What I wish I knew before starting my placement in the Operating Theatre

Getting the news

A few months ago, I was told that my next placement would be in Theatre. I had very mixed feelings about this news. Throughout my previous placement, there were times when I longed to understand the operations my patients would undergo when they left the ward for their scheduled surgeries. I wanted to know what their bodies went through during these mini excursions – as bizarre as that sounds.

So, when I heard that my next placement would be in theatres, it felt like an answer to a prayer. However, on the flip side, I was also a bit apprehensive. Theatres seemed like more of a ‘stop by for a day’ placement location. I was intimidated by how much of a highly specialised sector it was – surely there wouldn’t be much for me to do. How would I be able to contribute to the team; how would I be able to develop my nursing skills in such an environment. In other words, how would I become a better nurse being tucked away in theatres? Anyway, the bottom line is, I was so far from wrong.

I don’t know about everyone else, but when I am starting a new placement, I like to do a bit of digging to mentally prepare myself, see what I am getting myself into. Unfortunately, when looking for information about nursing placements in theatres, it was such a struggle. That is what gave me the urge to write this blog. So please, sit back, relax and read on to find out what I did, and what I wish I had done to make this placement an enjoyable experience.

Getting settled in

When you are assigned a placement in theatre, you could be placed in one of many areas such as Urology, Gynaecology, PACU (Post-Anaesthetic Care Unit, also known as Recovery), or like me, Trauma/Orthopaedics. Pre-placement nerves are very normal, my friends and I all had them. I think it will reassure you to know that the theatre staff are all quite sensitive to how daunting theatres can seem, regardless of what stage of your nursing training you are in. They appreciate that it is a very unfamiliar environment for most, and as expected, many people aren’t comfortable with the sight of unconscious people, blood, organs – the whole lot. I found that they were good at creating allowances for students to express if they were feeling overwhelmed, especially during an operation, which was comforting to know.

With all this in mind, it is still a good idea to do a little ‘pre-reading’ about your speciality. This is definitely something I wish I’d done. I know it might sound like common sense, but please brush up on your anatomy! The majority of theatre staff are used to describing every part of the human body using its anatomical name (definitely more so than when I was on the wards). A lot of your learning here will be done by listening to staff talk about their patient’s injuries and conditions. It makes your life so much easier if you can easily identify what part of the body they are referring to. I downloaded an anatomy app and I highly recommend it – trust me, this is a life saver.

Another thing that you’d really benefit from is looking up common operations in your speciality – for instance in orthopaedics, hemiarthroplasties are done frequently. Just having a faint idea of the general steps involved in one of these procedures isn’t necessary because you will soon learn this during your placement, but it does mean you can quickly identify these different stages in action.

Something else I found useful was taking a few minutes to familiarise myself with the commonly used/requested items whenever I found myself in a different theatre. This was a tip I got from a member of staff and it was very helpful. It always felt good when a scrub nurse or surgeon would suddenly ask for ‘swabs’ or ‘sutures’ or ‘diathermy’ and I knew exactly where to find them. It also shows to the rest of your team that you are making an effort to be helpful.

Similarly, I would also advise that you made the most of all the waiting time in theatres. Theatres are one of the intermediate stages of patients’ journeys, so we are always waiting for one thing or another before we can proceed. You have the opportunity to use this to your advantage by doing any of the things I have mentioned above, or even making progress with any portfolio work. It’s also worth using this time to research anything mentioned that you don’t have a strong knowledge base on just yet. This environment was so new and different to me, so I found that the research possibilities were endless.

On a similar note, I would really recommend keeping a list of every single procedure you have observed or taken part in. You never know when you might want to look back on them and reflect, plus the long list looks impressive! Just like someone might say ‘Did it really happen if you didn’t post it on Instagram?’, my attitude to this placement was ‘Did it really happen if I didn’t document it/reflect on it?’

Getting stuck in

My final points are mainly to do with the ‘scrubbing’ side of your theatre placement. For me, this was by far this most intimidating part of my placement. Luckily, my supervisors were really supportive. They acknowledged how frightening it was for me, but they still encouraged me to give it a go. I had expressed in my initial interview that I wanted to get the opportunity to scrub in alongside the scrub nurse and the surgeons, however, whenever the opportunity turned up I would shy away.

My tips for handling things is to take note of what you focus on when you aren’t scrubbed. I found it very easy to focus on what the surgeons were doing, because I was so intrigued by the actual process of the surgery. Of course, this is never a bad thing, because it is how we all learn. However, I wish I focused more on what the scrub nurses were doing during an operation, especially during operations I had seen multiple times. Observe and take note of everything: how the nurse sets up their trolley, how they prepare the instruments for the surgeons to easily access, how they are quick to acknowledge when and how they do their instrument/disposable swab counts. I believe if I focused even more on what the scrub nurse was doing, I would have felt a lot more comfortable when it came to scrubbing in.

It also helps to acknowledge who the kind surgeons are, because sometimes a big part of the fear is fear of looking incompetent around people you aren’t comfortable with. Even though no one expects you to be an expert, I would advise you take note of who the kind, patient surgeons are, and if possible, always make yourself available to scrub up when they are the ones operating. It’s one less thing to worry about! From my experience, the surgeons can be quite patient and encouraging, because even they were beginners once.

To build your confidence up, getting involved in as many operations as possible is beneficial. Starting with smaller, less complicated cases helps, even if it just means you being gowned up and sterile, but just observing – get comfortable occupying a sterile field. Try to focus on memorising the main instrument trays for your speciality. Get a print-out of the tray instruments list and make an effort to learn the name of all the items in there.

There are things you just can’t learn from looking in from the outside. A lot of learning happens when you throw yourself in and you challenge yourself to get involved. Of course, this goes for when you are ‘running’, or ‘scrubbing in’ too, (as opposed to just observing).

It can be easy for you to take on the role of an observer in theatres, especially in the earlier days, which is fine; you are still finding your feet. But I recommend you get comfortable asking people what they are getting on with, how to do what they are doing. Ask if they need any help and generally immerse yourself. That’s how you build up your confidence, which later strengthens your initiative. Eventually, even if like me, it is not until the last few weeks of placement, you will be able to know what needs to be done without any prompting, and it feels great.

Conclusion

I hope I have provided you with useful insight into this niche nursing placement experience. If you are looking for an opportunity to live out your Grey’s Anatomy dreams, let this be your reality-check: things are not quite as exciting. However, I can assure you, if you are willing to get involved, use your initiative and push past the fear, you will really, really enjoy it. As I keep re-emphasizing, theatre is so different from the rest, it sometimes felt like I was starting all over again as a first year student. So please be kind to yourself, allow yourself time to learn and adjust without feeling incapable. Finally, don’t sell yourself short! Yes, you are a student, but there is always something you can bring to the (operating) table.

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