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New to the Operating Room (OR) Team: Who the Heck are All These People in My OR?

Specializes in OR, education. Has 16 years experience.

Who will be in the operating room during your surgery?

Care of the patient undergoing surgery can involve a large variety of staff who come from a variety of specialties and settings. Here is a brief overview of some (but likely not all!) team members who may be involved in the operating room.

New to the Operating Room (OR) Team: Who the Heck are All These People in My OR?

They say it takes a village to raise a child. At times, it also seems like it takes a village to care for a patient in surgery! For many nurses, exposure to the OR in nursing school is very limited, and when they start their first day in the OR, it can be overwhelming to see the sheer number of people involved. So just who are all these bodies in the OR? Here, I’ll introduce them to you and add in a bit about my own personal experience with these team members.

Naturally, whether you see all of these folks in your OR will vary based on your practice environment, staffing structures, and facility policies, but here’s a rundown of who they just might be:

The Registered Nurse...

I know, you’re reading this and thinking “Duh!” Of course there’s the registered nurse - me! But what can your role be as the RN?

Circulator. The circulating nurse is not a member of the sterile surgical team, but has many responsibilities outside of the sterile field. Typically, the circulator is responsible for assisting the room set up and completing a patient interview in the preoperative area, bringing the patient from preop to the OR, preparing the patient for the surgery by positioning them and performing a skin prep, documenting the surgery in the patient’s medical record, providing sterile items and medications to the field as needed, communicating with sterile surgical team members regarding sterility (and breaks thereof) and surgical counts, and coordinating care with the postoperative destination, whether that’s the PACU (aka, recovery room) or another nursing unit such as ICU.

Scrub nurse. The scrub nurse is a member of the sterile team. He or she is responsible for obtaining necessary supplies, setting up and maintaining the sterile field, handling instruments and sharps in a safe manner, participating in surgical counts, assisting the surgeon by holding retractors or suctioning, and other duties as permitted by facility policy and scope of practice.

The Sterile Surgical Team...

This may vary based on the setting where you work, the staffing plan, and the type of cases done.

Surgeon. I know, another duh! moment. Gotta have the surgeon for surgery.

Resident. These members of the team are fully licensed physicians, but may have varying levels of experience. The facility may also have restrictions on what they are permitted to do alone, with supervision, or not at all. I personally work only with third and fourth year surgical residents who are not permitted to obtain consent for surgery, may make the incision without the attending in the operating room, cannot begin the actual procedure without the attending scrubbed in with them, can close without supervision, and can enter orders.

Fellows. These members of the surgical team have completed their full residency and are now undertaking additional training in a subspecialty.

Medical student. These members of the team are not yet licensed physicians. The level of participation in the surgery may be very limited, and sometimes they are in a “scrub to observe” role.

Physician assistant/nurse practitioner. These are advanced practice roles that you may be familiar with from nursing school or previous nursing experience outside of the OR. Their role in the OR is to be the first assistant. They can manipulate tissue, obtain hemostasis by suturing or cauterizing, place trocars for laparoscopic or robotic surgery, close incisions, and other duties. PAs and NPs with additional training are allowed to harvest saphenous vein for cardiac bypass grafts without a surgeon being present (the surgeon usually arrives about 20 minutes later to open the chest). In addition to their role in the OR, they will round on patients admitted to the hospital and see patients in the office.

RNFA and Surgical Assistant/SFA. Much like the PA or NP, they will function in the role of assisting the surgeon, but they are not advanced practice providers. RNFAs are RNs while SFAs (CSFA if certified) who have completed additional education and training to function in the role of the first assistant. They may also become certified in the role. Unlike the NP or PA, these team members do not typically see patients on the nursing unit or in the surgeon’s office.

Surgical technologist. The surgical technologist and the scrub nurse are the same role. The key difference is that a surgical technologist has graduated from a program that specifically prepares them for the scrub role in the operating room. You may run into a handful of team members who have been around for many years who completed on the job training rather than a diploma or associate degree program, but this is no longer common.

The Anesthesia Team...

As with the sterile surgical team, this may vary based on your setting.

Anesthesiologist. A licensed physician who is responsible for completing a preoperative assessment, developing an anesthesia plan, obtaining consent, providing anesthesia directly, partnering with a CRNA who is providing anesthesia, managing induction and emergence, etc.

Resident. Much like the resident in the sterile team is specializing in surgery, the resident in the anesthesia team is specializing in anesthesia. Likewise for medical students.

