Thanks!! As you’ve seen already, I’m happy to ramble: feel free to hit me with any questions. The OR is a pretty alien environment to anyone who doesn’t work there.
Just keep in mind that as the surg tech, I’m literally the rock bottom of the OR food chain. And an anonymous internet stranger, so take this all in with the credibility it deserves (none at all!).
Depending on the facility there can be a lot of overlap in the duties of an OR nurse and the pre-op and post-op (PACU, or Post-anesthesia Care Unit) nurses - the hospitals I’ve worked at have all taken that mixed approach; but now that I’m in nursing school, one of my clinicals was in the OR of another hospital and they seemed to have those duties completely isolated. I don’t know which is the norm. Since I’m used to seeing the mixed approach, I’ll talk about each one:
In pre-op they they go through all the checks to make sure you’re actually good to proceed with the surgery - like going over meds to make sure you followed the preop instructions (some prescription meds interfere with anesthesia, so they need you to discontinue them up to a full week ahead of the surgery) or that you haven’t had anything to eat or drink within a certain time frame (that can kill you). Lots of patient education about what to expect going into the OR, and then getting you physically ready like changing into a patient gown, starting an antimicrobial prep and usually starting at least one IV.
The OR nurse retrieves the patient from preop and brings them to the OR. Once there they’ll help get you moved over to the OR bed and in the correct position - positioning is one of the more important duties for the OR nurse, since you’ll be under for potentially hours and completely paralyzed, you can’t detect or respond to discomfort. Even when you’re sleeping normally, if your body detects too much pressure on whatever part you’re laying on, it’ll make a small adjustment without you even being aware of it; but in the OR even that sensation is gone, and after spending hours in the same position, if it isn’t ergonomic it can seriously damage your joints or keep blood squeezed out of some tissue long enough that it actually dies. If your surgery is long enough you’ll need an indwelling catheter (otherwise your bladder gets so full it can actually cause damage). The nurse is usually the one to do the skin prep. usually with betadine, chlorhexadine, or alcohol, and from there the case is in the surgeon’s hands; but the nurse acts as kind of liaison between the sterile field and the rest of the OR: if something comes up and some supply item or instrument is needed that wasn’t opened at the start of the case, the nurse tracks it down and opens it in a specific way to get it onto the field without contaminating on it. They’re also your main advocate during the procedure - if you have an iodine allergy or something and the surgeon asks for ioban (sticky iodine-infused drape) the nurse (and tech if you have a good one) will step up to stop that from being used. Throughout the case they also chart everything that happens, which is generally their biggest gripe (tedious computer work) but still super important documentation so you know exactly what happened while you were under. Once the surgery is over, they’re hands-on again, making everything that’s connected to you that needs to removed (like the catheter) is taken out before you wake up since it’s uncomfortable otherwise; and that the things that need to stay attached remain in place and working (like your O2 mask, IV, etc); they’ll help anesthesia to make sure extubation goes smoothly, then scoot you back over to the gurney you rolled in on. They’ll help you get your orientation as you’re waking up (which can include restraining you as you try to throw kicks and punches), then transport you to PACU.
PACU nurses continue to orient you and mostly manage your vitals, which will be weird AF after anesthesia (part of nursing is identifying things that are ‘out of range’, but general anesthesia changes what normal ranges are pretty drastically). If you’re in pain when you wake up, they’ll help manage it (sometimes that won’t kick in till later because you’ll still have the local anesthetic working). They’re big on looking for post-op complications looking for signs like blood pressure dips that could indicate internal bleeding.
Once you’re stable, you’ll either be discharged and good to go home; or sent to a med surg floor for extra time to recover under close observation.
![[edit] Taking the photo down so I don't dox myself - glad y'all liked it!!](https://lemmy.world/pictrs/image/ec773f96-8962-405b-95fb-3084c5721db7.png){kind=link}
Thankfully! That was a fascinating read, and my day is better for having read it.
Thanks!! As you’ve seen already, I’m happy to ramble: feel free to hit me with any questions. The OR is a pretty alien environment to anyone who doesn’t work there.
Just keep in mind that as the surg tech, I’m literally the rock bottom of the OR food chain. And an anonymous internet stranger, so take this all in with the credibility it deserves (none at all!).
What do surgical nurses do in the OR?
Depending on the facility there can be a lot of overlap in the duties of an OR nurse and the pre-op and post-op (PACU, or Post-anesthesia Care Unit) nurses - the hospitals I’ve worked at have all taken that mixed approach; but now that I’m in nursing school, one of my clinicals was in the OR of another hospital and they seemed to have those duties completely isolated. I don’t know which is the norm. Since I’m used to seeing the mixed approach, I’ll talk about each one:
In pre-op they they go through all the checks to make sure you’re actually good to proceed with the surgery - like going over meds to make sure you followed the preop instructions (some prescription meds interfere with anesthesia, so they need you to discontinue them up to a full week ahead of the surgery) or that you haven’t had anything to eat or drink within a certain time frame (that can kill you). Lots of patient education about what to expect going into the OR, and then getting you physically ready like changing into a patient gown, starting an antimicrobial prep and usually starting at least one IV.
The OR nurse retrieves the patient from preop and brings them to the OR. Once there they’ll help get you moved over to the OR bed and in the correct position - positioning is one of the more important duties for the OR nurse, since you’ll be under for potentially hours and completely paralyzed, you can’t detect or respond to discomfort. Even when you’re sleeping normally, if your body detects too much pressure on whatever part you’re laying on, it’ll make a small adjustment without you even being aware of it; but in the OR even that sensation is gone, and after spending hours in the same position, if it isn’t ergonomic it can seriously damage your joints or keep blood squeezed out of some tissue long enough that it actually dies. If your surgery is long enough you’ll need an indwelling catheter (otherwise your bladder gets so full it can actually cause damage). The nurse is usually the one to do the skin prep. usually with betadine, chlorhexadine, or alcohol, and from there the case is in the surgeon’s hands; but the nurse acts as kind of liaison between the sterile field and the rest of the OR: if something comes up and some supply item or instrument is needed that wasn’t opened at the start of the case, the nurse tracks it down and opens it in a specific way to get it onto the field without contaminating on it. They’re also your main advocate during the procedure - if you have an iodine allergy or something and the surgeon asks for ioban (sticky iodine-infused drape) the nurse (and tech if you have a good one) will step up to stop that from being used. Throughout the case they also chart everything that happens, which is generally their biggest gripe (tedious computer work) but still super important documentation so you know exactly what happened while you were under. Once the surgery is over, they’re hands-on again, making everything that’s connected to you that needs to removed (like the catheter) is taken out before you wake up since it’s uncomfortable otherwise; and that the things that need to stay attached remain in place and working (like your O2 mask, IV, etc); they’ll help anesthesia to make sure extubation goes smoothly, then scoot you back over to the gurney you rolled in on. They’ll help you get your orientation as you’re waking up (which can include restraining you as you try to throw kicks and punches), then transport you to PACU.
PACU nurses continue to orient you and mostly manage your vitals, which will be weird AF after anesthesia (part of nursing is identifying things that are ‘out of range’, but general anesthesia changes what normal ranges are pretty drastically). If you’re in pain when you wake up, they’ll help manage it (sometimes that won’t kick in till later because you’ll still have the local anesthetic working). They’re big on looking for post-op complications looking for signs like blood pressure dips that could indicate internal bleeding.
Once you’re stable, you’ll either be discharged and good to go home; or sent to a med surg floor for extra time to recover under close observation.