Many Roles / Many Areas
The perioperative nurse can occupy one of many roles, including pre-op, operating room, and post-op (or PACU).
Had I been asked what these nurses do prior to my employment in the operating room, I’m not sure I could have thoroughly explained the important work these nurses do every single day.
Nurses working in the pre-op area have the very important duty of preparing and managing a patient prior to surgery. These nurses take a thorough physical assessment in order to address any potential problems that may increase the patient’s surgical risk. NPO status is verified, IV access is initiated, vital signs are assessed and labs are drawn in pre-op. Any issues such as abnormal values, abnormal vital signs, and skin issues near surgical site are reported to both anesthesiology and the surgeon in order to address any additional needs and the safety of proceeding with surgery.
Pre-operative procedures exist to improve surgical outcomes, reduce the potential for complications to arise, and ensure that anesthesia and surgery are as safe as possible.
Additionally, the preoperative nurse must address the psychological concerns many patients have prior to surgery. It is not uncommon for patients to present as anxious on the day of surgery and the preoperative nurse must take measures to provide comfort and reassurance to these patients during what can seem like a long wait before they are taken back to the operating room by the OR nurse.
In the Operating Room
Operating room nurses can have one of two roles during a case.
Circulating Nurse - The circulating nurse is the one who is in charge of the case and coordinates the activities of the assigned operating room. Known as the circulator, this nurse is tasked with ensuring all necessary personnel and equipment are ready prior to the patient ever leaving pre-op. This may include hanging IV fluids, establishing IV access in the OR if it does not already exist, ensuring a warming device is available to maintain patient normothermia during surgery, pulling medications such as antibiotics, local anesthetic, and irrigation fluids, ensuring the scrub tech or surgical assistant has all necessary instrumentation and all instrumentation has been confirmed as sterile, ensuring all patient positioning aids are in the room, verifying surgical consent with the patient as well as surgical site and laterality, performing counting of sponges, sharps, and instruments on the sterile field prior to incision, assisting the anesthesiologist with anesthesia induction, opening implants where applicable, verifying closing counts match pre-op counts, charting the case as well as charting and sending specimens to pathology as appropriate. Additionally, the circulator must be ready to coordinate emergency intervention if circumstances dictate such. In emergencies, the circulator becomes the delegator when interventions such as mass blood transfusions are necessary.
Scrub Nurse - In some facilities, nurses may also train to “scrub” cases. In this role, the nurse is performing the function of a scrub tech in that the scrub nurse must be sure all instrumentation and equipment are available for the specific case and that the surgical field sterility is maintained throughout the case. This role is very case-specific and the nurse must have knowledge of how the surgery is performed, the instrumentation the surgeon will need at each step of the case, and surgeon preferences.
The scrub nurse can also “first assist”, which means that they act as an additional set of hands for the surgeon and maintain optimal visibility of the surgical site through the use of suction, retractors, or even cameras in laparoscopic cases.
Ultimately, the OR nurse is the patient’s advocate at a time when they cannot advocate for themselves.
The role of the post-op nurse, or PACU (post-anesthesia care unit) nurse, are specialized professionals who provide intensive observation and intervention to patients who have just been under anesthesia. PACU nurses typically have a background in intensive care or emergency nursing. They are required to have Advanced Cardiac Life Support, be able to interpret ECGs, and often are required to have Pediatric Advanced Life Support as well.
PACU nurses responsibilities include airway management, monitoring vital signs, managing postoperative pain, treating postoperative nausea and vomiting, monitoring surgical sites and dressings in order to identify complications such as excessive bleeding, unusual discharge, and excessive swelling. In facilities that utilize patient-controlled analgesia (PCAs), the PACU nurse may be responsible for educating the patient on how it is appropriately used. The nurse-patient ratio for PACU nurses is typically 1:2 for stable patients and 1:1 for higher-risk patients including those still requiring respiratory assistance and pediatrics.
This article has only scratched the surface of what perioperative nurses do on a day to day basis. Surgery can be an anxiety-provoking time for anybody, especially those who may not fully realize what to anticipate. Perioperative nurses at every stage provide a calming and skilled professional presence at a time when the patient is most vulnerable.
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