Certified registered nurse anesthetist (CRNA). This role is an RN with advanced education to function in the role of primary anesthesia care provider. Depending on the facility policies and structures, the CRNA may function fully independently or be supervised by an anesthesiologist. In my facility, the anesthesiologist supervises up to four CRNAs, places orders, completes an assessment, and obtains consent while the CRNA is with the patient in the OR the full time.

Anesthesiologist assistants. These professionals are able to work in 17 states and function much like the CRNA under the direction of a qualified anesthesiologist.

Anesthesia Technician (AT). This member of the anesthesia team may have attended a formal program or had on-the-job training. Their key role is to assist the anesthesiologist and/or CRNA in the care of the patient. They usually are responsible for stocking supplies, preparing equipment for use, and assisting with insertion of invasive lines such as arterial lines, Swan-Ganz catheters, or central lines. Again, your setting will dictate how active a role they take- and this can even vary across organizations! My multi-facility organization has a wide variation in the utilization of ATs. In my facility, they get right on in there and assist the anesthesia provider with placing invasive lines and such. In the other facilities that have anesthesia residents, they are primarily on the stocking side and have limited patient interaction.

What about all those other non-sterile people?

Imaging technologists. Some surgeries require x-ray or ultrasound imaging. The imaging technologist will bring the equipment into the OR, set it up, and run it at the direction of the surgeon. If using x-ray imaging, be sure you are properly protected with lead shielding.

Support personnel. These are unlicensed team members who may have varying titles - I’ve worked with patient care assistants and operating room assistants who did the same job. They assist in moving and positioning patients, turning over and cleaning rooms between patients, restocking supplies, obtaining positioning equipment, and obtaining beds for the patient after surgery.

Autotransfusionist. This team member is responsible for setting up and running the equipment that collects blood from the surgical field, processes it, and returns it to the patient. While not present in all types of surgeries, they are typically involved in surgeries where large amounts of blood loss are anticipated.

Perfusionist. This team member is involved in cardiovascular surgery involving cardiopulmonary bypass (CPB). They are responsible for setting up and operating the “heart-lung” machine, giving medications and blood to the patient through CPB, and ensuring the patient’s physiologic functioning while on CPB.

Vendor. These team members may or may not be permitted into the OR based on your facility’s policy. If permitted in the OR, they may guide the surgeon and team on use of their products. In my facility, we heavily rely on the orthopedic reps who are present for total joint and fracture surgeries, as well as neurosurgical reps.

That’s a lot of people, but there’s still more bodies in my room!

  • Depending on the type of case, you may have additional staff from other areas of the facility participate in the care of the patient. For example, for some vascular cases we have interventional radiology techs in the room. For some cardiac cases, we have cardiac cath lab or TEE techs involved.
  • When a new procedure comes to your facility, there are often many other people who are involved. You may see a proctoring physician (one who is already familiar with the surgery) who is there to supervise and/or assist the surgeon performing the new procedure. There may be other resources necessary for these situation. When my facility first began transcatheter aortic valve replacement surgery, we had 25-30 people in the room! We are now down to about 8-10.
  • Students. You may see student nurses observing in the OR or student surgical technologists completing clinical experiences in the OR.
  • Staff from inpatient or other perioperative units observing. You may have a facility that encourages staff from other areas to observe surgeries for the patient population they provide care for. A nurse from the preoperative, postoperative, or PACU area may observe surgery to have a better understanding of what the patient experiences before or after they provide care.

Still more people in your room? I’d love to hear about who else helps provide care for the patients in your OR!

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4 Comment(s)

Wow! That is so interesting! Thank you for sharing!

heather42r, ADN, BSN

Specializes in OR. Has 7 years experience.

Great article! I was racking my brain trying to think of anybody else and all I could come up with was neuromonitoring for some of our spine cases! It's crowded in there sometimes isn't it!?

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 16 years experience.

18 hours ago, heather42r said:

It's crowded in there sometimes isn't it!?

Indeed. 

18 hours ago, heather42r said:

all I could come up with was neuromonitoring for some of our spine cases!

My facility utilizes outside companies, so in my experience I would lump them in with vendors. But I'm sure other facilities are different!

Brenda F. Johnson, MSN

Specializes in Gastrointestinal Nursing. Has 29 years experience.

Yes, it does take a village doesn't it? I work in GI, but sometimes we go down to the OR. I am always amazed at the number of people setting up, etc. Each has a place and a role (thank God for all of them!)