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Registered nurses who work in the operating room are called perioperative nurses. They might be RN first assistants, who help the surgeon directly by controlling bleeding, exposing the wound or suturing, or scrub nurses who handle dressings, instruments and other items. Both RN first assistants and scrub nurses work within the sterile field – the area that must be kept sterile to prevent infection. The circulating nurse, however, works outside the sterile field and has many different duties.
Support and Mobility
A circulating nurse is responsible for managing nursing care in the operating room. Because she is mobile during the operation, she has a broader perspective than either the scrub nurse or RN first assistant. Although she is a support person for the members of the surgical team, two of her primary roles are patient advocacy and safety. The circulating nurse is also the point of contact with the outside world because she is not tied to the sterile field and can go in and out of the operating room.
The circulating nurse’s observer role allows her to watch for possible errors during the procedure, such as possible contamination of an instrument. An article published in the June 2012 “AORN Journal” reported that in a study of 18 surgical procedures in a cardiovascular operating room, an average of 11 potential errors occurred in each surgery. The circulating nurses prevented 77 percent of the errors and intervened to mitigate the remaining 23 percent. Due to the vigilance of the circulating nurses, no harm occurred to any patient.
Patient advocacy is another important role for the circulating nurse. She is the person who initially performs a nursing assessment before the surgery and must earn the patient’s trust. Her task is to elicit potential risks or identify anxiety on the patient’s part by establishing a bond before the operation begins. Her clinical skills allow her to recognize potential problems – a patient who is pale may be anxious or may need to have a lab test to ensure he has adequate red blood cells for the operation to take place. The circulating nurse must be ready to assert her concerns to prevent harm to the patient.
A Variety of Tasks
There are three stages in each operation: Preoperative, intra-operative and postoperative. Preoperatively, the nurse assesses the patient and prepares the operating room, equipment, supplies and tools. She assists with the induction of anesthesia and helps position the patient. During surgery, she may add sterile supplies as necessary and monitor intravenous fluids or drainage bags. She counts instruments and dressings with the scrub nurse to ensure nothing is left inside the patient. She may also leave the operating room during the procedure to inform the family about the surgical team’s progress and patient’s condition. When the surgery ends, she helps transfer the patient to the recovery unit, provide the recovery room nurse with a report of the operation and the patient’s condition and then assist with clean-up in the operating room.