[Marie_LPN]

When i was a student, we were not given a list of rules, or any guidelines for our OR observation. So needless to say, i felt like a fish out of water. Now that i've seen both sides of the coin, as a student observing, and now an OR nurse, here's a few tips to help someone else.

First Things First:

• There is no point in doing the full makeup and hair hooplah. The mask will rub off the makeup, the hat will flatten the hair.
• Eat a real breakfast the morning of. Not an energy bar and a soda, real breakfast like eggs, bacon, and juice.

Bring With You:

• Nametag (we don't know who you are without it)
• Pen
• Small notepad
• Clinical Objectives sheet
• Alcohol swabs or Cough drops (for odor distraction if necessary)

When You Get There:

• Let the charge nurse know you are there, who you are, and what school you are with. Sometimes we need to document this on our visitors sheet. They will then direct you to the changing room.
• Never forget HIPAA! You may be required to sign an agreement for privacy before you are allowed to observe
• If you're taking notes on anything, refrain from using pt. name, or MR number. Identify your pt. as, for example "56 y.o M h/o yadayada. It's actually best if you leave ALL names off your paperwork.

Getting Dressed

• Change into OR attire. This includes, scrub top, scrub pants, long sleeved jacket (it's cold in those rooms, you'll need it), hat, and shoe covers.
• WEAR YOUR NAMETAG. Without it, we don't know who you are or why you are there.
• Shoe covers should be worn the whole time 1) to protect your shoes 2) your shoes are from the outside.
• Hats should be worn the whole time in the OR. All of the hair must be covered. If earring are worn, they must be covered by this hat as well.
• If observing in a room that has the laminar flow air handling system on (ex. of some cases that use this: total joint replacements, spinal surgeries), a second head covering may be required. This second covering is worn in addition to the hat you already have on, and it is a full hat that ties around the bottom of your neck. Some staff call this second hat a "hood." Make sure the first hat is covered completely by the hood. The hood looks like one of these:

• Masks are to be worn in the OR room when the sterile supplies are open, and during the case, until the incision is covered by the bandages. They should form-fit to your face, with both sets of strings tied. Use a new mask for every case.
• If you are allowed to observe a case up close (such as standing at the head of the bed), you should put on eye protection. You never know when something goes a-flyin (and it does, often).
• 'Isolation' masks that are used on the med-surg floor isolation pts. are not approved for OR filtration usage, so those should never be worn in the OR. Say no to:

What about Sterility and Such

• The first rule you're usually told: if it's blue, don't touch it or reach over it. It's safer to assume that everything blue is sterile.
• Anything draped in clear plastic is also sterile (ex. C-arm X-ray cover)
• Do not reach over or point over a sterile field for any reason.
• If you are unsure on whether or not something is sterile, treat it like it IS sterile until you can ask about it
• Assume that anything laying on the floor is filthy and dirty. If you touch anything that might have touched the pt., go wash your hands with soap and water. If the nurse tells you to wash your hands, do it. They're telling you to do so for your own safety.

Radiation Procedures and Protection

• You should wear a lead apron and a thyroid shield when observing any case involving X-rays.
• If you are not wearing the wrap-around type of lead apron, do not turn your back to the X-ray machine when it is on.
• If lead is not available for you for that case (this is common when we have a high load of X-ray-using cases), either step out of the room during X-raying, or stand behind a non-sterile person who is wearing lead.
• Please do not fold or crumple your X-ray apron! This breaks the lead, creating holes, and decreasing protection for the person wearing it.

Regarding Surgeons and Anesthesiologists

• Do not take offense if the doctors don't talk to you. They are concentrating on the situation at hand.
• On the other hand, there are plenty that DO like to teach.
• I don't suggest asking anesthesia questions until AFTER the pt. is intubated, the tube is secured and connected to the circuit, the anesthesiologist isn't touching the pt., and/or they have sat down in their chair. And ask if it's OK to ask questions about what they did/are doing. Don't just assume it's ok to do.
• Also, before asking the surgeon any case-related questions before, during, or after the case, ask them if it IS ok to ask questions.

Regarding Nursing Staff and Patients

• Always ask the permission of the pt., nurse, and doctor before going in the room. Do not just assume that you're allowed. Pt. privacy is always respected, first and foremost. The circulator is the pt. advocate. Always check with the nurse before interacting with the pt.
• Ask the pt.'s nurse, then the pt. before looking at the pt.'s chart. To do so w/o permission could get you in a position where you will be asked to leave the room, and quite possibly the unit, for privacy violate (seen it happen more than once).
• When talking to the pt., try to talk to them in a lowered voice. Privacy, again.
• Chances are, when you're in a room, you have NO idea where to stand to watch. We don't even know where you should stand till the pt. is draped and everything is arrange. The safest bet is to stand up against the wall out of the way, and wait. Chances are, the circulator will point out a good place to stand.
• OR staff will typically not talk to you during a case. We're trying to listen to what the surgeon says, and it's hard to hear a mumbling doctor when we're talking and listening to someone else.
• A quick way to insult and alienate OR staff (tech or nurse, doesn't matter) is asking if they are a "gopher".

During the Procedure

• Don't lock your knees while watching. Step around a little bit, even if you don't have much room to move.
• If you feel weak, step out. If you're in a total joint room and aren't "allowed" to leave, at least sit down. And if you are allowed to leave a TJ room, chances are you can't come back in, because of infection control.
• If the smell is overwhelming (and there's a high possibility of this), bring alcohol swabs with you. Poke one inside of your mask when needed. Or eat a cough drop.

[pharmgirl]

Awesome info........(God willing ...will be starting program in Fall).....will keep this all in mind........any other advice for other areas?????

[ashez0520]

This is helpful. I'm finishing up my first clinical semester, and girls in my group have gotten to go to surgery, hopefully I will this Tuesday. Nice to review, as my instructor only really mentioned the blue/sterility stuff. Thanks!