Nurse Tech role in Operating Room?

NewNurseyGirl2009 · Apr 4, 2009

I set up the OR, taking it all apart when were done. I gown the surgeon and glove them, maintain a sterile field and hand the dr. all the instruments and hold retractors. You learn alot about anatomy doing it.

Carliestarling · Apr 4, 2009

Hi Patrick! I started as a Nurse Tech in the OR. In my hospital we were given the AORN's peri-op 101 courses along with an extensive preceptorship. I got to scrub in and second assist (hold retractors, suction, etc..) and I was trained to circulate the room. If you are a technically inclined person, the OR will be great for you. But bear in mind, it is entirely different than any other kind of nursing. Don't expect to be giving meds very often, other than pouring meds to the field. (lidocaine, marcaine, etc..) Your pt. assessment will be quite different from what you learn in nursing school as well. You wont have much atonomy, as the Dr/Anesthesia is always there. You'll put many foleys in though! )

Now a days, most hospitals utilize RN's as circulators, preferring to use Certified Scrub Techs in the scrub role. It's cheaper for the hospital, and since techs aren't legally allowed to do many of the things RN's are licensed for, it makes sense financailly for the hospital to keep the RN's free from the field. However, as anyone will tell you--an OR RN should know how to scrub, because there are times when they will be called upon to do so--in an emergency when no scrub techs are available. Also, it benefits all when a nurse understands the surgery, because she can then best anticipate the needs of the team. But unfortunately, that is a skill set fewer and fewer nurses are learning these days.

What to expect from an average day in an OR? Well, you will go in, change into your scrubs, and be ready for report. This is not anything like a report you'd get one to one--like on the floors--but it's usually a group report--updates on equiptment, things like that. At this point, you look at the board, and get your assignmnet for the day.

Next, if you're in the role of circulator for the day, you'll go to your room with your scrub and make sure all the equiptment is up and running, and all supplies and instruments are ready for the first case. You'll look over the Dr's preference cards and find out how to position your patient, what meds to pull, type of positioning aids needed, type of prep, foley or not, etc.. You'll help the scrub tie their gown, you'll pour their meds and count with them, and if they have everything they need, you'll go to pre-op and check your patient. This includes a quick assessment, and a check of their chart for consents (have to be SIGNED!), pregnancy tests, allergies,labs, orders, and a recent H&P. You'll do a brief interview with your patient, and once you know the Dr. is in house and anesthesia is ready, you'll bring your pt back to the room.

Next, you get your pt onto the OR table, and stay by anesthesia's side until the pt is under. Then, once anesthesia's satisfied, you can begin to position the patient. You have to be very careful during positioning, and bear in mind that a patient can sustain nerve or pressure injuries secondary to improper positioning, so this is very important. (I probably pad too much). You'll need to apply a bair-hugger to maintain patient temperature, as hypothermia is a major concern also.

So, now that the patient is positioned, it's time to hustle, as by now the Dr. is probably scrubbing up at the sink just outside the room, and will come in and stare at you (maybe even complain) if you are taking too long. Now's the time to apply the bovie pad (attaches to the cautery device) to make sure the pt is grounded. (Bovie burns are another risk). Then comes the foley (if ordered) and the prep. (Careful with using too much prep, you never want alchol based preps to pool on a pt--once again--risk for burns/fires). Now back away from the patient, tie up the doctor and let the scrub come in and begin draping--creating the sterile field.

But DO NOT allow anyone to begin to even think about picking up an instrument until you have the entire room's attention: Time Out! Read the consent, verify correct patient using two indentifiers, correct side/site, any allergies, any implants or special devices/equiptment available, and the antibioics used.

Now scramble to plug in everything that the scrub throws off the field, and be on standby for anything else that may be needed. During this time, you can chart. But unless your scrub is really good and knows the case and surgeon really well--you'll probably have to get up several times to deliver instruments/supplies to the field. Once they start to suture the pt, you'll need to count with your scrub again. (If any counts are wrong--notify the surgeon at once--they may have to get an X-ray to be certain nothing was left inside the patient if the counts cannot be reconciled).

Hopefully there was time to chart everything--once the Surgeon leaves the room, make sure the scrub has all the dressings they need, and assist as needed. Don't move the patient until you get the okay from anesthesia--remember nursing basics--ABC's come first. Anesthesia is truely running the show from behind the curtain, and while you are paying attention to everything else, they are maintaining an airway and blood pressure. Finally, it's time to get the patient over to PACU, and give them report along with anesthesia. During this time the Orderlies come in and (if its a small OR, the nurse/scrub) turn over the room for the next case. Then, the whole thing starts over.

