Operating Room Nursing, Katie Curren, Huntington Hospital

Clinical coordinators specialize in one area (e.g., plastics, cardiac, neuro, ortho) and ensure that each case has the correct equipment and supplies. They also circulate as needed.

Our managers and auditors are also RNs.

For some cases, we have registered nurse first assistants (RNFAs), who are nurses authorized to perform certain surgical tasks under the direction of a surgeon. As with certified registered nurse anesthetists, RNFAs must complete a special training program to qualify for this role.

Additionally, we have surgical nursing assistants, who help to position and transport patients and gather equipment, and certified scrub technicians (CSTs), who are responsible for maintaining the sterile field and handing instruments to the surgeon during procedures.

Some of our CSTs and nursing assistants are actually in nursing school. Two staff members recently graduated and passed the NCLEX, so we’ll have a new nurse residency for them in the near future.

What characteristics do you look for in an OR nurse?

As an OR nurse, you need to be self-motivated, accountable, flexible, and always ready to pivot. The OR doesn’t have the adrenaline rushes of the ER, but you have to remain aware of the field and the room, and be able to change gears quickly. If your patient starts bleeding, you’d better be right by the field with your lap sponges and your sutures, and if there’s an airway issue, you need to be ready to help anesthesia. You develop what’s called “OR ears“ where you can focus on charting and the room at the same time.

OR nurses need a strong sense of personal integrity, and must really grasp the vital importance of sterility. (I know when my hands are dirty even when they look clean!) For example, if you’re in a room by yourself, preparing a case and opening sterile packages, and realize you’ve contaminated something by mistake, you must be willing to admit your error and throw it away.

We have a set of carefully constructed care plans, and you must follow the care plans/guidelines scrupulously to ensure the best outcomes for your patient.

As the RN in the room, you also have to make sure the patient is positioned correctly so that there’s no nerve or skin damage. You must approach every case with the same sense of importance, whether the case is 30 minutes or five hours.

You only interact with patients for 10 or 15 minutes, but you have to be there for them and give them the sense that they’re safe and in good hands. When the patient is anesthetized and can’t speak for themselves, you must be their voice and their main advocate. If you see something during a procedure that isn’t right, you have to take responsibility and speak up.

What’s hardest for nurses coming to the OR from the floor?

Some nurses have a hard time adjusting to the demands of surgical sterility. For example, one day, a nurse who had transferred to the OR picked up one of our little stools and lifted it over the field. I immediately stopped her, but I thought to myself, “She’s not going to get it.” Fortunately, she reached the same conclusion, and she later became a nurse practitioner instead.

The OR can also be tough for nurses who want a predictable routine. Every shift in the OR is different: There are so many surgical procedures, and each day, you might work on a different case with a different scrub nurse, surgeon, or anesthesiologist. That’s one of the things I love, but it isn’t for everybody.

Also, being an OR nurse is more technical, which some people may not like, and some nurses miss having longer-term patient connections.

How do new grad nurses do in the OR as compared to floor nurses transferring in?

There’s a different comfort level. New grads have done their clinical training, but this is the first time they’re fully responsible for patients, and getting over those first-job jitters can be hard. So, it can take longer for the norms of OR nursing practice to click.

Could you illustrate something important about your work and how you approach it?

When I start my day, I have three goals: to complete the cases in a timely and safe manner; to ensure that my staff is taken care of by providing breaks, lunches, and support; and to end my day knowing that I’ve done my best and treated everybody (coworkers, doctors, and patients) with respect, kindness, and understanding.

My staff is very important to me, and I believe mutual respect provides a wonderful working environment. When I walk into work in the morning, I feel that I’m respected, appreciated, and valued by my staff, which motivates me to do my very best.

As a charge nurse, I feel like I’ve had an exceptional day if the board is empty. When I have 35 or 40 cases when I walk in, my goal is to get every case done so I can hand over a clean slate to the night shift.

Is there a patient story that stands out for you?

When I was a novice nurse in the L.A. County OR over 30 years ago, a teenage patient came in with multiple gunshot wounds. She was only 14 and had been at a party when it happened. We never found out if she survived or not, but we did the best we could for her.

That situation made me realize how life can change in the blink of an eye, which gave me the perspective to enjoy every day and let people know I appreciate them.

Are you involved in any professional nursing organizations?

Yes — I’m the newly appointed chair of the Recognition and Awards Committee of the Los Angeles chapter of the Association of periOp Registered Nursing (AORN). Being involved with AORN fuels my love for the OR. I would encourage any nurse or nursing student interested in a career as an operating room nurse to attend our meetings to gain greater insight and establish connections.

What’s something that you love to do when you’re not at work?

I love to garden; I have a drought-tolerant yard, and this year, my cacti actually flowered! I also love to hang out with my husband of 26 years and our three adult daughters.

KEITH CARLSON, RN, BSN, NC-BC, has worked as a nurse since 1996 and offers expert professional coaching at www.nursekeith.com.

In this Article: Career Advice, Surgery