Operating Room Nursing: One Nurse's View

"Are you crazy! Why do you put up with this? I'm done." This is the response I have gotten from many nurses after their first 3 months in the OR. Operating Room nursing is not for everyone. The hours can be grueling, the stress overwhelming and the work exhausting.

Why then do I love it so much? Am I crazy? OK, maybe a little...it's kind of prerequisite for working in an OR. Exhaustion becomes a way of life. You learn to eat when you can, drink when you can, sleep when you can and go to the bathroom when the opportunity arises.

You get stuck in a little room with 3-5 other strong personalities for hours on end. (More if you are a teaching facility, and have residents and med students present.) If you are the circulating nurse, you will need to orchestrate the actions into a cohesive whole. If you are the scrub nurse, you are on the front line any time something is missing or wrong.

Every second counts. You must be extremely efficient and be able to prioritize wisely. What needs to be done immediately, what needs to be done soon, and what can wait a minute. When to stop everything and when to hurry it along. How to do three things at once, and do them correctly. Decisions...Priorities...Multi-tasking, these are your challenges every moment.

Did you want to look nice at work? Maybe the OR is not for you. Everyone has the same blue hair and we all wear masks. I have worked with people for months and not recognized them in a store. "Oh, I've never seen you in clothes before!" is a common greeting between OR people. Another is, "So that's what you look like with hair." You should see the looks you get from innocent bystanders when you are greeted this way.

The dress code is pretty rigid in an operating room. First, lets discuss jewelry. Jewelry is a nest of dirty, harmful, downright killer germs. Bet you never thought about what was growing in that dark, warm space under your wedding ring! Rings, bracelets and watches need to be removed.

Necklaces can break and fall into the area being operated on (what we call the wound). Please remove all necklaces. Same thing goes for earrings, please remove them...or...you can cover your ears with your cap to keep them enclosed. Sounds sensible, but it really makes hearing harder.

I guess belly piercings would be OK to leave on...they are covered. I almost forgot these...they weren't very popular back in the day...

Lets discuss nails next. Nails are another place that harbor all those murdering germs. Especially those lovely fake nails and wraps. Get them off! Keep those nails natural, clean and no longer than 1/4 inch. Standards have changed slightly in the past few years...now you can have polish on your nails, but make sure it is not chipped! Chipped nail polish can fall off into places we would rather it not go!

How about our scrubs. Nowadays, you see all these scrubs that are almost fashionable. What a breakthrough in nursing. Forget all that in the OR. We must change each morning into scrubs supplied by the facility...these are the ones that look like you are wearing a sack.

So...fashion divas...Run!

The OR room shown is pretty messy, but I wanted to show a few (yes, just a few) of the pieces of equipment you will learn to operate and troubleshoot. The number one troubleshooting technique of an operating room nurse is...turn it off and turn it on. Surprisingly, it is number one because it usually works.

We learn to operate the multiple operating room beds. We call them tables between ourselves, and beds to the patients. Who ever heard of operating on a bed? There are the regular tables used for most procedures. There are fluoroscopy tables used when you need to x-ray the body. There are spinal tables and fracture tables. Some of these look like torture equipment! (See the picture of the Chic Fracture Table--Yes, you can really lay someone down on it...Skill required)

OR nurses also operate various lasers, warming devices, cautery units, anti-embolism units, cameras, light sources, drills, suction units, monitors, blood transfusion devices, positioning devices...I won't bore you with the entire list, I think you get the idea.

In the operating room, technical skills are as important as people skills.  Equipment necessary to the procedure has to function and function correctly.  Many pieces of equipment can harm the patient if not functioning correctly.  The surgery may have to halt at a crucial moment if something is not working.  All equipment needs to be checked prior to starting.

"Why don't you try the threader from the Mitek anchor set?", I asked.  "What the hell is that?!", the doc answered.  

OR nurses need to know the names and location of thousands of instruments.  There are instruments that are used by most specialties, but also specialized instruments used by one or the other.  There are instruments for General surgery, Orthopedic, Podiatry, Plastics, Vascular, ENT (ears, nose & throat), Eyes, GYN/OB, Laser, Endoscopic, and on and on. 

Thinking outside the box is a skill of the experienced OR nurse.  You need to think of new ways to use old things constantly.  Every person is different inside, literally!  No two operations are the same.  Sometimes what you usually use, doesn't work...creativity is a must!

I didn't realise I had so much to know and do as an OR nurse!  I didn't even touch on the personalities you encounter.  (I'll do that in another.)  As I said before, OR nursing is not for everyone. 

You need to love a challenge, have high energy, be able to think on your feet and hit the ground running.  Doctors yell at you every time something is missing or something goes wrong.  You are the unseen nurse.  No-one remembers your care, because they were asleep for it.

You need to have a very strong ego, everything will be your fault the instant it happens.  Later, you may get an apology...but in the instant you just let them rant.  I was taught that one of the ways I perform my job as patient advocate is to let them yell.  It was explained to me this way...better they yell at me, than their hands shake in the wound.  Much better!  Let them get it out!

However, it is also the only place in nursing that has such instant gratification!  Some-one's gallbladder is making them sick, take it out...there, they are cured.  The baby will die if it is not delivered now, take it out...there, the baby lives.

Although the docs yell a lot, they learn to depend on you and respect you more than if you were a floor nurse.  They perceive you as being smarter, more reliable.

You are challenged every day.  You learn something every day.  It is an ever changing, never static or dull, environment.  You have to BE there mentally and physically 100% at all times.  As I say, not for everyone, but I seem to thrive on it. 

Prior to becoming an OR nurse, I never stayed in the same place for longer than 3 years (and that only twice).  Things would become boring...same old, same old.  That is never a day in the OR!  I have been in the OR for 15 years and still love it.