Welcome to this video tutorial on intraoperative nursing. The intraoperative nurse cares for the patient from the time the patient is moved onto the OR bed, until the patient is transferred to the care of the recovery room nurse, or postanesthesia care unit.
You may have heard the term perioperative nursing—this encompasses the preoperative, intraoperative, and postoperative phases of the patient’s surgical experience. This video will focus on intraoperative nursing care.
Nursing Responsibilities
Nursing responsibilities during the intraoperative phase include continuing the assessment of the patient’s physiologic and psychologic status, promoting safety and privacy, preventing wound infection, and promoting healing.
The surgical team must work together to deliver safe and effective care to the patient in the intraoperative phase. The team is divided into categories based on responsibilities, and consists of the primary surgeon and assistants, the scrub tech/nurse, circulating nurse, and anesthesiologist. The surgeon, assistant, and scrub tech work in the sterile field, while the circulating nurse, anesthesiologist, and other personnel function outside the sterile field.
The circulating nurse is an RN with several responsibilities, including.
- Coordinating patient care before, during, and after the surgical procedure
- Providing emotional support to the patient and assisting the anesthesiologist during the initiation of anesthesia
- Ensuring patient safety, positioning and monitoring the patient, and enforcing policies and procedures throughout the surgery – including a “time out”
- Maintaining sterile technique while providing supplies and equipment for the sterile team
- Documenting all nursing care during the intraoperative period and making sure that surgical specimens are labeled correctly and placed in the appropriate media
- Recognizing and resolving environmental hazards that involve the patient or surgical team, including protecting the patient from electrical hazards
- Ensuring with the scrub tech that all sponge, instrument, and sharps counts are completed and documented
- And communicating relevant information to family members and other healthcare workers outside the OR
Surgical Environment
The surgical environment is designed to provide a safe therapeutic environment for the patient. Traffic in and out of the operating suite is kept to a minimum to decrease potential contamination from air turbulence and bacterial shedding. Floors, walls, and ceilings are made of materials that are easy to clean with antimicrobial agents. The temperature in the OR is kept between 68 and 75 degrees to reduce the risk of infection. The relative humidity is kept between 40 to 60%, which diminishes bacterial growth and restricts static electricity.
Asepsis
Aseptic technique involves following practices that prevent contamination from pathogens and must be followed by all members of the OR team to reduce the risk of surgical site infections. The Association of periOperative Registered Nurses [AORN] governs the guidelines and protocols pertaining to all phases of perioperative nursing. They routinely release updated guidelines that detail proper procedures to minimize infection and contamination, ensure patient/environment/staff safety, properly maintain surgical equipment, and more.
A perioperative nurse is a registered nurse [R.N.] who works in the operating room. Sometimes called a surgical or an operating room nurse, this specialized nurse cares for patients before, during, and after surgery.
In the operating room, the perioperative nurse may serve as a scrub nurse, selecting and passing instruments and supplies used for the operation, or as a circulating nurse managing the overall nursing care in the operating room and helping to maintain a safe, comfortable environment.
Scope of practice
Perioperative nurses use a comprehensive, multidisciplinary approach to patient care, assisting surgeons and surgical teams to care for a patient before, during, and after surgery.
Specifically, responsibilities and duties of a perioperative nurse include:
- Working with patients prior to surgery to complete paperwork, and help answer questions or calm fears about surgery
- Monitoring a patient’s condition during and after surgery
- Selecting and passing instruments and supplies to the surgeon during operation [sometimes referred to as a scrub nurse]
- Managing the overall nursing care in the operating room to help maintain a safe and comfortable environment [sometimes referred to as a circulating nurse]
- Educating patients on best practices for recovery, including pain management and keeping wounds clean
- Cleaning surgical equipment and operating rooms to maintain a sterile environment
Work environment
Perioperative nurses work in hospital operating rooms, outpatient centers, and doctors’ offices. Perioperative nurses have a lot of contact with patients of all ages, surgeons, and other members of the surgical team. Often times, perioperative nurses are working with new patients every day and typically do not form long-term relationships with their patients. The work environment can be stressful due to the nature of the position, but many nurses find it a rewarding role.
Becoming a perioperative nurse
Successful perioperative nurses are excellent problem-solvers with the desire to care for people. Many nursing degree programs require a strong background in science along with taking the certified nursing assistant course. Prior experience in the health care field can often help set a nursing student or a recent graduate apart from their classmates.
Higher education requirements
The typical pathway to becoming a perioperative nurse is different for everyone, but most include the following: