BHEC Pre-Op/PACU/OR Circulator RN

Pre-Op/PACU RN/OR Circulator RN

Per Diem

Position Summary:

The Pre-Op/PACU/OR Circulator RN is the surgical team member who is responsible for coordinating and controlling the multi-disciplinary activities required to provide a safe environment for patients undergoing surgical intervention. The RN provides nursing care to surgical patients during the preoperative and postoperative phases. Involves assessment, planning, implementation, and evaluation of surgical patients.

Provides safe, knowledgeable, compassionate, educative, individualized and goal-directed nursing care to patients and their families in the immediate post-anesthetic period. Applies physiologic and psychosocial knowledge and skills to promote, restore, and maintain the patient's physiological processes in a safe, comfortable, and effective environment, while facilitating the patient's adaptation to their surgical experiences.

The Nurse supports the center’s policies and procedures as well as its nursing philosophy.

Accountable To:  Director of Nursing/Supervisor/Manager

Pre-Op/PACU Responsibilities:
Pre-Op/PACU RN duties will consist of, but are not limited to:

• Assessment
  • Assesses the physical status of the patient through personal observation and interaction.
  • Assesses the individual psychosocial and spiritual needs of the patient and significant other.
  • Demonstrates understanding and interpretation of diagnostic measures such as labs, chest x-ray and EKG.
  • Obtains an overview of the patient's status by reviewing the patient's chart. 
  • Consults with the peri-operative nurse who interviewed the patient pre-operatively.
• Planning
  • Plans for a safe, efficient, effective, and clean environment for preoperative and post-operative care.
  • Identifies problems and plans action to resolve problems.
  • Identifies goals for the individual patient and communicates these goals to others involved in the patient's care.
  • Assures that patient has appropriate discharge instructions; is accompanied by a responsible adult upon discharge; has the telephone number of the physician to call in the event of need during the first 24 hours post-surgery.
• Implementation
  • Takes action to implement nursing care and resolve the problems identified for the individual patient.
  • Utilizes supplies, equipment, and resources to contain cost without compromising delivery of care.
  • Reduces chances of nosocomial infection by directing attention to infection control and environmental safety practices.
  • Reports and documents information accurately and in a timely manner.
  • Utilizes professional nursing judgment in the delivery of care.
  • Uses safe methods of handling equipment.
• Evaluation
  • Evaluates action taken to implement nursing care plan and resolve problems accordingly.
  • Modifies intervention to achieve goals if previous intervention was not effective.
  • Evaluates own nursing practice and seeks ways of growing professionally.
• Interpersonal Relationships
  • Recognizes and utilizes appropriate lines of communication.
  • Foster cooperative efforts in meeting the goals of nursing by sharing workload.
  • Communicates a positive and caring attitude toward unit, peers, staff, and all other contacts.
  • Seeks guidance, direction and assistance where needed.
  • Conveys ideas, concepts, and facts relative to patient care in a logical, understandable, and concise manner.
• Accountability
  • Seeks appropriate learning opportunities.
  • Demonstrates competence and expertise in nursing practice.
  • Assumes responsibility for professional nursing practice within the law.
  • Maintains confidentiality of all patient and Center's communications/documents.
  • Utilizes judgment in determining nursing actions.
  • Acts as patient advocate in the coordination of patient care.
  • Always maintains safety rules.
  • Has knowledge of equipment and supplies and is familiar with their location in Recovery Room and Surgery, i.e.: emergency call system, oxygen, mechanical ventilator assistance equipment, including airways, ambu bag, defibrillator, cardiac monitoring equipment, tracheostomy set, laryngoscope and endotracheal tubes, suction equipment, emergency drugs and supplies specified by the Medical Staff.    
  • Monitors emergency equipment.              
  • Has an in-depth knowledge of anesthetic agents and their actions, emergency drugs, impending complications, and emergency treatment of complications, should they occur.
  • Follows recovery room guidelines.

OR Circulator Responsibilities: 

Performance of the duties of the Circulator, according to the set standards, is crucial to the smooth flow of events before, during, and after a surgical procedure.  The Circulator duties will consist of, but are not limited to:

• Be thoroughly familiar with and totally comfortable in the role of patient advocate, as applied to Operating Room nursing.
• Assume the responsibility for improvement of patient safety during the state of enforced dependency created intra-operatively.
• Responsible for creating a safe, therapeutic environment in which the patient's psychological, physiological, and physical needs are identified, anticipated, and met.
• Provide a channel of communication between events and team members in the operating room and persons who may not be in the immediate area, but who are concerned with the patient's operative status.
• Make provisions for instrument, supply, and equipment requirements of surgical procedures, as assigned.
• Responsible for documenting accurate, timely data appropriately.  (This includes documentation of Charge sheets, Incident Reports, Nursing Notes and Surgical Logs.)

