BONUS | OR Etiquette 101: Essential Tips for Your First Day in the Operating Room (Part 1)

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In this episode of "So You Want to Work in Healthcare," host Leigha welcomes back Heather Struhl, also known as Heather The Injector, for part one of an insightful discussion on Operating Room Etiquette. As they delve into the essential practices and behaviors expected in the OR, Leigha highlights the gap in education surrounding this crucial topic. This episode aims to equip aspiring healthcare professionals with the knowledge they need to navigate the operating room environment successfully. Stay tuned for part two, where they will continue to explore OR etiquette in greater detail.

*Not Medical Advice. Our views do not reflect the views of our employers.*

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Transcript

Leigha:
So you want to work in healthcare, but you're not sure where to start. I'm Leigha your host of this podcast, and I'm bringing you the inside scoop on healthcare professions. From doctors to PAs to healthcare administrators and CRNAs, my goal is to let professionals tell their stories and give honest reviews of the careers they have chosen. So whether you're considering a job in healthcare or you simply have an interest in what we do, this show is for you. This is part one of the OR Etiquette 101 episode. We had so much to cover that we had to split it up into two episodes, so today this is part one, and make sure you stay tuned for part two coming soon. Welcome back to the So You Want to Work in Healthcare podcast. I'm here again with Heather Struhl also known as Heather the Injector. You might know her from my previous episodes and we do these shorter episodes in between the longer interview style episodes to give you guys some more in-depth insight on specific topics on becoming a PA or going to med school or just going in the healthcare field in general. Today is the episode you've all been waiting for. That is OR Etiquette 101, meaning Operating Room Etiquette. If you follow me on TikTok, you've probably seen my OR Etiquette videos. The last one I posted got a lot of comments asking me to delve into this a bit more and give you guys some more insight because I'm realizing that there's actually a huge gap in the education on this. So Heather and I are going to go over that with you today. A quick word from our sponsor of this episode. This podcast episode is sponsored by InCrowd. InCrowd is a healthcare market research organization focused on collecting feedback from diverse medical professionals on a wide range of healthcare topics through brief microsurveys. They partner with leading names in the life sciences industry and pair them with healthcare professionals who are instrumental in providing expert feedback to research. On average, most microsurveys take less than 10 minutes to complete. All of their microsurveys and qualitative interviews are paid, and you can even receive partial compensation if you screen out. Take part in as many or as few surveys as you'd like, when your schedule allows. Participate with your mobile phone, computer, or tablet when it is convenient for you. Research is anonymous and all information is protected by their data privacy compliance. I just took a survey yesterday, it took me about 5 minutes, and I made $40. That's better pay than my job as a PA. Join InCrowd today by clicking on the link I'll share in this episode's show notes and earn money sharing your medical expertise. InCrowd is a brand within the Apollo Intelligence family of companies. Thank you to everyone who's already subscribed. Don't forget to subscribe and give us a nice little five star review if you can. If you do leave a written review, I'll shout you out on the next episode. We are going to start with Heather's medicine pop moment, pop medicine moment, pop medicine moment of the week. Heather, take it away.

Heather: All right, so Katie Ledecky has POTS, and swimming may help her manage it. What is that? So that's basically symptoms that are related to reduced blood volume that occur when standing up, and it's usually triggered when you're standing up after lying down. So it most commonly affects women between the ages of 15 and 50, and the symptoms include lightheadedness, fainting, rapid heartbeat, and they're typically relieved by lying down. So do you want to go into how swimming has helped her?

Leigha: Yeah, she apparently published a memoir earlier this year called Just Add Water My Swimming Life and in it she talks a little bit about her POTS which again is Postural Orthostatic Tachycardia Syndrome. This syndrome has no cure and it impacts the autonomic nervous system. She basically just says how like reclined aerobic exercise such as swimming and strengthening your core can provide relief and she notes that it's kind of funny. I think this is like so so interesting.

Heather: It really is. I had no idea. I never thought about swimming as being a treatment for it. It makes a lot of sense.

Leigha: So this is kind of crazy. I remember learning about POTS but to be honest I forgot what it is. I'm starting to think I have POTS because when I stand up I really quickly I faint or I almost faint but this has been going on since I was a kid. I'm gonna look into this. Anyway, it's pretty cool because it has to do with standing up. These symptoms happen when you go from like a sitting or lying down position to a standing position, and it usually gets worse with exercise. But for Katie, swimming may actually help her POTS because some say that a good treatment for POTS is exercising in a supine or lying down position. And when you're swimming, you are in that prone, laying down kind of position. So it makes sense. Maybe this is why she's so fast. Maybe her body just operates better in a horizontal position.

