We explain the three categories of an operating nurse specialty, and the different responsibilities in the surgical process each role has in the OR.
Registered nurses can practice in numerous specialties and settings. One such is in the operating room. The operating nurse specialty occupies three general categories, each with different responsibilities in the surgical process. While functions differ, all types of operating room nurses share similar educational requirements and required physical and mental skills.
The Scrub Nurse
Scrub nurses earn the title because they actually scrub their hands and arms. Upon scrubbing, the nurses wear gloves, sterile masks, and a gown.
Theses tasks form part of their duties in preparing themselves, the surgeons, patients and the operating room for surgery. A scrub nurse sterilizes the instruments and arranges them in an organized fashion for easy access by the nurse and surgeon. These instruments vary with the surgery, but typically include the scope, headlamp, clamps, forceps and scissors. The scrub nurse will also prepare the patient by attaching monitors, ventilators to provide oxygen to the patient and other equipment. Assessment of the patient may help identify for the surgeon, anesthesiologist and others on the surgical team the patient’s needs or conditions that may impact the surgery.
During the surgery, the scrub nurse hands instruments to the surgeons. This requires familiarity with the type of procedure and the instruments needed. To reduce delays during the surgery and the attendant risks of complications, the nurse must anticipate what instruments and materials the surgeon will use or need at various stages of the procedure. Caring for the patient in the operating room also involves monitoring vital signs and administering medications throughout the surgery.
The Circulating Nurse
In a different fashion than a scrub nurse, the circulating nurse helps prepare the patient for surgery. Such functions include obtaining patient signatures to informed consent paperwork. In these forms, the patient reads about the potential risks of the procedures and verifies agreement to have the surgery performed. The circulating nurse must verify the patient’s identity, age, height, weight and the presence of allergies. The inspection of the sterilization and the condition of the instruments falls to the circulating nurse.
Many of the circulating nurse’s duties occur away from the sterile area. However, these operating room nurses have important tasks during procedure and inside the operating room. As the title suggests, the circulating nurse relays supplies, messages and information between the operating room and areas outside. In the room, the anesthesiologists may need assistance from the circulating nurse in handling induction equipment or preparing the patient’s skin to receive anesthesia.
From the circulating nurse comes records of the surgical team’s actions, fluids and medications applied, complications and other events in the surgery. The nurse observes loss of blood, urine and other body fluid and reports it to the surgeons. Any specimens extracted from the patient are labeled.
As the surgery concludes, the circulating nurse takes the patient into the recovery room. There, the recovery nurse receives from the circulating nurse information about the patient’s progress during surgery, any complications, the patient’s condition. The circulating nurse must verify that the count of instruments after the surgery matches that before the procedure.
The Registered Nurse First Assistant
Registered nurses who achieve first assistant status work very closely with the surgeon during an operation. One critical task is providing hemostasis to prevent blood loss during surgery. The process involves using a variety of sealants and materials to promote clotting and restricting blood flow through vessels. RN first assistants also may cut tissues, help the surgeon open or expose the area of operation, suture wounds and surgical openings so that they are held together and heal following surgery, and otherwise manage wounds.
Complications during surgery require immediate attention. The first assistant may render CPR if breathing stops or medications for irregular heartbeats.
The postoperative duties include assessing the patient and the progress of recovery. Often, RN first assistants participate in rounds with physicians after the surgery. Patients receive from the first assistant instructions for care and activities and information about resources in the community to assist the patient.
The Physical and Mental Demands of Operating Room Nurses
Hospitals operate on a 24-hour, seven-day per week basis. Scheduled surgeries occur between the early daylight hours to late afternoon or early evening. However, emergencies or complicated procedures may place surgeries into late nights or pre-dawn hours. As such, operating room nurses can often work irregular schedules, including late nights, weekends and holidays.
Operating room nurses need the physical stamina for walking or standing for numerous consecutive hours. For circulating nurses in particular, strength helps them move patients into and out of the operating rooms. Organizational skills are essential for the circulating and scrubbing nurses to arrange and count instruments and supplies. All nurses in the operating room must have the ability to think and react quickly, especially to emergencies, complications and unforeseen events. The work in an operating room can prove stressful.
Becoming an Operating Room Nurse
Operating room nurses are registered nurses. Qualifying as an RN begins with nursing through an accredited program. Students can earn an associate’s degree in nursing from a technical or community college, a diploma via a nursing program offered usually at a hospital, or a bachelor’s degree in nursing from a four-year college or university. Medical centers may prefer registered nurses with a bachelor’s degree in nursing.
Nursing students typically take courses such as microbiology, nutrition, chemistry, physiology, anatomy and psychology. Practical exposure to the tasks of nursing comes from clinical sessions supervised by registered nurses or physicians. Nursing graduates with a four-year degree may pursue a master’s in nursing. The post-graduate education may enhance a registered nurse’s qualifications for an operating nurse position.
Upon graduation from an approved nursing program, aspiring registered nurses must earn a license from their states’ nursing board. The licensing process includes passage of the National Council Licensure Examination (NCLEX-RN).
Operating room nurses typically have prior experience in a clinical or hospital setting. Employers may find especially desirable candidates who have practiced nursing in an emergency room, trauma center, intensive care unit or recovery room. These environments expose prospective operating room nurses to the pressures and requirements for surgery.
