So they’re really letting me into the OR? – these were my first thoughts the night before my first day in clinical. The nervous energy filled my bedroom walls as I could barely get a full night’s rest before my first day of doing anesthesia… ever. What do I expect? How can I not look stupid? I was plagued with more questions than answers, so here’s some tips I’ve learned along the way.

Do’s for Your First Day in the OR

• Prepare Thoroughly

Integrated or front loaded, by the time you reach the operating room you could have a lot of knowledge on anesthesia, the challenge is now how to translate that knowledge to practice. Preparation will help ease your nerves and show your preceptor that you’re invested in your learning! Important topics to review are airway anatomy, airway management techniques, top drawer and emergency medications. Know your doses and most importantly mechanisms of actions of each of the drugs. 

Depending on your program and clinical expectations you may have to make a care plan on the first patient of the day or for all your cases of the day. Knowing what is expected of you is the first uphill battle, so be clear on all expectations. If you have access to your patient’s charts from home, do a thorough review of their history and why they are getting the procedure. You want to understand their current medical history, pay special attention to any past surgical and anesthetic history which could provide great insight into what you may do. 

As far as preparing care plans, I highly recommend Anesthesiologist's Manual of Surgical Procedures by Richard Jaffe. It has in depth explanations of procedures including, anesthetic considerations, patient pain level expected, blood loss and all information on pathophysiologies that would lead to a patient having this procedure. 

• Ask Questions

When your preceptor inevitably pimps you on a question that you have no idea where they even got it from – say “I don’t know, but I can look that up and get back to you.” These are trained anesthesia providers with years of experience – whatever answer you’re gonna make up is not going to suffice. Be confident in what you know and have the humility to learn what you don’t know, it's why you’re there after all. Sometimes you can even curtail the pimping but leading with, “Can you explain to me why you like to do ______ that way?” Again, curiosity shows you’re invested in learning and expanding your knowledge. 

Don’ts for Your First Day in the OR

• Let Stress Affect Your Communication

Often easier said than done! You’re under a lot of pressure in - and outside - the operating room. Everything is new, there’s alarms going off you have never heard, your running on no sleep and you feel slightly overstimulated. Going from being a competent ICU nurse to now being out of your element completely, is humbling to say the least. What would be best is to lead with a *deep breath* anytime these feelings arise. Saying “thank you” to everyone who does something for you is key, you want to be remembered as a team player by everyone, not just anesthesia. Lead with a smile and openness and you’ll be shocked at how many people are willing to help you. At the beginning there will be a lot of leaning on your preceptors, anesthesia techs, nurses, operating room staff etc. to first get acclimated to a new environment. As you get more self-sufficient with time, you’ll start to find your stride but always remember everyone is a teacher if you allow them to be. 

• Break the Sterile Field

Asides from your anesthesia colleagues, the surgical team often takes great care and preparation in creating their sterile field. They are also a part of your team in the operating room and you want the circulator, scrub nurse and surgeon on your team as well. Please be mindful of sterile technique and even how to hand them supplies if you’re called upon to do so. Review a youtube video on sterile technique if need be! Just remember, anything blue is not for you! 

Final Thoughts

In the end, the best SRNAs are those who come prepared with a positive and open attitude to clinical. As a newbie, there is more out of your control than in your control. If you focus on leading with kindness, you’ll make your transition a bit smoother. Find one thing a day that you feel confident you did well and don’t let the losses get you down for too long. We’re rooting for you at the head of the bed!

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