OR nursing QUESTIONS

marshag · Mar 1, 2004

Some of the reasons you posted here about why you like the OR are appealing to me. I, too, am thinking about doing an OR internship after giving L&D, nursery and LTC a try and disliking them all enough to leave after a few months. I am not a touchy feely person, I don't like dealing with families, having a patient load or even dealing with a patient many of the times etc. But I did have some questions:

Who is ultimately responsible for the patient in the OR? Is it the nurse that brings them in from preop, inserts foley, preps them, charts etc. and then cleans them up and takes them to PACU? If I think about giving the OR a try, I don't think I would want to do pre-op or any PACU. That sounds a lot like floor nursing. What kind of hours do you work and how much on call? Do you think OR is stressful?

Can you offer me some guidance? I am afraid I can't keep jumping from one specialty to another for much longer as I am a relatively new nurse and it will not look good on my resume. However, I think I would like to give OR a try before totally giving up on nursing altogether.

Thanks from Colorado!

What do I love about it?
I have only one patient and they are asleep. No families hovering around and making the job difficult. Everyone is focused on one job and one job only. No conflicting orders from different services, you are in the OR with the surgery service. Doctors treat you as part of a team, you don't get that on the floor. You develop close ties with the doctors, if you're good in the OR, you will be requested and respected, unlike the floor. If you like technology, it's here in the OR, if you aren't the touchy-feely type this is a great place to be. The hours are better, the days have an end (most of the time). You are focused, rather than scattered. You have a beginning, a middle and an end to a job.
I don't just stand all day, whether I'm circulating or scrubbed, sometimes you get to sit for longer periods of time, unlike the floor, where I never got to sit. At our hospital, you get a break and a lunch. Not on the floor where I worked 13 hours without a potty break.
You do lose nursing skills like starting IV's. We joke all the time we aren't real nurses anymore. I can live without starting IV's. I am highly skilled. ICU nurses no longer talk down to me, even the PedsICU nurses no longer talk down to me (and that's saying something). Most nurses don't eat their young in the OR, at least not in my experience.
If you have the opportunity to work at a university hospital you get to train the residents, they become your babies and they love you and respect you for keeping their butts out of trouble.
If I wasn't in the OR I wouldn't be a nurse. Would I rather be home watching movies all day? Yes. But if I'm gonna be a nurse it will be in the OR, not a unit or floor.
I'm finishing a BS and going to get a master's not in nursing, looking a public health, healthcare administration, business. Someday I want to wear real clothes again.

orrnlori, RN · Mar 1, 2004

I work 9am to 6:30pm 4 days a week. I take call one day a week for 4 hours beyond the end of my shift and I have to work one holiday per year. I'm a floater most days so I go from room to room, do breaks, do lunches, etc., then get my own room at 3pm for the rest of the day. I love to float. I also take care of lots of loose ends for various services because I work in them all.

The circulator is responsible for the patient, paperwork, instrumentation, equipment, permit, H&P, lab specimens, etc, etc, etc, and of course, whether the sun shines or not that day. :chuckle I would rather scrub and do every chance I get. It's a lot of fun.

Have you ever been in the OR for a day? I think you should attempt to get into an OR to see if it's what you want to do. I knew in nursing school after standing in the OR for 15 minutes that it was what I wanted to do and was lucky to get in after 7 months working in trauma. Our training program is 7 months long and you have to commit to working in the OR for 12 months beyond the end of training, so I would certainly need to know if it was what I wanted if there was a commitment like that attached to training.

Ferret · Mar 2, 2004

G'day all,

Over here the scrub nurse has the primary responsibility, but otherwise it is similar to what Ornlorri said. Try it out, OR nursing is great.

orrnlori, RN · Mar 2, 2004

Wow, the scrub has primary responsibility? Our scrub techs (some not all) show little or no initiative for anything but their tables. That's why they are paid so much less than the nurse. Interesting how different countries do things differently. Here, the scrub techs work under the license of the nurse, so therefore the nurse is primary for everything. Scrub techs aren't even licensed.

Ferret · Mar 3, 2004

Hi Ornlorri and all,

The scrub nurse is a registered nurse and has ultimate responsibility, scout (circulating) nurses can be Enrolled Nurses like LPN's, and we are starting to get technicians in the anaesthetic nurse role.

