A day in the life...

Editorial Team / Admin · Feb 14, 2016

Some quotes from another thread that you might want to check out: Ask an OR nurse

Well Paul, a typical day starts with most of us getting to work early, in order to get into scrubs, & I usually go to my OR & do a wipedown of everything with antibacterial wipes, including my phone, computer, door handles, as well as OR lights & all flat surfaces. We usually have our 1st case carts in the room & supplies/instruments spread out, ready to open, by the night shift staff (if they aren't busy doing cases). Before opening for our 1st case, all staff meets at the control desk for announcements, & any cases/instruments that need to be coordinated for the day. While my tech starts opening the supplies & instruments needed for the case, I gather meds I may need from the Pyxis, as well as any extra equipment that may be needed. I try to get everything for the whole day, so I'm not running too much between cases. I then log on to the computer, to input my case, & finish opening with my tech. Then the CRNA & I plan what may be needed for our patient, as we go to Pre-Op. We check the chart together, then go into the patient's room & introduce ourselves. We verify the patient's identity, check allergies, verify the procedure with them. We make sure all ordered lab work, EKG, Xrays are done & in the chart; as well as the surgeon has signed & verified the consent as well. We let family members say their farewells & with a warm blanket we're off the the OR. Keeping our patients warm, calm, comfortable, & maintaining their privacy is tantamount to everything we do. After getting the patient onto the OR bed, we make sure they have enough blankets, a pillow under their knees for back comfort, no lumps or bumps under them. We assist the CRNA with sedation, intubation, spinal/epidural, or regional anesthesia. Somewhere within this time frame I have to do a count with my scrub, before the procedure starts, as well. After that, it's time to insert a foley if needed, position the patient (if other than supine), prep, get the surgeons in & gowned, & the patient is draped. Before anything else, it's time for the Time Out: assuring we have the right patient, the right procedure, the right site, sterility has been verified, we have the correct equipment, medications, (& allergies), etc. The scrub doesn't hand over a scalpel until the Time Out is done. Once the surgery starts, I call Family Services to notify the family of the start time: it seems like eons to them, but the time between us taking the pt into surgery & actually starting is very busy. I finally can get my charting on the computer going; there are 16-18 pages to keep up with, & sometimes I feel like all I'm doing is sitting by the computer! One of the most important jobs we have as circulators is to keep our eyes on the field, making sure sterility is maintained; we make sure our techs have what they need; I also check with the CRNA frequently to see if they need anything. I run for implants, more meds, other equipment; more irrigation fluid, more gloves if someone contaminates theirs. There is always something to keep us on our toes. Once the case winds down, there is the closing count, then the final count that need to be done. Dressings, help with patient wake-up, get them to PACU where we give our intra-operative report. Run back to the OR, help clean up, turn over, get the next case cart in the room, & do it all over again.
I always buy good running or walking shoes for work, just about every year. Expect to be on your feet a lot; our computer stands were height-adjustable, so I often stood at mine, because as soon as I sit, someone needs something. I keep a small bottle of Ibuprofen in my pocket, along with chapstick (it's so dry in the OR). You never know when you will end up with a headache, backache, or whatever ache, & need to throw down some Ibuprofen. There are days when I get told to eat lunch @ 10:30, & days I haven't eaten lunch till 1:30. You learn to grab crackers from the break room as you run from the OR to pick up your next patient in Pre-Op. Maybe you get lucky & your CRNA says they need a "pee break" before getting the next patient, so you take advantage of that, too. Yes, we start early, we stay late, especially if someone on the next shift "isn't comfortable" taking over from you in your specialty, which being Neurosurgery for me, happens a lot. Nobody wants to come into brain surgery not knowing what they're doing, & the docs don't want them there anyway. I try to use it as leverage to leave early another day, if my room is done early. I don't have little kids, & my husband is a Neurophysiologist, so he understands if I'm not home "on time" because many days he isn't home either! I don't mind staying over, to keep my docs happy, & to assure the best possible care for my patient & their family (we keep in touch thru Family Services, especially during long procedures). I won't touch on taking call, as you know you'll miss Holidays, birthdays, events, etc. You'll be tired, hungry, thirsty, achey. But for the most part, we have weekends & holidays off (except for your required call) so it isn't all terrible. It just seems it when you're actually stuck being there. The best place I worked was an Ambulatory Surgery Center, for 7 years, where we had no call, no nights, weekends, holidays AT ALL. Too bad my husband's place transferred us. All in all, I wouldn't trade any position in the Medical Center where I am now. OR Nursing isn't for everyone, but for those of us who love it, it's the BEST!