Pre-Operative

• Verify patient identity, procedure consent, site, laterality (if applicable), and physician.
• Confirm NPO status, bowel prep adequacy, allergies, medication history and preoperative clearances.
• Ensure informed consent and anesthesia evaluation are complete.
• To ensure patient's safety and comfort and smooth flow of procedure, inspect the O.R. to be certain it is clean, complete, and safe.  All equipment should be checked for safety, functioning capability, and complete assembly.
• Direct and assist surgical technician in preparing for the surgical procedure according to established procedure and the Surgeon's preference card.
• Conduct surgical counts with the surgical technician and document, if applicable.
• To decrease patient's anxiety and help plan nursing actions intra-operatively, greet the patient in Pre-Op Holding Area for the purposes of identification, physical/psychological assessments.
• To ensure patient safety, accompany patient to the O.R. and assist in the transfer to the operating room table.
• From this point on, the Circulator remains at the patient's side during the induction of anesthesia, until the patient is anesthetized, positioned safely, and fastened securely to the operating room table.  Activities include, but are not limited to:
  • placing and securing the safety belt.
  • placing monitor electrodes per established procedures.

Intra-Operative

• Confirm patient identity, procedure, consent, site, laterality (if applicable), and physician using standardized time-out processes.
• Anticipate the needs of the surgical team and provide supplies and equipment as requested.
• Coordinates all activities within the O.R. to provide for a non-eventful, safe, effective, and timely surgical intervention.
• Provides for patient's needs, both physiologically as well as psychologically.  Maintains an environment free of disturbing sounds and statements.  Is ever alert for any break in technique which may contaminate the operative field.
• To provide safe patient care, maintains a running tally of sponge count materials and needles, and documents, informing surgeon of discrepancies.
• Ensure accurate specimen handling:
  • Proper labeling – accurate an complete identification
  • Placement in appropriate containers/solutions
  • Complete documentation and dispatch to laboratory per established ASC procedures 
• For medico-legal indices, maintains accurate records of patient-oriented data during the surgical procedure, i.e., vital signs.
• Assist with dressings.

Post-Operative

• Provide assistance as needed for delivery of patient care, remain at patient's side and assist Anesthesiologist as required with suctioning, extubating, etc., transfer to post-op gurney or wheelchair if patient receives only local anesthesia.
• Deliver a patient handoff report to the nurse in the Recovery Room area to identify procedure performed, findings/interventions, dressings (if applicable) and any complications or concerns.
• Ensure completion of all documentation.
• Ensure that specimens are accurately identified and delivered to appropriate area, make certain that all specimens have been placed for dispatch and entered in Specimen Log.
• Direct and assist with room turnover in accordance with infection prevention protocols.
• Ensure readiness of room and equipment for subsequent procedures.
• Participate in terminal cleaning and end of day activities (restocking room supplies and medications) in preparation for the following day. 

Other Responsibilities:

• Must comply with all HIPAA privacy regulations regarding the confidentiality of Protected Health Information (PHI).
• Must file an incident report for any unusual event that occurs to a patient or member of staff; this would include, but not be limited to, falls, needlestick injuries, aspiration of gastric contents, allergic reactions, and disruptive behavior by staff or patients. Also required to report any incidences or alleged incidences of abuse, harassment, or injury to self, other employees, or patients occurring at the Center or relating to the Center. Further specifications can be found in the Abuse Reporting documents and Code of Safe Practices, provided by the Director of Nursing.
• Meets the needs of the center as demanded by the surgical schedule, particularly when overtime hours and time changes become necessary.
• Serves as patients' advocate during the pre-operative, intra-operative, and post-operative phases of surgical intervention.

#LP

Qualifications:

• Must be licensed in the State as an R.N. and maintain BLS & ACLS certifications (and PALS if applicable).
• Has full command of the English language both verbal and written.
• Is willing to serve as patients' advocate during the pre-operative, intra-operative, and post-operative phases of surgical intervention.
• Meets the needs of the center as demanded by the surgical schedule, particularly when overtime hours and time changes become necessary.
• Minimum of one year of experience in peri-operative nursing (preferred but not mandatory) including a thorough working knowledge of surgical and aseptic technique.
• Have a working knowledge of the physiological and anatomical aspects of the surgical intervention scheduled.
• May be expected to lift twenty-five pounds without assistance. Required to obtain assistance when moving patients unable to assist in moving unless patient is in wheelchair or on gurney.  May be required to push patients in wheelchairs or on gurneys. Will be expected to obtain assistance when needed.