A Peek Inside the Operating Room: Eight Insights From a Circulating Nurse

When you think of the operating room (OR), what comes to mind? An intense and stressful work environment? A place where you have to think and act quickly? It’s certainly all of those, and more. I spent more than 40 years working in nursing before joining 3M five years ago. For most of that time I worked in the perioperative area and I can tell you that, yes, sometimes the OR is an intense, emotionally charged place. It is also a place where teams work together with a singular focus on the patient, making it a highly rewarding environment.

I knew from my experience during clinicals that I wanted to work in the OR. At my first hospital, I visited the nursing director regularly to see if there were any openings. After about six months, I got my chance. I first learned how to scrub – setting up the instruments and handing them to the surgeon during the procedure – and then I moved into circulating, a more typical RN role of providing direct patient care before, during and after the procedure.

Curious about what it’s like? Here are a few insights from my experience:

1. Your number one job is to be the patient’s advocate.

When a patient is in surgery, they need an advocate as they are unable to advocate for themselves. Some people may view the role of an OR nurse as more clinical and less caring, but I found it very patient focused. I would meet with patients before surgery to both reassure them and assess their readiness for the surgery, telling them, “I’ll be there when you fall asleep and I’ll be there until you are out of surgery.”

2. The job responsibilities can vary.

Most ORs will have nurses who perform two different functions: the more technical job of scrubbing – assisting the surgeon directly and handling instruments – and circulating. Circulating nurses’ responsibilities include:

  • Knowing all the pertinent information about the patient and verifying that it’s the correct patient on the table going in for the scheduled procedure.
  • Positioning the patient appropriately and properly prepping their skin for the incision.
  • Managing the room, including supplies, equipment, lighting and documentation. The circulating nurse ensures there’s not a break in sterile technique. If patient status changes, you may have to switch what you are doing – stepping in to help anesthesia, for example.
  • Initiating counts when it’s time to close – accounting for all sponges, blades and other instruments.

3. It took about a year to feel really comfortable in the role.

My orientation paired me with an experienced nurse for six months of scrubbing and six months of circulating, which helped me feel comfortable. Today, the orientation periods are usually shorter and nurses may have to adjust more quickly.

4. Every day may be different.

If you work at a specialty surgery center, your workday may be more predictable than if you work in a general surgery setting. Depending on the type of procedures you work on, one provider could do up to 20+ surgeries in one day. Eye surgery is an example of a surgery that may take less than 30 minutes. In this situation, you may be switching back and forth between two ORs all day. On the other hand, one complex surgery – such as a transplant or a reconstruction – can take the entire day and even extend beyond a normal shift.

Technology and increasing specialization also are changing work in the OR. Total joint replacements  used to be much more invasive procedures. Minimally invasive surgery has transformed how replacements are done, and some surgery centers focus entirely on these surgeries.

5. Every surgery is customized to the patient, but standards are always followed.

It’s important to follow protocols and standards to help ensure consistent patient care on outcomes. Every patient is different though, and care should be customized for each person depending on their scheduled procedure, skin condition, their body shape and their overall health status. It may mean you need to adjust positioning, make a different selection for skin preparation, or utilize different equipment to accommodate various needs.

6. A strong, but respectful, personality is helpful.

When you work in the OR, you are always advocating for the patient, so you need to speak up. You have to bring concerns forward in a clear, but respectful, way. Attention to detail and critical thinking skills are also crucial.

7. The hardest part of the job is the stress.

Emotions can run high in the OR. If you are working on a cardiac case, a trauma case or a ruptured aneurysm, everyone is highly focused on reaching the critical point in the surgery. You may also have irregular hours and be on-call for emergencies.

8. The best part of the job is the teamwork.

There is nothing as satisfying as working with a good team. If your team is aligned, you will probably know what the surgeon or scrub tech needs before they do. You are all focused on one patient at a time and are working together to provide excellent care for them.

Kim (far left) working in the OR.

I loved my years working as a nurse. While my roles varied – from staff nurse to nurse manager and clinical director and from setting up a brand-new surgery center to a pain management center – in each case, my focus has been on the patient.  If you are compassionate, want to be an advocate for your patients, love being part of a team, and don’t mind a high-stress environment, being an OR nurse might be a great fit for you, too.

About Post Author

Kimberly Prinsen, RN, MSN

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