I haven’t answered a call light in 12 years. The most use my stethoscope gets is when my kids pull it out to play doctor. I don’t spend an entire shift assigned to the same 4-5 patients and I don’t know what they love, what they hate, or what they plan to get back to when they leave the hospital. I only get about 5 minutes – maybe 10 – to talk to my patient before we roll back to the Operating Room (OR). And, they spend most of their time with me asleep.
I work in a very specialized field. A lot of the skills I learned in nursing school and then practiced when I worked on the floor just don’t apply in the operating room. But while my skill set is unique, my goal to provide the safest and best care for my patients is the same as every other nurse. How I care for my patients, though, is very different. But different does not mean non-existent.
So what do OR nurses even do?
First, don’t use this picture to answer that question! There are so many misconceptions about OR nursing. Yes, we’ve all worked with nurses who are trying to hook up with a doctor – but that’s not exclusive to the OR. And if you watch any medical show – well, don’t. They’ve got it all messed up.
But, that picture of what floor nurses think we do is spot on. I’ve spoken to nurses from other units who don’t think that OR nurses even do patient care, or they just don’t really know what all we do. Nurses in orientation have left the OR because they said that they “just really missed patient care.” And new grads are discouraged from coming straight to the OR for fear they won’t develop their nursing skills or learn “proper” patient care. Obviously, there’s a misconception that feeds the idea that there isn’t patient care in the OR.
I’m a Circulating Nurse. Everything that I do revolves around patient care, patient safety, and efficiency. I’m not always scrubbed into a case – like the picture above makes it look. Most of the time I’m not. But everything I do in the OR is geared toward caring for my patients.
What does patient care in the OR look like?
Patient care is:
- Being the voice for your patient when they can’t speak for themselves
- Having an accurate and complete consent – and only doing what the patient has agreed to
- Breaking down an entire case during set-up, even though it causes a delay, because every patient deserves a proper sterile field, and contamination puts them at risk
- Proper positioning before a procedure to protect skin, nerves, and sensitive areas – and taking the time to do it right, even if the surgeon wants to rush you
- Prepping the surgical site correctly, with the correct type of prep solution, and maintaining aseptic technique
- Leading (sometimes enforcing) the Time-Out – making everyone stop, one last time, to make sure that everything is correct before the incision is made
- Not being afraid to yell, “STOP!” when you see an error
- Adhering to policies regarding surgical counts to avoid retained surgical items and future complications for your patient
- Communicating your patient’s allergies to your team to avoid any issues with latex or giving the wrong meds
- Knowing your patient’s labwork – will they need blood? Is it available?
I could keep going. But, I don’t need to make an all-inclusive list. Instead, I hope you see that patient care is the undercurrent of what we do every. single. day. Yes, it looks different. But the OR is different.
Maybe we should move past the idea that patient care is only defined by a pre-approved list of specific tasks. Instead, let’s remember that, regardless of specialty, we’re caring for the whole patient. And that care is going to look different across the spectrum of specialties that we call nursing. And yet, we all share a common goal: provide the best and safest care for every one of our patients, every single day.
Y’all keep up the great work out there,
Melanie
Very well said Melanie.
It is so very true.
We are the patients advocate and that is what we do!!
Thank you, Pam! Yes, we are the voice for our patients and we must advocate for them!
The OR was the best experience of my life. I also became a RNFA to assist the doctor and loved it. I now do moderate sedation for colonoscopies and enjoy the turn over and experience.
Well said. It takes an OR circulating nurse to stand up to a surgeon, anesthesiologist, perfusionist, etc and say no you can’t do something, stop what you are doing and listen, or we WILL follow policy.
This article was sent to me by a former supervisor who was very supportive of this type of pt care in the OR. I recently retired from the OR after 30 years because I no longer felt able or safe being this type of circulator for my patients.
I’ve been kicked out of a room before for standing up to a surgeon. You can bet your butt in stood outside the door watching my patient until a different nurse got there, received report and continued to hold the surgeon accountable for correct patient care! Three OR is no place for the timid!
This and so much more! It’s not that we don’t care for our patients, and it’s not that we don’t use everything we’ve learned in nursing school while doing so. We spend each day building on all of that knowledge to care for not only the patients, but to be able to directly assist the surgeons and anesthesiologists care for our patients in a critical setting. We have a very unique knowledge base and skill set that goes beyond the basics of nursing school. On any given day, a floor nurse could not walk into the OR and fill my shoes. This article touches on the building blocks of patient safety in the OR, but what we do is so much more involved. No matter how intricate though, every action we take can be linked back to keeping our patients safe throughout the Perioperative experience.
This I agree with. Skills learned and used in nursing education and floor nursing was/is the building foundation that I always used to build my perioperative skills. Therefore I felt I was treated with respect by the Surgeons and Anesthesia providers.