Heather: It's fascinating. She's so fast.

Leigha: She's insane.

Heather: Watching her swim is so much fun. I think she swims faster than I can walk. Go Katie. She's the greatest. The goat.

Leigha: All right, let's get into this episode. I know you've all been waiting for this, especially if you're thinking about going into surgery or you just have a surgical rotation coming up. Do not skip this episode because we are going to give you everything you need to know on your first day in the operating room. I will start by saying, first and foremost, please, please, for the love of God, introduce yourself. I mean, when I have a student and they are just standing there staring, I don't know who you are. And I think what I think people don't understand is a lot of people come in and out of the OR and a lot of times you might not recognize them. Maybe they're doing research, maybe they're from like Central Sterile or something and you've never seen them before. So if it is your first day in the OR or just your first day with a specific PA that is precepting you or resident or whoever it is, please introduce yourself to everyone. First, probably the circulating nurse. Yes, they're in charge of the whole room. Yeah. do it in a way that doesn't it totally interrupt them and I know this is like I'm giving a lot of annoying specifics but you just have to read the room. I think that the the theme of this whole episode today is going to be awareness. I always say like you can't teach awareness. I feel like people either have it or they don't and if you don't have the awareness at least be aware that you don't have it and it's fine go into a different part of medicine but like just at least be aware that there are like other people there who don't know who you are and if you're just like cool and you introduce yourself it is going to go so far.

Heather: Oh, absolutely. And if you see them in the corner counting or doing something important, wait till they're done. And when they're walking over to somewhere else in the room, just absolutely, like you said, read the room. And also, with introducing yourself, everyone's wearing a surgical cap and a mask. And unless you really know that person well and recognize their eyes, for the most part, you don't know who they are. I mean, I recognize my friends in the OR because someone's a lot taller than me. I know your eyes, your stature, you're a close friend. It's totally different. But a random person, no one's going to have any idea if you're here supervising somebody else, you're here from JACO monitoring what's going on in the OR, or if you're just a student. So it's always good to be friendly, and they're more likely to allow you to stay. because you also wanna stay out of their way.

Leigha: Don't slow the flow. Don't slow the flow, but make yourself present and known. It's okay to show your personality too. Just be a human. I said that in one of my videos on TikTok. I'm like, be a human, just talk to these people. You're respectful of them, they're professionals, but also you don't have to, be a robot and be scared either and not everyone's going to be nice to you unfortunately. I hope that changes and I think it has changed a bit with like the younger generations coming into more leadership roles but like you're gonna get that person who even when you're really really nice and personable like they're gonna ignore you or they're gonna maybe be like a little bitchy back like just realize it's probably not your fault. They're probably just really stressed because they're doing a really stressful job and you happen to just be in their way at the moment.

Heather: Exactly. And another aspect of that with reading the room I've had a student in the past who just couldn't read the room whatsoever and they were super eager to be there, which I really like and I admire. It's a great quality, but at the time I remember I was prepping the patient for surgery and that student decided that was a really good time to ask me all these obscure questions, almost like they were quizzing me about various different things and how this could help themselves get into school. It just wasn't the time, but I would have been happy to tell you about what was going on in the OR, what the procedure would be that we're doing, things of that sort that were pertinent to what was going on. So reading the room is really important.

Leigha: Yes, yeah. Timing is everything in the operating room. And you're not going to know everything right away. Obviously, we don't expect you to know everything right away, which also I think is a good idea. If your preceptor doesn't ask you, let them know, hey, this is my first rotation and it's my first day and I've never actually scrubbed before. Can you watch me scrub? Because I've had students who I have them on their first day of their first surgical rotation, and they just go and scrub into me. I'm like, wait. I have to watch you. You've never done this before. So don't be afraid to just be humble, I guess, and ask for help and ask people to give you pointers.

Heather: Absolutely. No one will ever get mad at you if you ask for help because you don't know the answer. They're going to get really mad when you do pretend that you know, you're not properly sterile, or you dirty the field, which we'll get into. So always just ask a question, don't be afraid, and that's going to make you look even better. It doesn't even matter if you know the answer, it just matters if you're being honest and you have to prioritize the patient's safety first.

Leigha: Yeah, 100%. I've seen people, not just students either, like I've seen fellows do this. people who are about to be their own surgeons. I've seen them contaminate the field and not know that they did and then kind of be argumentative about it. Just listen to the people around you. Even if you know that you didn't contaminate the field, if someone thinks you did, just go re-scrub.

