There are a lot of unknowns and misconceptions about the role of a Registered Nurse in the operating room. So today I wanted to go over exactly what I did as an RN in the OR. This, of course, may vary or be different in other hospitals. However, I wanted to share my experience and what I did in order to shed light on the role. I hope that if you’re looking into a position like this that you will find this helpful. Perhaps you know someone who is an operating room registered nurse and you are interested in knowing more about what they do.
What does an RN do in the OR?
There are technically two roles nurses can play in the OR – a circulator or a surgical assistant.
Circulator Registered Nurse
This was my role in the OR and the most common role for a nurse in the OR. As a circulator you act much like a conductor of an orchestra. You are the conductor of the operating room. You’re assigned to a surgery with a surgical technologist who you work very closely with. You typically have a half an hour to an hour and a half (however sometimes a lot less time than necessary!) to set up your case. Each surgery is referred to as a case.
Each case has a preference card which tells you what surgery it is, what equipment, supplies and instruments are needed, what medications you need to give, how to position the patient, and any extra special requests from the surgeon.
Before the Surgery
While setting up the OR for the case you also need to go meet your patient in pre-op. You’ll need to get report from the pre-op nurse. Then you will run through a series of standard questions with the patient. You also need to draw up any medications that are typically ordered from the anesthesiologist. The most common medications I have given before taking them back to the OR are Versed(which is a sedative) and Decadron(which is used to help prevent nausea and vomiting). These both are given through the IV. A pre-op antibiotic is something else you will usually hang to run through the IV as well.
After meeting your patient in pre-op you’ll go back to your OR. You will make sure you have everything you need and finish helping the surgical tech set up the room. You will also need to coordinate with your anesthesia team. This typically means making sure there is a CRNA (certified registered nurse anesthetist) available for your case.
Once everything and everyone is set to go and the surgeon gives the go ahead you will bring the patient back to the operating room. Some important last minute checks before bringing the patient back include double checking to make sure all the consents are signed and verifying the surgeon marked the correct surgical site if applicable. Also, it is important to answer any last minute questions the patient or family might have.
During the Surgery
Next, you will bring the patient back to the operating room. Once in the room you will get the patient positioned appropriately for the surgery. Most times you will just have the patient move over on to the operating bed unless it is a procedure requiring the patient to be face down. Next, you will work with your CRNA and anesthesiologist to get the patient comfortable and off to sleep. Once asleep you will then finish positioning your patient which can be a process depending on the surgery.
When the patient is asleep and positioned the nurse’s next job is to prep the incision site using either a chlorhexidine sponge stick, a betadine scrub, or a different solution depending on what the surgeon prefers. Then when the incision site is prepped and the appropriate amount of dry time is taken the surgeon can begin the procedure. The nurse will then also move around any necessary equipment to get that into place and hook up any necessary cords or tubing. One very important thing to note before the procedure begins is that the nurse and tech have to do a sponge count (or an instrument count if it’s an open belly case). This can be done before bringing the patient to the room or before prepping the incision site just as long as it gets done before an incision is made.
When the procedure has started the nurse can then go and start on charting. They must also simultaneously be listening to the surgeon and tech in case they need any other supplies or instruments. What the nurse does during the procedure greatly varies depending on the procedure itself. You may need to collect and label specimens, you may need to make several trips to the supply room for things, you may need to move equipment around the room, or you may need to track down an inpatient bed. There are many things that the nurse juggles throughout the procedure.
Once the procedure finishes up you will do another sponge and/or instrument count and verify there is nothing unaccounted for. You will contact reception so they can get the family so the surgeon can meet with them and let them know how things went. You will help your anesthesia team with waking up the patient and then moving them back on to their bed. Then you will bring your patient to recovery with your anesthesia provider. Lastly, you will give report to the recovery nurse.
After the Surgery
When you are done with all that you’ll return to your room and see if there is anything that needs to be taken care of in there. Such as specimens that need to be sent to the lab or implant records you need to put in the chart or pass along to your resource people. Then last but not least you will finish up your charting.
When you have everything done and finished you will check in with your team leaders and see what cases you’re on for the rest of the day. Then you’ll do it all over again. Now I may have left out a few things throughout the process but I feel that this gives you a very good overview and understanding of what you do as a circulating operating room registered nurse.
Surgical Assistant Registered Nurse
This role isn’t as common in the OR for an RN. A surgical assistant often referred to as a first assist can be either an RN, surgical tech, nurse practitioner, or physician’s assistant with the proper training.
As a surgical assistant you are scrubbed into the sterile field so you would gown and glove as the surgeon and surgical tech does. You may also help with prep and positioning before the procedure starts. Once scrubbed in you will help to hold retractors, utilize suction, suture up when finished, or function as needed for the surgeon during the procedure.
In this role you also typically work at the surgeon’s clinic and you would see the patient in the clinic setting as well as in the OR. As I said this is not my role so I don’t know as much about it but I hope that gives you a better idea of how the nurse functions as a surgical assistant.
Any other questions?
If you have any questions in regards to being an operating room registered nurse or anything I could clarify further on please leave me a comment below! You can also feel free to send me a message either on here or through my social media! I’d be happy to answer any questions you may have!
Hope you enjoyed the insight and have a great day!
xoxo,
Heather
