Critcal Care vs. the OR

MB37 · Sep 29, 2008

I only spent two days in the OR in school, never worked in one, so correct me if I'm wrong. It seemed to me that the OR RN was kind of a manager of the room. There were scrub techs there who were sterile and assisted the surgeon, the RN was not sterile. This hospital didn't employ scrub nurses or RN first assists. She (I followed women both times) met the patient for a few minutes, did a super quick assessment, and looked over the chart to make sure everything was in order. She'd wheel the pt into the room, then start setting up for the surgery. She was responsible for positioning the pt, strapping them to the table, putting in cath if necessary, and prepping the site. She did all the instrument counts with the tech, and made sure all the equipment that would be needed was there. She did a LOT of documentation before and during the surgery, and made sure everyone did the "pause for the cause." She was in charge of the room and the surgery, made sure everyone followed all the rules, and ensured pt safety and comfort. She'd make sure the pt was warm enough and not positioned in a way that could cause harm after a several hour surgery. Pt advocate was definitely in the job description.

ICU nursing involves a lot more direct pt care and use of "skills." We have 1-2 pts, and you're in and out of their rooms all day. There is also a ton of documentation - assessments are done and charted at least q1h, for example - but that means that every hour you have to go in the room and assess the pt. If they're vented/sedated, you do a lot of interaction with the family - they're usually scared and overwhelmed, and sometimes have tough decisions to make. You do a lot of education. In the OR, anesthesia is responsible for keeping the pt alive. In ICU, the nurse manages a lot more of the care. You usually have RT to manage the vent, but you're responsible for watching the pts sats, suctioning, responding to alarms, and sometimes changing vent settings because you're the one who's there all day. You go with the pt to all of their tests and procedures. You assist the physicians, NPs, and techs when they come to do procedures at the bedside. You watch your pt constantly, since they're in ICU because their conditions can change in an instant. You have a lot of autonomy - there are standing orders and protocols to follow, but often the nurse will act first and call for the order later to keep the pt alive. You have to call MDs constantly - there might be 3 different services consulting on the pt, so you act as the go between. You also don't always have a CNA/PCT, so you're responsible for total care. You do the baths, change the linen, clean up when they poop, and do frequent oral care if they're vented.

I don't think the specialties are very similar at all, but I've only worked/done clinicals at one hospital. In both you are the pt's advocate, and you're responible for coordinating care from various disciplines. PACU is more like ICU nursing, with the frequent assessment and low ratios, but you only have the pt for a few hours.

cjmjmom · Sep 29, 2008

I have worked in SICU and OR and in my opinion these areas do not overlap much at all.

In the OR there is minimal patient contact. The circulator briefly interviews pt. in pre-op and rechecks the chart to be sure everything is signed properly and all abnormal tests have been reported and dealt with; wheels pt. into the OR helps position pt. on table, may prep pt., helps out during surgery with getting equipment and supplies, counting etc., helps put patient back on cart and assists anesthesia with taking pt. to PACU. Technically the RN circulator is "in charge" of the room but actually the responsibility of the patient is shared with anesthesia, surgeon, residents, assisitants and the RN.

In Critial Care the RN is at the bedside doing just about everything and is totally responsible for the patient during her shift (except of course the physician(s) covering the patient is also responsible).

Of course there is massive documentation in both areas.