What Do Operating Room Nurses Do? - page 4

I'm here to set the record straight. I am as much a RN as the next nurse and I do patient care. Operating Room Nurses assess, diagnose, plan, intervene, and evaluate their patients just like... Read More

  1. by   subee
    Quote from ILoveRatties
    I think the OP significantly overstates the patient assessment and intervention done by OR circulators. I spent a year as a SRNA and, believe me, it is the CRNAs who have that major role. The surgeons do the surgery, the CRNA takes care of the patient, the scrub techs hand off instruments and supplies to the surgeons, and the circulators do something else. I think they take care of the environment--assuring that everything goes smoothly. The OR is like an alien world, and the OR RN assures safe passage for the patient. They are keeping track of the big picture. They have to know everything about the big picture that can go wrong, how to prevent it and what to do if the **** hits the fan.

    The CRNA monitors all the vital signs, gives meds, intubate, oxygenate, etc., etc. including induction, maitenance and emergence from anesthesia. The OR RN doesn't write a vital sign down nor track any of that during the surgery. They assure proper and functioning equipment, supplies, assist with positioning at the beginning and throughout the case. You can say 'go-fer' but that's insulting and incorrect. The OR RN is not sterile and not doing the second-by-second monitoring of the pts condition, so is free to be able to move around the room and leave the room to get things, etc.

    I wouldn't like to have a non-RN keeping track of the big picture during my surgery.

    All I know is that everyone in the room was aware when there was a newbie or an incompetent circulator running the room. It affected everyone else. All the roles are necessary in the OR. It is sort of like being a coordinator. Assuring that things run smoothly. The CRNA, scrub, and surgeon are very very focused on their own thing during surgery--the OR RN is free from that, but does what no one else can do--pay attention to the big picture.

    What they do is important. The best OR RNs might look like they are doing nothing, but that is because they have it all under control.

    For sure, it is a unique specialty in nursing. The OR nurse doesn't need to do much of the hands-on patient things. Someone else is doing them. No one develops much rapport with the pt--the contact is too short-term. The pt is usually asleep and if not, the CRNA is at the pts head doing the talking, touching, reassuring etc. No, it is not like bedside nursing--that kind of nursing is for the bedside. The OR calls for caring for the patient in another way--but it is just as much nursing.


    What exactly is it that you believe constitutes nursing. What skills SPECIFIC TO NURSING are they using? I don't think its an insult to nursing that RN's are not be best people for the OR. I don't believe that we have anyone who is the best person for that job. RN's should be taking care of PATIENTS - not surgeons, VCR's, running to pyxis, filling forms, etc. We do need SMART people to do the job and people who can work under pressure, but do they have to go through the system that we've designated as "nursing education?" I think we need a new type of practitioner to work in the OR with a different education than other RN's have. Been in the OR almost 30 years and think that we need to rethink OR nursing. Its way too expensive for the employers to be training the provider. They should come out of school up and running immediately - not a year later.
  2. by   shisalion
    Quote from Jeffthenurse
    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.
    Hey Jeff, here's a great "gofer" scenario for you. Female patient, age 60 with diabetes, HTN and CAD that goes in the O.R. for excision of a bladder tumor. The surgeons get in there, lacerate an artery towards the end of the case and the patient commences to bleed out fast. The surgeons are frantically trying to find the bleeder, anesthesia is frantically opening up the fluids, calling for volume expanders and trying to keep the blood pressure down. The circulator is getting blood products, volume expanders, setting up extra suction and throwing multiple lap sponges on the sterile field. The surgeons proceed to stuff a bunch of laps into the patient's abdomen. They couldn't tell how many they put in there. After things calm down the surgeons remove the laps and just want to close her up as quickly as possible. The circulator is finishing the 125 lap sponge count and comes up one short. The circulator checks again (including all trash cans in the room) as the surgeons are rapidly closing fascia. Still one lap sponge short. Circulator tells the surgeon and receives a snippy comment about not counting correctly. The scrub team checks around the sterile field and back table for the missing sponge. The count is done one more time and still one lap sponge short. The circulator suggests a KUB to check the abdomen before closing the patient and the surgeon refuses, again stating that the circulator is wrong. The circulator says the lap sponge count is incorrect and will document in the perioperative record the incorrect count as well as the surgeon's refusal to consider a KUB. The surgeon pauses, orders the KUB and... low and behold.... the lap sponge tape was seen in the patient's abdomen on the film. The surgeons then opened up the fascia, pulled out the missing sponge and closed her. Had the circulator caved in to an arrogant surgeon, the patient would have suffered a sentinel event of a retained sponge requiring another surgery. In this scenario, the perioperative RN circulator had the authority to document in the patient's record without cosignature because of independent licensure. That made the surgeon think twice about closing the patient and sending her to PACU with an incorrect sponge count. Patient care technicians are not licensed independently. If they worked in the O.R. as primary circulators, who is going to cosign their documentation? Anesthesia? The surgeon? Better yet, would a patient care tech have the balls to stand up to an arrogant surgeon to protect a patient? So, if RN's are too "overqualified" to be in the perioperative suite, why are we still there? Perioperative RN's are in the O.R. because the O.R. team and the patient needs us. This is only one of many scenarios I've experienced in the O.R. as a circulator. Your flippant "gofer" comment shows that you really don't have any idea what we do.
  3. by   McFly85
    Thanks for all the info. I've always been interested in the OR.
  4. by   Rose_Queen
    Quote from subee
    What exactly is it that you believe constitutes nursing. What skills SPECIFIC TO NURSING are they using? I don't think its an insult to nursing that RN's are not be best people for the OR. I don't believe that we have anyone who is the best person for that job. RN's should be taking care of PATIENTS - not surgeons, VCR's, running to pyxis, filling forms, etc. We do need SMART people to do the job and people who can work under pressure, but do they have to go through the system that we've designated as "nursing education?" I think we need a new type of practitioner to work in the OR with a different education than other RN's have. Been in the OR almost 30 years and think that we need to rethink OR nursing. Its way too expensive for the employers to be training the provider. They should come out of school up and running immediately - not a year later.
    So if you don't think nurses should be in the OR why are you there?

