The perioperative nurse

The perioperative nurse that functions as a Circulating RN
in the operating room performs sharps, sponge, and instrument
counts per policy with the scrub tech or scrub nurse. She
implements the safe transfer of the patient to and from the
OR bed and ensures that the side rails and safety straps are
used appropriately.

Before the patient enters the OR suite the chart is checked for
surgical and anesthesia consents, allergies, history and physical
physician's preoperative orders, laboratory, electrocardiogram
values, x-ray reports, correct patient name, number and surgical
procedure and NPO status. This information is then verified
with the patient and after proper verification the patient is
taken into the OR suite. Accurate and effective verification of
information and documentation of same is necessary on the
surgical record, charge slips, quality assurance monitors and
lab slips. Patient confidentiality is maintained and patient
information is communicated only as needed to provide continuity
of care. The dignity of the patient is protected by providing
as much physical protection as possible.

The Circulating RN is responsible for positioning of the
patient using proper body alignment and body mechanics and
demonstrates proper positioning of the patient on the OR
equipment that is appropriate to the operative procedure
(beach chair, stirrups for lithotomy position, hip table,etc.).
The nurse maintains the patient's skin integrity and ensures
that clothing and bedding are clean and dry, uses proper techniques
when prepping the surgical site and adjusts bedding and clothing
by lifting rather than using shearing force. The apropriate
dressing is applied when the operative procedure is finished
and at that time the RN provides equipment for transporting
the patient and supplying any equipment needed for airway
maintenance during transport of the patient ( i.e. portable
O2, ambubag, portable monitors, nasal airway).

Demonstration of competency to create and maintain the sterile
field and the use of universal precautions and the recommended
hand wash for scrubbing for operative procedures is followed
per policy.

The perioperative Circulating RN checks sterility of items
to be used during the operative procedure by verifying the
expiration date, package integrity and by the sterile indicator
color change. Sterility is maintained when opening sterile items
and moniting of draping and the sterile field for breaks
in technique or sterility. If a break in sterility or technique
occurs, corrective action is taken to correct the break.

Other competencies are opening instruments and sterile supplies
using sterile technique to the back table of the scrub, pouring
sterile solutions into sterile containers, adjusting the OR
lights, preparing labels and taking care of specimens per policy,
remaining with the patient during induction of anesthesia
and assisting anesthesia with the induction, assisting with
gowning of surgical team members, anticipating needs of the
surgical team members and supplying items as needed, sending for
the next patient in a timely manner and perparing for
subsequent procedures.

Lastly, I would like to direct this to my fellow OR nurses.
I think that we will all agree that we want to be the best
that we can be...to be the best of the best. I feel that we can
only do this if we are knowledgable in our professional specialty
and are always reaching out to learn more because in these times,
"technology" is taking us on a very fast ride.

Join AORN (Association of Operating Room Nurses) and become
a CNOR (Certified Nurse of the Operating Room).
I have been a member of AORN since 1992 and that is also the
year that I passed the CNOR exam. When I sign a document
with my name I do it proudly when I sign it with the title "RN,CNOR".
It is not only to your advantage but to the
advantage of every patient that you care for, every doctor
that you come into contact and work with and to the advantage
of your team mates in the OR. Read your journals, take the CEU
tests, never stop learning....strive to be the best that you can be.

Perioperative Nurse

Roles of the Perioperative Nurse

Perioperative NursePerioperative nursing is a specialized area of nursing practice. As a fundamental member of the surgical team, the perioperative registered nurse works in collaboration with other health care professionals which may include the surgeon, circulating nurse, anesthesia provider, surgical assistant, and other assistive personnel. The perioperative registered nurse provides nursing care to surgical patients preoperatively, intra operatively, and postoperatively.

The perioperative nurse plans and directs nursing care for patients undergoing operative and other invasive procedures. Perioperative RNs work in all types of health care facilities, such as hospitals, ambulatory or outpatient surgery centers, and physician offices.

There are several roles that the perioperative nurse fills to ensure quality patient care in the operating room.

Circulator Nurse
The circulator is responsible for managing the nursing care of the patient within the OR and coordinating the needs of the surgical team with other care providers necessary for completion of surgery. The circulator nurse observes the surgery and the surgical team from a broad perspective and assists the team to create and maintain a safe and comfortable environment for the patient. The circulator nurse assesses the patient's condition before, during, and after the operation to ensure an optimal outcome for the patient. Circulating during surgery is a perioperative nursing function. The role of the circulator may not be delegated to a UAP, Licensed Practice Nurse or Licensed Vocational Nurse.

In the operating room, most patients are anesthetized or sedated and are powerless to make decisions on their own behalf during the intraoperative phase. The circulating nurse serves as the patient advocate while the patient is least able to care for him or herself.

OR Director
The OR director manages the business of the facility's ORs. The OR director oversees and is responsible for budgets, staffing, supplies, scheduling, and other areas that keep the OR running.


Scrub Nurse
The scrub nurse works directly with the surgeon within the sterile field, passing instruments, sponges, and other items needed during the procedure. Surgical team members who work within the sterile field have scrubbed their hands and arms with special disinfecting soap and generally wear surgical gowns, caps, eyewear, and gloves. This is a nursing role that may be delegated to a UAP, LPN or LVN.

Registered Nurse First Assistant (RNFA)
The RNFA has gone through additional extensive education and training to deliver surgical care. The RNFA directly assists the surgeon by controlling bleeding, using instruments/medical devices, handling and cutting tissue, and suturing during the procedure. The RNFA may also be involved with patient care before and after surgery.

Patient Educator
The perioperative RN educator works with the patient and assists his or her family members in providing information to enable the patient to make informed decisions regarding surgical care and treatment.