Question for the OR nurses. Keep in mind I'm not trying to start a flame war, I'm genuinely curious about this:
Why do we need a RN in the operating room? Most of the tasks (fetching for supplies, time-outs, advocating for patients) can be done by a LPN/Surg Tech. What makes the RN education applicable to the OR? Pre-op interviews comprise mostly of making sure documents are signed and whether the pt is NPO. I don't know any circulator that actually does a head-to-toe assessment during pre-op interview. As for med-passing, the anesthetist does that mostly. A lot of OR nurses I know are quite clueless regarding pharamcology.
I think nurses are fantastic and are much needed in health care, but I don't see why one has to go through 4 years of school to be an efficient OR nurse. Being a patient advocate requires compassion and common sense, and that's not specific to RNs.
Enlighten me. And again, I'm not trying to insult anybody. I may just be painfully ignorant as to what a circulator does. In that case, please convince me that what you learned in nursing school is actually useful in the OR?
Are you a surgeon? Just curious.
You have posed a great question. Many times when I spend 20 minutes of turnover time in search of an all-elusive gel pad, I ask myself, "Did I REALLY go to school for 4 years to be a sterile waitress, a gopher dressed in scrubs, or an IT tech when the computer/arthroscopy machine/laparoscopy machine needs fixing?" It can get frustrating sometimes.
However, when I catch errors or notice that an order was not written, I am thankful for my nursing education and experience.
A few examples:
A CRNA announced to the surgeon that he was going to go ahead and give Toradol. The surgeon was busy teaching a resident how to ream the femur for a Gamma Nail placement, and either didn't hear the CRNA or his statement didn't compute. I immediately spoke up and told the CRNA that the pt was allergic to Toradol, and pointed to the whiteboard where the allergy was listed in big red letters.
I always review my pt's H&P thoroughly prior to a procedure. I read the e-chart the night before and make notes with questions, should I have anything to clarify with the surgeon. If I notice that my pt's HCT is in the toilet, and an order for PRBCs was not written, I ask the surgeon if he would like some blood ready before we go back to the OR. If I notice that my pt's K+ is 6.5, I alert both the anesthesia care provider and the surgeon. If I see that my pt's INR is 3.5, I ask the surgeon if he wants to delay the surgery so that the pt can receive some FFP.
When we are positioning a pt for surgery, I know which nerves are being compromised by a particular position, and take steps to protect those nerves.
I know because of my education and experience, that induction and emergence are the most dangerous times of any surgical procedure. I am trained to recognize MH and know how to reconstitute and deliver the appropriate medications. I also know how to interpret VS on the monitor and recognize when a pt is becoming unstable. Thankfully, the anesthesia attendings are never far, but in the mean time I can offer assistance to a new anesthesia resident when they are floundering.
An RN knows how to delegate, and must implement critical thinking skills during a crisis.
When a procedure is unexpectedly extended for a period of time, and I know that there is not a bair hugger on the pt, I ask the anesthesia care provider for a temp reading. You wouldn't believe how many times this gets overlooked, and the anesthesiologist gets this look of surprise, and then we put on the bair hugger. I get the dubious honor of showing everyone my backside as I crawl under the drapes to put it on! An RN understands the importance of normothermia both in the intraoperative setting and in the post op phase.
Inevitably, if a pt goes down fighting, they emerge fighting. Because I learned soothing techniques AND because I understand various drugs used intraoperatively exaggerate sensitivity to light, temperature and sound, I know that I should have the OR warmed, the lights dimmed and the room QUIET. This is especially important in the peds population.
There have been plenty of times that I feel like nothing but a gopher. But the examples offered above are a testament to why we need RNs in the OR. Most of the time, the circulators are the ones that notice things FIRST, because it is our job to do so.
Patient safety is absolutely front and center in the mind of a circulator. RNs have the education, experience and critical thinking skills to ensure every aspect of patient safety by implementing appropriate and efficient patient care during the intraoperative phase.
Last edit by canesdukegirl on Oct 22, '11