Transcript Operating Room Nursing

Operating Room Nursing
What is OR nursing?
• An OR nurse is considered a periOperative
nurse that is responsible for the care of the
patient before, during and after surgery.
• The circulator is required to be a registered
nurse- nonsterile to help anesthesiologist and
surgeon during surgery
• Depending on the hospital, an RN can also be
trained to scrub.
Team Work
• The operating room consists of a team. This
includes
– The surgeon
– The anesthesiologist
– The surgical scrub technicians
– The RN circulator
– Potentially a Physician’s Assistant and/or sales
representatives
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Specialities
• There are different specialities that exist in the
OR and differ depending on the hospital
– General
– Gynecology
– Ear, Nose and Throat (ENT)
– Dental
– Plastics
– Vascular
– Orthopedics
Responsibilities
• Before surgery
– Ensuring the OR has the proper equipment, any
positioning devices, and the operating room table is in
correct position, anesthesia circuit and suction is hooked
up, BAIR warmer and sequential compression devices
(SCD’s) are readily available
– Counting sharps and sponges (instruments if needed) with
the scrub person
– Pulling medications such as local and antibiotics
– Reviewing the patient’s chart to ensure the history and
physical is within 30 days, the surgical consent has been
signed within 60 days, and the day of surgery note has
been entered by the surgeon.
Preop Interview
It is the nurses responsibility to interview the patient
preoperatively and verify
– identity, surgical procedure, marked if surgery consits
of laterality (ie right or left), allergies, if they are on a
beta blocker that it has been taken within the past 24
hours, any metal implanted in the body, and the last
time they had anything to eat or drink, they do not
have anything on that can be removed (ie dentures,
jewlerly etc.)
– The patient has spoken with both the surgeon and
anesthesiologist and they have no questions before
taking them back to the operating room
Responsibilities cont.
• In the operating room
– Assisting the anesthesiologist with hooking the patient up
to monitors, administering oxygen and intubating the
patient
– Positioning the patient, hooking up the BAIR warmer, SCDs,
cautery pad if needed, prepping the surgical site
– Tying up the scrub techs and surgeon
– Hooking up equipment cords needed on the sterile field
– Conducting a Time Out that verifies the correct patient,
surgical procedure, laterality, allergies, available blood
products if needed, DVT prophylaxis, implants/special
equipment in the room and any concerns
Responsibilities cont.
• During surgery
– Charting
– Opening needed supplies to the sterile field
– Getting additional supplies
– Assisting the anesthesiologist as needed
– Handling specimens and cultures
– Performing first and final counts with the scrub
tech during closing if applicable
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Responsibilities cont.
• After surgery
– Calling postop/PACU to alert them of our arrival
– Transferring patient onto stretcher
– Assisting anesthesiologist as needed with
emerging the patient from anesthesia, any
complications, extubating etc.
– Helping to transfer patient to postop/PACU
ANA Code of Ethics
• Provision 3
“The nurse promotes, advocates for, and
protects the rights, health, and safety of the
patient” (ANA, 2016).
• Provision 8
“The nurse collaborates with other health
professionals and the public to protect human
rights, promote health diplomacy, and reduce health
disparities” (ANA, 2016).
Patient Interaction
• As operating room nurses we have a short
amount of time before surgery to interact with
our patients
• It is important that in that short amount of
time we show compassion to ensure the
patient we will be their advocate while they
are under anesthesia
Communication
• In the operating room effective
communication is imperative between the
anesthesiologist, surgeon, and nurse to ensure
the patient’s safety.
• “Poor communication between team
members in OR is regarded as risk factors for
mishaps and complaints” (Kumar, Har Dash, &
Chawla, 2013, p. 373).
Communication cont.
• Airway, breathing, and circulation are priorities
and must be monitored throughout the surgery.
• If the patient has to be intubated again due to
complications, a new IV is needed, blood
products are necessary, and additional
medications are needed; the anesthesiologist and
nurse must work together as a team.
• During the surgery the anesthesiologist and nurse
are usually the only two unsterile team members
in the operating room.
Communication cont.
• Communication between the surgeon and
anesthesiologist is important as well.
– For example, the surgeon should ask the
anesthesiologist if it is acceptable to proceed with
the start of the surgery.
– The anesthesiologist might have the surgeon
momentarily stop surgery due to a change in
patient condition.
Is the Operating Room the right
nursing for you?
• Enjoy working as part of a team
• Schedule Monday-Friday with oncall after
hours and on weekends
• Interested in anatomy, surgical procedures
and sterile technique
• Detail oriented with strong communication
skills
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References
• American Nurses Association. (2016). Code of
ethics for nurses with interpretive statements.
Retrieved from
http://nursingworld.org/DocumentVault/Ethics1/Code-of-Ethics-for-Nurses.html
• Kumar, M., Har Dash, H., & Chawla, R. (2013).
Communication skills of anesthesiologists: An
Indian perspective. Journal Of Anaesthesiology
Clinical Pharmacology, 29(3), 372-376.
doi:10.4103/0970-9185.117116