A Typical Day For A Circulating Nurse In The Operating Room
"I’m not telling you it’s going to be easy, I’m telling you it’s going to be worth it."— Art Williams
A Typical Day
This is about a typical day for a circulating nurse in the operating room. Understand that this is a condensed version. I could give every detail, but I think that would get much too long. Circulating room nurses do much more than is mentioned here. Let me know in the comments below if you would like a story with more detail.
Start Of Day
Mary woke thinking about the day’s cases. First was a total knee, then an ORIF, then anyone’s guess. Wondering if the call crew took anything off her extras cart she brushed her teeth. A quick run of the brush through her hair, some clothes and she was off.
Totals are a tremendous set-up, which is why it was first. First cases got 30 minutes to set up. After that, turnover time should be no more than 15 minutes. Kelli agreed to meet her 15 minutes early so they could have a few more minutes to get ready. Running the necessary equipment through her mind, she parked and rapidly started toward the building.
After badging herself into the OR dressing room, Mary quickly changed and went into the OR. She checked the book to see if the call crew had been in during the night. They had been there, but not for ortho. “Yippee,” she celebrated under her breath. Room 6 should still be ready for her and Kelli. They had positioned the furniture before leaving yesterday.
Although there was no such thing as a routine case, she had a routine circulating. Checking the book was just the beginning. Without a routine there would be no way to remember all the many little actions that went into getting a surgery ready.
Setting Up For Surgery
Moving toward room 6, she grabbed her extras cart and the implant cart. She noticed the instrument cart was gone and correctly assumed Kelli had beat her to work. In the room Kelli was laying supplies and instrument sets around, getting ready to open them. Mary began helping Kelli. When everything was double checked and positioned they started opening for the case.
She liked working with Kelli. Kelli was pretty easy-going, as OR staff went. She had years of experience and no longer sweated the small stuff. That didn’t mean Kelli wasn’t anal retentive. Without that exacting nature you don’t last in the operating room. Everyone was anal here, at least to some degree.
Most of the supplies were open and other staff were moving around in the hall. Mary knew it was 6:30 am without looking at the clock. Now they had half an hour left until the patient came back. Mary told Kelli to scrub in while she continued opening. Kelli scrubbed and came back into the room. Mary tied her up. Moving as if in a dance, Mary and Kelli continued to set up without ever being in the other's way. They were getting in the zone.
After all the supplies and the 15 instrument trays were opened, Kelli and Mary counted. Kelli continued to set up for the case. Mary left the room to see the patient and get the required medications. Looking at the clock on her way out, Mary saw she had 15 minutes left until it was time to take the patient back. She quickly headed for the pre-operative holding area.
Check The Patient
Mary found her patient, Joe Doe, changed and on the stretcher. He had been given a warm blanket and looked apprehensive. Mary introduced herself, giving Joe her attention. Asking his name and birth date, she checked his answer against his name band and the chart.
She went over her other questions before asking Joe if he had any questions. Joe denied any questions, so Mary started explaining what would happen when they went back to the operating room. Mary once again asked Joe if he had any questions. She wondered out loud if he was warm enough. Joe said he did not have any questions and claimed he was warm enough.
While Mary was speaking to Joe, Dave, the anesthesiologist, arrived. He checked the chart while Mary continued asking her questions. At Joe’s lack of questions, Dave introduced himself. Mary took the chart and Dave asked a few questions. As Dave started explaining the plan for anesthesia, Mary said she would be back in a bit.
Watching Over The Patient
Getting The Medication
Mary quickly arrived at the medication dispenser. She pulled the required medications, including the maybes. Better to have them and not need them, than to need them and not have them. Medication in hand she swiftly walked back to the room.
Finishing The Set Up
In the room, Mary gave report to Kelli. Kelli told her they were missing curettes. Mary ran and got them. Kelli had everything ready and set up. She broke scrub and hurried to the bathroom. Mary set up her prep stand. Clippers, prep and the foley catheter kit were all present. She grabbed a tourniquet and some webril for padding. She was set.
Dave returned and began getting his supplies ready. He asked Mary if she could bring the patient back while he set up. No one wanted to hold up Dr. Jerk. Nurse, doctor or in between, Dr. Jerk was an equal opportunity ogre. He played no favorites.
Bringing the Patient Back
Mary rolled her eyes at Dave, but he was not watching. She hated pushing the stretcher alone and Dave knew it. No wonder her back hurt every morning. She left the room to bring Joe back.
“Steph, is there anyone that can help me push a patient back?” Mary asked the charge nurse.
Steph replied, “Jason called in sick so we do not have any extra people.”
Mary sighed and headed to the holding area to get Joe. She saw the housekeeper and wrangled him into helping her push Joe back. Hoping it was a good omen, Mary smiled.
