Shortage of OR Nurses

Hi, Everyone:

I have 2 questions:

1. I have read many posts that say that there is a shortage of OR nurses. Can anyone tell me why that is?

2. I have been reading that OR/Circulating nurses only concentrate on one patient at a time, but I thought that a Circulator is in charge of many different OR rooms at once and goes in and out of all of these rooms to see what is needed. Would someone please clear this up for me?

Thanks.

Sorry I can't answer our questions but I would like to respond to one of your questions.

I have an interest in possibly pursueing OR upon graduation but I must say that the many posts I have read here on allnurses concerning the way OR nurses are treated I may re-consider. Perhaps this is the answer to question #1? Maybe someone with knowledge/experience can chime in here:nuke:.

Hi, Everyone:

I have 2 questions:

1. I have read many posts that say that there is a shortage of OR nurses. Can anyone tell me why that is?

2. I have been reading that OR/Circulating nurses only concentrate on one patient at a time, but I thought that a Circulator is in charge of many different OR rooms at once and goes in and out of all of these rooms to see what is needed. Would someone please clear this up for me?

Thanks.

I can answer your second question more easily than the first. Circulating nurses are the unscrubbed/unsterile members of the team in the OR who are in charge of the patient, their safety, their documentation and other charting and paperwork; assisting the other members of the team, including the anesthesiologists and those who are scrubbed in on the case by providing them with sterile materials and supplies they don't already have on the field, or have run out of during the case, or need because of some change in the process that occured during the procedure; they are also in charge of counts of needles, sharps, instruments and any other items that must be accounted for with a definititive counting process before, during and after the surgery, acquiring and dispensing medications to the members of the team in the sterile field, and sometimes for anesthesia as well, say from a Pyxis, during the case; calling for extra assistance for the scrubbed members or others who need extra hands because of some unforseen circumstance, sending labs and specimens to Pathology for frozen sections should that be required, and so on and so on and so on.

They do NOT leave the room during their case to run in other rooms and attend those cases. Each nurse is assigned to one case at a time. Each case has at least one circulating nurse - and on bigger, more extensive procedures, sometimes more than one. Hope that helps clear that part of your question up some.

Thank you for the information. Is there a separate nurse assisting the surgeon across the table, or is that a Scrub Tech? Is there extreme physical labor in being a circulating nurse?

Thanks,

There is another person handing instruments to the doctor and this may be a surgical tech or an RN who scrubs.

Being a circulator is a physical job-I am constantly on my feet. We also move patients and lift heavy instrument trays.

Now that trauma season is here, I put away my nursing clogs and I wear sneakers instead-it's a lot easier to run that way!

Sorry I can't answer our questions but I would like to respond to one of your questions.

I have an interest in possibly pursueing OR upon graduation but I must say that the many posts I have read here on allnurses concerning the way OR nurses are treated I may re-consider. Perhaps this is the answer to question #1? Maybe someone with knowledge/experience can chime in here:nuke:.

Yes, there are cranky people in the OR at times, but you learn assertiveness when you do this job. And I don't think there are any specialties where nurses are treated all that well. For the most part, it's been my experience that surgeons treat the OR staff decently. Their cases and how smoothly these cases run are in our hands. You'll always get a jerk here and there, but usually, we tend to get along.

All:

Thanks for the information. Not to beat a dead horse here, but I have a few more questions:

1. Does the Circ. Nurse ever work as the Scrub Nurse?

2. Does the Circ. Nurse ever get pulled to work on the floor?

3. What is the Circ. Nurse doing when the OR has all of the tools needed for the case? Does she/he assist the OR techs?

4. I am confused about the Scrub nurse/OR Tech position. Both the OR Tech and the Scrub Nurse are handing tools to the surgeon?

Thanks,

All:

Thanks for the information. Not to beat a dead horse here, but I have a few more questions:

1. Does the Circ. Nurse ever work as the Scrub Nurse?

2. Does the Circ. Nurse ever get pulled to work on the floor?

3. What is the Circ. Nurse doing when the OR has all of the tools needed for the case? Does she/he assist the OR techs?

4. I am confused about the Scrub nurse/OR Tech position. Both the OR Tech and the Scrub Nurse are handing tools to the surgeon?

Thanks,

1. There are some nurses that can scrub(I'm one) but in any given case, you are either the scrub or the circulator, you cannot do both at once.

2. I don't know about other places, but in my hospital, OR nurses don't float to the floors, and we don't have anyone from the floors float to us.

3. The circulator is foremost the patient advocate. We chart, position the patient, prep, put in foleys, monitor the field for sterility, deal with the blood bank/check blood with the anesthesiologist, do counts with the scrub, give meds to the scrub etc etc etc. That patient is our main concern.

4. Your scrubbed person may either be a nurse or an OR tech.

If you are in nursing school, you may be able to observe in the OR. This may give you a pretty good idea of what the OR is like.

