Surgical Nursing Surgical nurses, often referred to as perioperative nurses or operating room nurses, are registered nurses (RNs) who are responsible for providing nursing assistance in surgical settings, including the preoperative, intra-operative, and post-operative phases of surgery. In addition to assisting healthcare professionals and surgeons, perioperative nurses work closely with the surgical patient and the patient’s family. Surgical nurses are considered the backbone of the surgical team, and they take on a key role not only in surgical procedures, some of which may be life-saving, but also in the patient care that takes place before and after the procedure. Through the implementation of a comprehensive, multidisciplinary approach, perioperative nurses work closely alongside all members of the surgical team. Perioperative nurses who achieve additional training and experience may also advance into leadership roles, such as operating room directors, who are responsible for managing budgets and staffing, as well as for oversight of the business end of a hospital’s surgical center. Surgical Nurses and the Nursing Process Surgical nurses utilize the nursing process to assess, plan, and implement patient care before, during, and after a surgical procedure. The assessment process includes: Reviewing the patient’s current and path health history Analyzing laboratory results Assessing the patient’s psychological and physical condition Ensuring the patient has an understanding of the surgery or procedure Surgical nurses frequently review the nursing care plan throughout the process, revising as necessary. Their work involves addressing a number of factors, such as skin integrity and efficient circulatory/gas exchange, although patient safety always remains the surgical nurse’s top priority. Surgical nurses must have the ability to interact well with people in the midst of stressful or difficult situations, and they must possess a caring and empathetic attitude. Their work involves oversight of the entire surgical process, from start to finish. Therefore, they must possess the ability to: Make critical decisions Direct others Coordinate the patient’s care Collaborate with physicians and other healthcare professionals Surgical nurses possess strong leadership skills, excellent problem-solving abilities, superb communication and interpersonal skills, and strong collaborative abilities. Job Settings and Description of Duties for Surgical Nurses Although surgical nurses have traditionally worked in general inpatient hospitals, today’s surgical nurses may also work in a number of outpatient settings, such as: Day surgery (ambulatory) centers Outpatient clinics Physicians’ offices They may also focus their area of surgical nursing expertise in a subspecialty such as: Cardiac surgery Trauma Pediatrics Oncology Dental Plastic and reconstructive Urology Neurosurgery Surgical nurses may also find a number of professional opportunities outside the operating room, working as management consultants, clinical educators, researchers, and medical sales professionals. The job duties of surgical nurses can be broken down into the three phases of a surgery: Pre-operative care Surgical nurses prepare patients for surgery by completing a number of steps: Educating the patient on any pre-operative instructions leading up the surgery Ensuring that all pre-operatives tests and bloodwork are completed Ensuring that the patient’s chart is comprehensive and all paperwork is completed and signed Settling patient into the room and prepping the patient for surgery Interviewing and assessing the patient on the day of the surgery Intra-operative care Within the operating room, perioperative nurses may serve in one or more capacities: Scrub nurse: Assists the physician by selecting and passing instruments and supplies during the surgery Circulating nurse: Manages the overall operating room as to ensure a safe and comfortable operating room environment RN first assistant: Directly assists the surgeon Post-operative care Upon completion of the surgical procedure, surgical nurses are responsible for: Monitoring the patient and addressing any signs of distress, infection, shock, bleeding, or other problems Dressing wounds Assisting patients by helping them deal with the effects of the surgical procedure or by providing pain management Instructing the patient and patient’s family on at-home, post-operative care (discharge orders) Ensuring that the patient is comfortable Surgery Surgery is a method for treating disease or injury by manual operations. Surgery may be done through an existing body opening, but usually it involves cutting or puncturing tissue with a sharp instrument in the process of incision. (See Display 7-2 for descriptions of surgical instruments and Figure 7-9 for pictures of surgical instruments.) Some form of anesthesia to dull or eliminate pain is usually required. After surgery, incisions must be closed for proper healing. Conventionally, this is done using stitches or sutures, but adhesive strips, staples, and skin glue also are used. Many types of operations are now performed using a laser beam. This is an intense beam of light that can be used for surgery and for diagnosis. Some procedures require destruction of tissue by a harmful agent, such as by heat or a chemical, in the process of cautery or cauterization. Some of the purposes of surgery include: • Treatment: For excision (cutting out) of diseased or abnormal tissue, such as a tumor or an inflamed appendix. Surgical methods are also used to repair wounds or injuries, as in skin grafting for burns or realigning broken bones. Surgical methods are used to correct circulatory problems and to return structures to their normal position, as in raising a prolapsed organ, such as the bladder, in a surgical fixation procedure. • Diagnosis: To remove tissue for laboratory study in a biopsy, as described above. Exploratory surgery to investigate the cause of symptoms is performed less frequently now because of advances in noninvasive diagnostic and imaging techniques. • Restoration: Surgery may compensate for lost function, as when a section of the intestine is redirected in a colostomy, a tube is inserted to allow breathing in a tracheostomy, a feeding tube is inserted, or an organ is transplanted. Plastic or reconstructive surgery may be done to accommodate a prosthesis, to restore proper appearance, or for cosmetic reasons. • Relief: Palliative treatment is any therapy that provides relief but is not intended as a cure. Surgery is done to relieve pain or discomfort, as by cutting the nerve supply to an organ or reducing the size of a tumor to relieve pressure. Surgery may be done in an emergency or urgent situation under conditions of acute danger, as in traumatic injury or severe blockage. Other procedures, such as cataract removal from the eye, may be planned when convenient. Elective or optional surgery would not cause serious consequences if delayed or not done. Over time, surgery has extended beyond the classic operating room of a hospital to other hospital areas and to private surgical facilities where people can be treated within 1 day as outpatients. Preoperative care is given before surgery and includes examination, obtaining the patient’s informed consent for the procedure, and preadmission testing. Postoperative care includes recovery from anesthesia, follow-up evaluations, and instructions for home care.
