What do OR nurses do all day?

Debbie_LPN · Jan 30, 2005

I am sorry to you dedicated OR nurses who use this board for serious topics but I had no where to turn. Usually I do my posts on the student forums, because I'm a second semester student in an ADN program. I just am overwhelmed with all the areas of nursing and I was hoping I could get some insight. Do OR nurses have a group of patients to care for or are they strictly in the OR and where the patients come from or go to is of none of their concern? Do they make incisions, sutures, do surgery??? I have so many questions. Where can I get these kinds of answers? I don't know any one who is an OR nurse. Thank for your time.

Not an OR nurse, but when we did our OR rotation, we all asked that same question. They told us nurses scheduled for the day would be assigned to a certain room all day, and if the surgery for that room was cancelled, they would just wait for the next one. They had 3 nurses to a room scheduled: a scub nurse, an assistant scrub nurse, and an RN that helped the doc. But that's just one hospital, i'm sure they might be different....

shodobe · Jan 30, 2005

You are going to find a wide opinion of what OR nurses do all day. I have to be a bit biased since I have been doing this for 28 years now and still think OR nurses are the best in the hospital, but all nurses feel this way about their unit(and they should)! It really depends on where you work and how large an OR department is. I work at a small 4 room OR and we have only RNs as staff, this is a rarity in today's OR. There are two staff, a scrub and a circulator, assigned to each room. The schedule is done the day before so you will know what you are going to do the next day, this can however change at a drop of a hat. We do have some nurses who do some specialty scrubs, eyes and such, but do all other procedures. In California the ratio is 1:1 so you are only concerned with that patient and no others. We do care very much for the safety and welfare of our patients and take the job very seriously. The patient is asleep and defenseless and relies on us, as RNs, to be their advocate for them in a time of need. We are not always up and cheerful everyday and do have those times where some things just bug us and we are not in the best mood. We try to be as cheerful and understanding as possible and try to get the patient to relax and have faith in us and their surgeon. Our time with a patient, awake, is limited and we don't always get the chance to really know our patients, but if you can look at a chart and read between the lines you can get a good sense of what the patient is all about, be it good or bad. As a OR nurse you ahve to be able to shift gears at any time and go from the routine to the emergent. OR nursing is more than what alot of other nurses see. We are behind closed doors and away from the general population of the hospital and some staff really don't know what we are all about. If you can, it would be good to see if you could shadow an RN in the OR for a day to see what OR nursing is all about. Also, do a search through this section and you will find out quite a bit. Sorry I couldn't answer all your questions, if I think of anything else I will post tomorrow. Good luck! Mike

serenity30 · Feb 7, 2005

I am thinking about doing OR nursing and have read some of the threads i would like to know what is the pay scale for an OR nurse and doing they work five days a week or 12hr shifts, i am stillunsure what they do

porsch65 · Feb 13, 2005

Hope this helps you out. I work in Canada, so things may be slightly different here than in the U.S. I work in a 6 theatre surgical suite. There are 31 R.N.'s and 3 L.P.N.'s, two of them just recently graduated. We all take turns circulatating and scrubbing. Don't kid yourself that we just sit at a laptop all day. We start out our day getting our room ready if it hasn't been done the night before by our call-team. Ususally we have three nurses to a room. Someone usually goes out to interview our patient. Make sure that they are NPO etc. The interview is very important, in that you are the last stop before surgery. Making sure of allergies, preexsisting medical conditions, what kind of meds they are on, not just RX but over the counter and "herbal" meds, and any other extraciricular street meds.Do they have any implants, pacemeakers, lenses in the eyes, plates, screws or mesh in their body. Is all their jewelery off, anything pierced. Is their lab work complete, have they been grouped and matched. Confirming which side surgery is to be on. Do they underdstand what is going to happen, is the consent complete and legal. Do they have questions? On several occasions I have caught things that have neccessitated cancelling the surgery until another time. You are the patient's advocate the entire time that he/she is under your care sleeping and awake. Your interview must be thourough, so that if there is anything that the surgeon or gasman isn't currently aware of you can bring it to their attention.

You bring your pt. to the room, introducing the team to them. You do everything you can to make that pt. feel relaxed and comfortable. Many pts. are just a little nervous, who wouldn't be? when they come in for sx. You assist with the intubation and safely getting that pt. off to sleep.

Depending on whether your case is big or small, you may have to assist your gasman with the insertion of various line, epidurals etc. This can be time-consuming and he/she needs your undivided attention. Sometimes depending if it is a really big case you may spend the entire case with the gasman. Hanging blood etc.

