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A Day in the Life of a Surgical Nurse
Being a surgical nurse is very different from other specialties because surgical nurses care for sleeping patients. Surgical Nurses see patients very briefly before surgery and then take them back to the operating room where they will be put to sleep by an Anesthetist or Certified Nurse Anesthetist (CRNA).
Surgical nurses are very territorial and mysterious. No one else really knows what goes on behind those operating room doors (neither patients nor other nurses). It’s a whole different world in surgery and without the proper training, you are not allowed into the surgery area.
Surgical nurses do not change dressings; they usually do not give drugs (except for local monitoring). They don’t respond to traffic lights or care much about patients’ families. So what the hell do they do?
Well, behind those surgical doors are some exceptionally skilled nurses who deserve recognition and praise, which they rarely get.
They don’t see how a patient recovers. Patients are so high on Versed that they have amnesia after all their surgical experience.
If they are on day shift, they arrive at the hospital or facility around 6:00 to be ready to set up a case at 7:00. This gives them time to change into scrubs and read their schedule. The schedule is their destiny for the next 8-12 hours. They look at the large board near reception to find out if they are the duty nurse or the circulator that day. The main thing they are looking for in the council is which surgeon they will work with. This simple thing can make or break their day. There are good surgeons and bad surgeons, just like any other section of the population. “Please God, don’t let it be so-and-so.”
Surgeons may be friendly, but their skills can be awful. Or they may be great surgeons, but real idiots. Hopefully that day you will be assigned all the surgeons who are both friendly and good at what they do…but that is not likely.
If you are assigned to be the Circulating Nurse then grab your Technician/Nurse and both of you go find your first cart of the day. This could be anywhere in the mess of other carts that have been filled with items needed for other cases. Hmmm, what a joy it is when you have a big spelling case and half the tools are non-sterile and need flashing. Better yet, half the items on the preference sheet are missing.
You have to rush to find them while your nurse is opening the sterile field. When you come back you “dance with your nurse”. Not literally, but “dancing with your nurse” actually means that you help the nurse strap on the scrubs. They can’t do it themselves, or it would render them non-sterile, from reaching behind their backs.
You then have to count everything including all tools, raytecs, rounds, needles and blades. Remember that all of this is done between 6:30 and 7:00. Heaven forbid you miss a spin or any of the above elements. It’s a nightmare when you lose something. I’ve been in cases where we were removing a sponge, needle, or tool; these cases are so funny. In cases where the surgeon has previously left a sponge inside the patient, you definitely need a small amount of wintergreen on your mask, or risk throwing up your guts! (and that’s putting it lightly). Anyway, once everything is counted, your nurse is happy, your operating bed is covered, and all the equipment is in the room, it’s time to go out and say hello to the patient.
Go to pre-op to introduce yourself to the patient and evaluate the chart. God knows what crazy stuff you’re going to find in there. The labs may be far away and the operation may be cancelled. The patient may be allergic to latex, so the entire sterile field has to be demolished, because you have already placed a latex foley there. You walk into the room and address the patient as coldly as possible (trying to remember that this patient is scared out of his mind) unless he’s had Versed. Such a wonderful drug!
The anesthesiologist has usually seen and evaluated the patient before you arrive, and the patient has already been asked 3 or 4 times if he has eaten or drunk anything since midnight. But when you ask the same question to the patient, his answer suddenly changes. They tell you all they had was a donut and coffee for breakfast that morning! Okay, so now the case is abruptly dismissed and you’re lucky enough to be tasked with taking the entire OR apart and starting over. One of several other scenarios could be that the patient is allergic to shellfish or peanuts (which is the allergy de jour these days). Everyone and their mother have a peanut allergy. Or maybe the patient is just allergic to his own mucus!
Today the patient has none of these problems. They are neither obese nor pregnant, so there will be no need to pull out the Hercules bed. Hip hip hooray, the operation will proceed. He starts taking her back to surgery after she takes her “margarita in a vial,” (Versed), and before she tells everyone in the pre-op area any secrets she has.
He keeps talking about your stupidity all the way to surgery, and he tells you he’ll never forget how wonderful you are. In your mind you’re thinking Yeah right, you won’t remember your name when you wake up, let alone mine. After entering the OR you transfer the patient to the table to find that she is still wearing her underwear (complete with latex bandage), even though she has told you she has a latex allergy… Great!
Assist the CRNA or anesthetist in getting her to sleep, (quickly, because she’s driving you crazy), with her “jabber, jabber won’t shut up”. CRNA or Anesthetist to put her to sleep, (in a hurry, because she’s driving you crazy), with her “jabber, jabber won’t shut up”.
Alas, he is sleeping, and all is silent for a few minutes, until Doctor Friendly bursts. He’s had a bad day out and about, and has been called 54 times by staff at his office, so he’s in a great mood, and you’re in for a great day.
Nothing on the preference card is right, and you spend your time running around looking for tools (the dirty ones, which need to be viewed). This only pisses the surgeon off more and makes your day even better. The bovie doesn’t work and the Rad Tech has been called for a C-arm 10 times but it’s still MIA.
When everything starts to fall into place and all the issues have been resolved, you can relax for 5 minutes and sit in silence, hoping it stays that way. Finally the surgeon is closing up and you start counting. First laps and raytec, then tools, then needles. They are all correct (well, except for one tiny needle) which is nowhere to be found. The scrub still matters. “No, it’s still missing.” The surgeon is about to take someone’s head off and verbalizes it freely. Run to the magnet on a stick to roll it across the floor and find the damn needle. Finally, you find it near the nurse’s foot.
The patient’s starting to wake up and you’re done with the case. Transfer the patient to post-op and provide the PACU nurse report. Yes, it’s lunchtime and you’re exhausted, with only five more cases to finish.
This is a day in the life of a surgical nurse. Many nurses in other specialties believe that surgical nurses don’t actually do much or aren’t “real nurses.” While the role of Surgical Nurses is very non-traditional, they work very hard and are an integral part of the nursing profession. Unfortunately, they fail to see the fruits of their labor. Once the surgery is done, they never see that patient again and usually have no idea how well the patient did while recovering. The patient does not remember the great care she received from all the operating room staff and, for the patient’s sake, it’s probably for the best.
Surgical nurses are highly skilled at what they do and truly deserve more respect from both surgeons and other nurses. So, next time you meet a surgical nurse treat her right, you might be next to walk through those mysterious double doors and onto that operating table.
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