Actually, I'd say the OR is one of the better places on having predictable times to go home. Other than on call, I've only stayed late a handful of times on my specialty team (the rest of the OR may be a bit different), and of those times, I looked at the schedule ahead of time and volunteered to stay if needed as soon as I came in.
So, here's what my typical day consists of (keep in mind this is specific to my facility and cardiac surgery):
Once I clock in, I change into scrubs.
Then, I head into my OR, where I:
-turn on all of the equipment (hyper/hypothermia blanket, bovie(s), video equipment if doing endoscopic vein harvest, vital sign monitors that the surgeon, PA, and perfusionist use)
-set up my bed with bovie grounding pads and hands-free defibrillator pads (makes access to them easy, plus having them on the bed with the hyper/hypothermia blanket helps make them a bit warmer for the patient)
-pull up the cardiac cath films and chest x-ray (and chest CT if reoperation) on the image viewing station
-open the patient's chart in the EMR (review H&P, look at scanned consents which include surgical and blood, look at labs, read the cath report, note allergies, look up what antibiotics are ordered)
-remove all necessary medication from the Pyxis
-once I have my room ready to go, I'll head out to preop. In preop, I conduct my patient interview: confirm the patient's name, date of birth, procedure, surgeon, ensure site marking has been completed, verify allergies with the patient, make sure latex and iodine are okay, check if the patient has any metal implants (can affect positioning of bovie grounding pads), make sure anything removable (glasses, dentures, hearing aids, contact lenses, jewelry, prosthetics...) is removed and given to the family for safekeeping, explain to the family that I will be out to update them at some point during the surgery and when/where the surgeon will speak to them postop, make sure anesthesia sees and consents the patient
-then, it's off to the OR with the patient. Once in the room, we're giving the patient warm blankets, putting on all of the monitors (EKG, pulse ox, cerebral oximeter, entropy sensor) as well as those bovie grounding pads and hands-free defibrillator pads. Other specialties wait until the patient is asleep to put those larger pads on, but because our patients are very sick and may crash upon anesthesia induction, they are in place so that we can move if something happens. We will also do our anesthesia time out.
-at this point, anesthesia will start the arterial line and I'll enter some timing information into my documentation. Once the arterial line is in place, I'll page the surgeon and verify that it's okay to induce anesthesia. Once the okay is given, anesthesia will go off to sleep. I'll be placing the foley while anesthesia is intubating (my facility has techs whose sole role is to assist anesthesia, so I only have to do that in emergencies).
-once the foley is in place, we position the legs so that they are frogged and supported (facilitates access to the vein for the person harvesting it)
While I'm doing the tasks above, the 2 scrub people are opening their instruments and supplies.
-once I'm done with those tasks and the scrub person is ready, we do our counts. During this time, anesthesia is placing the central line and pulmonary artery catheter.
-then, it's time to position the arms (tucked at sides), and prep. Our cardiac prep is chin to toes with the legs being prepped circumferentially, and it requires 2 people and a lot of Chloraprep sticks to do this
-once the patient is prepped, the scrub staff will drape. Once the drapes are in place, I'm hooking up the suction lines, video equipment, bovie pencil, sternal saw, and video equipment.
-then, I pass up all of the necessary medications
-once the surgeon and/or PA (our PAs are permitted to start vein harvest prior to surgeon arriving in the OR), we do our surgical time out. If the surgeon arrives after the time out is completed with the PA, we will do a second time out.
Okay, that's a lot of work. Now, it's a little less hectic and I can take care of the bulk of my documentation. I'll also be keeping an eye on what's going on up at the field so that I can anticipate having to pass up extra supplies/sponges/etc.
When the surgery is finishing up, I'm doing our closing and final counts, passing up dressings, and getting all of the information to call report- how many grafts we did, what drips are running, etc. Then, I call report to the ICU charge nurse. The surgeon will break scrub once the sternum is closed, which is when I call the waiting room to place the family in the privacy room. The PA will finish closing the incision, and I'm passing up dressings to the scrub.
Once the PA is finished with the closure, we will start taking off the drapes and I'll tape the dressings in place. A PCA will bring in the patient's bed and transport monitor, and we'll remove the bovie grounding pads (defibrillator pads stay in place for transport). Patient gets moved over to the bed, call the ICU to say we're on the way, and take the patient to the ICU.
Report any changes since the initial phone call to the nurse taking the patient, and head back to the OR where I will finish my documentation and then assist with room turnover.
Depending on the schedule, I may be done for the day or I may start the process all over for a second surgery.
Basically, I've found the beginning and the end of my cases to be the busiest while there's some downtime while the surgeon is scrubbed in. Keep in mind, this is cardiac surgery where the cases tend to be several hours.

scrubulator · Feb 24, 2016

6:55- Clock in and change into hospital provided scrubs

7:00- Check work assignment=OR 2 with a lap cholecystectomy at 7:15. Walk over to OR 2. Get room ready. Check surgeon preference list if you are unfamiliar with anything. Get meds, open sterile pack/items/meds from case cart. Count misc. items and instruments.

OR Work assignment=OR 3 with a port a cath insertion at 7:45 start so go to OR 2 and help them set up. Then set your own room up.

7:15-Pt arrives in room, check pt in (what is your name, allergies, what are we doing and where, anything to eat/drink, any metal in body?, contacts or loose teeth?). Help move pt from cart to OR table, belt strap on patient, skin assessment. Then anesthesia takes over and intubates. Go back to scrub and see if they need anything else. Surgeon usually walks in at this point, verify any special needs the surgeon wants.

7:20- Pt intubated, help position patient. Sometimes you put in foley and prep patient (chloraprep or whatever). Surgeon goes to scrub, you tie surgeon up.

7:25-Pt drape with sterile supplies. Perform time out.

7:26-Incision

7:27 til end of surgery (~9am)- If surgeon needs an item, run and grab it otherwise catch up on charting-what you did and what you opened (for charging purposes). Once that is done look at next case cart and make sure you have anything. Specimen has come out. Collect specimen and send to pathology. If site is still bloody go run and grab hemostasis agent. Coordinate where is pt is going postop. Surgery is done. Call recovery. Count all misc items (and instruments if the laparoscopic turned open). Perform postop debriefing with surgeon. Give dressing to scrub. Stay beside patient for extubation. Make sure patient is ok, and send them to recovery

NOTE-this is a very basic lap chole case (and just one case....you could have 3 more lap chole's to follow or something completely different), but its pretty much what we do if its a straightforward case but trust me, it can turn real crazy-real fast.