What is the nurse’s part in OR scenario? Carla Summers is a nurse practitioner who provides care to patients experiencing surgical intervention. She functions primarily within the geographic boundaries of the operating room; however, her responsibilities include a preoperative assessment of each patient she will be caring for in the course of a day. Information obtained and data collected during the preoperative assessment will be utilized to develop a plan of care, which will be implemented prior to, during, and after surgery. Carla’s focus is the patient. During the preoperative period, her objectives are to do a nursing assessment, provide continuity of care, assist the patient to manage his anxiety, and provide information to the patient about the operating room. When the patient arrives in the operating room, Carla carries out nursing activities presently called circulating duties. She humanizes care by providing emotional comfort and support. During the operation, she protects the patient from undue harm by proper positioning, correct placement of electrosurgical grounding pads, and other facets of physiological monitoring essential during the surgical procedure. All nursing activities focus on the desired end results for each patient. As a nurse, Carla has a commitment to preventing illness and maintaining the level of health her patient had prior to surgical intervention. She believes the patient has

a right to be protected during the surgical procedure and the overall goal is promotion, restoration, and maintenance of psychological and physiological alterations. Carla Summers is a nurse who “has it together.” She is a strong person who receives satisfaction from within when she knows she has done something well. She is not motivated by verbal accolades and external rewards from surgeons, but by the fact that she knows the patient she cared for during the operation had the best care possible and the patient will not have postoperative complications due to her neglect. The postoperative evaluation made on the second postoperative day is also a source of rewards as she finds the patient progressing well with no pressure areas, rashes, burns, nerve damage, or wound infection. Becky Cramer is also a nurse employed in the operating room. Becky still maintains that nursing activities regarding surgical intervention begin when the patient enters the operating room suite. She has not conducted a preoperative assessment, therefore she carries out the routine activities essential to all cases. She is highly organized and very efficient and has everything Dr Brown could possibly want for this case. As a nurse, Becky has the choice of whether she will perform the activities of scrubbing or circulating. Like many nurses she prefers to scrub and chooses to do so whenever possible. She thinks it is not as difficult to pass instruments, if you’re good at it, as it is to perform circulating activites. The case starts with Becky passing the tools, sutures, and keeping the sponges counted and accessible to the surgeon with

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great efficiency. She is able to anticipate every move Dr Brown makes and he isn’t kept waiting at all. During the entire case, she makes two decisions relative to the patient’s well-being, one decision being to elevate the Mayo stand when the operating room table was raised to prevent pressure on the patient’s legs. The other was to remove the electrosurgical equipment from the operative field when the anesthesia was changed to an explosive agent. After the case is completed, Dr Brown, playing the typical paternal role, pats Becky on the back and tells her what a “good girl” she is. He tells others how good Becky is and everyone perceives Becky as the best nurse in the operating room. Becky thrives on this external reward system. This is how she continues to be motivated. As we look at Becky’s activities, it is obvious that her focus was not the patient. It was on things and how expertly she could do those tasks. She has been exteraally rewarded for doing things or tasks, not for focusing on the patient and being the patient‘s advocate during the surgical procedure. You may feel I have not honestly portrayed current practice in the operating room and you may be right. However, I maintain that Becky is a truer reflection of an OR nurse than either you or I care to acknowledge. I hope this article will stimulate you into thinking how you perceive the role you assume in the operating room. Many nurses in the operating room perceive their role as being a handmaiden to the surgeon. This implies they see themselves as an extention of the surgeon and their prime responsibility as performing tasks that will enhance the surgical procedure. They carry out orders prescribed by the surgeon. Other OR nurses perceive their role to be that of patient advocate. They practice nursing, which is defined as prevention of illness and maintenance of health. They see themselves functioning independently of the surgeon who, as a medical practitioner, is diagnosing and treating illness. For a long period of time, operating room nurses have been focusing on things and tasks. This has been communicated to the public and other nurses. Nurses outside the