Heather: Yeah, go change your gown. If someone saw you contaminate your gown, don't argue. You just do it. You change it. Just do it.

Leigha: So the second thing that I think a lot of you are not getting for some reason in school is how to choose your glove size. I don't think we were given gloves to try on size-wise. I think we practiced putting them on sterile. but I don't think we were ever given like, Hey, try these on. Here's your size. Cause you need to know your size because you need to put your gloves on the field or have the nurse put the gloves on the field, the sterile field. And, and if they're not the right size and like you're screwed and they have to go get another size for you while they're doing a million other things. So I think the best way to do this, if your school doesn't provide surgical gloves, you can literally buy them on Amazon. Like you can get surgical supplies on the internet. I know there are ways to like measure your hand. So you can buy a few different sizes and see which one fits you best. There are different brands and different brands are going to be a little off on the sizes, but for the most part, you're probably going to be between like a size and a size and a half. Like for instance, some gloves, most gloves, I'm a seven, but there's a, this thick pair of orthopedic gloves where I'm a seven and a half.

Heather: Yeah, same. So that's one good way to do it. Another is, and when you introduce yourself to the nurse or the surgical tech, ask for help. If you say, hey, this is my first case, I've never gotten gloves for myself. I'm not sure how to open them. I'm not sure what size, they will appreciate that when it's when there's time before the procedure starts, and they're going to be happy to help you. For sure.

Leigha: They'll be happy to help. And that brings me to my next point. A lot of people were like, well, nobody even tells us where to get the gloves. Well, here's where you have to take a little initiative, right? Like, if the nurse isn't helping you and or he or she is busy, like there are a million other people in the operating room, go out into the hallway and ask somebody walking by. Because usually the gloves are going to be out in the hallway or in like the sub sterile room in between operating rooms. But like it's not always obvious. Like in our hospital, it's kind of like hidden in a cabinet and there's only like two places in the OR where you can find them. So if the operating room is not near those two cabinets, you might not see the gloves or they might not have the size you need. So I think the first question you ask your preceptor is, where are the gloves? Can I try a few on if you don't know your size?

Heather: I agree. And don't assume someone's going to get your gloves for you.

Leigha: Never, never assume that. They're not going to.

Heather: You'll get kicked out of the OR.

Leigha: Yeah, if you walk in there, if you just like roll in and you're like, do you have my gloves? Like, bro, that is the worst way to start in the operating room. You're done. You are done. There's no coming back from that. Nobody has your gloves. Now, on the topic of what you need, usually you need a mask, which is going to be right outside the room. you put that on yourself it is not sterile. You also need some sort of eye protection which is also usually outside of the room. Most surgeries you're gonna get like these little eye like kind of glasses that are just disposable. In orthopedic surgery we wear hoods in our hospitals so if you're doing your orthopedic joint replacement rotation, you're going to also need a hood and you're going to need a gown. You should always have all these things, unless the nurse says she has or he has one for you. Don't assume that they have any of these things. So gloves and gown and then maybe a hood.

Heather: Also, when you do introduce yourself, the nurse will likely ask if you're planning on scrubbing in, because often they'll grab an extra hood, an extra gown for you, and they'll just say, hey, can you grab your gloves that you need? And just put them in a pile. And when the scrub nurse is opening everything onto the field, they're going to open everyone's gloves. But they just want to have everything ready to go.

Leigha: That's a great point. If you're experienced and you're comfortable opening your own gloves onto the field, don't just do it. Please, please ask the nurse first or the scrub tech first. They might not be comfortable with you doing it, which is totally fine. I still have nurses I work with now. I've been I've been doing this for 12 years and they prefer to open it themselves. So like ask the nurse, do you want me to put these on the field or would you like to like and they'll let you know exactly what you should do there. That's a really important point. Because the scrub nurse is in charge. Yeah, scrub nurse is in charge and or the circulating nurse is in charge and then the OR tech as well. A lot of times the OR tech is a nurse in many hospitals, like an actual scrub nurse. So just kind of like make sure you're talking to both of these people. One of them is scrubbed in, one of them is not.

Heather: So usually you do need two pairs of gloves and usually double glove in the OR. That way if one of them rips, you have that second layer there, which is also why it's so important to properly scrub in, make sure you're nice and clean. You want to protect the patient, keep the field as sterile as possible. So sometimes the nurse will want you to have a third pair just on the side, just so if one does rip, they have another one right there.

