DUTIES AND RESPONSIBILITIES OF NURSES IN OT

Nursing personnel or nursing section in OT is headed by the Nursing Director or Chief Nursing Officer (CNO). The other members of the nursing team working under the nursing director are as the following:

• Deputy Nursing Director or Deputy Nursing Officer (DNO)
• Nursing supervisors
• Scrub nurses
• Circulatory nurses
• Nurse – in – charge store
• Nurse – in –charge reception, admission, transfer etc.

The nurse patient ratio in OT is –

• Major OT - 1: 2 per table
• Minor OT - 1: l per table

HIERARCHY OF NURSING PERSONNEL IN OT

Duties and responsibilities

NURSING DIRECTOR AND DEPUTY NURSING DIRECTOR

• The unit of nursing services in OT is headed by the Nursing Director.
• Nursing director should have a qualification of post-graduation in nursing with the experience in OT Nursing.
• He/she is the administrative or managing authority of nursing services in OT.
• She has three areas of responsibilities: Administration, Management, and Education & research.
• The Nursing Director is responsible for: -
  • Maintaining high standards of patient care in the department.
  • The welfare, employment and professional development of staff.
  • Forward planning and ordering.
  • Liaising with other hospital departments, e.g., the Department of Surgery, the Department of Anaesthesia, the School of Nursing, senior nursing administrators, Personnel Department, Pharmacy, Works Department and laundry.

NURSING SUPERVISOR

• Nursing supervisor needs to have a postgraduate qualification in nursing with experience in OT nursing.
• Responsibilities are-
  • The day-to-day running of theatre suite.
  • Planning OT activities as per the surgical schedule.
  • Delegating responsibilities to the scrub & circulatory nurse for smooth conducting of the surgical schedule.
  • Assessing the requirements of equipment's & articles & other supplies along with arranging for obtaining them.
  • Communicating effectively to the nursing personnel under her to ensure that all information is received.
  • Weekly/monthly ordering of stock.
  • Liaising with surgeons and anaesthetists working in the suite regarding operating lists and equipment orders.
  • Evaluating the effectiveness of the performance of the nursing personnel in OT.
  • Informing the nursing director of any changes or problems in the suite.
  • The continuing education of staff and student nurses.
  • Conducting research in OT Nursing and participating in the team researches conducted in OT.

SCRUB NURSE

• The scrub nurse is on works directly with the surgeon within the sterile field, passing instruments, sponges, and other items needed during the procedure.
• She is the members of the surgical team who prepares and preserves a sterile field in which the operation can take place.
• Duties of scrub nurse-
  • Before an operation
    • Ensures that the circulating nurse has checked the all the equipment needed during procedure.
    • Ensures that the theatre has been cleaned before the trolley is set.
    • Prepares the instruments and equipment needed in the operation.
    • Prepare own self by using sterile technique like scrubbing, gowning and gloving.
    • Receives sterile equipment via circulating nurse using sterile technique.
    • Performs initial sponges, instruments and needle count, checks with circulating nurse.
  • When surgeon arrives after scrubbing
    • Provide assistance for gowning and gloving to the surgeon and assistant surgeon as soon as they enter the operation suite
    • Assemble the drapes according to use. Start with towel, towel clips, draw sheet and then lap sheet.
    • Assist the surgeon in draping the patient aseptically according to routine procedure.
    • Place blade on the knife handle using needle holder, assemble suction tip and suction tube.
    • Bring mayo stand and back table near the draped patient after draping is completed.
    • Secure suction tube and cautery cord with towel clips or Allis.
    • Prepares sutures and needles according to use.
  • During An Operation
    • Maintain sterility throughout the procedure.
    • Awareness of the patient's safety.
    • Adhere to the policy regarding sponge/ instruments count/ surgical needles.
    • Arrange the instrument on the mayo table and on the back table
    • Before the incision begins, provide two sponges on the operative site prior to incision.
    • Passes the first knife for the skin to the surgeon with blade facing downward and a hemostat to the assistant surgeon.
    • Passes the retractor to the assistant surgeon.
    • Watch the field/ procedure and anticipate the surgeon's needs.
    • Pass the instrument in a decisive and positive manner as needed in the procedure.
    • Watch out for hand signals to ask for instruments and keep instrument as clean as possible by wiping instrument with moist sponge
    • Always remove charred/burned tissue from the cautery tip
    • Notify circulating nurse if you need additional instruments as clear as possible.
    • Always keep 2 sponges on the field throughout the procedure.
    • Save and care for tissue specimen according to the hospital policy
    • Remove excess instrument from the sterile field.
    • Adhere and maintain sterile technique and watch for any breaks. If any breaks found then inform immediately to the surgeon.
  • End of operation
    • Undertake count of sponges and instruments with circulating nurse and correlate with the pre-surgery findings.
    • Informs the surgeon regarding count result.
    • Assist the surgeon for suturing the surgical incision.
    • Apply the dressing over the surgical site.
    • Clears away instrument and equipment.

CIRCULATOR NURSE

• The circulator is responsible for managing the nursing care of the patient within the operating room and coordinating the needs of the surgical team with other care providers necessary for completion of surgery.
• The circulator nurse observes the surgery and the surgical team and assists the team to create and maintain a safe and comfortable environment for the patient.
• The circulator nurse assesses the patient's condition before, during, and after the operation to ensure an optimal outcome for the patient.
• The circulator nurse must be able to anticipate the scrub nurse's needs and be able to open sterile packs, operate machinery and keep accurate records.
• Duties/Responsibilities of Circulating Nurse
  • Before an operation
    • Checks all equipment for proper functioning such as cautery machine, suction machine, OR light and OR table.
    • Make sure that theater is clean.
    • Arrange furniture according to the need of the procedure.
    • Place a clean sheet, arm board (arm strap) and a pillow on the OR table.
    • Provide a clean kick bucket or pail.
    • Collect necessary stock and equipment.
    • Turn on the aircon (AC) unit and adjust the temperature of the OT room as per the patient need.
    • Help scrub nurse with setting up the theater Assist with counts and records.
  • During the induction of anaesthesia
    • Turn on OR light.
    • Assist the anaesthesiologist in positioning the patient.
    • Assist the patient in assuming the position for anaesthesia.
    • Anticipate the anaesthesiologist's needs.
  • After the patient is anesthetized
    • Reposition the patient per anaesthesiologist's instruction.
    • Attached anaesthesia screen and place the patient's arm on the arm boards.
    • Apply restraints on the patient.
    • Expose the area for skin preparation.
    • Catheterize the patient as indicated by the anaesthesiologist
    • Perform skin preparation.
  • During operation
    • Remain in theater throughout the operation.
    • Focus the OR light every now and then.
    • Position kick buckets on the operating side.
    • Replenishes and records sponge, instruments and needles or sutures.
    • Ensure the theater door remain closed and patient's dignity is upheld throughout the procedure.
    • Watch out for any break in aseptic technique. If any breaks found then inform immediately to the surgeon.
  • End of operation
    • Assist with final sponge and instruments count and documented.
    • Signs the theater register.
    • Ensures that all the specimen are properly labelled and signed.
  • After an operation
    • Assist the scrub nurse for patient dressing.
    • Helps in removing and disposing the drapes.
    • Helps to prepare the patient for transporting to the recovery room.
    • Assist the scrub nurse, taking the instrumentations to the service (washroom).
    • Make arrangement for preparation of theater for the next case.

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