Being a surgical nurse is very different from other specialties, because surgical nurses deal with patients who are asleep. Surgical nurses see patients very briefly pre-operatively and then take them back to the operating room where they will be put to sleep by an anesthesiologist or certified registered nurse anesthetist (CRNA).
Surgical nurses are very territorial and mysterious. No one else really knows what goes on behind those OR doors (not the patients, not the other nurses). It is a completely different world in surgery and without proper training, you are not allowed to enter the surgical area.
Surgical nurses do not change bandages; they generally do not administer medications (except for local monitoring). They don’t call on the answer lights or deal much with the patients’ families. So what the hell do they do?
Well, behind those surgical doors are exceptionally trained nurses who deserve recognition and praise, something they rarely get.
They don’t see how a patient recovers. Patients are so high on Versed that they have amnesia after their entire surgical experience.
If they are on the day shift, they arrive at the hospital or center around 6:00 a.m. M. To be ready to build a case at 7:00 a.m. M. This gives them time to change into scrubs and read their schedule. The schedule is your destination for the next 8-12 hours. They look at the big blackboard by the front desk to find out if they are the cleaning nurse that day or the circulator. The main thing they look for in the board is which surgeon they will work with. This simple thing can make or break your day. There are good and bad surgeons, just like any other segment of the population. “Please, God, don’t let it be like this.”
Surgeons can be friendly, but their skills can be horrible. Or they can be great surgeons, but real idiots. Hopefully on that day you will be assigned all the surgeons who are friendly and good at what they do … but not likely.
If you are assigned to be the circulating nurse, then you take your cleaning technician / nurse, and you both go to get your first cart of cases of the day. This could be anywhere in the clutter of other carts that have been filled with items needed for other cases. Hmm, what a joy this is when you have a large orthopedic case and half the instruments are not sterilized and need to be flashed. Better yet, half the items on the preference sheet are missing.
You have to run and find them while your cleaning nurse opens the sterile field. When he returns, he “dances with his nurse.” Not literally, but “dancing with your cleaning nurse” actually means that you help the cleaning nurse tie her sterile gown. They cannot do this on their own, or you would leave them unsterilized, to search behind your back.
Then you need to count everything, including all instruments, raytec, laps, needles, and blades. Remember that all of this is done between 6:30 am and 7:00 am. Heaven forbid you miss a lap or any of the above items. It’s a nightmare when you lose something. I’ve been in cases where we were removing a lap sponge, needle, or instrument; these cases are very funny. In cases where the surgeon has previously left a sponge inside the patient, he definitely needs some wintergreen on his mask, or he is likely to vomit! (and that’s putting it lightly). Anyway, once everything is counted, your cleaning nurse is happy, your OR bed is covered and all the equipment is in the room, it is time to go out to greet the patient.
You go to the preoperative to introduce yourself to the patient and evaluate the graph. God only knows what crazy things you will find there. Labs can be a long way off and surgery can be canceled. The patient may be allergic to latex, so the entire sterile field must be broken down, because he has already placed a latex foley there. You walk into the room and address the patient in the coldest way possible (trying to remember that this patient is scared to death) unless they’ve had Versed. What a wonderful drug!
Generally, the anesthesia has seen and evaluated the patient before arrival, and the patient has already been asked 3 or 4 times if they have eaten or drunk anything since midnight. But when you ask the same question to the patient, suddenly his answer changes. They tell you that all they had was a donut and coffee for breakfast that morning! Well now the case is abruptly canceled and you are lucky enough to be tasked with breaking up the entire OR and starting over. One of the many other scenarios may be that the patient is allergic to shellfish or peanuts (which is Joure’s allergy these days). Everyone and their mother have a peanut allergy. Or perhaps, the patient is simply allergic to his own snot!
Today the patient does not have any of these problems. They are not obese or pregnant, so it will not be necessary to remove the Hercules bed. Hip hip hooray, the surgery will continue. You start taking her back to the OR after she has had her “margarita in a jar”, (Versed), and before she tells everyone in the pre-op area all the secrets she has.
He continues to talk gibberish all the way to the operating room and tells you that he will never forget how wonderful you are. In your mind you are thinking Yes, of course, you will not remember your own name when you wake up, much less mine. After entering the operating room, you transfer the patient to the table and find that he is still wearing his underwear (with latex bands), even though he was told he had a latex allergy … Awesome!
You help the CRNA or Anesthesiologist to put her to sleep, (in a hurry, because it is driving him crazy), with your “chatter, charlatanism does not shut up”. CRNA or Anesthesiologist to put her to sleep, (hurry, because she’s driving you crazy), with her “jabber, jabber won’t shut up.”
Unfortunately, she’s asleep and all is quiet for a few minutes, until Doctor Friendly bursts. You’ve had a bad day making rounds, and your office staff has called you 54 times, so you’re in a good mood and have a beautiful day ahead of you.
Nothing on the preference card is correct, and he spends his time looking for instruments (the dirty ones, which need to be flashed). This only annoys the surgeon more and improves his day even more. The bovie doesn’t work, and the Rad Tech has been called for a C-arc 10 times, but it’s still MIA.
When everything begins to calm down and all the problems have been resolved, you can relax for 5 minutes and sit quietly, waiting for it to continue. Finally, the surgeon is closing and begins counting. First laps and raytec, followed by instruments, then needles. They are all correct (well, except for one little needle) which is nowhere to be found. The scrub counts again. “No, still missing.” The surgeon is about to rip someone’s head off and freely verbalize it. You run to the magnet on a stick to roll it on the ground and find the damn needle. Finally, he finds it next to the scrub nurse’s foot.
The patient begins to wake up and you are done with the case. You transfer the patient to the postoperative period and deliver the PACU nursing report. Yes, it’s lunchtime and you’re exhausted, with only five more cases to go.
This is a day in the life of a surgical nurse. Many nurses in other specialties believe that surgical nurses don’t really do much or are not “real nurses.” While the role of surgical nurses is not traditional, they work very hard and are an integral part of the nursing profession. Unfortunately, they don’t get to see the fruits of their labor. Once the surgery is over, they never see the patient again and usually have no idea how well the patient did in their recovery. The patient does not recall the great care he received from all the OR staff, and for the patient’s sake it is probably for the best.
Surgical nurses are highly trained in what they do and really deserve more respect from surgeons and other nurses. So the next time you meet a surgical nurse, treat her well, you may be the next to go through those mysterious double doors and onto the OR table.