Grey’s Anatomy has the Operating Room (OR) all wrong.
- There is no mood lighting (HELLO! we need to see in here!)
- The surgeries are not all traumas (unless you’re at a trauma center, and even then, you can’t shock a flat line).
- The nurses are actually the ones running the show (I mean obviously).
- The doctors are not sleeping with the interns on the operating table (Ew! Who KNOWS what that table just had all over it).
Whether you watched the show or not, you may be curious and think you might want to work in the Operating Room (OR). Well, I’m here to answer a few frequently asked questions and let you into a day in my life as a circulating operating room nurse. Hopefully, I won’t scare you off.
What is the difference between perioperative nursing, circulating nurse, and scrub nurse?
"People who work in the OR are like gremlins in the basement, you know they are there but you have no idea what they are doing and you aren’t sure you want to add water."
Perioperative nursing, sometimes referred to as “surgical services” refer to the people who work in the pre-op, post-op, and operating room.
“Scrub Nurse” used to refer to the medical professional who assisted the surgeon by scrubbing in, but in modern times a scrub technician performs that role.
The Registered Nurse in the operating room is now called a Circulating Nurse and is in charge (despite what the surgeons would have you thinking).
What does a Circulating Nurse do? (Circulating Nurse Responsibilities)
I get asked this question by other nurses almost every day.
Like most nursing, my first and most important job function is to be a patient advocate.
The secondary tasks delegated to the Circulating Nurse involve hunting and gathering skills. Before the patient even enters the room the OR team (nurse and scrub) must gather all known equipment, supplies, and medications needed for the case.
Most surgeries are done under general anesthesia, which is very dangerous. During the operation, the circulating nurse’s responsibility is to ensure patient safety at all times. This includes:
- Assisting anesthesia with intubating/extubating
- Positioning and securing the patient on the operating table
- Ensuring all equipment in the room is working and safe for patient use (no exposed wires, etc.) opening additional supplies
- Maintaining the sterile field
- Controlling access to the OR
- Preventing the wrong site/wrong surgery from occurring
- Preventing retained objects
- Observing the operation to ensure the patient remains safe and secure
- Most importantly… being the patient’s voice while they do not have one.
How does a circulating nurse role differ from regular nursing?
This is another question I get all the time.
1. Most of the skills (except skin and wound assessments) that you learned in nursing school, I do not do. To work in the operating room, I had to go through an additional 4-6 months of classroom and on-the-job training to learn how to be an OR Nurse.
2. Another big difference is that I don’t push meds. While I have some medications I open and give to the field (antibiotics, epinephrine, and local anesthetics), I am not giving injections, hanging IV bags, or giving oral anything. I don’t start IVs; they are either done in pre-op or anesthesia does it. I don’t take vital signs, but I do need to interpret them.
3. When it comes to pay, our yearly raises and bonuses are tied directly to the metrics of the unit, with the main metrics being on-time starts and room turnover times. They apparently did the math and it costs approximately $37 a minute to run one operating room (you do the math for your hospital if there is more than one room). So literally every minute counts and we have a lot of pressure to meet our metric goals. If we don’t meet our goals, our yearly bonuses and raises are reduced, even if the delay is because of something out of our control like the surgeon or patient being late.
When it comes to pay, our yearly raises and bonuses are tied directly to the metrics of the unit, with the main metrics being on time starts and room turnover times. They apparently did the math and it costs approximately $37 a minute to run one operating room (you do the math for your hospital if there is more than one room). So literally every minute counts and we have a lot of pressure to meet our metric goals.
A Day in the Life of a Circulating OR Nurse
A typical day at the office for me looks a little something like this…
- 5:30 am – Alarm goes off. I get up, get ready, get my coffee, and get out the door.
- 6:40 am – I clock in and change into facility-provided scrubs, which are required to maintain infection control measures. These scrubs are scratchy, ugly, unstylish, boxy, ill-fitting, and a horrible green color. But on the bright side, I get to show my personality through my scrub cap which can be made from any type of “lint-free” (think quilters cotton) fabric I desire. This is our flair, we are proud of them, envious of others’ caps, and will bribe anyone who can sew to make us more.
- 6:50 am – Attend morning huddle and gets our room assignments. Each nurse and scrub is assigned to a room for the day and we are responsible for all the cases scheduled (or added on) in that room.
- 7:00 am – After the huddle, we go to our rooms to set them up for the first case of the day (if possible). Hopefully, I get this done by 7:15 so I can use the restroom and get the rest of my coffee down.