As they entered the room, Mary noted that Kelli was back. Kelli assisted with moving Joe over to the OR bed. Mary and Dave sat him up for his spinal. While Dave was putting in the spinal anesthesia, Kelli checked each medication with Mary and poured them onto her back table. As Dave finished the spinal, Kelli was out the door to scrub back in.
Prepping the Patient
Mary tied Kelli up and went to work. This was when her job really began. She remembered how hesitant she was the first time she prepped a patient. Everyone was waiting and watching her, it had made her so nervous. Not any more.
Dave had given Joe some milk of amnesia and Joe was asleep in 10 seconds. The crew began chatting. Talking about the show,“Game of Thrones”, Mary continued to work.
The tourniquet went on and the foley was inserted. Finally the leg was prepped. It was a long, heavy leg and, without help, Mary was feeling the strain in her arms and shoulders.
As Mary held the leg, Kelli began draping. Mary asked if anyone has seen Linda, the first assistant. No one had and Dave worried aloud that she was late. He told the others that Linda was late two days ago and Dr. Jerk had a conniption fit. Mary hoped Linda showed up soon or the day would start with some yelling.
Circulating Nurse Prepping The Patient While Everyone Watches
Tantrum Number One
Dr. Jerk walked into the room. “Are you ready,” he asked.
“We are all ready for you,” Mary answered holding the prepped leg with one hand and pulling out the time-out sheet with the other. “How about we do the time-out since you are here." They went over the time-out and everyone agreed on the information.
Mary looked out the window and saw Dr. Jerk scrubbing. “Thank goodness,” she uttered under her breath, relieved that they would cut by 8:00 am.
Dr. Jerk walked in, hands in the air. “Why the hell isn’t this leg draped!” he yelled. Then he noticed Linda was not present. “Damn Linda,” he raged. “This is the second time she’s been late this week!”
“I knew something was missing,” Mary joked.
Kelli dressed Dr. Jerk. Doctors were never able to put their hoods on without help. That was a skill only the scrub nurses possessed.
Dr. Jerk took the foot from Mary and Mary tied him up. Kelli and Dr. Jerk finished the draping and began the surgery. Cut time was 7:54 am. Mary could not believe Linda was still not there.
Tantrum Number Two
Dr. Jerk asked for a curette. Mary forgot to open them earlier and hurriedly grabbed them. While she opened the pack, Dr. Jerk turned to Kelli. “Can’t you remember the simplest things?! What the hell is wrong with you, are you just plain stupid, or do you not care!” Dr. Jerk bellowed at the top of his lungs.
“Sorry, sorry,” Mary placated as she handed the curettes to Kelli, “Kelli asked me for them but I forgot to open them.”
“What the f@@k! Can’t anyone do anything right around here!” Dr. Jerk roared, continuing his temper tantrum. Mary knew all the yelling was because Linda was late. She and Kelli just happened to be in front of his frustration. Besides, he loved to yell and intimidate people. He had told her so.
Tantrum Number Three
The tantrum was over and the doctor seemed better. Right then, Linda showed up. They did another time out. Kelli had to leave Dr. Jerk’s side to go dress Linda. Mary saw the vein in Dr. Jerk’s forehead start pulsing. That was a bad sign! He was going to erupt on Linda now.
“Hi Dr. Jerk,” Linda said.
“When you were in school, did they ever teach you to read a clock! You know, these days they have digital clocks that tell you the time! Do you know how to read numbers!” Dr. Jerk bellowed in response.
“Yes, sir,” replied Linda.
“You are f@@king worthless! This is the second time you were late this week! Now you are holding up my surgery!! I’m complaining to Terry (the OR manager)!"
Linda ducks her head, “Sorry sir,” she responded. Mary, Kelli and Linda all know there was no sense in explaining to Dr. Jerk. It would just make him yell more.
Mary tied up Linda, and everyone was finally in place. Kelli had the curettes and surgery started again. It was no wonder Kelli had anxiety fits before working with this guy. She told Mary she was usually up all night before having to work with him. He intimidated her. Mary had told her numerous times to stop letting him intimidate her because if he knew he could he tried more often. He was just a monster through and through. However, he was an excellent surgeon.
Mary did not care how much of a jerk the docs were, just if they could do surgery well or not. She would rather put up with the trolls if it meant good outcomes for her patients. Truth was, you did not often find a monster who could not do surgery well. Docs who were not as skilled were usually much nicer.
Mary thanked God that medical schools seem to be putting out some doctors with manners nowadays. She had worked with some nice doctors who were also excellent surgeons in the last few years. There were even a couple in this facility. Would wonders never cease?
End Of Case
The surgery continued with only three more temper tantrums. As she said a silent prayer of thanks, Mary made sure the room bed and CPM (continuous passive motion) machine were waiting. She opened the dressings onto the mayo stand.
