Definition: Nursing Care given to surgical patients preoperatively, intraoperatively, and postoperatively by a Registered Nurse or a delegated professional person.
This is a highly specialized area of nursing in which a Registered Nurse works as a team member of health care professionals. Other health care professionals include the surgeon, anesthetist, scrub nurse, and circulating nurse. As per the definition the peri operative nurse provides care before, during and after the operation.
A peri operative nurse needs to be sensitive and highly skilled in evaluating patient’s needs within strict time constraints and under conflicting pressures.
Picture 1. Perio perative Nurses at work.
The Peri operative Nurse(s) have many objectives. These include the planning and directing of nursing care of patients undergoing operative and other invasive procedures. This care is provided in different environments which include health care facilities like hospitals, doctor’s surgeries, and outpatient surgery units.
To achieve these objectives the peri operative Nurse may delegate certain patient care tasks to other suitably trained and competent personnel.
When UAPs (unlicensed assistive personnel) are hired and used according to institutional policy, the Registered Nurse is accountable and must supervise the peri operative care given. The delegation of care must be appropriate – One Registered Nurse cannot reasonably supervise more than three to four UAPs. The UAPs must have the skills to care and seek assistance from the peri operative Nurse when the need arises.
The following are specialized roles of peri operative nurses:
- Circulating Nurse.
The circulating nurse works outside the sterile field. She is responsible for managing all the nursing care of the client in the Operating Room. Additionally, she coordinates the needs of the surgeon’s team with other care givers necessary for completion of surgery.
She observes the surgery and the patient. She tries to anticipate the surgeon’s needs and patient’s needs. Her main task is to assist the team to create and maintain a safe and comfortable environment for the patient and all employees. Circulating during surgery is a peri operative nursing function. This function cannot be delegated to UAPs. Check national and institutional policies for more accurate information.
The circulator nurse assesses the patient’s condition before, during, and after the operation to ensure an optimal outcome for the patient.
During the operative phase, patients are anesthetized / sedated and are unable to make decisions for themselves. The circulating nurse acts as the patient’s advocate during this phase.
The scrub nurse executes her responsibilities with the surgeon in the sterile field. She passes instruments, sterile sponges and other articles needed for the operation. The sterile area includes the Operating table, instrument tray and the draped field. Members of the surgical team (including the scrub nurse) must have scrubbed their hands and arms with special disinfecting soap and generally wear surgical gowns, caps, eyewear, and gloves. Antistatic foot wear may be needed to prevent the discharge of static electricity.
In some institutions this role can be delegated to UAPs, LPNs or LVNs. Please check the institutional policy of your institution.
The main role of the RFNA is to help the surgeon control bleeding. She is usually the expert who knows what the surgeon will need (medical instruments/devices for handling different tissues – controlling bleeding, cutting and suturing) during the whole procedure. The RNFA is involved in patient care before and after the surgery. Remember: She is not scrubbed.
The most important role of the recovery nurse is to help the patient recover from the effects of the anaesthesia. This is usually done in the recovery room or in some instances in the Intensive Care Unit. During this phase the patient is under the effects of anaesthesia and management of pain and the commencement of spontaneous respirations are important stages which the nurse must be able to balance.
She will be able to utilize the help of the anaesthetist and surgeon as needed.
In some institutions, peri operative pain management is a specialist task which is delegated to a specially trained nurse. This nurse has the authority to prescribe pain relieving medications including morphine and other narcotics.
The patient educator is generally a Registered Nurse who assists the patient or his family members and provides them information to enable the patient to make informed decisions regarding surgical care and treatment.
The Operating Room Director manages the business aspects of the operating room. He oversees the budget, staffing, supplies, equipment and other components which are needed for the smooth running of the operating room. He is also responsible for insuring that supplies and equipment are available for emergency operations during after office hours.
In some institutions the Director is a surgeon. In most institutions the OR Director is a highly specialized Registered Nurse.