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operating room who perceive the nurse in the OR as technical or task-oriented have gained that perception from us. We have not clearly defined the role of the nurse functioning in the operating room. Not only must we preach it, but only through practice will others beIleve it. What is a role? What are functions and duties? According to Webster, a role is a “part or character which an actor presents in a play.” A function is the “kind of action or activity proper to a person, thing, or institution.” A duty is an “action required by one’s position or occupation.” These definitions help us differentiate between the role we assume as a nurse and the nursing activities we carry out while in that role. Many nurses have been unable to make the differentiation and continue to call themselves circulating and scrub nurses. I maintain that these are not roles but activities carried out while functioning in the role of nurse practitioner in the operating room. Nurses call themselves “operating room nurses.” I contend there is no such thing. Nurses practice in the operating room setting but are not nursing the operating room. They are nursing patients who experience surgical intervention. Circulating and scrubbing are duties, functions, or better still, nursing activites. However, they continue to plague the nurse who confuses roles and functions. The Association of Operating Room Nurses has made an attempt at defining roles appropriate to the nurse practitioner in the operating room setting. These were presented to the House of Delegates at the 1976 Congress in Miami and voted down. Why? I believe it is because we are so confused about roles and functions that we cannot grasp the importance of broadening our scope of practice and focusing on the patient instead of tasks. The conceptualization of nursing practice in the operating room is all for naught if you, the nurse in the practice setting, do not perceive your role as professional. By continuing to focus on the tasks and arguing about who should scrub or circulate, we lose our perspective in terms of the real focus-the patient. We have encouraged operating room technicians in their perception of what they can do in the operating room. We have con-

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sistently talked “scrub” and “circulate,” and as they look at those tasks, they believe, quite honestly, they can perform those functions. But, nursing encompasses two components important to providing for the needs of patients-technical and professional. The professional nurse can delegate some technical aspects of care (tasks) to the technician, but the technical aspects nonetheless remain an integral part of the professional nurse’s total responsibility.’ Utilizing both technical and professional skills, the nurse has mastered large amounts of content from both the physical and social sciences to be a safe and competent practitioner. Nonnursing personnel do not have the depth of knowledge they need to be able to synthesize diverse pieces of knowledge in such a way to provide maximum benefit to the patient. The knowledge base for nursing has and will continue to expand in staggering, geometric progression. It will require much more than a year or two of superficial knowledge to be able to incorporate both technical and professional aspects of nursing and reap the expected patient outcomes. As a beginning, I challenge the nurse in the operating room to look critically at what she perceives her role to be. Does the role you are currently playing focus on the patient? Are you utilizing Standards of Nursing Practice: Operating Room as your model for practice? Are you a nurse practitioner, a nurse clinician, or a clinical specialist who perceives her role as an advocate of the patient preoperatively, intraoperatively, and postoperatively? Nursing is continually evolving, new roles are being assumed, and change is inevitable; therefore, we must not allow ourselves to maintain the status quo or to be stagnant. What role are you assuming in the operating room?

Julie A Kneedler, RN, EdD Assistant director of education Notes 1. Margaret L McClure, “Entry into professional practice: The New York proposal,” Journal of Nursing Administration (June 1976) 15.

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AORN offers industry seminar The AORN Committee, Collaboration with Industry, has invited 50 new sales representatives to a one-day orientation seminar designed to introduce them to the operating room environment. The orientation seminar will be from 8:30 am to 4:30 pm Monday, Dec 6,at the Key Bridge Marriott in Washington, DC. The program will offer basic information on asepsis, surgical technique, and ethics. The theme, “Key to the OR door,” will be carried out by discussion of how to approach the operating room supervisor, AORN liaison with other organizations and federal agencies, the fundamentals of aseptic technique, and AORN standards. These sessions are intended to make sales representatives more comfortable in the operating room. The program includes round table discussions and a question and answer period. Leaders for the seminar are A Jane McCluskey, AORN Board member, chairman of the AORN Committee, Collaboration with Industry, and assistant director, nursing practice, OFURR, Genesee Hospital, Rochester, NY; Jerry Peers, AORN executive director, and AORN Past President Patricia Rogers, operating room supervisor, Arlington Community Hospital, Arlington, Va. Preregistration is necessary and attendance is limited to one representative from each company. Registration may be made by calling AORN Headquarters,

303-755-6300. The committee hopes that the program will lead to further sharing of expertise between OR nurses and industry. If this program is successful, the committee will consider offering regional orientation programs.

A Jane McCluskey, RN Chairman, AORN Committee, Collaboration with Industry

AORN Journal, November 1976, Vol24, No 5

What is the nurse's part in OR scenario?

What is the nurse’s part in OR scenario? Carla Summers is a nurse practitioner who provides care to patients experiencing surgical intervention. She f...
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