloween mask. If that image isn't enough to dissuade you from thinking about OR nursing as a possible career choice, here is a realistic simulation exercise you can try, while preparing an excellent dinner entree.

O.R. SiMULATION EXERCISE

Gather the following items: a friend, sponge scrubber, toothpicks, rubber gloves, scarf, shower cap or plastic bag, man’s long-sleeved shirt, whole chicken or leg of lamb, drawer full of silverware, laptop computer with spreadsheet software, clock, marinade ingredients, zip loc bag, meat thermometer, kitchen scales.

1. Turn the thermostat down to 55 degrees. Spill bleach all over your kitchen counter and let it dry. If you are short, find a stool to stand on.

2. Put on a shower cap. If you don't have one, a plastic bag will do (that's what I used). Do not pull it down over your face because it is not a toy. Tie a scarf around the bottom half of your face to cover your nose and mouth. Make it tight enough that the only air you can breathe is that which you have just exhaled. See photo inset. I used an Hermes scarf, but any scarf or bandana will do.

3. Wash your hands for 3 to 5 minutes. You might find it helpful to sing all the way through Aretha Franklin's Think two times while you're doing it, which is what Dr. Miranda Bailey does on Grey's Anatomy. Use the coarse side of a scrubber sponge to scrub your knuckles until they are red. If you don't have an orange stick handy, use a toothpick to clean under your nails. Don't touch anything. Turn off the faucets with your elbows. I should have told you earlier to be sure to go to the bathroom before you started because you sure aren't going to get to do that again any time soon.

4. Get your friend to help you put on some rubber gloves, then put on a man's shirt backwards. If you accidentally touched anything in the process, take it all off and go back to step 3.

5. Open a silverware drawer and count everything in it. On the computer spreadsheet, record the tally of how many forks, knives, spoons and other utensils are in the drawer. Perform a risk analysis of the area, taking into consideration environmental, human and procedural factors. Assign each risk factor a numeric score. Develop nursing diagnoses for each risk factor. Examples include Risk for Imbalanced Body Temperature related to frigid environment, Ineffective Breathing Pattern related to having to wear a mask, Alteration in Comfort related to standing on your feet for a really long time. Develop measurable goals and outcomes with specific target dates and times for each diagnosis. 

6. Document the time when you meant to start the procedure. Then look at the clock and record the current time as the actual start time of the procedure. Enter an explanation of any variance in the planned and actual start time of the procedure. Record the name of the person performing the procedure and your own name, and indicate when each person entered the case. Document how the "patient" (defined below) arrived into the procedure area (from Kroger, via grocery bag, refrigerator, etc.).  

7. Assist your friend as they de-bone a whole chicken or leg of lamb, using only the utensils you counted earlier. If they start to do something really stupid, or are doing it all wrong, don't say a word. I recommend the leg of lamb because we grilled a boned and butterflied leg of lamb that had been marinated in mustard, mint, rosemary, garlic and olive oil on Easter, and it was outstanding.

8. Count the utensils again, recording the numbers on your spreadsheet. Record the time when the procedure is complete. Document how the lamb leg or chicken tolerated the procedure. Measure and document any fluid that drained from the specimen during the procedure. Bag and label any bones or fat that were removed from the specimen. Document that you called the waiting room to advise the lamb or chicken's next of kin that the procedure was a success. Document your assessment of the progress being made on the Risk Assessment goals and outcomes identified above (Met, Not Met, Progressing).

9. Select each of the ingredients of your favorite marinade. Document the size of each container (in grams), its price, the manufacturer, the ingredients and the expiration date on your spreadsheet. Document exactly how much of each was used. When you're done, throw all of the containers and their unused ingredients away.

10. Count everything again, documenting the tally. Make sure this count matches the first count because, if it does not, you are in a world of trouble. Put the lamb or chicken, with the marinade, into a plastic bag. Document the exact size, manufacturer, price and expiration date of the bag, indicating its post-procedure destination (e.g. refrigerator, counter top, table). Stick a meat thermometer into the specimen and document the reading, then weigh it and document the weight. Record your subjective assessment of how well the outcomes and goals defined above are being met. Document anything else you can think of, knowing it could never be as much as what people in a real OR document. 

WELL? IS O.R. NURSING FOR YOU?

So what do you think? Did you enjoy that experience? Do you think you could be an OR nurse? Maybe you would rather be a nurse on a geriatric medical floor, in which case I can teach you to make an occupied bed and help you simulate what it is like to insert a Foley catheter into a very old man's pecker. I'll give you a hint: really old man junk looks a lot like a fried egg. I dare you to try not to think of that tomorrow morning when you are eating your breakfast.

Gosh, it sure is great to be back with you! Didn't you miss me?