Dressings in place, they moved the patient to the room bed. Dr. Jerk set the CPM and turned around and thanked them. He left to dictate his note. Dave and Mary took Joe to the recovery room.
Joe was waking up well. The spinal was still supplying pain control. Dave and Mary gave report to the John, the PACU nurse. John said he was happy, so they were off to get ready for the next case.
Mary checked the board. “Ugh,” she thought. The ORIF got bumped for a bowel resection with Dr. Gossip. Dr. Jerk caught her at the board. He thanked her for her help today, forgetting all the yelling he had done.
She teased Dr. Jerk about all his yelling. He knew she did not approve or appreciate it. Giving his style of apology, he joked, "You know I'm a hothead."
“How typical,” she sighed inwardly. At least today she was not been on the receiving end very often.
Good Information About Opening the Case
The bowel resection was opened in room 7. “Great,” Mary thought, “No telling what we have.” The float nurse, Debbie, was not the most exacting. Mary noted that none of the extras were pulled and headed out to get them. She also put together a stapler cart to have in the room.
Kelli was scrubbed in and started asking Mary for items as soon as Mary stepped back into the room. It was frustrating when someone else opened your case because you never knew exactly what was there (and what wasn't). Mary ran and got Kelli's requests. Mary opened the items and they started counting.
Just then, Dr. Gossip walked in. “What, you’re not ready yet?!” he fumed. “When should I be back, next week?”
“Give us 10 minutes and we will be ready to take the patient back,” Mary informed him. “Is the patient here?" Mary asked.
“They better be! Let me go check!” Dr. Gossip called over his shoulder as he headed to the front desk.
Get A Break?
Mary asked Kelli if she had a break at all between cases. “No break, but I did run and pee.” Kelli said.
“Hopefully, someone is planning to come give us a break after we get this case started,” Mary muttered.
“By then it will be lunch!” Kelli answered.
“Who knows, maybe they will let us take 45 minutes,” Mary laughed, knowing there was not much chance of that.
Hurry Up And Wait
Completing the counts, Mary poured the medications and was off to see the patient. She arrived in the pre-op area and there was no patient in sight. Mary asked the charge nurse, Steph, where the patient was. Steph told Mary they were still waiting for the patient to arrive from the floor. Mary took that to mean Steph had not called for the patient until Dr. Gossip asked about it. Mary asked her to call room 7 when the patient arrived to the holding area.
Mary went back to the room and informed Kelli the patient had not yet arrived. Kelli continued setting up quickly, but not quite so frenziedly. Mary gave a big sigh and sat down. Oh, that felt nice! Sitting, she rolled her stool over to the stapler cart. It was the OR nurse’s favorite time, hurry up and wait. May as well double check things while she waited.
Seeing The Patient
Mary double checked the extra supplies and the stapler cart. Uh oh, she forgot some extra 45 refills. Dr. Gossip almost always used 75’s, but if he looked at the cart and saw the 45’s missing, Mary was sure that was what he would want. Everything else looked good. Mary went out for the 45’s.
Mary passed Steph in the hall. “Oh good, Mary, your patient’s here.” Steph informed her.
Mary changed direction and proceeded to the patient wondering exactly how long he had been there. She passed Dr. Gossip. “Mary, the patient’s here. Get them back,” he said. Mary asked him to tell Dave, who was in the doctor’s lounge, and continued to head towards the patient.
Mary asked all the questions. He was pretty routine, health wise. She reviewed what would happen when they went to the OR room. Jerry, the patient, denied any questions. Mary checked the chart and informed Jerry that Dave, his anesthesia provider, would be along in a minute.
Pre-operative Interview and Going to the Operating Room
Taking The Patient Back
Mary headed to the stockroom to grab the 45’s and brought them into the room. She informed Kelli the patient had arrived. As soon as Dave saw him, they would come back. Kelli said fine, she was all ready. Mary brought her a high stool to sit on while she waited.
Mary went back and listened to Dave ask his questions. She told Dave the partials were out. Dave explained the anesthesia plan and Jerry had no questions. Dave told Mary to wait 3 minutes and then bring Jerry back. “Damn,” Mary thought, “I hate pushing beds by myself.” She looked for help, but everyone had disappeared.
The 3 minutes went by and Mary started pushing Jerry back. She chattered with Jerry while they went. His wife and daughter were in his floor room. Mary assured him she would call them and keep them updated on how the procedure was going. As they spoke, Mary found out that Jerry had a new puppy. She focused on the subject and asked Jerry some questions. Mary knew that talking about their pets calmed most people down.
Holding Hands As Patient Goes To Sleep
Hurry Up And Wait
Still talking about the puppy, they entered the room. Dave looked up and said, “Oh good, just on time.” Dave entered the puppy conversation. In between talking about the puppy, Jerry moved over to his OR bed. Mary went to work strapping him down, explaining everything she was doing. Kelli came closer and joined in the puppy conversation.
