Perioperative nursing practice is flexible and diverse and includes a variety of nursing roles that incorporate both behavioral and technical components of professional nursing. The scope of perioperative nursing begins in the preoperative phase. During this phase, the nurse provides care from the time a decision is made for a surgical procedure until the patient is transferred to the OR bed. At this time nursing practice continues into the intraoperative phase and when the patient is admitted to the PACU. Perioperative nursing ends with the post-operative phase.
PRIMARY RESPONSIBILITIES & AUTHORITIES:
The Registered Nurse in the operating room is responsible for providing nursing care to the surgical patient. Perioperative nursing begins in the preoperative phase. Responsible to assure admission assessments are completed. Provides care for the surgical patient in the Operating Room and the Recovery Room. Continually assessing patients and the care they receive and reports or corrects any negative or unsafe conditions that may effect the health or well-being of the patients or personnel.
OTHER DUTIES AND RESPONSIBILITIES:
- Preoperative assessment
- Surgical unit
- Completes preoperative assessment
- Coordinates patient teaching with other nursing staff
- Explains phases in perioperative period and expectations
- Develops a plan of care
- Surgical Suite
- Assesses patients level of consciousness
- Reviews chart
- Identifies patient
- Verifies surgical site with patient and physician and the site is marked with YES.
- Verifies an informed consent has been obtained .
- Determines a plan of care
- Individualizes patient care, assists in explaining procedure & teaching appropriate to age and educational level.
- Psychological support
- Tells patient what is happening
- Determines psychological status
- Gives prior warning of noxious stimuli
- Communicates patients emotional status to other appropriate members of the health care team
- Respects patient rights/ privacy
- Maintenance of safety
- Performs TIME OUT. Assures that the sponge, needle, and instrument counts are correct.
- Positions the patient.
- functional alignment
- exposure of surgical site
- maintenance of position throughout procedure
- Applies grounding device to patient.
- Provides physical support.
- Knowledgeable of sterile technique and applies techniques to each procedure.
- Prepares items for sterilization, sterilizes items and monitors sterilization.
- Knowledgeable of instrument type, function, and name.
- Takes care of and handles surgical instrumentation according to policy.
- Prepares surgical packs and trays.
- Selects appropriate specialty equipment for special procedures and assists in their use.
- Assures the physical preparation of the Operating Room
- Verifies exposure to sterilization process and integrity of sterile packaging. And opens appropriate supplies.
- Follows the appropriate dress code as directed by hospital policy.
- Selects and prepares supplies and instruments for the sterile field.
- Assists anesthesia personnel as needed.
- Anticipates the need for additional supplies during the operative procedure.
- Operates all equipment as needed following all recommended practices and procedures.
- Communicates and documents all information regarding the surgical procedure.
- Monitors and controls the surgical environment as indicated in policy and procedure.
- Prepares all specimens for laboratory analysis.
II Physiological monitoring and care.
- Calculates effects on patient of excessive fluid loss.
- Distinguishes normal from abnormal cardiopulmonary data.
- Reports changes in patients pulse, respirations, temperature, and blood pressure.
- Aides in selecting catheters, drains and other appliances and assists in their use.
- Aides in selecting sponges, dressings, sutures and stapling devices.
- Applies thermoregulatory devices to the patient.
- Demonstrates the preparation and use of appropriate hemostatic and blood replacement agents and devices.
- Performs urinary catheterization and monitoring of urinary output.
- Identifies developing emergency situation, initiates appropriate action, assists in the treatment of the patient.
- Documents the intraoperative care of the patient.
III Psychological monitoring
- Provides emotional support to patient.
- Stands near/touches patient during procedures/induction.
- Continues to assess patients emotional status.
- Communicates patients emotional status to other appropriate members of the health care team.
- Functions in the role of the scrub person.
- Follows principles of correct hand scrub.
- Gowns and gloves self and others.
- Passes correct instrumentation, supplies and suture as needed by the surgeon.
- Prepares medication and irrigating solutions as needed by the surgeon.
- Maintains the highest standards of sterile technique during the operative procedure.
- Follows established policy and procedure for all counts.
- Initiates corrective action when counts are incorrect.
- Anticipates emergency or unusual circumstances and initiates corrective action.
- Follows appropriate postoperative routines.
- Demonstrates knowledge of the progressive steps inherent in specific surgical procedures.
- Displays dexterity in the use of required instrumentation and supplies.
- Anticipates the needs of the surgeon in order to expedite the surgical procedure.
- Demonstrates organization of work.
- Nursing management.
- Provides physical safety for the patient.
- Maintains aseptic, controlled environment.
- Effectively manages human resources.
- Communication of intraoperative information.
- Gives patients name.
- States type of surgery performed.
- Provides contributing intraoperative factors, i.e., drain, catheters.
- States physical limitations.
- States impairments resulting from surgery.
- Reports patients preoperative level of consciousness.
- Communicates necessary equipment needs.
- Cares for the patient in the Recovery Room
- Monitors vital signs, LOC, I & O
- Provides control for blood pressure, output, temperature, ventilation, pain control, patient complaints.
- Assures equipment functions properly.
- Responsible for narcotic counts & restocks supplies.
- Assures crash cart is stocked, outdates are checked, tests the defibrillator and documents such.
- Postoperative evaluation.
- Determines patients immediate response to surgical intervention.
- Evaluates Effectiveness of nursing care in the OR
- Determines patients level of satisfaction with care given during perioperative period.
- Evaluates products used on patients in the OR.
- Determines patients psychological status.
- Assists with discharge planning.
- Accountable as a health care professional.
- Respects the rights of the patient by maintaining confidentiality and privacy of the patient.
- Provides a safe, efficient, and supportive environment for the patient.
- Demonstrates sound judgment in decision making.
- Demonstrates initiative in expanding ones knowledge of new procedures and subjects.
- Promotes the importance of continued education.
- Recognizes the importance of teamwork, consideration, and cooperation within the operating room.
- Promotes responsibility as an individual and member of the health care team.
- Assists in the coordination of efforts of all members
- Functions in an efficient and professional manner in all aspects of surgical care.
- Develops a code of behavior that includes ethical and moral responsibilities.
- Understands that each practitioner is individually responsible for his/her actions.
- Recognizes legal and policy limitations in individual responsibility.
Lifting approximately 50 pounds.
Transporting, lifting and transferring patients.
Standing/ walking for lengthy periods of time.
Risk of exposure to blood and body fluids, expected to use personal protective equipment.
Well-lit, ventilated area.
ON CALL REQUIREMENTS:
The RN will be responsible to alternate call schedules on weekends and nightly when day shift procedures end. Call will consist of one or more nightly call schedules Monday through Friday and 1 or 2 weekends per month. Holiday call will also be scheduled on a rotating basis.
Employees will be paid an hourly rate for authorized on call time and must be able to return to work within 30 minutes after notification of need to return to work. Guidelines for call pay will follow the Livingston Hospital & Healthcare Services, Inc. employee handbook policy.