Leigha: Yeah. Yeah. And also keep in mind, a lot of people like to wear different gloves for the bottom layer and the top layer. Like I wear these like smooth blue gloves on the bottom and then like a more, I guess like tougher pair on top and it just makes it easier to put the gloves on. It's a better feel on my hands, but it's all preference. So again, like if you can try gloves ahead of time by either ordering them online or trying them on at your school or whatever is a good way to just get used to what you like.

Heather: Yeah. And also when I was new to the OR and I would talk to the nurse or the surgical tech and I would just ask, you know, what's your preference? Like, what do you like to wear? I'd like to try what you like to wear in my size. And they'll often help you pick the size. I mean, my hands are super small, so they took one look at my hands and knew I'd be the small size. So that was really easy. But I think there's also, there might be a rule of thumb. something like maybe a size smaller than your shoe size, which is… Oh, really? I think there's like a common rule of thumb, not for everybody, because I know a lot of people that are tall and have big hands and super teeny feet, so that doesn't always work. But for me, that is the case. So it's always good to just ask for help. And if you show interest, it doesn't take them very long to explain it. And especially if the case has not yet started and they have ample time, they're going to be a great resource.

Leigha: For sure. Always get there a little bit early so you can figure all this stuff out.

Heather: Absolutely. It's better for you to wait around rather than to come in late.

Leigha: Okay, back to scrubbing in. If it is your first time, ask somebody to watch you to make sure that you are doing it the way that they are comfortable with. For example, I work in orthopedic surgery and total joints. I was taught that we should do a full scrub before every case, especially if you leave the OR or if you're not leaving the OR, then you can use like the Purell or the Avogard or whatever people have in their hospital. But like if it's your first scrub of the day, you're obviously doing a full scrub with soap and water for at least two minutes. Do not throw your sponge in the sink because somebody else has to clean that up. Put it in the garbage. There's literally a garbage next to the sink. Always. There's always a garbage next to the sink. Use like the nail cleaner first and then start your scrub and your school should be teaching you how to do this so you should kind of have an idea. But yeah, I would have somebody watch you the first time because like every preceptor kind of has their own preference and their own way. And they might give you like some little tips or tricks and always do a full scrub, at least in the beginning of the day. I always do a full scrub too after I eat lunch because I feel like it's gross to like hold food and put it near your mouth and then like come back and just use the Purell. And when I say Purell, I'm talking about like a high grade surgical Purell. And you'll see that when you get to the OR.

Heather: I always did a full scrub for every case. That was just what I did in my training. And one of the surgeons that I worked with all the time was super particular. And you kind of pick up on these habits. And it's not a bad habit. So it's not a bad habit.

Leigha: I did it every time. Yeah, it's very, very smart. Now you were talking about the sterile field. Do you want to get into that a little bit?

Heather: Absolutely. So do not touch anything the color light blue in the OR. It is sterile. You do not want to contaminate it. And if you do, you will never be allowed back in the OR. So if you're not scrubbing in, like you keep your hands to your side, whatever you need to do, Just do not touch anything. You also want to make sure your scrubs that you're wearing don't brush against the table. Suck your stomach in when you're walking by. Do what you need to do just to not contaminate the field. But also, once you're scrubbed in and you have a sterile gown on, then you don't have to be as crazy because

Leigha: you're not going to contaminate anything. Right. So your gown is sterile. At that point, you don't have to worry as much. But what you do have to worry about is if you now have a sterile gown on and there's no sterile sheets over the table, you cannot, please do not let your gown touch the table. That is not sterile yet. This is how almost every student contaminates themselves at some point. So If you contaminate yourself, it's fine. It's not a big deal. Everyone's going to be fine. Go back out, re-scrub in, but always just like watch your stomach because I feel like that is the most common place to contaminate yourself once you're scrubbed in.

Heather: Also, another common question, and this is also throughout life, not just in the OR, but it's, what do you do with your hands when you're scrubbed in? This is such an important thing that we don't always talk about. A lot of people feel awkward. Whether you're at a bar, you're like, what do I do with my hands? So everyone has their own preference, and you really don't want to go below the waistline with your arms. You cannot put your arms to your side once you're scrubbed in.

Leigha: Right. What do they say? Nipples to belly button or something? Yeah, that sounds right.

Heather: I always did my like almost like hands in a prayer position against your chest. And I kind of just, you know, make like a little fist together and just hold my hands there, you know, like against your own body. That way I'm not in the way. Staying sterile. And yeah. But that's what you do with your hands.

Leigha: That's what you do with your hands. Do not put them below your waist. You're really, I don't think, supposed to put them in your armpits either. Like a lot of people will fold their arms and I don't think that's too sterile.

