KC Chick or anyone else in OR...

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    I'm curious as to what the role of the nurse is in the OR environment. I know there are basically three roles, Perioperative, Circulator and Scrub, but I am having a hard time finding out what these jobs entail. Can you tell me what your day is like?
  2. 4 Comments so far...

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    I have to get mental for what I am going to do that day.If I circulate then my approach is one of helping the scrub get ready for the case, getting all the supplies i will need for the case, helping anesthesia get ready,checking out the patient in the holding room to sse if i might need something special like say an A-line or pediatric supplies.I next interview the patient checking the chart for abnormal lab values, making sure the consent is signed and especially what we're going to do.The biggest problem I have is making sure the patient is READY!Too many times the patient comes to the OR with street clothes on and enough jewelry to make Mr T jealous!I try to answer as many questions as possible for the patient before going back to the room.I have 25 years OR experience so I can usually answer the most difficult question.Next take the patient back to the room and the age of the patient really determines what happens next.Ped patients are usually chased around the room for a few minutes before apprehension and gassed down.Adult patients are somewhat better, sometimes.Keep them warm and covered up, be there for induction and assist the anesthesiologist, be there for the instrument and sponge count, help the scrub with draping, hook up the bovie and suction, tie up the surgeon and wno ever is assisting, and then sit down and do your charting on the computer.This is only for the times I circulate and I will sit down and expound on the scrubbing side of this. Mike
    PS, I know I forgot some things, but you get the picture
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    Hi there shyviolet...this is the website for AORN (association of operating room nurses) http://www.aorn.org/ You can find tons of information about OR nursing here.

    As for perioperative nursing....the term actually consists of three parts: Preoperative, Intraoperative, and Postoperative. Since I'm a circulating RN, you could say I'm an Intraoperative nurse. In the OR, there are usually two roles that the RN can perform...circulating or scrubbing. At my facility, RNs circulate only and surgical techs scrub in for the case. This is done for cost reasons. In the next 6-12 months, they'll probly have to revert back to using RNs to scrub because they are very short on techs...can't even get enough from agency.

    Our OR has 9 rooms and the specialties consist of Ortho, Neuro, Cardovascular, General, GYN, ENT, Cysto, Eyes, and a little Dental. We do not have block scheduling, so as a nurse at this facility, we have to be prepared to handle any specialty. My day could consist of all General cases in my room -or- Ortho, Neuro, GYN, and General all in one day! Keeps you on your toes.

    My role as a circulator is to get the room ready with the scrub person (equipment & supplies), get report from the pre-op RN, take the patient to the OR, assist anesthesia personnel, position the pt. and prep the surgical site, assist the scrub person, document the procedure (who, what, where, when, etc.), help anesthesia when waking up the patient, and give report to the PACU nurse in recovery. Oh yeah...we have to play receptionist sometimes too when the Docs get pages or phone calls-I hate that part! They always get a call/page when you're busy doing something else.
    All of the above you are expected to accomplish in a TIMELY manner. Sometimes we resemble headless chickens!

    Mike, I know what you mean about problems with having the patient ready....so frustrating sometimes. The pre-op nurses don't seem to know the pressure that we're under to get the patient to the OR....ON TIME! Not to mention ready. I've brought patients back to the OR for an Inguinal hernia and the ABDOMEN has been shaved. OMG...I'd think they would know where to shave....could save a lot of time.

    Anyway, shyviolet....check out that AORN site...they've got tons of info.
    Anne
    Last edit by KC CHICK on Feb 24, '02
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    Hi shyviolet,

    So you want to know about a day on the job in the OR. I will just add my 2 cents worth.
    The day really starts the day before, by checking your assignment for the next day, what kind of cases and special needs. For example are we going to use some equipment I am not known with, do I have to make sure the loaner instruments are in the hospital and so on.
    The day starts for me by checking the room, is the anesthesia machine ready, do we have enough supplies, is the suction working, are there any changes in the schedule. After this we plan the day with the team working in the room that day, who is going to scrub for which cases (we have mainly RN's in the OR and take turns scrubbing and circulating).
    The scrub checks the set up for the case and makes sure he/she has all that is needed, after this the scrub gets ready for the procedure, while the circulator opens all supplies needed and counts with the scrub. With a bit of luck there is a second circulator who goes to daycare or the patient holding area to check the patient in (lab work, consent removal of dentures, jewelry), brings the patient to the OR and provides any comfort measures like a warm blanket and comforting words. The second circulator will then help the anesthesiologist with monitoring, IV start, any other lines inserted, epidural/spinal or general anesthesia induction. After which he/she checks for proper positioning and any padding needed. Then it is time to prep and assist the sterile team with the hook up of any equipment used (like cautery/bovie). When there is only one circulator she does both jobs and juggles priorities.
    After all this is done it is time to do all the charting required by law and by the hospital. During the case the circulator stays in close contact with the sterile team providing them with any extra supplies needed and counting instruments and other supplies used when needed.
    At the end of the case the team is responsible for safe transfer of the patient onto stretcher or bed , assising the anesthesiologist while the patient is waking up and safe disposal of sharps etc.
    During the change over from one case to the next one we are again responsible for checking our equipment is in working order and supplies are available and the whole thing starts all over again.
    Sounds like a lot of work? Yes it is! Sounds like a nice challenge? Yes it is!!!!!
    I am sure I have not mentioned everything but I hope this helps you in your decission making process.

    Marijke
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    Dern, you folks are very busy to say the least. If there is one thing that I have gained from chatting and dealing with medical people like this is a higher respect for you. I never realized that all this was involved in one surgery!!! I can only imagine how things turn out in the event of an emergency sugery. After reading this thread, I can see how professionals can get burned out on this type of work, and often times why they overlook things like a scared patient that is attempting to hide the fear from his parents (as was my case when I was younger). I see now more than ever the importance of telling the doctors/nurses when I am scared.

    Can anyone give the general series of events for taking a patient from admissions back to the OR for surgery? That is, what is supposed to happen. Both from what the patient sees, and what you all are looking for?

    Thanks.

    Nick


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