completely lost when it comes to OR nursing

Editorial Team / Admin · Aug 10, 2010

FA: first assist. Assists the surgeon, may suture skin, may bovie. Can be CFA (ST with additional education/certification), RNFA, PA, NP, another surgeon, resident, med student.

RNFA: registered nurse first assistant. RN with additional education. Is an FA.

ST: surgical technologist. Usually an associates program that trains people to scrub/take the table. Will sometimes be an LPN. Can also second assist.

SA: surgical assistant. Not sure of requirements/what they can do since my hospital doesn't employ them. According to another post, some states don't allow them.

Scrub nurse: RN/LPN who scrubs in, takes the table, second assist (assist with retraction, suction, follow suture, but not allowed to bovie, do the suturing)

Circulating nurse: RN, captain of the ship. Acts as the patient advocate, monitors positioning, responsible for documentation. For a more thorough but still incomplete description, see: Duties of A Circulating RN - Nursing for Nurses

If OR nursing is truly what you want to do, see if you can get a shadow day in the OR. Also, AORN offers a discounted student membership: AORN - Association of periOperative Registered Nurses

canesdukegirl, BSN, RN · Aug 10, 2010

Poet did a great job breaking it down for you. A bovie is electrocautery-we use a hot piece of metal that looks like a pencil when we need to cauterize a bleeder. This act is considered cutting or coagulating, so only the doc or the RNFA are allowed to do this. You can learn the basics of surgical flow in your med-surg book, but I will share with you some unwritten rules:

1. You must have thick skin to work in an OR. It is a tightly knit group, and for some reason, on the whole, new people don't get a very warm welcome. Although I myself do not practice this nasty attitude, I have seen many nurses who do. They do this only because it was done to them-nurses eating their young. The staff also usually treats medical students like they are just above idiot status-try not to do this. We all have to learn, and they are terrified too.

2. The surgeons are not ALL princesses, but there are quite a few that are. They will yell and raise a stink over some pretty trivial things. Don't be scared of them. Just be polite, and pay attention. If you ask questions about the surgery, they will automatically be impressed, but you gotta make sure you have done your homework, and you are not asking very basic questions-for example, if you are doing a total hip replacement, you already know that the patient has either degenerative osteoarthritis or they have some other pathology that led to the necessity of surgical intervention, so don't ask the doc WHY they are doing the surgery. Ask them instead why they like a particular implant over another, or ask them what their rationale is for using cement verses a press fit for a replacement of the hip. This shows that you are interested in the surgery, and you are familiar with some of the choices that the surgeon has to make.

3. When you go into the OR, be confident even though you are terrified. Just remember to always stay at least a foot away from the sterile field. Don't ever walk between sterile fields, go around them. Offer to help with getting warm blankets, getting the bed out of the room, opening the door for x-ray; little things like that to show that you are on the one hand willing to help, but on the other hand respecting the "unspoken boundaries."

4. This is one of my biggest pet peeves for some reason: a nursing or a med student that comes into the OR and SITS! This is a huge no-no, and usually only the circulator sits to chart. I don't usually sit because I would rather be able to survey the room continually.

5. Don't ever turn your back to the sterile field. EVER. When you chart and your computer is facing away from the field, turn it around. It is the circulator's responsibility to monitor for any breaks in sterile technique. You must always have one ear listening out for the conversation that goes on at the field (this will help you anticipate what the game plan is in case there is a change in plans), and one on the monitor to make sure the patient is safe and that anesthesia is paying attention.

6. Know the surgery. Even though I have been in the OR for many years, the night before, I review the surgery and the steps required for a good outcome for the patient. Yes, I am admittedly a complete dork, but this is someone's life, not just your job.

7. The OR is typically very chilly, so wear your TED hose, wear a camisole or a baby doll t-shirt under your scrubs. Don't wear a regular t-shirt, because nothing is allowed to show under your scrubs. In some hospitals, the circulator is allowed to wear a jacket over their scrubs, but I would check with your instructor first. It is difficult to pay attention to the surgery if you are freezing cold!

There are many other pearls of wisdom I could offer you, but these are some basics. Hit us up on this site again when you become familiar with the flow of surgery and we can help you out!

Good for you for wanting to do OR nursing. It is truly the BEST!

annernator · Aug 11, 2010

Ahh omgosh, thank yall so much!! I'm so excited about this, I really am.

Gina Bernard · Aug 12, 2010

Hi,

I'm from Canada where things are a little different but having all those acronyms explained makes it easier for me to understand the situation south of the border.

In Canada, we do not have nurse anaesthetists, only doctors can be anaesthetists and we are just beginning to see nurse as first assistant. Typically there are 2 nurses for each procedure, the circulating nurse, always an R.N. and a scrub nurse, either R.N. or R.P.N. The R.N. program varies from 3-4 years depending on the province and the R.P.N. is 2 years. We don't have an associate degree anywhere in Canada. There is the surgeon, the assistant, and anaesthetist. In more complex procedures, such as cardiovascular or joint replacement, you will find 2 circulating nurses and you may find a ressiratory therapist.

doesn't matter where you work, the goals are always the same - provide the best care possible.

Toronto nurse.