A Day In The Life Of An Operating Room Nurse: A Series Of Insights (3/4)
I’m writing a series of medium to long-form content pieces about being an Operating Room (OR) nurse, speaking from first-hand experience. I’ve been an OR nurse for 10 years, starting out at a 35-room level one trauma center. I have scrubbed and circulated surgical cases as a staff nurse and filled the Director of Perioperative Services and Clinical Educator roles.
This is the second piece of the series. The series aims to provide a glimpse into the typical day of an operating room nurse, partly to satisfy the curiosity of those who would otherwise never know and partly to demonstrate the challenging job and daily struggles OR nurses face. It’s also to provide nurses thinking of applying to the OR with a realistic view of their day-to-day life.
Once the patient is asleep, their airway is secured, and they are positioned appropriately, it’s time to prepare for the start of surgery. A surgical skin preparation is performed to cleanse the surgical site in order to help prevent a surgical site infection. The two main preps used are chlorhexidine gluconate and betadine.
The nurse is often the one performing the prep. Strict sterile technique must be followed, and the ability to think critically about prepping methods is a must. Prepping a leg with an open fracture requires a different technique from prepping a leg for a total knee replacement.
The beginning of a surgical procedure, commonly referred to as a “case,” is a busy time for an OR nurse. They are performing the prep, watching the sterile back table for contamination (we love medical students but must watch them like hawks), tying gowns for surgeons and other surgical team members, and searching their brains for any forgotten item or task.
Then, once the prep has dried, the team begins draping the patient so that the surgical site is exposed and the rest of the patient is covered in sterile drapes. While this is happening, the nurse continues to watch for breaks in sterility, plugging in cords that are thrown off the field, placing a bucket near the scrub for used sponges, and preparing for the time out. This is all done in a matter of minutes.
Performing a time-out is essential to ensuring the correct procedure is done for the correct patient with the correct laterality, if applicable. It may be difficult to fathom, but multiple incorrect surgeries are performed. Over a 20-year period, the US had 2447 wrong procedures and 27 wrong patient surgeries, according to the National Practitioner Data Bank.
Timeouts can vary from facility to facility, but basic safety concerns are universally addressed. The patient’s identity is confirmed using both name and date of birth. The surgical site is confirmed, including laterality, and is usually marked so as to be visible to the entire team. The consent form is read out loud, and all members of the team verbally confirm the information is correct. Other items often discussed are medications on the field, the patient’s allergies, if implants are available when applicable, and if anyone has any concerns.
Speaking up and going against popular opinion is a key skill for an OR nurse. They must not be intimidated by surgeons or by going against a group. There are times when the nurse may be yelled at or even have items thrown at them. Fortunately, this type of abuse is less tolerated now, but it does still occur. The OR is a high-stress environment; courage and firm morals are critical.