Technicians are like cancer... we have to fight the diminishing role of nurses in theatres or they will take over....

orrnlori, RN · Mar 3, 2004

Oh, I see, it's backwards from the US. Must be hard to be responsible for everything while you are scrubbed and sterile, trying to figure out how that would actually work. I like that name scout nurse. I definately feel like a scout on the days when I'm trying to track down the pans I hide for later cases that someone else has found and stolen back for their cases. But then that's part of the fun of the OR, who is the smartest at finding and hiding the most. :chuckle

Ferret · Mar 4, 2004

G'day All,

Hi Ornlorri, believe me, it took me while to understand how you do it too. How can a circulator be responsible for the count and instruments when the nature of scouting necessitates you spending time out of the theatre? (tracking down those elusive lost instruments) Scouts are responsible for the documentation, and accountable items, but the ultimate responsibility for the count and ALL instruments rests with the scrub.

Adiau!

orrnlori, RN · Mar 4, 2004

Ah, but our circulators ARE responsibile for the counts and instruments as well as everything else, paper work, patients, doctors, etc. All counts must be done by both the scrub nurse/surgical tech and the circulator together, and counts are recorded under both names on the records. If the counts are off, it falls on the shoulders of the RN. At least your scouts are nurses. Here our scrub techs aren't even licensed. We have some good scrub techs that are great co-workers but many of them have the "it's not my problem" attitude and help with little besides what directly affects their tables. This is why I prefer to work with another nurse, the teamwork can't be beat and there are no lines between what is my job and what is her/his job. We are both responsible equally. Very interesting differences. Thanks for your replies.

poopsiebear · Mar 18, 2004

i definately feel like a scout on the days when i'm trying to track down the pans i hide for later cases that someone else has found and stolen back for their cases. but then that's part of the fun of the or, who is the smartest at finding and hiding the most.

i couldn't agree with you more. we have a hiding place for magnetic pads and doppler probes.

i've been in the or for 2 1/2 years and i love it. or is like heaven compare to floor nursing, which i have done for 3 + years. i work 1 weekend every 2 months and 1 holiday a year. i'm on call once every 2 weeks, usually for 4 hours after one of my shifts, but i give away my call most of the time. all of us get 45 min lunch break (1 hour on a good day) with breaks in between. yes, i'm losing some of my nursing skills, but i have gained so much more from being in the or.

bessie

Ferret · Mar 20, 2004

As The RN is responsible for ALL the instruments, not just the accountable items, it seems to me that the circulator would find it difficult to do their own job while sitting on the scrub's shoulder watching the instruments, especially if your techs are as unconcerned as you say. Scary, really. Now I better understand the occasional newsclips we get over here from America, like the X-ray of a deaver retractor left in an abdomen, for example. I've wanted to scrub for four years, but became a very good scout in the process. Now I"m scrubbing for almost every case as part of my Perioperative Nursing course, and loving it! In normal circumstances, ideally we should have at least two RN's in a theatre, who take it in turns to scrub. Sometimes we have 3, or an EN, but things are hard on RN's when we are short-staffed and only have One RN and one EN on a list, and the RN scrubs for every case. The scout role is not very respected here, some people say that anyone can scrub, but a good scout makes any scrub look good, while others, especially young RNs, tend to focus on the scrub role and almost ignore scouting.

Ferret · Mar 20, 2004

As The RN is responsible for ALL the instruments, not just the accountable items, it seems to me that the circulator would find it difficult to do their own job while sitting on the scrub's shoulder watching the instruments, especially if your techs are as unconcerned as you say. Scary, really. Now I better understand the occasional newsclips we get over here from America, like the X-ray of a deaver retractor left in an abdomen, for example. I've wanted to scrub for four years, but became a very good scout in the process. Now I"m scrubbing for almost every case as part of my Perioperative Nursing course, and loving it! In normal circumstances, ideally we should have at least two RN's in a theatre, who take it in turns to scrub. Sometimes we have 3, or an EN, but things are hard on RN's when we are short-staffed and only have One RN and one EN on a list, and the RN scrubs for every case. The scout role is not very respected here, some people say that anyone can scrub, but a good scout makes any scrub look good, while others, especially young RNs, tend to focus on the scrub role and almost ignore scouting.

orrnlori, RN · Mar 20, 2004

I haven't seen the dever retractor picture, I have seen the large ribbon retractor x-ray, amazing isn't it. Still I hope you don't think this is the norm here!

I'll tell you, I've been in huge crush traumas where we were very lucky to get a good count on needles, etc. And sometimes given up and just x-rayed thoroughly at the end of the case looking for needles. But I've never had a lost instrument in the 5 years I've been here and pray I never do.

So you don't count instruments and sharps together with the circulator at the begining and at intervels in the cases and closing?

This is so interesting, but maybe I'm confused. The original question was who was responsible for the patient's care in the OR and went on to ask about foley's, prep, charts, etc. So there, the scrub does all the initial positioning, padding, prepping, etc. start the paper work, then scrub in and scrub the case and the scout fetches for additional things and does additional paperwork while you're scrubbed?