Role and responsibilities of a surgical nurse

Also known as perioperative nurses, surgical nurses are registered nurses (RNs) who specialize in the care of patients undergoing surgical procedures. Their expertise spans a wide range of surgical specialties, including general surgery, orthopedics, neurosurgery, cardiovascular surgery, and many more. Their role is far from static; it evolves dynamically with the patient’s journey through the surgical experience.

The responsibilities of a surgical nurse can be broadly categorized into three distinct, yet interconnected, phases: pre-operative, intra-operative, and post-operative.

The successful outcome of a surgery often begins long before the patient enters the operating theatre. In the pre-operative phase, the surgical nurse lays the critical groundwork, ensuring both patient and environment are optimally prepared.

Patient Assessment and Education

• Comprehensive Health Review: Surgical nurses conduct thorough patient assessments, reviewing medical history, current medications, allergies, and previous surgical experiences. This extends beyond physical health to include psychological and emotional readiness.
• Procedure Clarification: They explain the surgical procedure in understandable terms, addressing patient concerns and misconceptions. This includes discussing what to expect, pain management strategies, and the typical recovery timeline.
• Informed Consent Verification: While the surgeon obtains primary consent, the surgical nurse verifies that the patient fully understands the procedure, its risks, benefits, and alternative treatments, ensuring their consent is truly informed.
• Pre-operative Instructions: Nurses provide detailed instructions regarding fasting, medication adjustments, and hygiene protocols (e.g., specific antiseptic washes) to minimize infection risk.

Equipment and Environment Preparation

• Sterile Field Establishment: A crucial responsibility is to ensure the operating room is meticulously clean and sterile. This involves overseeing the sterilization of instruments and prepping the environment.
• Equipment Verification: They check and test all necessary equipment, including anesthesia machines, vital sign monitors, electrosurgical units, and specialized surgical instruments, ensuring every piece is functional and readily accessible. This precision prevents delays and enhances safety during critical moments.
• Medication Preparation: The nurse meticulously prepares and labels all medications required during the surgery, often collaborating with the anesthesiologist to ensure accuracy and readiness.

This is where the surgical nurse truly shines, performing a complex choreography of tasks that directly impact the safety and success of the surgery. Within this phase, surgical nurses typically operate in one of two distinct roles: the Circulating Nurse or the Scrub Nurse.

The Circulating Nurse: Orchestrator of the OR

The circulating nurse is an unscrubbed RN who manages the overall nursing care in the OR, ensuring a safe and efficient environment. Their responsibilities include: * Patient Advocacy and Safety: They are the patient’s primary advocate, ensuring their dignity, privacy, and safety are maintained throughout the procedure. This includes proper patient positioning to prevent nerve damage or pressure ulcers. * Environmental Control: They monitor the OR environment, including temperature, humidity, and lighting. They manage traffic flow in and out of the OR and ensure doors remain closed to maintain sterility. * Documentation: Meticulous documentation of all intraoperative events, including patient vital signs, medications administered, specimens collected, sponge and instrument counts, and any deviations from protocol. This record is crucial for legal and quality assurance purposes. * Anticipation and Provision: They anticipate the needs of the surgical team, retrieving additional instruments, supplies, and medications as required, often before the surgeon even asks. This proactive approach minimizes delays. * Communication Hub: They act as the primary communication link between the sterile field and outside the OR, relaying messages, coordinating with other departments (e.g., pathology, blood bank), and ensuring family updates are provided. * Specimen Handling: They are responsible for correctly labeling, documenting, and preparing all tissue specimens for pathological examination.

The Scrub Nurse: The Surgeon’s Right Hand

The scrub nurse is a sterile, gowned, and gloved RN (or surgical technologist supervised by an RN) who works directly within the sterile field alongside the surgeons. Their responsibilities demand exceptional precision and knowledge of surgical procedures: * Maintaining the Sterile Field: Their primary duty is to protect and maintain the integrity of the sterile field, preventing contamination that could lead to surgical site infections. * Instrument Management: They meticulously organize, count, and hand instruments and supplies to the surgeon and assistants during the procedure. This requires an in-depth knowledge of numerous surgical instruments and their specific uses. * Sponge, Sharps, and Instrument Counts: Performing explicit, accurate counts of all sponges, sharps (needles, blades), and instruments used during the procedure, in collaboration with the circulating nurse, to prevent retention of foreign objects within the patient. These counts are performed at specific intervals (e.g., before incision, before closing body cavities). * Anticipation of Surgical Needs: Through experience and keen observation, they anticipate the surgeon’s next move and have the necessary instruments ready, often before a verbal request is made. This fluency significantly reduces operative time. * Care of Specimens: Receiving, carefully handling, and passing specimens to the circulating nurse for proper labeling and transport.

The surgical nurse’s role doesn’t end with the final stitch. The immediate post-operative period is crucial for patient stability and safe transition.

Immediate Post-Operative Care (PACU/Recovery Room)

• Monitoring and Assessment: Nurses in the Post-Anesthesia Care Unit (PACU) continuously monitor the patient’s vital signs (heart rate, blood pressure, respiration, oxygen saturation), level of consciousness, pain level, and incision site. They assess for complications such as hemorrhage or adverse reactions to anesthesia.
• Pain Management: Administering prescribed pain medications and assessing their effectiveness, ensuring the patient’s comfort and promoting early mobilization.
• Fluid Management: Monitoring intravenous fluids, urine output, and any drainage from surgical sites.
• Communication and Handover: Providing a comprehensive report to the receiving nurse on the ward or intensive care unit, detailing the surgical procedure, anesthesia, patient’s condition, and any specific post-operative instructions or concerns.
• Patient and Family Support: Reassuring and educating patients and their families about the immediate recovery process, potential side effects, and next steps for recovery.

Beyond specific tasks, successful surgical nurses possess a unique blend of critical skills: * Critical Thinking and Problem Solving: Rapidly assessing situations, anticipating potential complications, and making sound decisions under pressure. * Attention to Detail: Absolute precision is non-negotiable, particularly in sterile technique, medication administration, and instrument counts. * Excellent Communication: Clear, concise, and effective communication with the entire surgical team, patients, and families. * Sterile Technique Mastery: A profound understanding and strict adherence to sterile principles to prevent infection. * Adaptability and Resilience: The ability to remain calm and focused in dynamic, high-stakes environments, adapting to unexpected changes during a procedure. * Extensive Anatomical and Physiological Knowledge: A deep understanding of human anatomy, surgical procedures, and potential complications.

The surgical nurse is far more than a supporting character; they are a central pillar upon which successful surgical care stands. Their relentless dedication to patient safety, meticulous attention to detail, and comprehensive skill set across the entire perioperative journey make them indispensable members of the healthcare team. From the moment a patient is assessed for surgery to their critical hours in recovery, the surgical nurse provides the expertise, vigilance, and compassionate care that directly translates into optimal patient outcomes. They are truly the unsung heroes of the operating room, embodying the precision, professionalism, and profound impact of nursing in its most dynamic setting.