OR nursing vs. floor nursing

RNtUamazing · Dec 12, 2012

Ask your manager if you can observe some surgeries. If you're turned down, ask the surgical director if you can come in on your day off and observe. Circulators are much more than "go-fers". I ensure patient safety with assessments, counts, positioning... I make sure that equipment and supplies are on hand and working, potentially cutting down on time the patient spends under anesthesia. I communicate to the team correct patient, correct doctor, correct surgery, correct side, allergies, and any other vital information that the patient is not able to communicate while under anesthesia. I know their histories to make sure there isn't any contraindications for surgery. I make sure their lab orders are correct so results on cultures, specimens, ect are available to the medical team as soon as possible. I ease their mind before surgery, hold their hand during induction, and call their families during surgery. I do a lot more than just those things, but the list is too long. Surgical nursing is real nursing. It is also real challenging. I come home every day exhausted and happy. It is an amazing specialty to be a part of if you have the right type of personality and enough energy.

Editorial Team / Admin · Dec 13, 2012

but I feel like there may actually be time in the day for a lunch break?!

There are no guarantees. Today, my lunch lasted a whopping 15 minutes- and that even caused us to delay a surgery for several minutes (which was okayed by my boss- the surgeon never knew). Some days, there's just so much going on and just not enough people to go around giving lunches. Yes, the chances are much higher than the floor, from what I hear, but still no guarantees.

I did shadow in the OR during nursing school, and the nurse I shadowed basically ran back and forth to get supplies the MD asked for the entire time...is this what OR nurses generally do

I'm gonna go with you missed a lot of what the nurse you shadowed was doing. There is so much more than being a go-fer to OR nursing. You are the last line between the patient and wrong site surgery, incorrect anesthesia procedures, and so many other things. OR nurses are responsible for:

-Interviewing the patient in preop. This confirms consents and what the patient are saying match what the OR schedule says and that you will have the correct instruments and supplies. Also verifying allergies so that appropriate antibiotics, prep solutions, and type of gloves (latex okay vs. non-latex) are available. (had a patient this morning who was allergic to every single skin prep solution we stock- had some interesting discussions about improvising). Verify that all paperwork is in order- consents, orders, implant documentation.

-Upon arrival in OR, confirming again correct patient/procedure/site/laterality/type of anesthesia.

-Positioning: avoiding any pressure areas, ensuring appropriate surgical site exposure.

-Prepping: decreasing chance of infection, ensuring proper solution is utilized (such as avoiding any alcohol containing preps if there is involvement of mucous membranes or open wounds).

-Documenting: if it's not documented, it didn't happen.

-Medications: we use many meds/solutions in the OR that are very specific and we actually mix them ourselves, leaving pharmacy out of the loop.

-Assisting anesthesia as needed: cricoid pressure, giving drugs if anesthesia provider unable (sterile while inserting lines, etc.).

-Many, many more.

or do they assist with the surgeries? Sorry for so many questions, any information will help me tremendously :) Thanks!

Depends on the facility. Some will have nurses learn to both circulate and scrub. Others reserve the role of scrubbing for surgical technologists (generally cheaper to use) and nurses only circulate. An advanced role that some nurses can take on is that of registered nurse first assistant (RNFA). These nurses have additional training and are allowed to do more than other nurses and surgical technologists in the scrub role.

My advice:

OR nursing is not for everyone. It's a tough environment, and not all people are easy to get along with. Spend several days observing if at all possible.

Here's how you should spend your observation time:

-Focus on what the nurse is doing. Forget about watching the surgery. Yes, surgery is interesting to watch; however, that is not the focus of the OR nurse's job. This is the biggie.

-Ask questions, but do so at appropriate times. Anesthesia induction, time out, during counts, while hooking up all the things that are passed off the field, when the patient is waking up, are generally not good times to ask questions because the nurse needs to give his/her undivided attention to that task.

-Watch the interaction between team members in the OR. This can give you a feel for how well (or not) people in the department work together.

Make a list of the pros and cons. My personal pros: no weekends worked unless on call and the phone rings, only day shift, great teamwork environment. My personal cons: the current call situation at my position is a bit, shall we say, overwhelming. However, I work in a specialty that is only staffed by a select few who cover all of the call- and it was my choice. Surgeons- they can be not so pleasant at times (and that may be an understatement on occasions.)

Only you can decide if OR nursing is for you. Use the list of pros and cons you create, use the knowledge gained from observing, and utilize available resources to learn about OR nursing. The Association of periOperative Nurses is the professional organization for OR nurses. Their website is: Association of periOperative Registered Nurses