    Also, my hospital's critical care orientation is six months. Should RNs not work there because they aren't ready to right out of school?
  5. by   conuan61
    I have to say, it is always interesting what lengths nurses will go to to simply invalidate the professional roles of other nurses. I have been an RN for over 25 years. The first 8 years as a critical care RN and the last 17 years as a private practice CRNA. I hold a MSN and am completing a doctoral degree in Nursing. I would never advocate having a non-RN in the role of the circulating nurse. Those of you who disagree simply do not understand the OR...your ignorance is a powerful seductress. It can make you believe any avenue or path your mind takes you down.

    Suffice it to say, that after 17 years of working all hours of the day and night in the OR without an anesthesiologist (and for those of you out there that don't realize CRNAs practice without an anesthesiologist, surprise...there has never been a law that requires it...we are educated to independently select, administer, and manage all types of anesthesia), I WANT and DEMAND an RN by my side as I care for my anesthetized, intra-operative patient. RNs can assess, intervene, and evaluate in all situations...I believe that CSTs and SAs are all wonderful professionals in the OR setting, but only RNs possess the required education and experience to help me when the going gets tough. And as far as being up and ready to work the OR upon graduation...no nurse should be able to do anything independently upon graduation. That's ludicrous...that is why we have orientation/preceptor programs out there. I challenge anyone to TRUTHFULLY say they were ready to jump right into their first job after graduation without the help of a more seasoned nurse. Critical care, OR, ER, med/surg floor, OB, dialysis, occupational health, home health...they all require orientation to familiarize the RN with the accepted practice in that area...school teaches generalized care and theory, but not specific workplace clinical practice...that's what orientation is for. I don't even like a new grad who comes in acting like they can do it all...they simply do not have the necessary experience or bag of tricks to pull from yet, and they usually make serious mistakes.

    I suggest the rest of you out there that have only briefly worked the OR (or have never worked the OR) stop professionally bashing your peers and begin to stand united as NURSES...that's how medicine has gotten as far as it has...physicians stand united as a group...wake up folks...we nurses seem to spend more time being petty, trying to whine about who is better than who...it's self destructive. We are nurses and should stand proud TOGETHER. Ignore the "jeffthenurse"s out there that have all but left the profession for whatever reason...they are not worth it...they feed off others' frustration.

    Let's strike a blow for nurses supporting nurses huh?
    Last edit by conuan61 on Dec 1, '09
  6. by   desertnurse222
    Couldn't agree more. Well said. I am so sick of us nurses throwing each other under the administrative/MD bus. We have enough to deal with without turning on each other! If we stuck together we could change the system in a myriad of positive ways, but instead we always fall for that 'ol divide and conqour routne. It is a shame.


