Outpatient Surgery Centers or Ambulatory Surgery Centers provide same day surgical procedures meaning the patient is admitted, operated on, recovers and is discharged with a few hours with no additional hospital stay. There are three main types of nursing in the outpatient surgery field, the scrub nurse, the circulating nurse or the perianesthesia nurse. There is a different description for each position.
The Scrub Nurse in Outpatient Surgery works directly with the surgeon. The RN will be standing at the table throughout the operation. Sterile protective equipment such as mask, gown, gloves and cap will be worn by the RN during surgery and will be put on before entering the operative area. It is the Scrub Nurse’s job to ensure that the sterile field in not contaminated. The RN will hand instruments and supplies to the surgeon as requested and return them to the sterile tray after use. It is the responsibility of the RN in Outpatient Surgery to keep track of dressings, towels and other supplies during the surgery and may help steady an instrument if the First Assistant is busy.
The Circulating Nurse moves around in the OR during the operation. The Circulating Nurse does not need the same protective gear as the scrub nurse but must also maintain sterility if she comes in the sterile field of the room. The RN may move equipment for easier access by the surgical team and move it back out of the way when not in use. Attention to procedure so as to provide medications to the anesthesiologist or obtain extra sterile instruments or surgical supplies when needed. The OR RN also helps with the count of dressings and needles and watched to ensure there are no breaks in sterile technique during the procedure or operation.
The Perianesthesia Nurse does her job outside of the OR. The RN admits the patient to the center, assesses the patient upon admission, collects and records the patient’s medical history and educates the patient and/or family members. The OR RN may start an IV, administer preoperative medicals and accompany the patient to the operating room. After the surgery, the patient will come back to the RN where they will be monitored during the recovery process. The Registered Nurse must be alert for signs of trouble after surgery including breathing problems, bleeding or any other complications from the anesthesia or surgery. All activities and patient’s responses to care will be documented accurately and timely. When the patient has recovered, the RN will give him and/or family members discharge instructions and help the patient to their transportation.
Skills and Characteristics of the Outpatient OR RN: Compassion and sympathy to help the patients and/or family members feel an emotional connection. Good communication skills are required to obtain information from the patient and to educate the patient and family, as well as to discuss health care plan issues with other team members. Emotional stability helps the RN maintain personal balance when dealing with emergencies, stress and human suffering. The RN in this setting will often spend many hours on their feet and are required to lift and move patients. Physical stamina is necessary for these days. The RN must be able to think quickly in an emergency and use good judgment and organizational skills in order to assure all patients receive necessary care. Time management skills are particularly important in this setting as all tasks must be accomplished in the same day.
Demonstrate Safe and Effective Use of the following equipment: Defibrillator, cardiac monitor, pulse oximeter, dynamap, 02-Medical gases/cannula/mask/flow meter, Computers and printers, IV pumps, Infusion pumps, Laser, Cyro-analgesia machine, Doppler, electrosurgical cautery and be able to troubleshoot the equipment utilized routinely.
Requirements of the Outpatient Surgery RN includes:
- Appropriate assessment skills which includes prioritization and delegation of patient care activities.
- Knowledge necessary to provide patient care by making sure all instruments, supplies and equipment are available for the procedure.
- Assessment of the patient’s pain during admission and throughout the day
- Demonstrate correct application for sterilization including the use of: steris, chemical disinfectants and determine the proper method of sterilization for each item.
- Protect the welfare of the patient with accurate labeling and handling of specimens. All surgical specimens will be initialed and recorded as required.
- Follow all policies and demonstrate appropriate use of medications and medication administration, including reassessment of patient’s responses to medications.
- Ensure all patient safety goals are incorporated into the care of the patient utilizing the nursing process.
- Knowledge of aseptic technique.
- IV Therapy: insertion, aseptic technique, site, dressing, tubing changes and use of pumps.
- Institute corrective actions during an emergency situation in a calm and efficient manner.
- Carry out the physician’s orders and assist the physician during procedures if required.
- Completes accurate documentation in a timely manner.
- Provide support and comfort to the patient and/or family members