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Operating Room Nurse: Roles

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Specializes in OR, ER, Med-Surg, ICU, CCU, Home Health. Has 40 years experience.

What Do Operating Room Nurses Do?

I have been an Operating Room Nurse since 1995. Previously, I worked in the Operating Room as a LPN/Surgical Technician from 1980-1994. I love working there. I do tire of hearing comments from other nurses that OR nurses don't really do nursing duties.

Operating Room Nurse: Roles

I'm here to set the record straight. I am as much a Registered Nurse (RN) as the next nurse and I do patient care.

Operating Room Nurses assess, diagnose, plan, intervene, and evaluate their patients just like every other nurse. We are responsible for maintaining a sterile environment in the operating room, monitoring the patient during surgery, and coordinating care throughout the process. We are also responsible for making sure the OR team provides the patient with the best care possible.

Let me tell you how.

The RN specializing in Perioperative Nursing practice performs nursing activities in the preoperative, intraoperative, and postoperative phases of the patients' surgical experience. Based on the Standards and Recommended Practices for Perioperative Nursing--A.O.R.N., the operating room nurse provides a continuity of care throughout the perioperative period, using scientific and behavioral practices with the eventual goal of meeting the individual needs of the patient undergoing surgical intervention. This process is dynamic and continuous and requires constant reevaluation of individual nursing practice in the operating room.

Assessment

The patient enters the preoperative area and is assessed by the preoperative RN. The perioperative RN (Circulating Nurse), then interviews the patient with particular emphasis on ensuring the patient has informed consent, has been NPO for at least 6 hrs. prior to surgery, and current medical history to determine any special needs for the care plan.

The perioperative nurse explains to the patient what will happen during the operative phase and tries to alleviate any anxieties the patient and their family may have. The nurse develops a rapport with the patient that enhances the operative experience for the patient by building trust and assuring the patient and the family of the best care possible.

The assessment includes, but is not limited to:

  • Skin color, temperature, and integrity
  • Respiratory status
  • History of conditions that could affect surgical outcomes (I.e. diabetes)
  • Knowledge base related to the planned surgery and complications that could arise
  • NPO status
  • What medications were taken the morning of surgery and the time taken
  • Allergies and what reactions the patient experiences
  • Placement of any metal implants, especially AICD's and pacemakers
  • Time of last chemotherapy or radiation therapies
  • Verification of patient's name and date of birth
  • Checking to verify all medical record numbers match the patient's name band and paperwork

This information is then used to develop the perioperative nursing care plan.

Diagnosis

The nursing diagnosis is written in a manner that helps determine outcomes. Some nursing diagnoses for surgical patients are:

  • Impaired gas exchange related to anesthesia, pain, and surgical procedure
  • Potential for infection related to indwelling catheter and surgical procedure
  • Activity intolerance related to pain
  • Anxiety related to anesthesia, pain, disease, surgical procedure
  • Alteration in nutrition less than body requirements related to NPO status

Planning

Planning the patient's care in the operating room is focused on patient safety. The nurse gathers supplies needed for the procedure according to the surgeon's preference card, positioning equipment, and any special supplies needed as determined by the nurse's assessment and the patient's history. Preparation assures that the nurse will be able to remain in the surgical suite as much as possible to provide care for the patient. The nurse leaving the room is avoided as much as possible, but unforeseen circumstances may require the nurse to leave to obtain equipment or supplies. When the patient is brought to the operating room and transferred to the operating table, patient comfort and safety are the priority. The nurse provides warmed blankets for the patient and applies the safety strap across the patient. The surgeon is called to the OR suite and the "time out" is performed with the patient participating. Items verified in the time out are the patient's name, date of birth, allergies, procedure to be performed, correctness of consent, site marking, if applicable, and any antibiotics to be given within one hour prior to incision. The patient is instructed to take deep breaths before and after anesthesia to maintain oxygen saturation above 95%. Strict aseptic and sterile techniques are maintained throughout the surgical procedure to reduce the risk for postoperative infection. The nurse remains at the bedside during the induction phase and holds the patient's hand to help reduce anxiety. The patient is reassured as needed.

Nursing Intervention

The circulating nurse and the scrub nurse/technician work as a team to protect the sterility of the operative field by maintaining constant surveillance. Any breaks in sterile technique, such as a tear in the surgeon's glove, are remedied immediately.

The nurse provides for patient comfort by placing warm blankets, remaining at the patient's side until anesthesia has been successfully induced and the anesthesia provider releases the care of the patient to the surgical team. At this time a foley catheter will be placed, if indicated, using aseptic technique. The patient will be positioned and all pressure points will be padded to prevent altered skin integrity. The surgical skin prep is then performed aseptically and allowed to dry before placement of the surgical drapes. Fumes from a wet surgical prep can form pockets of gas that have the potential to be ignited by a spark from the electrocautery used in surgery.

Prior to the surgical incision, the anesthesia provider initiates the infusion of the antibiotic ordered by the surgeon. A preincision verification performed by the circulating nurse rechecks the patient's name, the surgical procedure, the site/side of the procedure, the antibiotic infusion has started, and the prep is dry.

Evaluation

The circulating nurse monitors the patient vigilantly during the course of the perioperative phase which includes preoperative, operative, and postoperative stages of surgery. He/she is responsible for the smooth transition for the patient between these phases. Evaluation of the patient's response to the surgical intervention is ongoing and continuous. Have the surgical outcomes been met? If not, reassessment takes place to plan further.

Conclusion

The patient under anesthesia is totally dependent on the surgical team for their well-being. The perioperative nurse advocates for the patient. He/she is their voice during the surgical intervention.

Whether scrubbing, circulating, or supervising other team members, the perioperative nurse is always aware of the total environment, as well as the patient's reaction to the environment and the care given during all three phases of surgical intervention. The perioperative nurse is knowledgeable about aseptic technique, patient safety, legal aspects of nursing, and management of nursing activities associated with the specific surgical procedure being performed. OR nursing is unique: it provides a specialty service during the perioperative period that stresses the need for continuity of care and respect for the individuality of the patient's needs.

More Information

Operating Room / Perioperative Nursing

What it's Like to be an Operating Room Nurse

 

Beth, RN, CNOR, ASN Degree with Honors from St. Petersburg College, St. Petersburg, FL, Staff RN

1 Article   60 Posts

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147 Comment(s)

scrubcircrn

Specializes in scrub tech 3 year, Circulator 2 years. Has 2 years experience.

I'm so happy to see such a well written article explaining the surgical nurses duties. I am a new circulator but have been a scurb tech for a few years. Our pts are in a condition that they cannot see for themselves that everything is as it should be. We are there advocates in the surgery environment. The last thing I say to a family is we'll take good care of their loved one and I mean that with everything in me. I would expect no less from a nurse taking my family for surgery. Every nurse has a specialized set of duties no matter where they are in the medical setting but we are all nurses and we are all needed.

KEaFutureRNHopefully

Has 2 years experience.

That you SO much for directing me to your article! It helped me out a lot.

What a great article! I am a pre-nursing student and found this very informative and reassuring. For anyone who is having surgery or knows of family or friends that are having an operation this is a good thing to share with them.

What a great recap of what we do in the operating room! I would also like to add that the training period for a circulator in the operating room is usually 6-9 months or more. Whereas, a circulator can transfer to the floor and take care of patients in a matter of days.

Until I became an OR nurse I had no idea all that was involved. I even had physicians tell me that all I would do is pass instruments! But it is much more involved than that. I think this is the one true area where patient advocacy matters most--speaking for the anesthetized patient. I also took the CNOR and it was one of the toughest certification exams I have taken (just passed my Adult NP certification exam).

Every OR patient deserves an RN!

Eileen MSN, ARNP, CNOR

Kei35

Specializes in OR, Home Care, Managed Care, Case Mgmt. Has 10 years experience.

I love this article. I had so much fun in the OR while I was an OR nurse. It's hard to explain what we do to others because they'd have no idea since there is not much exposure to it in nursing school! You did an amazing job putting the pieces together. Thank you!

Thank you, BETH CNOR for the concise description of what we do every day!

WELL DONE!!!

ms.beth,thank you very much for this splendid article.

rubichick

Specializes in Surgery, Dialysis. Has 6 years experience.

Very well said. Thank you for informing everyone. :yeah:

Thank you. I have an OR interview next week and I think your article will be helpful. :)

mzkede

Specializes in PP, OR, med-surg,oncology, urodynamics. Has 9 years experience.

Thank you so much for this post!!! From one circulator to another, it's appreciated!!

desertnurse222

Specializes in Critical Care.

Thank you! I am entertaining the thought of transfering from critical care to the OR and this was very hepful!!:up:

Jeffthenurse

Specializes in Nurse Manager, Med-Surg, Instructor.

