Role of Operating Room Nurses in Surgery

Common duties of an OR nurse

The role of an OR nurse requires a diverse skill set and the ability to work seamlessly with other healthcare professionals. OR nurses are involved in every stage of the surgical process, from preoperative preparation to postoperative care. Their duties can be categorized into three primary phases: preoperative, intraoperative, and postoperative. 

Preoperative duties  

Before surgery, OR nurses are responsible for preparing both the patient and the operating room. This involves verifying the patient’s identity, reviewing their medical history, and ensuring that all necessary preoperative procedures have been completed. OR nurses often act as patient advocates, ensuring the patient’s consent for the procedure is obtained and that they understand the surgery’s risks and benefits. 

In the operating room, OR nurses are responsible for preparing the surgical environment. This includes setting up surgical instruments, ensuring all equipment is functional, and verifying that sterile techniques are followed to prevent infection. They collaborate with other members of the surgical team, such as anesthesiologists and surgical technologists, to ensure everything is ready for the procedure. 

Intraoperative duties  

During surgery, OR nurses take on roles that are essential for the smooth progression of the procedure. Their primary responsibilities during this phase include: 

Circulating nurse: In this role, the OR nurse is not scrubbed in but remains outside the sterile field. This nurse manages the overall environment of the operating room so the surgery proceeds smoothly. The circulating nurse is responsible for documenting the procedure, tracking surgical supplies, and anticipating the needs of the surgical team. This nurse also acts as a liaison between the surgical team and other hospital departments, coordinating additional resources or equipment, if needed. 

Scrub nurse: In this role, the OR nurse works within the sterile field and directly assists the surgeon. This role involves handling surgical instruments, passing them to the surgeon as needed, and making sure the sterile environment is maintained throughout the procedure. The scrub nurse must have a deep understanding of surgical techniques and be familiar with the instruments and procedures used in the operation. 

Instrument nurse: This role involves the meticulous task of counting instruments and sponges before, during, and after surgery so that nothing is left inside the patient. The instrument nurse works closely with the circulating and scrub nurses to maintain an accurate count, which is crucial for patient safety. 

First assistant: In some cases, an OR nurse may serve as a first assistant, directly aiding the surgeon with tasks such as suturing, retracting tissues, or controlling bleeding. This role requires advanced training and a high level of expertise in surgical procedures. 

Postoperative duties 

After surgery, OR nurses are responsible for safely transferring the patient from the operating room to the recovery area, monitoring the patient’s vital signs, and providing immediate postoperative care. OR nurses also document the surgery’s outcome, report any complications, and properly clean and sterilize the surgical instruments for future use. 

Additionally, OR nurses may be involved in patient education, providing instructions for postoperative care and answering any questions the patient or their family may have about recovery. 

Challenges for OR nurses  

The operating room is a high-pressure environment that presents plenty of challenges for OR nurses. These challenges can be physical, emotional, and mental, requiring OR nurses to be resilient, adaptable, and highly skilled. 

Among the challenges for an OR nurse are: 

Maintaining aseptic technique: This is a vital necessity throughout the surgical procedure. The risk of infection is ever-present, and even a minor breach in sterile protocols can lead to serious complications for the patient. OR nurses must be constantly vigilant so that all members of the surgical team adhere to strict sterile procedures. This includes monitoring the sterile field, identifying potential sources of contamination, and taking immediate corrective action if a breach occurs. 

Handling surgical instruments: The responsibility of managing surgical instruments can be daunting, particularly during complex procedures that require a vast array of tools. OR nurses must be thoroughly familiar with each instrument, understanding its purpose and how it is used in the surgery. The instruments must be readily available, passed to the surgeon efficiently, and counted accurately, which requires a high level of focus and organization. 

Communication and teamwork: Effective communication and teamwork are essential in the operating room, where miscommunication can lead to errors and compromise patient safety. OR nurses must be able to communicate clearly and assertively, often in high-stress situations. They must also be skilled in working as part of a multidisciplinary team, collaborating with surgeons, anaesthesiologists, and other healthcare professionals. 

Managing stress and fatigue: The operating room is an intense environment, and OR nurses often work long hours in physically demanding conditions. The combination of prolonged standing, the need for precise movements, and the mental stress of high-stakes procedures can lead to physical and emotional exhaustion. Fatigue can impair judgment and increase the risk of errors. Thus, OR nurses must manage stress levels and maintain their well-being. 

Dealing with complications: Unexpected complications can arise during any surgical procedure, and OR nurses should be prepared to respond quickly and effectively. Whether it’s a sudden drop in the patient’s blood pressure, an allergic reaction, or a surgical instrument malfunction, OR nurses must remain calm under pressure, rapidly assess the situation, and assist the surgical team in taking corrective action. 

Strategies for managing challenges  

To effectively manage the challenges they face, OR nurses can adopt several strategies, which include:  

Continuing education and training: Continuous learning is essential for OR nurses to stay current with the latest surgical techniques, technologies, and best practices. Participating in continuing education courses, attending workshops, and obtaining advanced certifications, such as the Certified Perioperative Nurse (CNOR) credential, can enhance an OR nurse’s expertise and confidence in the operating room. 

Simulation training is another valuable tool. Simulation allows nurses to practice their skills in a controlled environment, where they can refine techniques, improve their response to emergencies, and gain experience with new surgical procedures and equipment. Regular participation in simulation exercises helps OR nurses stay prepared for a variety of scenarios. 

Building strong communication skills: Improving these skills is important for OR nurses to function effectively in the operating room. Active listening, assertiveness, and clear verbal communication are key components of effective teamwork. OR nurses can benefit from training in communication techniques, such as SBAR (Situation, Background, Assessment, Recommendation), which provides a structured method for conveying critical information in a concise and organized manner. 

Developing strong relationships with other members of the surgical team also enhances communication and collaboration. When OR nurses build rapport with their colleagues, they create a positive working environment where team members can rely on each other and work together efficiently. 

Stress management and self-care: Managing stress and maintaining physical and emotional well-being helps OR nurses to perform their duties effectively. Regular exercise, adequate sleep, and healthy eating habits contribute to physical resilience, helping OR nurses endure the physical demands of their job. 

Mindfulness practices, such as meditation and deep breathing exercises, can help OR nurses manage stress and maintain focus during surgeries. Taking short breaks when possible, even if only for a few minutes, allows nurses to recharge and reduce fatigue. 

Additionally, seeking support from colleagues, mentors, or professional counselors can be beneficial in coping with the emotional challenges of their role. Peer support groups provide a space for OR nurses to share experiences, discuss challenges, and offer each other encouragement and advice. 

Time management and organization: Effective time management and organization are key skills for OR nurses, given the fast-paced nature of the operating room. Developing a routine for preparing the operating room, managing instruments, and documenting procedures can help OR nurses work more efficiently and reduce the risk of errors. 

Using checklists and protocols is another effective way to stay organized and ensure that all necessary steps are completed before, during, and after surgery. Checklists can help OR nurses stay on track and ensure nothing is overlooked, particularly in complex procedures with multiple steps. 

As surgical techniques advance, the role of OR nurses will remain vital. Their dedication to patient safety, attention to detail, and commitment to lifelong learning ensure that they will continue to be indispensable members of the surgical team.