The role of the operating room nurse is extremely important. They are the captain of the ship or operating room in this case. I am going to explain their role as a day in the life of an operating room nurses. Hopefully this help you understand and may entice you to explore this as a career goal.
You arrive at work for your scheduled shift. Go in the locker room and change into provided scrub attire. The scrub attire is provided due to need to minimize outside contaminants from entering the operating room area. You will note that the entrance to an operating room area is clearly marked with signs stating operating room attire required past this point. You will also cover your shoes with shoe covers, and your hair with a surgical bonnet, also provided. Now you are ready to proceed into the operating room area and check out your assignment for the day.
Your assignment is usually posted on a schedule, white board, or more recently the schedule can observed on a large monitor like a plasma TV. You will find your OR room assignment, the cases set to be completed in that room for the day, the patient ID, surgeon performing, and surgery to be performed. It may also contain your partner, a surgical tech or perhaps another nurse. Also of importance, the anesthesia provider. This may be an anesthesiologist or CRNA (certified registered nurse anesthetist. Depending upon the surgery, the surgeon may have scheduled an assistant or they may employ their own physician assistant. It is important to remember things change frequently in an operating room. A surgeon may be delayed, an emergency may come in, or another surgery may run longer than expected. So the first case of the day is the only one you can guarantee is going to be done in your room.
Next you need to go to your assigned room and check to see if your case cart is there. This cart contains all the supplies and instruments required for the surgery and usually contains the preference card. The preference card is paperwork that lists all supplies, instruments, equipment, hints for setting up the room, and any surgeon specific preferences. This card also alerts you to what is to be opened for the surgery and what you should have available should the need arise for its use. Depending on the size of the facility and assigned staff duties, this may be your responsibility. I have worked in OR’s that have staff dedicated to pick the supplies and instruments and delivering them to the room in the morning. Sometimes it was my responsibility, or the surgical tech’s, or the set up staff. Ultimately, though, it is the nurses responsibility to make sure everything needed is in the room.
Then you and the surgical tech will open all the necessary supplies and instruments in a sterile manner and ensure that sterility is maintained. During your perioperative training, you will learn how to properly open packaging and instrument containers and check for sterility. Once all supplies are open, the surgical tech will go to do their hand scrub and return to the room to set up these things in an organized fashion. While they are setting up, you can check your equipment to make sure it is all functioning properly. I usually also use this time to go and interview the patient, and tell the surgical tech that I will return to perform the surgical count.
The patient will usually be in a pre-operative holding area. This area is staff with nurses that perform duties to prepare the patient for their surgery. Once again, it is your responsibility to ensure all pre operative orders have been carried out. Read over the surgeon’s orders. Check the order for consent against the consent that was obtained and the scheduled procedure to ensure they all match. Check over lab work to make sure it is done, on the chart, and within normal limits. A standard of care for most surgery performed is giving a prophylactic antibiotic prior to surgical incision. The hospital should have a program in place to ensure this done appropriately and it is the surgical nurse’s responsibility to ensure the proper antibiotic is available and ready to be given.
If the patient’s chart is not at the bedside, take it to the bedside and interview the patient. Introduce yourself and give your title. Ask the patient to give their name and date of birth, while you check this information against their identification bracelet and chart information. Ask them to tell you what surgical procedure they are having performed and about any allergies they may have. Ask when the last time was that they had anything to eat or drink. Once all is well and you know there is no contraindication to proceeding, explain to them what they can expect upon arrival into the operating room. I usually use this explanation ” Well, Mr Smith, looks like everything is in order” “Once the surgeon arrives we will be heading back to the room” “When we get in there is will bright and on the cool side, but I have nice warm blankets back there to keep you warm.” “First thing we will do is line up the stretcher and the bed, lock them in place and have you move over to the bed.” “But we don’t want you to do anything until we say go” “Once we have you safe and secure, we will be connecting you to monitoring equipment to keep an eye on your heart rate, blood pressure, and oxygen saturation.” ” The anesthesiologist is then going to give you medication through your IV to drift you off to sleep”. “We will be with you the entire time.” “The surgeon will fix you up and then when you hear us talking to you again, that means we are all done and you are going to the recovery room.” “Any questions?” If they have any questions, I answer them honestly. I then excuse myself to finish getting things ready, and tell them I will be back when the surgeon arrives. I then go back to the operating room to finish up with preparations there.
By this time, the surgical tech should be done or just about done setting up. We then count all the instruments, sponges, sharps, and any other supplies we want to be sure do not remain in the patient post surgery. This is very important. You should make sure that you know your facility’s surgical count policy and always abide by it.
When the surgeon has arrived and spoken to the patient, and complete what he needs too, you can proceed to the room with the patient. Once in the room follow the steps exactly as you describe them to the patient during the pre op interview. Stay at the patient’s side while anesthesia is induced. This is so the patient is assured you are there and so the anesthesiologist will have a second set of hands to help in there tasks. Once the patient is asleep and anesthesia say to proceed, you need to place your patient in the proper position for the surgery. You may need to place a foley catheter. Prep the area to be operated on. Tie up the surgeon’s gown. Read aloud the patient name, type of surgery to be performed, allergies, antibiotic given and any other pertinent information.
Now you can accurately document all patient care rendered up to this point. Monitor sterile surgical field to ensure that sterility is maintained. Immediately address and correct any breaks in sterile technique. Dispense any required additional supplies to sterile field. Organize and supplies coming off sterile to ensure ready for final counts. When surgery is nearing completion start counting necessary supplies and instruments to ensure nothing is retained in patient. Report count completion to surgeon, also if there is family in waiting area that needs to be spoken too. Dispense supplies to sterile field to dress incision. Make sure surgical tech cleans the patient prior to moving them to stretcher or bed.
Now you transfer patient to recovery room, give report to receiving nurse. Make sure you address all pertinent information, health history, surgery performed, dressings, drainage devices etc. Complete documentation.
Report to charge nurse and communication board to see what is next in your room. And start the process all over again.
I have worked in general surgery. I like this area because I get a diverse case exposure. I may start the day with a laparoscopic cholecystectomy and next be assigned a lumbar laminectomy or total hip or knee replacement. I like doing different types of surgery. Some of the large institutions have specialty teams ie. the ortho team or the vascular team. This is great for nurse that like one particular type of surgery. I like to change things up, so have been quite happy to work in facilities that don’t have that designation.
I hope this article has helped you understand a little better of what a nurse in the operating room does. This is my experience and the role may vary slightly from facility to facility.
Lisa Seigler RN
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