Somedays, depending on the nurse tech program you're in, you'll get the chance to scrub in. You should get a good six months before you'll be confident to perform in this role on your own, and since you wont get to do it every day, you may never get to be as completely confident as the scrub techs are. But that's okay--learn what you can from the scrubs, many are passionate about their jobs and are willing to teach someone who really wants to learn.

And some days, especially in the beginning--you'll have computer time. This is when you'll be working with the AORN modules. I know you'll be dying to get into the rooms, and classroom days will seem unbearable, but remember--you're getting paid to learn, and soon enough you'll be in the rooms every day.

Best of luck to you on your interview! Let us know how it goes!

Icenurse · Apr 5, 2009

Hi there,

Just wondering... so you don´t use scrub nurses at all?? In Iceland we only have RN´s in the OR. Both the circulatory and the scrub are RN´s. It is very important to nurses here to keep this role and great importance is laid upon gettin RN´s to specialise in OR nursing by the hospital. Hope that will keep on beeing the case.. because i love the OR:yeah:

cruisin_woodward · Apr 5, 2009

yes, it depends on the hospital... We have several RNs that do both. I prefer to scrub, I was an ST for 10 years, but also circulate. We also use both RNFAs, and CSTFAs. Some hospitals only use RNs for all roles, others use CSTs to scrub, and some (although not many) use CSTs to circulate, and have an RN supervising between 2 or 3 rooms. The law states that an RN must be present in the room..a CRNA is acceptable. This is opposed by AORN. learned to circulate in ST school, and I wouldn't be surprised if they go with the cheaper alternative of STs... If MAs can give medications, why can't an associate prepared CST? And as far as assessing the patient...I have never seen an OR nurse with a stethescope...

pagandeva2000, LPN · Apr 5, 2009

The OP is applying as a tech, and is in the first semester in the nursing program. It seems that the inquiry is about what a tech usually does. I don't know for sure, but I hear that they sterilize equipment, circulate and gown, clean up and count instruments at the completion of the surgery. Seems interesting to me...I have often inquired if I can apply for such a position as an LPN.

cruisin_woodward · Apr 5, 2009

we don't have nurse techs where I work, but we have pt care assistants... Here is what I did when I was one...

Prep pt for surgery (shave prep)

Transport pts

Run to SPD, lab and pharm

Clean and sterilize instruments

Clean room and help with turn over

Check case carts

Not a very glorious job, but you get out of it what u put in. You can either be a robot, or you can learn a lot... There is very little pt contact.

Hope this helps..let us know how the interview goes...make sure you ask in the interview what the job duties will be...if you are interested in OR, then it's a good place to start!

Carliestarling · Apr 5, 2009

Just wondering. What states allow CST's to circulate? I'm surprised more RN's (or AORN) aren't pitching a fit about that. And what is there for a "supervising" RN to do between 2-3 rooms? Once the case is going, what need is there for them if there's a CST circulating? Just for someone licensed to hold accountable if something goes wrong? Because there is no way CRNA's are going to want to be held accountable for the whole room when their one to one pt. care is so important and requires their full attention. Not being confrontational here, just trying to understand what's evolving out there. Thanks.

Carliestarling · Apr 5, 2009

As an LPN, you could be able to scrub. I've worked at a couple of places that had LPN's employed as scrubs.

cruisin_woodward · Apr 5, 2009

I am not actually positive, but we were taught to circulate in ST school, and that was what we were told. But AORN has been against it. They are also against licensing STs. This would aleviate the accountability on the RNs shoulders. This has been a long long battle between RNs and STs.

pmr32 · Apr 7, 2009

So my interview is tomorrow, never had a real interview before (i've had jobs but I always just seemed to get them from walking in) so any ideas what kind of questions I can be expecting? Thanks for all the great answers everyone, they're really helpful!

WoofyMutt80 · Apr 7, 2009

I am a tech in a Cardiac Cath Lab, and my formal training was medical assistant school. I stock the supplies in the rooms (we have 2 procedure rooms) and in our supply closet. Also I call various depts for certain supplies. I go in and prep the patient by shaving the area (usually the groin, and the men love their "bikini cuts") put on the EKG leads for the heart monitor, B/P cuff and SpO2 monitor. I also set up the room, help open up the sterile package, and assist the scrub nurse in setting up the sterile field. Also I hook up the lines to the contrast bottle and the Heparinized Saline bag in the pressure cuff and the lines for the hemodynamic monitor. Lastly I hand the scrub nurse the sterile catheters and wires and tie the gowns of the doctors and hold the bottle of Lidocaine while the scrub or doctor draws it up.