The Registered Nurse in the Operating Room

Once the preadmission procedures are finished and the operating room is prepared for the procedure, the patient is transported to the operating room. Transport measures include walking with the patient, carrying the patient (if a child or infant) and the use of a stretcher or chair. Transport of the patient is frequently considered a chore by the registered nurse and can be delegated to an aide or orderly. During transport the patient is vulnerable and many times would benefit from the support of the nurse to help alleviate some of their anxiety. Some institutions have anesthesia providers transport patients to the operating room so anti-anxiety medications can be given prior to the transport.

Patient safety is of primary importance at this time. When stretchers are used the siderails need to be in the up position during transport. Movement should be with the patient's feet first with a smooth, non-jerking motion. Speed also needs to be considered to prevent the patient from getting dizzy or nauseated. When transporting a child in a crib, the side rails should be raised to the highest position to prevent the child from crawling over the top of the rails.

Before moving a patient to the operating room table, the wheels of the stretcher or chair should be locked. Someone needs to be standing on the side of the stretcher and on the opposite side of the operating room table. If awake and alert, the patient will be asked to move to the table slowly. If the patient is unconscious or unable to move themselves to the table, a minimum of four people need to be available to transfer the patient by lifting using a sheet or by using a device, like a roller. The use of proper body mechanics during the transfer of the patient is essential to the safety of the OR personnel. Anesthesia providers usually take charge of the moving of the patient. Patient safety determines how the patient will be transferred or moved.

Once the patient is moved to the operating table, the nurse applies the safety strap with a brief explanation of it's purpose. The purpose of the safety strap serves as a reminder to the patient that they are on a narrow table and should limit movement. The nurse remains at the patient's side during this phase of the surgical experience, offering emotional support. Holding the patient's hand until they are under anesthesia is not an uncommon occurrence.

Patient positioning for surgery is one of the most important facets of patient care management. It is directly related to the surgical outcome and is considered as important as safe administration of anesthesia and good preoperative preparation.

The patient is positioned after induction of anesthesia and only after the anesthesia provider says the patient is stable and can be moved safely because the patient's protective reflexes are impaired.

The responsibility for safely positioning the surgical patient involves the entire surgical team. The surgeon determines the position of the patient for optimum exposure of the surgical site, with the approval of the anesthesia provider who will either agree with the position or make an alternative suggestion. The anesthesia decision is based on concerns for airway maintenance, vascular access, and cardiovascular stability. The ability to assure physiological stability for the patient is paramount in anesthesia's decision to accommodate the surgeon.

The perioperative nurse then coordinates the activities related to positioning, such as preparation of positioning aids and equipment. The nurse obtains information for the safe positioning of the patient from the preoperative assessment and formulates a plan of action using safe moving and lifting techniques.

I have worked in the OR since 1980 with a 3 year break for nursing school and Home Health Nursing after graduation. I started in the operating room as a LPN in Sandusky, Ohio. The hospital where I was working had an opening for a scrub in the OR. I was currently working in their skilled nursing facility and definitely wanted a change. I interviewed for the position and when I said I would commit to 3 years, I was given the job. I was so nervous on my first day. I had some understanding of sterile technique from some of the procedures I was used to performing on the unit, but not to the extent that I was about to learn.

The Operating Room is a world unto it's own. OR nurses are unique practitioners. Many other nurses don't even consider them nurses. The OR nurse hears things like "Your patients are all asleep. How much nursing can you do?", "You're just an overpaid gopher", and "Anybody can do your job". Well, I'm here to tell you that we do a lot of nursing, we do more than go-pher supplies, and No, you can't without a lot of specialized training.

As a LPN in the OR I was considered a surgical technician. I finally started to feel comfortable in that role after about a year. I was no longer sweating when I got called in for an emergency case. I was in love with this job and still am. In 1993 I topped out of salary at my job. I was only 42 years old and knew that I couldn't work for that amount of money for the next 23 years. So I went back to nursing school. Working in the OR was not conducive to my school schedule. A friend at school introduced me to Home Health Nursing. I could make my own schedule and still get to school on time. It was a great fit and I was enjoying the patient contact and teaching again. I graduated from nursing school in December, 1994 and passed my NCLEX exam in January, 1995. I was happy as a home health nurse, but started missing the OR. I started working in the OR per diem through an agency. I knew I had to return full-time.

And the rest, they say, is history. I returned to the OR and have never looked back. I did travel nursing for almost 8 years. I saw a lot of this great country. I traveled from coast to coast. Now, I'm working at UNC Hospitals in Chapel Hill, NC. I scrub and circulate for the General Surgery team. I love the surgeons I work with. The work is hard, but rewarding. I wouldn't trade it. I recommend the OR to any nurse who hasn't found his/her niche in nursing. It just may be the OR.