Thank you for a well written, informative, thorough article. I still feel however, that OR nurses are overqualified for the position. Any nurse would be overqualified. The patients are only in the OR for a short time, informed consent, NPO status, the chart, tests, have already been checked several times up on the unit, and "the nurse develops a rapport!!", yeah, for about 2 minutes! Most of the assessment part involves being a last second secretary. Diagnosis? The care plan has already been written up on the unit; education will be done on the unit----the patient isn't going to remember much about whatever you will teach them. ...."Holds the patient's hand to comfort them...", aaawww, you really need a BSN for that! I feel different about nurses in the recovery room. They're often Critical-Care nurses. I'm speaking from being a patient and from 33 years of nursing experience. It's just my opinion and I thank you again for your article.

I plan to discuss this again on my radio show on an AM station in Philadelphia, PA in the future. I just never saw the need for a Registered Nurse in the operating room. Often, you're just a gofer.

:specs:

BethCNOR, BSN, RN

Specializes in OR, ER, Med-Surg, ICU, CCU, Home Health. Has 40 years experience.

Jeff, I'm really glad that your surgery went well and that overqualified gofer that took care of you didn't have to do any work while you were under anesthesia. Where have you practiced your 33 yrs. of nursing? A radio show? Are you even practicing nursing?

I am disappointed you don't feel there is a need for a registered nurse in the OR. Have you worked in the OR?

Yes, I only have a short time to develop a rapport with my patients, but believe me, I do. I try to make them feel more at ease before they come to the room. I explain what will happen to them when they get to the OR. Yes, I only have one patient at a time, but that patient gets 100% of my attention. No, I don't need a BSN to hold a patient's hand, but I do need compassion, something that it sounds like you are quite lacking. The OR has its own care plan so it is NOT written on the floor. I cannot tell you how many times I have discovered discrepancies in consent, labs, and NPO status that should have been caught on the unit, but weren't.

I agree, PACU nurses should be critical care nurses. Some are, some aren't.

I appreciate your comment, but I do wholeheartedly disagree with you. It's just my opinion.

Jeffthenurse said:
Thank you for a well written, informative, thorough article. I still feel however, that OR nurses are overqualified for the position. Any nurse would be overqualified. The patients are only in the OR for a short time, informed consent, NPO status, the chart, tests, have already been checked several times up on the unit, and "the nurse develops a rapport!!", yeah, for about 2 minutes! Most of the assessment part involves being a last second secretary. Diagnosis? The care plan has already been written up on the unit; education will be done on the unit----the patient isn't going to remember much about whatever you will teach them. ...."Holds the patient's hand to comfort them...", aaawww, you really need a BSN for that! I feel different about nurses in the recovery room. They're often Critical-Care nurses. I'm speaking from being a patient and from 33 years of nursing experience. It's just my opinion and I thank you again for your article.

I plan to discuss this again on my radio show on an AM station in Philadelphia, PA in the future. I just never saw the need for a Registered Nurse in the operating room. Often, you're just a gofer.

I disagree with just about everything you've written. From what I understand, when things go wrong, they can go wrong fast, and in an immediate life/death way. Nothing is guaranteed or assured. If I were a patient, I'd want those OR people to be the most "overqualified" people I could have (I dislike that term intensely - an HR hiring manager's "buzzword"). You make it sound like OR nurses are mere caretakers, and I don't buy it for a second. So you have a radio show eh? I avoid talk radio nowdays for many reasons - most of what they preach I'm not buying.......

Jeffthenurse

Specializes in Nurse Manager, Med-Surg, Instructor.

I have been practicing nursing for over 33 years as a staff nurse, nursing supervisor, nurse manager, educator, preceptor for new nurses and/or students, clinical instructor, and health care sales rep, and all of these jobs entailed more than holding someone's hand or fetching NSS or D5W for the doctor! And yes, I am practicing now as a home care nurse which also entails more thought and expertise and critical-thinking than talking to a patient for less than 2 minutes.

I went into broadcasting so I can highlight nurses' expertise and put nursing into a good light for a change. I've had many nurses on the show in the past 6 months, talking about a variety of topics. I believe that nurses in the operating room just highlights doctors feelings that nurses are just handmaidens and can be pushed around. That contributes to the overall feeling in this country that nurses are insignificant. Look at the assault rates in emergency rooms and on med-surg units. Physical violence directed at nurses is on the rise. There are many reasons for it and one of them is that nurses aren't respected. Maybe if nursing was dominated by male nurses it would be different. Maybe we should take over! Then we'll trade----operating room staff will not be nurses and hospital administrators will be nurses. That's a good deal....maybe we should look into it.

desertnurse222

Specializes in Critical Care.

Oh, boy,are you gonna get it! You didn't seriously just play the gender card (in addition to insulting your peers! )Are you trolling or what?!!!