role of OR nurse

chartleypj · Nov 4, 2003

try this:

http://www.AORN.org

stevierae · Nov 4, 2003

Originally posted by teebutter
I am a nursing student right now and I am really interested in surgery and hope to be involved in it someday. I was just wondering what exactly OR nurses do. I appreciate any information you'd like to share. Thank you.

You will read and hear and learn about the many things we do; as you sort it all out, never forget this:

OUR PRIMARY ROLE IS THAT OF PATIENT ADVOCATE.

THE CIRCULATING RN IS IN CHARGE OF THE ROOM.

THIS DOES NOT MEAN THAT HIS/HER ROLE IS LIMITED TO ASSUMING RESPONSIBILITY FOR THE UNLICENSED PERSONNEL IN THE ROOM, ALTHOUGH THIS IS PART OF HIS OR HER ROLE.

I AM TYPING THIS IN CAPS (SHOUTING!!!) BECAUSE EVEN EXPERIENCED OR RNS TEND TO FORGET THIS.

There are, unfortunately, OR nurses who either by commission or omission--often because they don't want to make waves or be branded "troublemakers---" don't actively advocate for their patients--they will complain in the nurses' lounge about how they don't feel a case should have gone forward because of factor A, B, or C, causing or contributing to an unsafe patient care situation--but that is as far as it goes. The case proceeds regardless, with the nurse praying that nothing goes wrong.

In reality, as the nurse in charge of the room, the circulator should be actively taking whatever steps are necessary to ensure a safe patient care situation.

This may mean going head to head with the anesthesiologist and the surgeon--diplomatically, at least at first; we are, after all, a team--and stating that, until factor (or factors) A, B, C is in place that she will not circulate the case. (I will say "she" from now on just for the sake of convenience.)

She should not even bring the patient to the room when a patient care situation is suboptimal or downright unsafe.

She can go up the chain of command if her concerns fall on deaf ears at this level--that is, starting with the charge nurse at the desk, the OR manager, the chief of the service, the chief of anesthesia, the chief of surgery, the hospital administrator and risk management, the hospital ethics committee, and, of course, involving the patient and his family or other support sytem in the decision as to when, how, and WHETHER to proceed.

This, I think, is our role and responsibility in informed consent--not to obtain it; not to explain risks and alternatives--that is the joint responsibility of the surgeon and anesthesia---- but to let the patient know that the operating room scenario may enfold in a different manner than he has been led to believe--he has a right to know and a right to participate in the decision making as to how, when, or IF to proceed under the current conditions.

I think to allow a case to go forward under suboptimal patient care conditions without informing the patient of the full truth of the situation is abysmal, and in my opinion constitutes nursing negligence.

I would rather quit--or even be fired-- than to feel as if I am powerless to ensure quality care for my patient, or to feel as if I have to ask permission of "the desk" to "do the right thing."

Unfortunately, "the desk" is often under pressure to keep cases moving and to keep the surgeons--their moneymakers-- happy at any cost; even when it means sacrificing quality patient care.

Any operating room nurse in this discussion area can tell you his or her war stories about how quality patient care often comes secondary to keeping cases moving and surgeons happy, at least on the part of O.R. management.

Maybe you will become an O.R. nurse, and will go into the profession with your role as patient advocate deeply ingrained, because you were wise enough to ask about what our primary role is, and I suspect will listen. I commend you.

I would love for you to print this, as well as the other responses you get, out and bring them to your clinical group for what I am sure will be a lively discussion and an excellent learning experience.

Let us know your clinical instructor's thoughts, as well as those of your fellow student nurses.

shodobe · Nov 5, 2003

stevierae, my ears are hurting!!!! You are right. Too many times cases just go on because...........? Most of the anesthesiologist I work with are ones to accept reason, not as much for the surgeons. The surgeons tend to want to get it done to get the primaries off of their backs. Get the patient done and out of the hospital. I just shake my head when surgeons want to do cases envolving patients that need a good workup and not just a cursery look over. Old patients need to be looked at a little more than docs are willing to do. Not in the HMO scheme of things. Good example is tonight where I had a call from a Ortho guy wanting to put on a Hemi. He had not seen the patient but wanted to know when we could do it. I told him after 6pm and was told by his office person he would get back to me. In the meantime, looking at the ER record on the computer, I notice all of the labs being out of wack, K-2.8, Na-125, etc.... I told anesthesia that maybe giving this patient one day for a workup would be beneficial and they agreed and we told the surgeon and he also agreed. Just working together sometimes, and I mean sometimes will work out what's best for the patient. I still can't hear to well. Mike

teebutter · Nov 6, 2003

Thank you so much for taking the time to respond in such a detailed way. I will definitely print it out and save it to remind me of what will hopefully be my role in the future. I really appreciate it. Thanks again.

stevierae · Nov 6, 2003

Originally posted by shodobe
In the meantime, looking at the ER record on the computer, I notice all of the labs being out of wack, K-2.8, Na-125, etc.... I told anesthesia that maybe giving this patient one day for a workup would be beneficial and they agreed and we told the surgeon and he also agreed. Just working together sometimes, and I mean sometimes will work out what's best for the patient. I still can't hear to well. Mike

Notice that Mike did not have to come off as confrontational--he simply fulfilled his role as patient advocate and had a rationale for why he thought the case should be delayed--a K+ of 2.8 SHOULD be grounds for automatic delay of an elective case until the cause determined and appropriate therapy instituted; unfortunately, if no one speaks up with their concerns, the case proceeds; the circulating nurse feels angry and powerless that the case proceeded under these conditions, when in reality she had a responsibility to intervene on behalf of the patient, as did the charge nurse at "the desk." Mike communicated with his team and they valued his input. Everyone benefitted; most of all the patient.

Also notice that Mike WAS "the desk" that night--he could have been passive, looked the other way and allowed the case to proceed, leaving the decisions about this patient's life up to anesthesia and the surgeon, putting the assigned circulator in the position of "bad guy" and avoiding conflict for himself, as "the desk" is often wont to do.

Instead, he intervened on behalf of this patient in his role as charge nurse at the desk early in the game. This should be the way it is in every operating room--unfortunately, it often feels as if the circulator and "the desk" have totally different agendas, and that the circulator cannot count on "the desk" backing her in her decision to delay a case when patient care conditions are suboptimal.

Think I'll do my next travel assignment working for Mike!