    That said,I have a quick question. I have ten years of critical care experiencce (all types) , and have had various applications in for an OR position for a while now. These postings have been there for over a month, but no one has called me for an interview. Is it absolutely necessary to hire on in a hospital to get in the system, then transfer to the OR? I am highly motivated with a strong CV and great references, but I can't get anyone to call me. What gives? Is there a certification I could be completing in the meanwhile to up my chances of being given an opportunity to learn the ropes in an OR environment?
  7. by   subee
    Quote from shisalion
    Hey Jeff, here's a great "gofer" scenario for you. Female patient, age 60 with diabetes, HTN and CAD that goes in the O.R. for excision of a bladder tumor. The surgeons get in there, lacerate an artery towards the end of the case and the patient commences to bleed out fast. The surgeons are frantically trying to find the bleeder, anesthesia is frantically opening up the fluids, calling for volume expanders and trying to keep the blood pressure down. The circulator is getting blood products, volume expanders, setting up extra suction and throwing multiple lap sponges on the sterile field. The surgeons proceed to stuff a bunch of laps into the patient's abdomen. They couldn't tell how many they put in there. After things calm down the surgeons remove the laps and just want to close her up as quickly as possible. The circulator is finishing the 125 lap sponge count and comes up one short. The circulator checks again (including all trash cans in the room) as the surgeons are rapidly closing fascia. Still one lap sponge short. Circulator tells the surgeon and receives a snippy comment about not counting correctly. The scrub team checks around the sterile field and back table for the missing sponge. The count is done one more time and still one lap sponge short. The circulator suggests a KUB to check the abdomen before closing the patient and the surgeon refuses, again stating that the circulator is wrong. The circulator says the lap sponge count is incorrect and will document in the perioperative record the incorrect count as well as the surgeon's refusal to consider a KUB. The surgeon pauses, orders the KUB and... low and behold.... the lap sponge tape was seen in the patient's abdomen on the film. The surgeons then opened up the fascia, pulled out the missing sponge and closed her. Had the circulator caved in to an arrogant surgeon, the patient would have suffered a sentinel event of a retained sponge requiring another surgery. In this scenario, the perioperative RN circulator had the authority to document in the patient's record without cosignature because of independent licensure. That made the surgeon think twice about closing the patient and sending her to PACU with an incorrect sponge count. Patient care technicians are not licensed independently. If they worked in the O.R. as primary circulators, who is going to cosign their documentation? Anesthesia? The surgeon? Better yet, would a patient care tech have the balls to stand up to an arrogant surgeon to protect a patient? So, if RN's are too "overqualified" to be in the perioperative suite, why are we still there? Perioperative RN's are in the O.R. because the O.R. team and the patient needs us. This is only one of many scenarios I've experienced in the O.R. as a circulator. Your flippant "gofer" comment shows that you really don't have any idea what we do.
    Everyone's emotions are getting in the way here. I'm not a circulator and I can count. No one is suggesting that a PCT become a circulator. I'm suggesting that we need ANOTHER KIND OF "NURSE"!!!!!!!!!! Perhaps a new kind of nurse with a new kind of license. For arguments sake, call this person an ORN (Operating Room Nurse). Yes, everything the circulator does is important and I'm NOT PUTTING DOWN WHAT YOU DO!!!!!!!!!!!!!! I am actually saying (anyone listening?) that the job is TOO IMPORTANT TO BE LEFT TO RN's who have NO training in the OR. I am, however, implying that the educational paradigm for the OR is more training skewed than the education of an RN. To the CRNA who replied to this thread; yes a pair of "trained" hands are vital but I prefer that that person learn about cricoid pressure in an academic setting, not on the job. Mechanics can learn on the job - I prefer my health care providers to have an education in the PARTICULAR SKILL SET that they do before they come to work. By the way, I'm not the person who made the gofer comment so don't flame on me. There are surgical tech programs that are two years in length. Now, compare that to the RN who has two years of community college almost everything they studied (with the exception of microbiology) has no TRUE applicability to the OR. Maybe that two year tech program could be redesigned for a person who could scrub and circulate. Do you need do have RN behind your name to count pads, deal with arrogant surgeon? I know LOTS of RN's who were really good at caving in. Certainly I was when I was young. Having RN behind my name had NOTHING to do with becoming more assertive. I work with plenty of appropriately assertive techs.
    '
  8. by   Rose_Queen
    Quote from subee
    Everyone's emotions are getting in the way here. I'm not a circulator and I can count. No one is suggesting that a PCT become a circulator. I'm suggesting that we need ANOTHER KIND OF "NURSE"!!!!!!!!!! Perhaps a new kind of nurse with a new kind of license. For arguments sake, call this person an ORN (Operating Room Nurse). Yes, everything the circulator does is important and I'm NOT PUTTING DOWN WHAT YOU DO!!!!!!!!!!!!!! I am actually saying (anyone listening?) that the job is TOO IMPORTANT TO BE LEFT TO RN's who have NO training in the OR. I am, however, implying that the educational paradigm for the OR is more training skewed than the education of an RN. To the CRNA who replied to this thread; yes a pair of "trained" hands are vital but I prefer that that person learn about cricoid pressure in an academic setting, not on the job. Mechanics can learn on the job - I prefer my health care providers to have an education in the PARTICULAR SKILL SET that they do before they come to work. By the way, I'm not the person who made the gofer comment so don't flame on me. There are surgical tech programs that are two years in length. Now, compare that to the RN who has two years of community college almost everything they studied (with the exception of microbiology) has no TRUE applicability to the OR. Maybe that two year tech program could be redesigned for a person who could scrub and circulate. Do you need do have RN behind your name to count pads, deal with arrogant surgeon? I know LOTS of RN's who were really good at caving in. Certainly I was when I was young. Having RN behind my name had NOTHING to do with becoming more assertive. I work with plenty of appropriately assertive techs.
    '
    But using the argument that OR RNs should have their own education program could make a case that every specialty should have its own education program. How much exposure do most students get to ER nursing? I had 2 days. I also only had 2 days in L&D. So before anyone gets exposure to any type of nursing, they should have to know which specialty they want to work in and apply to that program. And then if that argument gets made, nurses lose their flexibility to change specialties for any reason- burnout, family obligations, flexible schedules, etc. which is probably why some people even go into nursing.
  9. by   Batman24
    TY for all the excellent info. Very informative and helpful. As someone interested in this field I am so grateful for the breakdown of all you do.
    Last edit by Batman24 on Nov 28, '09
  10. by   HopefullyOR
    Thank you for the post! It is my goal to eventually be in the OR, get my CNOR, then go onto RN First Assistant!

