01.01 Perioperative Nursing Roles

Okay guys I'm super excited to get to talk to you a little about the different nursing roles within the perioperative setting!    If I could pick just one single thing for you to take away from this lesson on perioperative nursing roles, it would be that the perioperative nurse is a title referring to the different types of RNs who care for patients before, during, and after surgery.   Who is considered a perioperative nurse? There are a few different nurses that would fall under this title including the pre-op RN, circulating RN, scrub RN, RN First Assist, and the PACU RN.  Each of the listed nurses play a significant role in the care of a surgical patient.    As a perioperative nurse caring for a surgical patient, what are your goals?  You will provide safe and effective care that meets every possible need that your patient may have before surgery, and guys this can mean of course their physical needs but also things like their mental, spiritual, and cultural needs too!   Before we dive deeper into the specifics of each perioperative nursing role, I wanted to give a visual so you can see in what phase of the surgical process each perioperative nurse will function.  In the preoperative area you're going to have the pre-op nurse who will care for the patient before surgery.  The circulating RN, scrub RN, and RNFA are going to care for the patient during surgery in the intraoperative area or operating room.  Finally, the PACU RN will care for the patient after surgery in the postoperative setting or post anesthesia care unit.   Okay so a little bit about the pre-op nurse.  The pre-op nurse will be the first to have interaction with the patient before surgery.  Assessment of the patient preoperatively is very important to the safety of the surgical patient.  Reviewing the patient’s allergies, current medications, NPO status, and completing a thorough head-to-toe physical assessment paying close attention to the skin are all important roles of the pre-op RN.  Verifying and completing pre-op orders like lab work, antibiotic orders, and informed consent are additional roles of the pre-op RN.  Make sure you check the specific lessons on informed consent and preoperative nursing assessment to see more details.    What role does the circulator play? The circulator is going to provide care to the patient during surgery.  While in the OR specifically, the circulator will be the non-sterile person assisting those at the sterile field.  Before bringing the patient to the operating room, the circulator will basically make sure their patient is ready to go!  Do you remember all the stuff that the pre-op nurse does for the patient?   Well...the surgical nurse will review this, especially lab work results and consent forms!   The circulator will also make sure other important legal paperwork, like the history and physical is signed by the provider and, super important, the surgical site is marked by the surgeon.  The circulator will also provide emotional support to the surgical patient.  I can tell you from years of being a perioperative nurse, surgery makes even the toughest of people very anxious! Circulators play a huge role in decreasing the risk of injury by verifying the correct surgery is being completed on the correct patient, ensuring needle, instrument, sponge counts, and maintaining proper positioning of the patient.  Finally, a very important role is decreasing the infection risk by proper surgical site preparation, verifying a proper OR environment, and confirming sterile technique is being followed.  Guys be sure to take a look at the lessons we have on proper positioning, the sterile field, surgical prep, and intraoperative nursing priorities for more details!   The scrub nurse is a perioperative nurse who provides care in the operating room during surgery.  The scrub nurse will be a sterile member of the team in surgery.  The role of the scrub nurse is to prepare and maintain the sterile field and assist the surgeon during the procedure with things like passing instruments, needles, and sponges.  The scrub nurse works with the circulator from the sterile field with tasks including verifying correct needle and sponge counts.  One more thing I want to mention, you will sometimes see a non-RN in this role, also known as a scrub or surgical technician.  The roles between a scrub RN and a surgical tech can overlap but the training, licensing, and education is very different.  The surgical technician functions under the RN and certification is voluntary in most states.  Make sure you check out the policy/law in your state and facility!   The registered nurse first assist or RNFA is an RN who has received additional certification to assist the surgeon during the surgical procedure.  The RNFA will aid the surgeon in providing wound exposure, controlling bleeding, suturing, and closing of the surgical site.  So this is a super cool career within the nursing profession if you just love to be in the surgical setting and like to get your hands dirty.  What an awesome specialty and certification to work towards!     The PACU nurse cares for the surgical patient after the surgery has been completed.  Because a patient typically receives anesthesia in order to have surgery, assessment by the PACU nurse is critical.  Things like level of consciousness, airway, and breathing are monitored closely.  Vital Signs and pain are also assessed. The PACU nurse determines the patient's readiness for safe discharge with the use of the Aldrete Score, and will also help the patient understand postoperative wound instructions and follow-up instructions.  Guys make sure you check out the additional lessons on anesthesia and post-op complications for more details!    Okay guys so when it comes to patient education and perioperative nursing roles, remember these patients are about to have surgery because something is wrong.  They often times are quite anxious as this is a very foreign event and there may be a lot of unanswered questions in regards to their health.  So always remember to tell your patients who you are, what your role is, what they can expect from you and your time together.  This knowledge helps the surgical patient to feel empowered and a little more at ease.   All right guys, key points to take away with you, the pre-op RN will provide care before surgery, assess the patient, and make sure there has been informed consent.  The circulating RN will care for the patient during surgery, prevent injury, and infection.  The Scrub RN and RNFA will also care for the patient during surgery and assist the surgeon.  And remember, the circulator is the only non-sterile RN in the operating room while the scrub RN and RNFA are sterile at the field.  The PACU RN will care for the patient following surgery, assess the airway, vital signs, pain, and make sure they can go home without any issues!   Okay guys that's it for this lesson on the different perioperative nursing roles, I hope enjoyed the lesson!  Make sure you check out all the resources attached to this lesson, as well as the rest of the lessons in this course. Now, go out and be your best self today. And, as always, happy nursing!