All:

Thanks for the information. Not to beat a dead horse here, but I have a few more questions:

1. Does the Circ. Nurse ever work as the Scrub Nurse?

2. Does the Circ. Nurse ever get pulled to work on the floor?

3. What is the Circ. Nurse doing when the OR has all of the tools needed for the case? Does she/he assist the OR techs?

4. I am confused about the Scrub nurse/OR Tech position. Both the OR Tech and the Scrub Nurse are handing tools to the surgeon?

Thanks,

To elaborate on question #2 - The Operating Room/Surgery is a highly specialized area that requires a different skill set from "floor nursing" and it takes anywhere from 6 months to a year to orient a new RN to the ORs when she/he firsts starts working there. Some places have a very structured orientation, including class work, hands-on "Lab" practice learning the skills you need to do your job, and working with a preceptor or preceptors learning in the "real world" of Surgery. These programs generally focus more on the role of the RN as a circulating nurse than as a scrub nurse, but scrubbing can be learned in a separate type of training, either in conjunction with or separate from learning circulating skills.

AORN has a program structure that can be used to accomplish this and some hospitals may use this - some use their own based on a program devised by their staff members and Clinical Education. How long it takes to orient a new nurse to the unit can depend on several factors - the type of facility and the level of care provided, as in whether or not it is a teaching institution, a Trauma center, a small rural hospital, and so on. It also can depend on the learning curve of the nurse who is doing the orientation.

Since Surgery is such a different world in and of itself, there is almost no cross-venturing between nurses who work in OR and the nurses who work the units on the floor. The skills required to do either are very different, and it would be impossible for a floor nurse to "rotate" to OR in a pinch, without already having those current skills in place - same with going out of OR to the floors. I have worked in hospitals from 3 and 4 OR rural hospitals with less than 100 total beds, to large metropolitan teaching hospitals affiliated with major universities, and I've never see it happen in any of them.

Regarding your confusion related to who passes instruments, and assists the surgeon, there is a very informative website at www.ast.org which is the professional association website for Certified Surgical Technologists, or "scrub techs" as they are commonly known. There is a great deal of information there regarding identifying the surgery team members, what skills and knowlege are required to work as a Surgical Technologist, which in effect gives you a job description, and information regarding educational and certification requirements. I am not a proponent of this website in this instance to try and interest you in the profession - more to the point, to give you an idea of who is in the OR and how they all function as members of the team.

AORN is the professional association for Operating Room Nurses, and can give you more information from that angle. Since I am an AST member, and a Certified Surgical Technologist, I can tell you more from my perspective than I can from the view of the RNs. But there are plenty of them here who can tell you more, as some already have.

As far as circulating in the OR is concerned......It's very physical at times. Don't forget to add crawling along with moving and lifting!! I've crawled underneath the OR table many, many times to adjust this or that.

From an outsider's perspective, I'd say part of the OR nurse shortage is that trainings aren't done often enough! My hospital's OR is very, very short (so I hear from their nurses) to the point that they aren't getting breaks, but they won't hire little ol' me, who's dying to get in, because I only have ICU experience. It takes so much time/money to train a new OR nurse, I guess, that they can't just go out and hire people when they need them.

I just graduated last week..... and I am ecstatic to say I was hired before graduation into an OR residency program here in the NYC area. I am soooo excited to start and still in disbelief a bit that lil' ol' me is going to be an OR nurse!

The hospital I am going to will start me off as a floor nurse on a med surg/tele unit and after 4-6 months will start me in the OR residency program. The training is 10 months (which is an awesome training program). It is mainly a heart hospital so although I will start with general surgery, I am hoping on those open heart cases!!! :redbeathe

Oh my gosh.... I feel like I'm living a dream....... !!!!!

Now to pass NCLEX.........

There are states that require a circulating nurse to oversee more than one room at a time. Anyone can correct me if I am wrong, but I believe Minnesota and Connecticut are two examples. This practice is dangerous to the patient and there are people that are trying to make it required in all states that there is only one patient per RN.

I have worked in the OR for about 2 years and it is exhausting, physical work. But I steal the line from the Peace Corps that says "it is the toughest job you'll ever love". And you HAVE to love it or you are going to be miserable. I am seriously considering leaving my hospital OR for a surgical center where they do not have the heavy cases. But I am sure I will miss those heavy cases and the trauma cases once I leave.

Operating room nurses are specialized, needing specific training. There are times when you will be dealing with difficult people; whatever member they are of the team. AORN is working to change the culture in the OR from the "captain of the ship" mentality to one of mutual respect.

Also, operating room nurses (I believe) are the only nurses that have their own language; PNDS (Perioperative Nursing Data Set). This is exciting; blazing a trail for other nurse specialties to have their own language. Cementing the fact that nursing is a profession and not just a job.

It might be a good idea for you to join AORN. They give you much information that is very useful.

Good luck!