    and subee... most facilities will not let you into OR nursing without previous RN experience AND periop training- be it outside training or in-house. The hospitals here don't even let you apply for their periop programs before you have 6 mos- 1 yr acute care nursing.
  11. by   conuan61
    I agree totally poetnyouknowit...Suggesting a "new kind of nurse" with a different license is just fragmenting the system more than it already is...we have LPNs (LVNs), RNs with ADNs, Diplomas, BSNs, MSNs and PhDs, DNSc (DNS), and DNPs. That's all we need now is to add another type of "Nurse" to the mix with a different license...that doesn't even make good sense. This is not emotion, it is true experience in the OR speaking! RNs have been providing HIGH quality care in the OR forever with very positive results. AORN is one of the strongest of the nursing organizations in our profession. I think that speaks for itself a great deal. Check the massive contributions RNs have made to military OR nursing too...war is where many discoveries are made to improve nursing and medical care.

    And subee, I work in a facility where they train the 2 year associate degree surgical tech students from a community college...they are wonderful professionals and the OR would be hard pressed to function without them, but...their education is very technique based and is not specific to patient care (you know...what we RNs are supposed to be doing?) They are educated to assist the physician in the room and at the field...most of them have absolutely no idea what all is involved in the actual CARE of the patient before, during and after the OR. They have little to no pharmacology education beyond local anesthetics and do not practice using a system like our nursing process. Most of them also go through a 6 month orientation process upon graduation...they are not "up and running" when they graduate either. There HAS to be an RN involved in the case...if you have indeed worked for 30 years in the OR as you mentioned earlier, how can you not understand? You are suggesting that OR RNs do no more for the patient that a technician can do...I hope I never have surgery in your facility then...I hope you are never forced to have surgery in just such a set-up as you suggest either...I for one want an RN in my OR (and all the other appropriate professionals) whether I'm the CRNA or the patient. ANYTHING else is cheating a patient out of the care they deserve.
  12. by   subee
    Quote from conuan61
    I agree totally poetnyouknowit...Suggesting a "new kind of nurse" with a different license is just fragmenting the system more than it already is...we have LPNs (LVNs), RNs with ADNs, Diplomas, BSNs, MSNs and PhDs, DNSc (DNS), and DNPs. That's all we need now is to add another type of "Nurse" to the mix with a different license...that doesn't even make good sense. This is not emotion, it is true experience in the OR speaking! RNs have been providing HIGH quality care in the OR forever with very positive results. AORN is one of the strongest of the nursing organizations in our profession. I think that speaks for itself a great deal. Check the massive contributions RNs have made to military OR nursing too...war is where many discoveries are made to improve nursing and medical care.

