I chose to research Operating Room Nursing because I have always liked things that are fluid or non-static. My idea of an OR nurse is someone who is constantly moving, may be juggling several things at once, is very organized, neat and follows professional standards to the letter. They are someone who strives for excellence and wants to make a difference in someone’s life in many significant ways. Let’s begin with a question that seemed to creep up while researching this role. Is an OR nurse still a nurse? Yes! OR nurses still access, diagnosis, plan, intervene, and evaluate their patient’s just like as other nurse would.
The Registered Nurse in Perioperative Nursing practice performs nursing activities in the preoperative, intraoperative, and postoperative phases of the patient’s surgical experience. Based on the Standards and Recommended Practices for Perioperative Nursing – A.O.R.N, the operating room nurse provides a continuity of care throughout the perioperative period, using scientific and behavioral practices with the goal of meeting the individual needs of the patient undergoing surgery. This is a dynamic and continuous process and requires constant reevaluation of individual nursing practice in the operating room.
Generally, the patient enters the preoperative area and is assessed by the preoperative RN. The perioperative RN or Circulating Nurse interviews the patient with special emphasis on ensuring the patient has informed consent, has been NPO for at least 6 hours prior to surgery,
Operating Room Nursing
and has charted medical history to determine any special needs for the care plan. Procedures are explained and anxieties of the patient and family are addressed, therefore, the nurse develops a rapport with the patient that enhances the operating experience for the patient by building trust and assuring only the best of care will be given.
Planning the patient’s care in the OR is focused on patient safety. The nurse gathers all supplies needed for the procedure as determined by surgeon’s preference card (Seifert, 137) positioning equipment and any special supplies needed as determined by the assessment and patient history. This preparation assures that the nurse will be able to remain in the surgical suite as much as possible to provide care and to provide assurance to the anxious patient. In the case that a sterile field must be broken due to needing supplies or equipment, the situation of the nurse leaving the room is avoided as much as possible. However, surgical site infections (SSIs) are one of the most common types of healthcare-acquired infections. Most SSIs result from microorganisms found on skin, so meticulous skin preparation is crucial. Documentation must be made on old lesions, including rashes, moles and warts. Amount of hair on the body is also accessed. In the past excess hair was removed from incision areas, however, studies have shown that shaving can cause microcuts and increase the risk of SSIs. The first step is to assess the skin surrounding the surgical site. If a patient has unhealed wounds, scratches, or previous incisions, plan the skin prep area around those areas (Rushman, OR Nurse 9). The next step is to determine whether hair needs to be removed in the incision area. In the past, hair was removed because it was considered dirty and a potential source of infection. The current trend
Operating Room Nursing
is for the patient to use Chlorhexidine, which disrupts the cellular membranes of microorganisms. Skin prep may seem routine, but by following recommended practices as the patient’s skin is prepped may alleviate a costly SSI.
The circulating nurse and the scrub nurse/technician work as a team to protect the sterility of the operative field by maintaining constant surveillance. If a glove breaks, it is replaced immediately. The nurse provides for patient comfort in several ways, warm blankets are given, staying at the patient’s side until anesthesia had been induced and the anesthesia provider releases the care to the surgical team. Interestingly, a PerfecTemp Warming pad has been introduced to increase patient comfort. This pad replaces the standard table pad, warming and comforting patient’s from the minute they lie down to the minute they leave the OR, thereby reducing the 20 minute gap for preparation, thereby eliminating some operation time which is good news for the anxious patient.
The circulating nurse monitors vigilantly during the course of the operation. They are responsible for the smooth transition for the patient between the preoperative, operative, and postoperative phases. Evaluation of the patient’s response to the surgical intervention is ongoing and continuous. Should the surgical outcomes not be met, reassessment begins to plan further.
The patient under anesthesia is totally dependent on the surgical team for their total well being. The perioperative nurse is the patient’s advocate. They are that patient’s voice during the surgical intervention. Whether scrubbing, circulating, or supervising other team members,
Operating Room Nursing
the perioperative nurse is always aware of the total environment, as well as the patient’s reaction to the environment and the care given during the three aforementioned phases. The nurse excels in her/his knowledge of aseptic technique, patient safety, legal aspects, and management of nursing activities associated with the specific surgical procedure being performed. OR nursing is unique: it provides a specialty service during the perioperative period that stresses the need for continuity of care and respect for the individuality of the patient’s needs.
To protect the public, professional nurses are licensed. The state in which you are licensed dictates the scope of your practice according to legal and ethical guidelines. OR nurses also have codes of ethics and nursing standards of practice through the American Nurses Association (ANA). Legally, ethically, and morally, OR nurses have a responsibility to be patient’s advocates. The ANA’s code of ethics clearly endorses reporting any inappropriate or questionable healthcare practices, and outlines protocols. Organizations should have defined process for reporting questionable practices, but what if they don’t and it poses a risk for patients? The ANA’s code of ethics supports contacting the appropriate professional organization – even if it posed a risk to the nurse. As perioperative nurses, the OR nurse advocate’s for patients in the OR every day by simply reviewing the informed consent and other documentation to ensure patient decisions are accurately reflected, maintaining a safe environment, correcting breaks in sterility, and ensuring confidentiality. “With that trust comes
Operating Room Nursing
a responsibility to promote and advocate for patients, even when it means putting ourselves at risk” (Thompson, 2010).
After success on state boards and NCLEX Exam, the nurse wanting to be part of the OR must pass the CNOR – Certified Nurse Operating Room. The CNOR is a national certification exam which covers aspects such as sterilization techniques, maintaining a sterile field, critical thinking skills, exact dosage calculations, emergency situations like malignant hyperthermia, cardiac arrest, and so on. The exam consists of 200 questions and has an allotted time frame of 4 hours. National certification exams are an important part of a nurse’s career. Certifications increase the continuing education requirements beyond the state license requirements. To maintain CNOR certification, the nurse must obtain 150 continuing educational units specific to the OR every 5 yearsâ€¦..a continuous learning and teaching process.
In conclusion, the role of an OR Nurse is what I expected and more, namely, I had never considered the issue or hair removal. I thought someone else would perform that task as it seemed so minute, but after research, I now understand just how important hair removal is and why it is necessary. The perioperative environment is fast paced, unpredictable, and complex. In this environment, perioperative nurses are expected to work a variety of surgeries with patients of all ages (AORN Journal, Jan 2009, 249). Critical thinking skills enable perioperative nurses to understand and apply standards and guidelines to a variety of situations and specialty areas.
Operation Room Nursing