Heather: No, you don't want to scratch your like collarbone area. Definitely don't touch your neck. Like none of the above. If you have an itch, just forget about it. Or if you know people really well on the OR, you just say, hey, can you come and scratch my neck?

Leigha: Yeah, for real. I've had people scratch my body for me. I did an episode with Sanjay the the on doc and he was like, I could never go into surgery because if I had an itch on my nose, I'd have to scratch it. But it's crazy how you're like you can just your mind is a powerful thing and you can you just have to get over it.

Heather: And also your backside even though you have a sterile gown on that's not sterile anymore. Right, correct.

Leigha: So just keep that in mind. Don't put your back to the field if you can help it. Obviously, definitely don't let your back touch anything. Don't touch anybody else's back. I see this happen all the time, where somebody's back is to the person, and they reach over, and their sleeve brushes up against the other person's back. People aren't paying attention. The other thing about contaminating yourself is, please, please, please be honest. You are protecting the patient. If you even think you contaminated yourself, please go say something and go scrub in again. Yeah.

Heather: Or if you think your glove may have ripped, just take a step back. And if you don't know how to safely, sterilely pull your glove off, so that way you can just get another one on without re-scrubbing in and getting a new gown, let someone do it for you. They'll help you, and then they'll then change their glove.

Leigha: Right. Another reason why we double glove, so if you contaminate your hand, adjust your hand, you can just take off that top glove. You don't have to re-scrub in most of the time.

Heather: Yeah. And often throughout the surgery, we will change our glove. Yeah. It really depends on the surgery that you're doing. This superficial skin, for example, when the surgeon makes their incision, they're using one scalpel for that. And then when they go to the deeper layers of the fascia, they're immediately changing to a new. So, sometimes, depending on what you're doing, we want a new pair of gloves on. Or in orthopedic surgery, sometimes when we're putting the joint in, a lot of surgeons will change to a new, fresh pair. We're keeping everything super sterile. It's joint replacement surgery. It has to be sterile.

Leigha: So, that's also why. Totally. And then, one of the last things I think I want to touch on is, we kind of already mentioned it. The whole awareness thing. So it's not just when you're getting there and you're avoiding the sterile field. Like once you are scrubbed in, it's very important to be aware of everything that's going on. And that is how you become a really, really, really good surgical PA in my opinion, is when you can kind of, without having to like ask a question or look like at everyone, you kind of just know what's going on around you. You know where the back table is, you know where the tech is, you know, if you have a second assist tech, you know where they are and you know what, like, where you should be, if it's your first time, ask people, where do you want me to stand? Right? Cause like, you might feel super awkward, like, oh my God, I'm in the way, right? And somebody was so, I thought this was the coolest comment on one of my TikTok videos. They were like, Thank you for bringing up the thing about awareness. I am so spatially unaware. I do not want to go into surgery, but I have to do this rotation to graduate. What advice do you have for me? And I would say to that, like, just constantly be looking around, keep your hands to your chest, like Heather said, and and just observe the first time. Like, we don't expect you to actually do anything on your first day or two, really. unless they're asking you to help, like if they ask you to hold the leg or something. Just take a second, look at yourself, look at your gown, look at your hands, look at what you're about to hold and what you're about to touch. It's okay to take your time, and people might try to rush you, but it's better to take your time and not contaminate or mess something up, I think. Yeah.

Heather: Ask them where you should stand so you're out of the way, and that way you're aware, and they'll understand that. And also, I want to share a really quick story from my first procedure or my first surgery that I had watched. So this was back when I was doing my surgical rotation in PA school, and the chief resident thought it would be really funny to send me into a BKA. below the knee amputation. Oh, I had one of those, too. And it was so early in PA school, I really didn't know how I would do in the surgery. I had never seen a surgery before. And I was really worried I would faint. So I went into the room, and I asked if I could just observe and not scrub in, just in case, because I want to be out of the way. The nurse was so appreciative of that. And she said, sure. And if you end up wanting to scrub in, you let me know. And she said, and this is the truth, really, the reason to scrub in is so you can be a little bit closer and see better. So, just speak up if you're a little concerned, you're worried, hey, I may faint, I've fainted before, anything like that. Just be honest and they'll help you because the last thing they want is you fainting and hitting your head. Yeah.

Leigha: Oh, let's talk about fainting because I have a lot of experience with fainting. This is part one of the OR Etiquette 101 episode. Make sure you stay tuned for part two coming soon. This is the So You Want to Work in Healthcare podcast with new episodes every month. Don't forget to subscribe to stay up to date on the latest releases.