Jerry stated he was comfortable on the bed and did not have any questions. Dave had put on the heart monitor, blood pressure cuff and EKG leads. Dave pushed some milk of amnesia through the IV, and Jerry was out in about 10 seconds. Mary stayed at the bedside to help with the intubation. Dave had Jerry intubated in about 30 seconds, no help needed. Now it was Mary's turn to work.
Mary clipped the hair on Jerry’s abdomen and groin. They were doing a lower anterior resection. Next she put Jerry’s legs up in the Allen Stirrups. Dave helped Mary check Jerry’s body’s alignment, making sure it was straight. After that she put in the foley catheter and taped it to the bed. Then she started the surgical site prep. Mary needed to do the abdomen, groin and thighs with Duraprep, then the penis and anus with a iodophore scrub and paint. While she was prepping Dr. Gossip looked in, and went away.
After the prep, Mary helped Kelli with the draping, ensuring she only touched the non-sterile sides. She accepted the suction tubing and bovie cord from Kelli and hooked them up. Mary pushed the table and ring stand within Kelli's reach and they were ready to go.
Mary paged Dr. Gossip overhead. They waited ten minutes. She paged Dr. Gossip again. And they waited. She paged Dr. Gossip again. And they waited. Finally, Mary saw him at the scrub sinks. “Good,” she thought, “we can get started.”
Dr. Gossip walked into the room, hands up, and accepted a towel from Kelli to dry them. While Dr. Gossip was drying, he asked Mary why he never saw her in his room. “I only work with you when I want to know what’s being said about me,” Mary said as if joking. Both Dr. Gossip and Mary knew she was not joking. Probably not the best way to start the surgery, but Mary got very annoyed at all the gossip he slung around.
Kelli put his gown and gloves on him when he was done drying. Mary tied him up, and they were ready to start.
Dr. Gossip started the surgery and his talking. “So, what’s new in the OR?” he asked.
“Nothing new,” Mary stated.
Dave inquired, “Did you hear about Jen?” Dr. Gossip had not. “I guess Jen is f@@king Dr. Jerk.” Dave proclaimed.
Dr. Gossip giggled. “How long has this been happening? Jen is a nice looking girl and half his age. What could she see in him?” Dr. Gossip asked interested.
“A father figure?” answered Dave with a big smile.
“She had a very handsome boyfriend, what happened to him.” Dr. Gossip was delighted to ask.
“I guess they broke up because of Dr. Jerk,” laughed Dave.
This was all news to Mary. And it was the main reason Mary hated working with Dr. Gossip. She always learned stuff she would rather not know. She wondered if these new allegations were true. Deciding she would have tell Jen what’s being said about her, Mary continued watching the sterile field.
The conversation about Jen lasted at least ten minutes, and went from randy to randier. From there they shifted to Dave’s love life. He had recently become divorced.
“More information I don’t want to know,” Mary sighed in her mind. Ignoring them, she started triple checking to make sure everything was present. “Damn,” she thought, “We still need drains.”
Circulating Nurse Remaining Focused
She told Kelli what she was doing and ran to get the drains. When she re-entered the room two minutes later, Dr. Gossip was complaining. “Where is she?! I need suture and I need it now!!” Dr. Gossip’s voice was rising.
“I’m here,” Mary replied. Kelli told her which suture and the doc had it in less than thirty seconds. But, now Mary was in the radar. Dr. Gossip started complaining she was never in the room when he needed her. Everyone knew it was not true, but it was easier to let him rant than to disagree. Debbie stuck her head in to tell Mary she would be giving her a break in about 30 minutes.
Luckily for Mary, this got Dr. Gossip off her back and onto Debbie’s. “You’re not going to leave me to her?!” Dr. Gossip lamented. “She is such a ditz.”
Actually, Debbie was a competent circulator and Dr. Gossip liked working with her. He was just fishing for gossip from the people present (so he could spread it to her when she came in). He loved stirring the pot.
Mary told Dr. Gossip she had not had a break all morning. It was 12:30 and she needed one. The surgery was winding down and the resection completed. Closing would start in about 30 minutes, so the first counts would be done during her relief. Mary’s day was more than half over and she looked forward to her break.
We will end here. Debbie sent Mary to lunch and another nurse came and relieved Kelli. After lunch they were up to do one case with Dr. New. It was a routine procedure with a nice doctor (one of those new types). The case goes well, as expected. Everyone was happy at the end. Kelli and Mary were much more relaxed. Their day was done and no one died. That was a good day in the OR.
Before going home Kelli and Mary checked the assignments for the next day. The assignments were not yet done. It would be a surprise. Mary did not worry about it. As an experienced operating room nurse, she would handle it.
Doing a Cesarean Section
© 2018 Kari Poulsen