Registered Nurses' Roles in the Operating Room
"I’m not telling you it’s going to be easy, I’m telling you it’s going to be worth it."— Art Williams
What Is an Operating Room (AKA: Surgical Suite)?
First I guess I must explain what the operating room (OR) or surgical suite is. The OR is a group of rooms (called suites) where surgery is performed. When using OR in a sentence it can mean one of the rooms or the entire group. Surgical suite means the same as OR.
Licensed Roles In Surgery
Within this group of rooms, you will find a group of extremely dedicated, extremely talented individuals. Everyone has a role to play in the never-ending ballet of surgery. There is the surgeon (of course), but there are also anesthesiologists, Certified Registered Nurse Anesthetists (CRNA), Certified Nurse First Assistant (CNFA), scrub nurses and circulating nurses (registered nurses with OR training). Many unlicensed individuals are also involved in keeping the operating room running smoothly. We will look at roles for the registered nurses (RN) in the operating room.
Methods of Training OR nurses
The following three roles may be performed by registered nurses with operating room training. I had a 3 month class (in a classroom) I needed to complete before I was allowed into the operating room. An experienced nurse was with me for my first 6 months to mentor and assist me to learn the circulating nurse role. I was paid for my classroom time. If I left the hospital system before 1 year was up, I would have to repay some money for the course. (I didn’t really pay attention, I knew I would be in OR for a long time.)
There are other routes to becoming an OR RN. I have trained both new nurses and nurses transferring from another unit. At one location we would have them spend three months in the central sterile processing department (CSPD) learning the instruments and sets and simultaneously learning how to clean and care for them. Three months as a scrub nurse, learning which surgeon used what and why. And six months with a preceptor in the OR. Surgery involves information not used on other units—equipment of all sorts—just take my word for it, most is foreign to average people.
Each facility has its own routine for training individuals into their operating room. I can’t say if one is better than another. We all learn a little differently. The Association of periOperative Nurses (AORN) has a program called “Periop 101” that some people like.
There are different ways to learn, and different ways to teach, but if the outcome is competent and compassionate operating room nurses, who cares how they learned. Most registered nurses in the operating room will perform all of these roles depending on their daily assignment. Let's look at the three registered nurse roles: circulating nurse, scrub nurse and float nurse.
The Circulating Nurse Role
As a circulating nurse, you are in charge of the room. You ensure hospital policy and procedure are followed. You will constantly be performing infection control duties. Patient advocacy is your main job. Everything you do, you do to keep your patient safe.
When you are circulating you will help open the room and bring in the necessary equipment. You ensure the stand-by supplies and instrumentation is available. After you assess the patient, you give report to the scrub person.
During surgery, you handle all non-sterile functions. From opening needed supplies and instruments to documenting everything that is happening, circulating is a busy job. Some days you get in that "zone", you love the music playing, and everything you do seems right. These are the days you live for. The feeling of satisfaction after a good day is the reason you put up with the bad days.
After the surgery, you bring the patient to the post-anesthesia care unit (PACU), give a report to the nurse there, and it all starts again. Cleaning the room, opening the supplies for the case, and assessing your patient is a constant loop.
For a more detailed explanation of the circulator role you can read this.
The Scrub Nurse Role
I love being a circulating nurse, but I love the scrub role more. As the scrub nurse, you are part of the sterile field. You are right there where the operation is being performed. With a perfect view, you see all that is going on. You see first hand how truly amazing the human body is.
Scrubbing helps you to be a better circulator. It is hard to anticipate the surgeon's needs if you do not know what s/he wants. Scrubbing gives you the extra experience needed.
As a scrub nurse, you assist with cleaning your operating room. You gather the necessary supplies and instrumentation. You double-check everything, because if anything is missing the surgeon will look to you first. A thick skin is required as you will be on the "front line" every time something is wrong.
Setting up all of the instrumentation and supplies is the scrub nurse's responsibility. You make order out of chaos by neatly laying out everything that will be needed. You organize it all so that the circulating nurse can see everything to make counting easier.
During surgery, you will hand the surgeon the needed instrumentation, supplies and suture (the needle and thread to sew with). You watch the surgery to anticipate what the surgeon will need next. After you have worked with the same surgeon a bit, it is like you have ESP, handing him/her what is wanted without any words being said.
At the end of surgery, you initiate the "counts" (counting all the instrumentation, supplies and suture). You keep yourself and your table of supplies sterile until the patient leaves the room. You prepare the instruments to go to the central sterile department so they can be cleaned and sterilized.
For a more detailed look at the scrub nurse role go here.
The Float Nurse Role
As a float nurse, you do a little bit of everything in the operating room. You pull the instrumentation for the day's cases. You give coffee and lunch breaks to the nurses in the rooms. You help clean and prepare the rooms, readying them for their next patients. Holding extremities (arms and legs) for preps and being available to help position patients are normal activities. When you are part of the float crew, you will pick the supplies for the next day's cases.
Many people think being a float nurse is easier than being in a room. Personally, I would rather be in a room. No matter how busy I am in a room, I am always busier when floating. When you are a float nurse you must be very time conscious. You need to know when cases are ending and when cases are starting. Close contact with the charge nurse is a must. As a float nurse, you need to know all changes to the schedule.
You must be very flexible as the float nurse. In the operating room, everything is always changing. You may be opening a case, only to find you are needed immediately in another room. Emergencies may arrive that will send your plans for the day askew.
It is a thankless job. If you are in a room helping one crew, and someone else looks for you, that someone else will immediately assume you are in the lounge taking a break. You may get the third degree from this someone else. Many nurses do not understand the role of the float nurse. Unless you become familiar with the job and its responsibilities, you will think it is easy.
Floating with an experienced float nurse is an excellent way for you to become acquainted with the operating room. You get to see many different cases while giving breaks. You get to see different ways to prep and position. You get to learn the stock room and the instrumentation room. I recommend asking to float when you are new.
Ways to Help Yourself Succeed
These three roles are the main jobs of a registered nurse in the operating room. Any time you are not in a case you should be picking cases for the next day to learn where things are. If possible try to help in the Central Sterile Dept. Helping here will allow you to learn which instruments are in each set. It is important to know where everything is.
In each of these three roles, patient safety and patient advocacy are your main focus. Everything you do should be linked to accepted standards of practice. In the OR, where everything is changing, it is important to spend some of your free time reading up on new equipment, new techniques and new standards. Operating room nursing is truly a profession, not just a job.
Which Role Do You Like Best?
If you are currently working in an OR, which role do you like best.
What Do Nurses Do in the Operating Room?
This Video Gives Another View of the Operating Room
This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.
© 2017 Kari Poulsen