- 7:25 am – I report to pre-op with enough time to make sure I have time to properly interview the patient. During this interview, it is important that I make sure the consent is signed and dated appropriately, and that the patient can verbally tell me what they are having done. I once had a patient undergoing gastric bypass who said, “Oh, I’m having surgery that is going to make me skinny” in all seriousness. We had to stop everything and be sure she understood she was not going to wake up skinny, and that that would only occur months down the road if she put in the work. If the patient doesn’t understand, the surgery gets canceled and the surgeon gets very mad.
- 7:30 am (if all goes well): Once we are the in the room, a whole slew of things happen. We get the patient on the table, get them off to sleep, position them, prep the field, drape the field, connect the equipment, get the surgeon scrubbed in, and more! Usually, this process takes about 30-40 minutes depending on:
- How long anesthesia takes to get the patient to sleep
- How much positioning needs to be done
- How long it takes for the surgeon to get into the room
- Once we are ready, I do the final time-out, known as the pre-incision time-out and arguably the most important one as the surgery cannot start until this is done. This check is in place for patient safety, to ensure no wrong site, or wrong surgery occurs. I once had to reprimand and report a surgeon for making an incision before we started the time-out. It is very serious business.
- ~ 8:00 am: The surgeon makes their first incision, the music gets turned on, and the fun and games begin. During the surgery, I am doing all the things a circulator should do while also playing DJ/message service for the surgeon (louder! Change the station! I hate this song! Can you answer my phone?). Being in control of the room means I have had to firmly tell a resident to stop leaning on a patient leg, I’ve told drug reps to step away from the field and I’ve helped anesthesia push meds during a difficult extubation. I’ve also kicked people out of the room who didn’t need to be there to maintain patient privacy and let a surgeon know when they were headed in a direction the patient didn’t consent to (right breast mastectomy only, not bilateral!).
- ~ 9:00 am: If I am lucky, and we are properly staffed, I get a breakfast break between 8:30 and 9:00 am, and then head back to the operating room.
- ~ 12:00 pm: Sometime between 11:00 am and 1:00 pm, I’ll get my lunch break. We don’t have set breakfast or lunch times as it varies greatly on the availability of additional nursing staff. I have had days where I have not gotten a break at all because we’re so short-staffed. In the OR, we cannot leave our patient or room until someone relieves us, and we have to turn over our rooms in less than 19 minutes so that is often barely enough time to get the room ready let alone fit in a potty or snack break.
- Afternoon/rest of shift: The remainder of my day consists of as many cases are scheduled in my room, which can be anywhere from 2-13 depending on the length of the surgery.
- End of shift: At the end of the day, if we have time, we remove all equipment from the room that will not be needed the next day then prepare the rooms for the next day including equipment, supplies, and instrument trays.
Pros and Cons of a Career as a Circulating OR Nurse:
If you’re considering a career as a Circulating OR Nurse, the role comes with many benefits, but there are also some downsides to keep in mind. Here are some pros and cons to help you make an informed decision:
Pros
- 1 patient at a time
- The patient is asleep (so no back talk!)
- Strong team environment – we all rely on each other and cannot do what we do without trust in our teammates.
- Respect from the surgeon – it’s one of the few nursing positions where (most of) the doctors truly respect and listen to the nurses.
- The nurse is in control of the room. It’s an OCD person’s dream that everything has to be neat, orderly, and timely.
- “Normal” business hours. Typically, no holidays or weekends (plus more 8-hour shifts available).
- Working weekends = call pay + overtime
- One of the highest-paying nurse specialties
Cons
- Must be on call (not as bad in a normal hospital, but horrible at trauma centers).
- 12’s are harder to find, you have to use PTO to cover the holidays, and no shift differential for working weekends.
- Surgeons are divas – they want things their way and can throw temper tantrums if they don’t. (Seriously. Divas.)
- It’s very stressful – anticipating something going wrong at every second is very stressful and having to be aware of the entire surroundings adds to it.
- It’s physically demanding – like most nursing, but more because it also requires crawling on the floor to find/fix/connect things, lifting patients without assistive devices, holding heavy legs, twisting your body into a pretzel to reach something without contaminating the field… I could go on!
Why Do I Love it?
There are a crazy amount of things that are annoying, frustrating, and downright scary about the OR, but, I absolutely love it. I love the organization of it. I love the controlled chaotic dance that is how we move about the room (if you’ve ever been in the OR, you know what I’m talking about).
I love teamwork. We all rely on each other so much that I feel I get more of a team approach than I did on the floor. I love that the doctors ask me for my opinion and actually listen to it. I love procedures, the blood, the fascia, the bone fragments, the sound of a drill placing a screw into a fracture, the sound of a hammer pounding a knee implant in, and I love the cool technology we get to use.
Most of all, I love knowing that when the surgery is over, I have actually done something to cure a patient. Most of the time I am not treating the symptom, I am attacking and removing the root cause. And that brings me joy more than anything else and makes dealing with divas worth it.