When I would orient new graduate staff this was one thing that I told them. While you are learning skills in the OR, keep your nursing skills you have learned close by because much of the OR will be connected to them eventually.
Agreed. I utilize most, if not all, the skills I learned in nursing school, almost every day. From having a therapeutic, albeit short, relationship with my patient and their loved ones, to ensuring public health by utilizing aseptic techniques, and yes, the list goes on. It’s simply different, and I’m learning all the time. In 15 years, I can’t recount every single time I’ve “done something new,” either a technique, or piece of equipment, or change in practice brought about by research. I’m never bored! I’m contributing to a dramatic, hopefully positive outcome for a patient, one at a time.
All of this is right on spot. We are responsible for everything in that room. We are the hand holders when patients are frightened. The hardest thing any person can do is give up their control. We are there to reassure them that we will take the very best care of them. We wipe their tears. We comfort them. I’ve hugged many patients and held them to help reassure them that everything would be ok. I’ve told patients to cancel their case because they just didn’t feel good about doing it right now. I’ve had surgeons scream at me for this but I would rather have a patient wait until they are mentally on board. I’ve suffered the loss of one patient because of my ignorance. He started to cry before intubatiion and said he just didn’t feel right. Anesthesia gave him versed to help him relax. He coded the minute the incision was made and didn’t survive. I will never make this mistake again. We rely on all of our senses in the OR. We are the eyes,ears,and voice of our patients. I love being an OR nurse. I’ve been beat up my machines, low lights and monitors as well as patients who wake up combative but I wouldn’t do any other type of nursing. I’m with the patient at their most vulnerable time and I do make a difference.
As an OR nurse for going on 41 years now (it’s the only kind of nursing I have ever done), I’ve seen all kinds of nurses come and go. What dismays me most is when I see an OR nurse who seems to have completely lost touch with the humanity of the patient, who seems to lack awareness of the fact that the patient is a human being, with a life, with a history, with loved ones, with fears and anxieties – a real live person who may be facing the worst day of his or her life. Too often the patient is treated as an organism to be “worked on”, or as a “case”, or identified as an organ (“the gallbladder in Room 6”) It has become much worse in the last decade or so; I don’t know why. Maybe it’s a reflection of the general disconnect between people that has evolved with electronics and social media. I don’t know. But I just hope that new OR nurses can maintain their compassion and their connection to their patients and never lose sight of their patient’s humanity.
You’re so right, Lizabeth. We can’t lose our compassion or forget that the “case” we are doing is actually a human being who is most likely scared to death about what’s going on. We have to remember that we are caring for people, not just moving through a list of procedures.
OR nursing is a PASSION not a career…. I started straight out of nursing school in 1982, yes to some of you a million years ago….
It was what I knew I wanted to do from the start.. I wanted to be an Operating Room nurse…
I LOVED every second….. I had to take early retirement not do to my own choice… I had an allergic reaction to a medicine that caused some lung scarring…. Which wearing a mask and the stress of an OR wasn’t possible….
I worked in an area where I had a great deal of repeat patients…. I was a urology nurse… So I saw lots of repeat stones, repeat bladder tumors. I got to know some of my patients very well…
Four weeks ago, I was having knee surgery…. One of my favorite return bladder check up patients was there for something else. As I was registering he saw me…. On his little cane he came flying.. we both cried…. He kissed my forehead as he did over 50 times as he was going to sleep over the years…
Any one who doesn’t think that being a Surgical Nurse isn’t fulfilling is mistaken… I have been with patients under EVERY circumstance…. to tell a family bad news with the surgeon…. to tell the Good new, when we thought it was going to be bad…. to tell them their loved one didn’t make it…. That the baby we just did a c-section on was a boy or girl…..
I would have never changed a thing except for one….. Not taken that medicine that I was allergic to….. THE FLU SHOT… so I didn’t have to retire at 54 years old…. It destroyed me…. Until I realized God said enough…. You have done enough…
My husband is a urologist and it was a great run……. We had a great team. Out team was great…. I miss them….
The 5-10 minutes prior to bringing the patient into the OR is used to gain as much information as is possible about the patient. We also must establish trust and a rapport with the patient and family. We have to make certain the consent is worded properly. That the correct limb or body part is being operated on. Allergies, past and current health history we must be aware of. Many times the patient understands very little as what to expect during and after surgery. Patient ADVOCATE is not to be taken lightly. We’re the one taking away that loved one, while family is frightened, along with the patient. We are on the receiving end of “what’s taking so long to get the patient”?!!! I have been the only person the patient has told the truth to about NPO status. I’ve questioned consents and had them corrected, because the patient “just signed” what was in front of them. I’ve been around long enough to have witnessed open cases change to minimally invasive. Been in cases gone south, on-call enough hours to miss out on family holidays. Knew what to do or get before the team asked for it. Always made certain the implants were correct and available BEFORE stepping foot in the OR with the patient. Knew where the “oh sh**” trays and supplies were located in the sterile core. To the nurse commenting about new nurses not staying; I challenge the administrators and more senior nurses to give them the chance they deserve to become as good as you. If they don’t feel supported, they won’t stay and we need the next generation. They possess a whole new set of talents we don’t. They can teach us a great deal about technology, computers (EMRs), and much, much more. We need to mentor them. We need to let them know how scary it is not having all of the answers. How to prioritize the most important task given the situation. Someday we will need them to take care of us. OR nursing may be one of the most challenging; yet rewarding fields to be priviledged to work in. There will always be the nurse who goes above and beyond and the nurses who do the least to get by. Thank you for reading my windy comments. God bless the work we all do!!
