Info regarding being an OR RPN/LPN nurse

IsseyM · Jan 13, 2007

Hi Mischa G and welcome to this site. OR nurses can be circulators or scrubs. The majority of OR nurses are circulators. Scrubs are usually surgical techs who have gone to school to specialize in instrumentation and sterile technique. They assist surgeons with surgery in the sterile field. Circulators take care of everything outside of the sterile field.

So far this is what i came up with for OR nurse (Circulator) duties. This is quite long but i'm sure i missed out quite a bit since i'm still kinda new. These are some of the duties that are performed at my hospital. It varies with different places.

Set up the room for the procedure/operation to be performed. This includes checking to make sure all equipment, supplies and instruments are in the room or available if needed. Checking the preference cards which includes most of surgeon's preferences, glove size, the kind of prep solution, the position of OR bed, positioning devices, special beds, medications to be given on or off the sterile field, what kind of drains or dressings will be used, if xray will be required, etc.. The circulator also ties up the scrub's gown after they have properly scrubbed in, helps with opening sterile supplies onto the sterile back table, provide scrub with any medications to draw up, (for example local- 1%Lidocaine with epinephrine). Also you have to count sponges, sutures, blades with your scrub tech or scrub nurse. With big open cases like abdominal surgery, all instruments, sponges, sutures and blades must be counted. Pretty much anything that can be lost inside a patient must be counted.

The OR nurse has to interview the patient. They have to verify identification, verify the operation consent, anesthesia consent and blood consent. Ask about allergies, last time they ate/drank/voided, significant medical hx., any previous surgeries, any problems with anesthesia/past surgeries, any metal, hardware or implants inside or outside body (includes jewelry and piercings), any dentures or loose teeth, checking the labs/ekgs or any tests that were ordered to make sure they are within normal range-if not you must let surgeon and anesthesiologist know.

Once the patient is brought into the room the nurse must help transfer the patient onto the OR bed, put on safety straps, hook up leads, pulse ox, blood pressure cuff. Sometimes the anesthesiologist will do this. The nurse usually assists the anesthesiologist with intubation and may need to apply cricoid pressure if necessary. Once intubated the nurse can then do her own thing. Sometimes you have to do foleys, if not then the nurse begins to prep the patient..whether its betadine scrub with paint, ChoraPrep, Duraprep, or Hibiclens, it depends on the surgeon's preference. Once surgeons are gowned/gloved and the patient is draped (depending on what kind of surgery) cords are passed off the sterile field to be hooked up to electrical equipment, tubes hooked up to suction or irrigation, etc. Once everything is hooked up and turned on the nurse can then start her paper work; however, you must always keep your eyes and ears open....its easy to drift off into your own world. Of course you will be interrupted throughout the case, sometimes if the surgeons switch sides you will have to reposition their headlights, microscopes, foot pedals, etc. Some days you will have to get on your hands and knees. You may also have to run out of the room to gather supplies if they're not in the room. Our hospital has some of the worst preference cards so somedays my preceptor will have me running in and out of the room to get whatever we need. You may have to trouble shoot any malfunctions with equipment or switch out for new equipment but this is rare. (knock on wood)

Some cases have specimens that must be sent to the lab, so the nurse has to prepare to collect it and send it off.

In some facilities, you're the surgeon's secretary, you have to answer their pagers and cell phones, return calls for them. But i've heard in some places they don't allow surgeons to bring in their pagers or cell phones.

Once surgery is over the nurse notifies recovery and a brief report may be given to the PACU nurse. Sometimes the surgeon will ask the circulator or scrub to clean up the patient and apply appropriate dressings. The circulator and anesthesiologist take the patient to recovery and finish up any left over paperwork. Then you go back to your assigned room and get ready for the next case.

The beginning and the end of cases can be frustrating because its the busiest, there is so much going on.

Good luck!

IsseyM

sarcasmo · Jan 15, 2007

Excellent post IsseyM. I am an OR circulator, and that is an excellent summary of what I do day in and day out. Something else I want to add is that we do a lot of patient education, especially during our pre-op interview. We make sure the patient understands what is going to happen to them while they are in the OR, what to expect when they wake up, and to some degree, what to expect during their recovery period. We have a very limited few minutes to establish a repoire with these people who are turning themselves over to us, and we must make sure they have faith that we are going to take care of them in the very special environment of the OR. The majority of patients are asleep, with no conscious thoughts or movements....they depend on the OR team for breath, warmth, safety, dignity, etc. In the hospital where I work, the OR prides itself on looking at the patient's family as part of our responsibility as well. We keep family members up to date on surgical progress with hourly phone calls (depending on the case) and reassurances that things are going well and their family member is safe and well cared for. So we do a lot of technical work, but we do a lot of emotional and mental work too. It is very rewarding as I am sure you are discovering! It's fun to see a "new" OR nurse excited about her job!

IsseyM · Jan 16, 2007

Oh yeah Sarcasmo, i forgot about patient teaching. See i knew i would leave out some important details. I don't realize how much i teach, something my instructors used to tell me regularly. Thank you for the positive compliment on my post. I appreciate it. I'm glad i chose the OR.