If you are the scrub you need to set up your table for the case. You need to make sure that you have everything that you will need for your surgeon. You need to count and make sure that you keep track of everything that is on your table. When you are scrubbed you are joined at the hip with the surgeon. You have to pay attention to what is going on, you have to understand what you are doing for the pt. and why. You have to anticipate what the surgeon is going to need from you. You need to constantly to be aware that technique is not being broken, that your field remains sterile and orderly so that you can find what you need in a split-second when he/she asks for something.

The circulator: an underappreciated member of the team. He/she is the glue that keeps everything together. The circulator has to take care of the scrub, the gasman, the pt. and the surgeon. A lot of responsibility. Keeping track of sponges and doing the count. He/she opens for the scrub at the beginning of the case and helps to get them set up. Doing prep for the patient, washing and painting the surgical site, right side etc. making it as aseptically clean as possible. Inserting a foley if required. Positioning the patient as required. Being mindful of positioning the patient to maintain skin integrity and prevent the development of bedsores, ( which can show up 4-5 days later after surgery if the patient has not been properly positioned).

When the case is done you have to do a count and make sure that you have all your sponges, needles and instruments etc. You assist with transfering the pt. to the stretcher and take that pt. to R.R. or ICU. You need to be able to give an accurate report to the nures taking on that pts. care.

In between cases when the room is being cleaned you as the circuator and scrub are already preparing for the next case. Getting your case cart ready and assembling and last minutes supplies that you may need.

It is true that some cases ie lap choles etc. there may be lag time where it seem that you may not be doing anything but as Shodobe indicated you always have to be ready to go from a regular case to an emergent case immediately. One role that I have not touched on is that of the RNFA, perhaps someone with experience here can comment on that. Hope I have given you a better idea of what an O.R. nurse does all day. Pt. contact is limited, but I can not tell you how many times I have had a frightened pt whose hand I have held while they went off to sleep and again when they are waking up. Your role is the care of the pt is important. Maybe they won't remember your role in their surgery, some do, and if you can put that pt. at ease it so much better for their peace of mind. Again establishing that trust, as Shodobe mentioned between surgical team and pt. Working the O.R. is exciting and fulfilling. There is a steep learing curve and you are always learning. I don't know if you can get stagnant here.

Best regards and I hope this helps you out. R.N.

NurseDianne, ADN · Feb 13, 2005

Hi. I work in a small rural hospital where we have 1 OR suite and 1 PACU. We also have an endoscope room.

First of all, we have over the past several months been lucky (or unlucky) enough to have LPN nursing students with us 3 days a week. One of mine (and my co-workers) peeves is this. "Wow, I would love this job, ya'll don't work as hard at the floor nurses". :angryfire NOt a good thing to say.

Let me give you a run down....we get to work very early, there are NO perioperative nurses for us. We do it all. (as in we I mean, my OR supervisor, me (RN), 1 LPN, and a scrub tech) We also have a CRNA. Anywho....we do the preop teaching, the perioperative stuff, the charts, the set-up, the clean-up, the callbacks, the QA, the PI, we make all the surgical charts and endo charts, we scrub all the instruments and run them......we are in total charge of our department. And our days are long. We work M-F 6:00 am until we are finished. 2 of use take call every other week for after hours. I have everyother Sat & SUn that I can call my own.

So, my reply to the nursing student who thought our job looked easy was this...."we work very hard to make it look easy".

These nursing students did not come to the PACU to see all of that, their feet hurt and needed to sit down.

It sometimes looks like we have it made, maybe we only had one case that day, but all of the cleaning, paperwork and such still has to be done.

Did that help? I did not mean to offend anyone, just shed some light on the subject. I know how busy I am everyday, I cannot imagine working in a 6 suite facility.

Dianne :rolleyes:

stevierae · Feb 14, 2005

Ususally we have three nurses to a room.

3 nurses per room!!! WHY? Personally, I don't like extra "help" in my room when I am the circulator--it's like everything you start to do, the other person is simultaneously starting to do, and the 2 of you are falling all over each other--you just get in one another's way. Even residents often get in the way, even though they truly are trying to be "helpful."

I think one RN per room (that is, the circulator--if the scrub happens to be an RN, of course that makes 2 RNs in the room) should be enough no matter how big the case is. One can always call out for extra help in the rare event one needs it, but, in my experience, that would be a rare event. Most RNs when circulating simply prefer to run their own rooms--they have their routines down.

