OPERATING ROOM NURSES: THEIR ROLE HAS BECOME MORE PATIENT-CENTERED

Operating room nurses don't spend a lot of time handing over instruments and wiping sweat from surgeons' brows anymore.

"Most work as what we call circulators, which is someone who prepares the patient for surgery, presents them on the table and kind of follows them through the procedure," said Susan Thiele, education coordinator for operating room nurses at Southeast Missouri Hospital.

The nurse's role has become more patient-centered, say local nurses.

"You're looking at the patient as a whole person," said Carole Heisserer of St. Francis Medical Center. "You're the patient's advocate."

This is National O.R. Nurse Week.

Most O.R. nurses now fill a perioperative role, staying with patients from the time they are admitted for surgery until they head for the recovery room, Heisserer said.

O.R. nurses check the patient's chart and coordinate with surgeons and anaesthesiologists to make sure the patient receives appropriate care.

"You bring that patient back to the operating room and you're the operating room circulator with the entire O.R. team, the anesthesiologist, the scrub technicians, the surgeon and the assistant and whoever else is in there," Heisserer said. "In post-op, you're there when the patient wakes up from the anesthesia, and the patient is yours until you deliver that patient to the recovery room nurse. Then you go back and do it all over again."

Perioperative nurses "try to make sure all the bases are covered" in delivering surgical care, she said.

"I think being in the O.R. gives you a more expanded view to see the total patient," said Jan Goncher, director of nursing at Doctors' Park Surgery. "You're there before, during and after."

Goncher and Thiele have been working in the operating room since 1980, and Heisserer since 1987. All are certified O.R. nurses.

Some O.R. nurses do scrub and work within the sterile surgical field, handing instruments, sponges or other equipment to the surgeons. Registered nurse first assistants have completed additional education and directly assist the surgeon by controlling bleeding and by providing wound exposure and suturing during actual surgery.

A big part of the circulating nurse's job is educating the patient about what will happen during the procedure so the patient won't be nervous, Thiele said.

"I know people think that surgery is very bloody," she said."When you make an incision, like when you cut yourself, there's all kinds of little capillaries in there that are going to bleed. But when we're in surgery, we control that by cauterizing those capillaries so you don't bleed. You don't bleed the entire time you're in surgery. A lot of people don't understand that about surgery."

Regardless of TV shows like "E.R." and "Chicago Hope," the operating room usually is a calm place, nurses said, and that's the way they like it.

Perioperative nurses also train nurses working in O.R., as well as O.R. technicians, said Goncher.

Most institutions require an O.R. nurse to have had some ward or floor experience, Thiele said. Learning to work within the operating room is mostly on-the-job training under another nurse's supervision.