Patti,
I have been a circulator for almost 4 years. I started my nursing career in the OR straight out of school. I love what I do and can’t imagine loving another job the same. What you said is perfect! Often times we are rude to new nurses for not “getting it” quick enough. It takes so much time for nurses new to the OR to adjust to such a different environment. We all need to remember what it was like being new and clueless and give people our time, knowledge, and patience!
Cari
Very well said! I retired 2 years ago. I miss my team, too. I miss my favorite docs. BUT…….I am sure you would agree–DO NOT miss that corporate mentality dictating my life!!
Wouldn’t trade my experience at all! By virtue of our profession, we are specialized. Not every nurse is cut out to be in the OR. I am so very thankful I got to spend my last 10 years working in the OR!!
I’ve been in the OR since 1977. I’ve always felt that our role of patient care is very misunderstood. I’m the patients advocate when they have no family no friends and are unable to speak for themselves. They have me and I take this role very seriously.
Is there any way to get a reprint of this article? It is such an excellent description of what OR nurses do. Before I finished nurses training (1971), I knew I wanted to be an OR nurse. We do all of that & more while working in the OR. Thanks for such a great article.
Thank you, Elaine! I’m glad that you enjoyed this article. You can click the email option next to the different sharing icons and email the article to yourself or someone else and that will give you a copy of the article. Hope that helps 😊
My last 25 years of nursing were spent in the operating room as a circulating nurse. Before that, I worked as a floor nurse, emergency room nurse, intensive care nurse, and office nurse. If a nurse doesn’t think that the OR is patient care, he/she is in the wrong business. We are the eyes and ears and voice of our patients. We have to be sure that everyone else in the room is doing their jobs correctly. In an emergency, we have to be able to prioritize because EVERYONE else in the room thinks their needs come first.
I have always recommended that new graduates spend at least a year as a floor nurse. This is not because I think that floor nursing is “real patient care”. It is because new nurses need to learn to prioritize and to handle emergencies and to organize their patient care and to get comfortable communicating with other health care professionals. Doctors will yell; if you are right, you have to be able to stand your ground and advocate for your patient. Learning to do that is easier if you have support at hand as opposed to in the confines of an operating room with an unconscious patient on the table.
I was an OR nurse begining in 1975 . In my diploma program we had 3 weeks (4 full days /week) in the OR. I had a progresive instructor who encouraged talking to patients and handholding as they went to sleep. Over the next 15 years I went back to school and received a BSN and MSN. This article is great. Id like to add thatafter my first 4.5 years at an 800 bed trauma facility then 20 years in the military and 14 years in a small rural hospital I loved the smaller facilities. At small hospitals even in a manager role I usually spent at lesat 25 % of my time in a staff nurse role, thus management was done after 8 hours or on Saturday. In small facilities I had to be able to care for patients undergoing all things except neuro, transplants and cardiac procedures including trouble shoot video equipment; on call was often a c-section, lap appy or fractured hip. I also did a lot of Conscious sedation which added another set of skills and monitoring knowlegde. Then there was recovering our own patients in PACU when on call (minimum 1 day /week and every 3 or 4th weekend); another set of skills to maintain competency. I retired in 2014 when back issues made it to painful to work and provide safe care. While there were challenges maintaing competencies in multiple issues concurrently I found there was as much and often more direct patient care then as a team leader/med nurse on a very busy cardiac floor.
Great article. I’ve been an OR nurse for almost 30 years, the last several being in leadership. I always tell the new nurses I interview, especially the externs, that OR nurses rely on the nursing process just like all other nurses. The assessments and interventions are all extremely important but many take place before we ever lay eyes on the patient. Then when we are with the patient we stand in the gap for them. We are their advocate as well as the first line of communication to their families. I’ve cried, hugged, prayed and rejoiced with many families over the years.
There is no doubt that it is a different kind of nursing. A very special kind of nursing. I wouldn’t want to do, mentor, or lead any other kind of nurses.
Melanie
Great post! I so relate to you as well as every other OR nurse. Thank you for putting it out there so professionally.
Marybel
Thank you, Marybel! I’m glad you liked it 😊