    And subee, I work in a facility where they train the 2 year associate degree surgical tech students from a community college...they are wonderful professionals and the OR would be hard pressed to function without them, but...their education is very technique based and is not specific to patient care (you know...what we RNs are supposed to be doing?) They are educated to assist the physician in the room and at the field...most of them have absolutely no idea what all is involved in the actual CARE of the patient before, during and after the OR. They have little to no pharmacology education beyond local anesthetics and do not practice using a system like our nursing process. Most of them also go through a 6 month orientation process upon graduation...they are not "up and running" when they graduate either. There HAS to be an RN involved in the case...if you have indeed worked for 30 years in the OR as you mentioned earlier, how can you not understand? You are suggesting that OR RNs do no more for the patient that a technician can do...I hope I never have surgery in your facility then...I hope you are never forced to have surgery in just such a set-up as you suggest either...I for one want an RN in my OR (and all the other appropriate professionals) whether I'm the CRNA or the patient. ANYTHING else is cheating a patient out of the care they deserve.
    You still haven't made a cogent argument for having an RN in the room - just using vague generalizations. I happen to know that most OR nurses know NOTHING to VERY LITTLE about pharmacology since they don't have to give any drugs and what little pharmacology you do need to know could certainly be taught in an Operating Nurse program in a college setting - not helter -skelter on the job from people with no teaching credentials. RNS are NOT "educated" to assist the physician. Where was that question in the boards? They're taught a few technical tricks by people who aren't teachers. No there does not have to be an RN in the room - I understand perfectly. For right now, perhaps, there has to be an RN because we don't have anyone else, but when I had my surgeries, I was glad that it was minor and almost anyone would do. If I had to be on the table for a trauma, I want a good surgeon, a good anesthesia provider and a tech who served in the military. Those techs knew their stuff - they had to - they didn't have an RN to fall back on in the field. RN's were busy doing PATIENT care, not SURGEON care.
  13. by   conuan61
    "subee"...i have to stop this banter, but i have to say...your arguments are far from cogent also, except maybe in your own mind. i like to professionally spar as well as the next guy, but, just as your emoticons banging their heads on the wall show, you just seem to be angry about something in the or. i really can't understand your frustration over an established specialty branch of nursing that some of our colleagues choose to practice...unless of course you are an instructor in a cst program and are advocating for tech circulators.

    i see by your profile that you are a crna with a msn...wow...i have to say i am very surprised! you realize, using your analogy, there is a subset of professionals out there that believe that anesthetists don't have to be nurses either. thus the evolution of anesthesiologist's assistants. obviously, you feel that they are better fit to deliver anesthesia than crnas since they are "specifically trained" to give anesthesia....none of that excessive, messy nursing knowledge clouding their practice. why go through all that nursing education first if you are just going to "give anesthesia?" do you really have to be an rn first? not by anesthesiologists' assessment. please......you really remind me of a couple of my crna instructors from many years back who felt that they had "risen above" the other rns in the or. i don't practice like that...they are my professional colleagues and i respect them for their patient care skills...unlike you. your facility must be very rough…our surgeons are respectful to our rns…this isn’t 1950 with “yes sir” and “no sir” just because they are physicians. we are all colleagues.

    since you stated in your last post that military techs couldn't "fall back" on an rn because they were busy giving patient care, i am intrigued as to whether you have military background. i have several close friends who are military and my partner is an army crna who has served several overseas combat assignments . they tell me the army and navy are very pro-rn in the or when at all possible...my military or tech friends tell me that the rns in the military often directed some of the surgeons as to “where and when…” because they out ranked them (some of the career rns were majors, colonels, or lieutenant colonels) you act as though you don't truly understand or care to understand the difference between an or tech's and an or rn's responsibilities, yet you certainly must after 30+ years as a crna...i guess we simply have to agree to disagree.

    so…similar to the curt way you put it...yes, there does have to be an rn in the or...i understand perfectly too. there always has been and there always will be...you know, busy giving excellent perioperative patient care, not surgeon care...surgeon care is the responsibility of the or techs and sas...

    by the way, may i introduce you to "jeffthenurse"...you two have a lot in
    common.
    Last edit by conuan61 on Dec 1, '09

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