Man! If any OR I ever worked at was that overstaffed, you'd better believe people would be signing up on the "go home early" list! I never turn down a chance to get out of anyplace early! Heck, I'll go home even before I've changed into scrubs in the locker room, if I hear they are asking for volunteers!!

Of course, for those who want to stay, there should always be the opportunity to backscrub someone, or perhaps work on special projects (ordering, stocking rooms, picking cases, etc.) if nurses do that in your department. I think there are always cases that, no matter how experienced one is, one could backscrub on to pick up some new tricks. I love doing that when there are new, sharp techs around--those young guys are really, really talented when it comes to spinal instrumentation and total joint systems of all sorts! They never cease to amaze me!

Personally, I think that the circulator giving report to the PACU nurses is unnecessary. PACU needs to know one thing---what kind of anesthesia this patient had, so that they can plan how to recover him. That's the job of the anesthesia provider, who will also mention the name of the operation, fluids, Foley, I&O, complications if any, allergies, etc. Report is just a very basic starting point, anyway--it's not an excuse for the PACU nurses to not assess the patient and actually READ the chart on their own. I usually accompany my patients to PACU, but, since in most PACUs nowadays there are 2 PACU RNs to recover the patient, and often an LVN or aide or orderly helping with warm blankets, plugging in the SCD unit, etc., plus anesthesia helping hook up monitors, O2 and simultaneously giving report, we would just be one extra body in the way. Many ORs I have worked at now have anesthesia and transport orderlies, plus the surgeon and/or his resident(s) transport the patient to PACU, while we stay behind getting ready for our next case.

porsch65 · Feb 14, 2005

Good Morning Stevierae, yes we always try to staff with 3 nurses. This helps for break relief. Although we may be staffed for 3 nurses, once breaks start happening there are often two. Our third nurse comes in on the 2nd shift, 9:15 and then breaks start. I did say that I worked in Canada and that things here may be slightly different than in the U.S. Hope this clears things up.

stevierae · Feb 14, 2005

Good Morning Stevierae, yes we always try to staff with 3 nurses. This helps for break relief. Although we may be staffed for 3 nurses, once breaks start happening there are often two. Our third nurse comes in on the 2nd shift, 9:15 and then breaks start. I did say that I worked in Canada and that things here may be slightly different than in the U.S. Hope this clears things up.

Oh, OK, that makes sense. We have relief nurses come in on other shifts, too--i.e., 9 a.m. or 10 a.m, or even 11 a.m. or noon. They may not be assigned to the same room all day--they are there to give breaks (coffee & lunch for the circulators; just lunch for the scrubs, but generally the scrubs' lunches are longer since they do not get formal coffee breaks) to whatever rooms they are assigned by "the desk" to do so for. They also help out in other rooms as needed--i.e., just stopping by, popping their heads in, releiving people for meetings, doctor's appointments, etc., seeing if anyone needs anything or could use a bathroom break or an extra pair of hands.

I thought you were saying everybody is there at 7 a.m. (or whenever your day shift starts) ---my misunderstanding. :kiss

porsch65 · Feb 15, 2005

Hi Stevierae, just one more thing I wanted to clarify is that in Canada we do not use surgical techs, everyone in the O.R. is a nurse, either R.N. (31 of us) or L.P.N. (3 of those gals). But that day may be coming as we are a publicly funded system, and licensed professional staff are +$$$$. One Surgeon thinks that trained monkeys could do my job. I told him I don't think so... a monkey's bladder is not big enough. haha,

Take care and I look forward to reading more of your posts on the site

stevierae · Feb 15, 2005

Take care and I look forward to reading more of your posts on the site

Right back at ya, babe! :)

MelissaRN · Feb 21, 2005

I've been working as an OR circulating nurse for about 9 months. My orientation was long (about 6 months) and I still feel like a rookie. I think that being able to function in any kind of capacity as a circulator after 6 months is a huge accomplishment. We're basically learning 20+ years of technological advancements in that short amount of time. It's not an easy job and you're basically all things to everyone from the patient, surgeon, the scrub to the anesthsia team.

If the role of the nurse circulator looks easy it's because there are nurses that have been dedicated to the job for 20+ years and they work hard to make it all run smoothly and have a lot of patience with us newbies.

Oh and let's not forget those old school surgeons that feel that the best way to teach a newbie is to yell, rant and rave at them!! :chuckle