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 an anesthesiologist or certified registered nurse anesthetist (CRNA) will put them to sleep.
Surgical nurses are very territorial and mysterious. No one else really knows what goes on behind those OR doors (neither patients nor 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 dressings; they generally do not administer medication (except for local monitoring). They don’t respond to call lights or deal much with the families of the patients. So what the hell do they do?
Well, behind those surgical doors are some exceptionally skilled nurses who deserve recognition and praise, something they rarely receive.
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 am to be ready to establish a case by 7:00 am. This gives them time to change and read their schedule. The schedule is your destination for the next 8-12 hours. They look at the big board by the front desk to find out if they are the Scrub Nurse or the Circulator that day. The main thing they look for on the board is which surgeon they will work with. This simple thing can make or break your day. There are good and bad fools, just like any other segment of the population. “Please, God, don’t let it be so-and-so.”
Surgeons can be friendly, but their skills can be horrible. Or they can be great Surgeons, but real idiots. Hopefully all the surgeons who are kind and good at what they do will be assigned to him on that day… but not likely.
If you’re assigned to be the circulating nurse, grab your janitor/nurse and both of you go get your first case cart of the day. This could be anywhere in the clutter of other carts that have been filled with items needed for other cases. Hmmm, what a joy this is when you have a big orthopedic case and half the instruments are non-sterile and need flashing. Better yet, half of the items in the preference sheet are missing.
You have to run and find them while your scrub nurse opens up the sterile field. When you come back “you dance with your scrub nurse.” Not literally, but “dancing with your scrub nurse” actually means that you help the scrub nurse tie her scrubs. They can’t do this on their own, or I’d leave them unsterilized, for reaching behind her back.
Then you have to count everything including all instruments, raytec, laps, needles and blades. Remember that all this is done between 6:30 am and 7:00 am. God forbid you lose a lap or any of the above items. It’s a nightmare when you lose something. I’ve been on cases where we were removing a lap sponge, a needle, or an instrument; These cases are very funny. During cases where the surgeon has previously left a sponge inside the patient, he definitely needs some wintergreen on his mask, or he’s likely to puke! (and that’s putting it lightly). Anyway, once everything is accounted for, your scrub nurse is happy, your OR bed is covered with sheets, and all the equipment is in the room, it’s time to go out and greet the patient.
You go pre-op to introduce yourself to the patient and review the history. God only knows what crazy things you’ll find there. Labs can be too far away and surgery can be cancelled. The patient may be allergic to latex, so the entire sterile field must be disassembled, because a latex foley has already been placed. He walks into the room and addresses the patient in the coolest way possible (trying to remember that this patient is scared out of his mind) unless he has been Versed. What a wonderful drug!
Anesthesia has usually seen and evaluated the patient before you arrive, and has already asked the patient 3 or 4 times if they have had anything to eat or drink since midnight. But when you ask the patient the same question, suddenly his answer changes. They tell you that all they had for breakfast was a donut and coffee that morning! Well, now the case is abruptly called off and you’re lucky enough to be tasked with tearing down the entire OR and starting over. One of many other scenarios may be that the patient is allergic to shellfish or peanuts (which is the current allergy). 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 there will be no need to bring out the Hercules bed. Hip hip hooray, the surgery will proceed. You start taking her back to the OR after she has taken the “daisy in a vial” (Versed), and before she tells everyone in the pre-op area all the secrets she has from her.
He continues to goof around with you all the way to the surgery room, telling you that he’ll never forget how amazing you are. In your mind you’re thinking Yeah right, you won’t remember your own name when you wake up, let alone mine. After entering the OR, you transfer the patient to the table and discover that she is still wearing her underwear (complete with latex bands), even though she told you that she had a latex allergy…Impressive! !
You help the CRNA or the anesthesiologist to put her to sleep (in a hurry, because it’s driving you crazy), with her “chatter, the chatter won’t shut up”. CRNA or anesthesiologist to put her to sleep, (in a hurry, because it’s driving you crazy), with her “chatter, chatter won’t shut up”.
Unfortunately, she’s asleep, and all is quiet for a few minutes, until Doctor Friendly snaps. He has had a bad day doing the rounds, and his office staff has called him 54 times, so he is in a great mood and has a wonderful day ahead of him.
Nothing on the preference card is right, and you spend your time looking for (dirty, need to be flashed) instruments. This only annoys the surgeon more and makes his day even better. The bovie isn’t working, and Rad Tech has been called in for a C-arm 10 times, but he’s still MIA.
When everything starts to calm down and all the problems have been resolved, you can relax for 5 minutes and sit quietly, hoping that it stays that way. Finally the surgeon is closing and you start counting. First turns and raytec, then instruments, then needles. They are all correct (well, except for one little needle) that is nowhere to be found. The bush counts again. “No, it’s still missing.” The surgeon is about to rip someone’s head off and freely verbalizes it. You run to the magnet on a stick to roll it across the ground and find the bloody needle. Finally, you find it by the scrub nurse’s foot.
The patient begins to wake up and you are done with the case. You transfer the patient to post-op and deliver the PACU nurse’s report. Yay, it’s lunchtime and you’re exhausted, with only five more cases to finish.
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 aren’t “real nurses.” While the role of surgical nurses is very untraditional, 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 that patient again and usually have no idea how well the patient did in their recovery. The patient does not remember the excellent care he received from the entire OR staff and, for the patient’s sake, he is probably better off.
Surgical nurses are highly skilled at what they do and truly deserve more respect from both surgeons and other nurses. So the next time you run into a surgical nurse, treat her right, you may be the next to go through those mysterious double doors and onto that operating table.
