Being a surgical nurse is very different from other specialties, because surgical nurses deal with patients who are asleep. Surgical nurses see the patients very briefly in pre-op and then take them back to the operating room where they will be put to sleep by either an Anesthesiologist or a Certified Registered Nurse Anesthetist (CRNA).
Surgical nurses are very territorial and mysterious. No one else really knows what goes on behind those OR doors, (neither patients or other nurses ). It's a completely different world in surgery and without the proper training you're not permitted to enter the surgical area.
Surgical nurses don't change dressings; they usually don't administer medications (except for local monitoring). They don't answer call lights or deal much with patients families. So what the heck do they do?
Well, behind those surgical doors are some exceptionally trained nurses who deserve recognition and praise, which is something they rarely get.
They don't see how a patient recovers. The patients are so high on Versed that they have amnesia after their whole surgical experience.
If they're on day shift they arrive at the hospital or facility around 6:00 am to be ready to set up a case at 7:00 am. This gives them time to change into scrubs and read their schedule. The schedule is their fate for the next 8-12 hours. They look at the big board by the front desk to find out if they're the scrub nurse that day, or the circulator. The main thing they're looking for on the board is which surgeon they'll be working with. This simple thing can make or break their day. There are both good and bad surgeons, just like any other slice of the population. "Please God, don't let it be such and such."
Surgeons can be friendly, but their skills may be horrible. Or they can be great Surgeons, but real jerks. Hopefully that day you will be assigned all the surgeons that are both friendly and good at what they do ...but it isn't likely.
If you're assigned to be the circulating nurse, then you grab your scrub tech/nurse, and you both go to locate your first case cart of the day. This could be anywhere in the mess of other carts that have been filled with items needed for other cases. Hmmm, what a joy this is when you have a big ortho case and half of the instruments aren't sterile and need to be flashed Better yet, half of the items on the preference sheet are missing.
You have to run and find them while your scrub nurse is opening the sterile field. When you return you "dance with your scrub nurse". Not literally, but to "dance with your scrub nurse" actually means you help the scrub nurse tie her/his sterile gown. They can't do this on their own, or it would render them unsterile, for reaching behind their back.
You then must count everything, including all the instruments, raytec, laps, needles, and blades. Remember all this is done between 6:30 am and 7:00 am. Heaven forbid you lose a lap or any of the above items. It's a nightmare when you lose anything. I've been in cases where we were removing a lap sponge, a needle or an instrument; these cases are so much fun. During cases where the surgeon has previously left a sponge inside the patient, you definitely need a dab of wintergreen on your mask, or you are likely to puke your guts up! (and that's putting it lightly). Anyway, once everything is counted, your scrub nurse is happy, your OR bed is sheeted and all the equipment is in the room, it's time to go out and greet the patient.
You go to pre-op to introduce yourself to the patient and evaluate the chart. God only knows what crazy stuff you'll find in there. The labs may be way off, and the surgery may be canceled. The patient may be allergic to latex, so the whole sterile field has to be broken down, because you've already placed a latex foley on there. You walk into the room and address the patient in as cool a manner as you can, (trying to remember that this patient is scared out of their witts) unless they have had Versed. Such a wonderful drug!
Anesthesia has usually seen and evaluated the patient before you arrive, and the patient has already been asked 3 or 4 times whether they've had anything to eat or drink since midnight. But when you ask the patient the same question, all of a sudden their answer changes. They tell you all they had was a doughnut and coffee for breakfast that morning! Okay, so now the case is abruptly canceled and you're lucky enough to have the task of breaking the whole operating room down room down and starting over. One of numerous other scenarios may be that the patient is allergic to shellfish or peanuts, (which is the allergy de joure these days). Everyone and their mother has a peanut allergy. Or maybe, the patient is just allergic to their own snot!
Today the patient has none of these problems. They're not obese nor pregnant, so there'll be no need to pull out the Hercules bed. Hip hip hooray, the surgery will proceed. You begin wheeling her back to the OR after she's had her "margarita in a vial", (Versed), and before she tells everyone in the pre-op area every secret she has.
She goes on to talk your head silly all the way to the surgical suite, and she tells you how she'll never forget how wonderful 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 onto the table and find that she's still wearing her underwear, (complete with latex banding), even though she told you she had a latex allergy.....Awesome!
You assist the CRNA or Anesthesiologist to put her to sleep, (in a hurry, cause she is driving you nuts), with her "jabber, jabber won't shut up."
Alas, she's asleep, and all is quiet for a few minutes, until in bursts Doctor Friendly. He's had a bad day doing rounds, and he's been paged 54 times by his office staff, so he's in a lovely mood, and you're in for a lovely day.
Nothing on the preference card is right, and you spend your time running around searching for instruments, (dirty ones, which need to be flashed). This only pisses the surgeon off more and enhances your day further. The bovie isn't working, and the Rad Tech has been called for a C-arm 10 times but is still MIA.
When everything begins to settle down and all the issues have been resolved you can relax for 5 minutes and sit quietly, hoping it stays that way. Finally, the surgeon is closing and you begin counting. Laps and raytec first, followed by instruments, then needles. All are correct, (well except for one tiny needle) that is nowhere to be found. The scrub counts again. "No, still missing." The surgeon is about to knock someone's head off and freely verbalizes it. You run for the magnet on a stick to roll it on the floor and find the friggin needle. Finally, you find it next to the scrub nurse's foot.
The patient is beginning to rouse, and you are finished with the case. You transfer the patient to post-op and give the PACU nurse report. Yay, it's lunch time, and you're exhausted, with only five more cases to go.
This is a day in the life of a surgical nurse. Many nurses in other specialties believe that surgical nurses really don't do much or aren't "real nurses". While the surgical nurses role is very non-traditional, they work very hard and they're 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 usualy have no idea how well the patient did in their recovery. The patient doesn't remember the great care they got from all the OR staff and for the patient's sake, it's probably just as well.
surgical Nurses are highly skilled at what they do and really deserve more respect from both surgeons and other nurses. So, the next time you meet a surgical nurse treat them right, you may be the next one to come through those mysterious double doors and onto that OR table.
Michelle Raines, Former Surgical Nurse.
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