How to do the best job as a surgical nurse – from a surgeon

This entry is part 1 of 2 in the series Being the best nurse

teamworkWhen you went through your OR training for surgical nursing in nursing school, I’m sure that you heard from the experienced scrubs about what made a good scrub nurse and all the many different things you needed to know to become one. I want to offer you my perspective from the other side of the table – what does a surgeon want to see in a scrub? What will make you requested by the doctors and therefore make you the last person to be “downsized” in these uncertain economic times?   (BTW I once heard of a surgical scrub nurse getting fired in the middle of the day, between cases.  You don’t want to be that person.)

I’ll start by saying this: I am lucky enough to scrub with some amazing amazing amazing surgical nurses. How grateful am I? I travel out of town about once a month and always bring back a 12 pack of one scrub’s favorite, but very hard to find beer. Even if this means canvassing seedy liquor stores on the wrong side of a strange town I’ve never been in before. That is grateful.

The number one thing that makes a great scrub nurse is ANTICIPATION. A nurse that looks at the field constantly, who learns the basic flow of a procedure and can therefore get the next instrument ready is invaluable. I trained at a huge level I trauma center and to this day I still remember one of the scrubs who knew the cases better than the residents and who was constantly glancing back and forth: what’s going on? what are they going to need? what do I have and what do I need to get? If blood’s hitting the ceiling, ask for another pack (or three) of laps and a bunch of 3-0 silk. Then load’em up so they’ll be ready ASAP when asked for. The nurse that anticipates instead of responding to a request is a scrub partner, not a scrub assistant.

While a lot of surgeons are relatively fun people (okay, maybe not, but indulge me here), when operating, most of us like to/have to concentrate. TAKE THE TEMPERATURE in the room – not literally on the thermostat, but emotionally in the air. Is the surgeon tense, hunched over and quiet? Then keep the chit-chat to zero. Are they smiling and teasing the gas-passers at the head of the table? Then definitely share the story about your kid’s latest toilet training adventure (I’m not being condescending – I’ve actually done this on several occasions). But always cut the chatter when bad shit starts to rain down. Is the suction bucket filling up with blood like an exploding firework? Is there a sudden and frantic widening of the incision? Then everyone – anesthesia, the circulating nurse and scrub nurses need to stop conversing and get ready to help. ‘Cause nothing pisses me off like a patient in trouble with people in the background laughing at a joke.

Keep a journal and record surgeon’s preferences. Hospital preference cards are random number generators and bear no relation to reality. Keep your own log of what the docs need – is it their favorite radio station to be playing when they walk in (or do they demand absolute silence ’til the patient’s asleep)? Which one likes vicryl ties, which likes silk. This one always uses a Veress needle, that one thinks it’s the instrument of the devil.

Last but not least is advocate for your surgeon. Room turnover time is the A#1 biggest gripe of every blade wielder I know. Even though you can’t control MAFUT (mandatory anesthesia f*@& around time), you can help clean up the room, so the next case can get started that much faster. And you can keep tabs on what’s going on with the patient in holding – bug the nurses there to make sure they’ve been seen by anesthesia, that their meds have been given, that whatever needs to be on the chart or whatever films are needed get to the bedside pronto. Trust me, we’ll notice. And noticing will get you love and love will get you beer. Then we’ll all be happier.

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  1. How come you never bought me beer….hmmmmphhh..lol. I have to agree with what you said here.. ANTICIPATION! I was lucky enough to be trained by “yoda” of the scrub world, Carl. He was the king of anticipation and in the height of a trauma stayed so calm. His surgeon never had to wait for him to get another (insert what might be needed here).

Trackbacks

  1. NursesPTO says:

    [...] I really don’t know much about these nurses. We rarely ever see them, and in ICU it is typically not a good thing when an OR nurse is the one bringing your patient back from the OR because it could only mean one of two things, either they were too sick to go to recovery or they were coding in the OR and were rushed back to the unit so as not to count against the surgeon’s statistics…Either way, we prefer not to see them I know they do wonderful things in the OR and have to deal with the wrath of surgeons, so for this I commend them. BTW, you can read about what it takes to be a good surgical nurse from our very own Dr. Rachael Keilin:Surgical nursing tips. [...]

  2. NursesPTO says:

    [...] under Nursing This entry is part 2 of 2 in the series Being the best nurseBeing the best nurseHow to do the best job as a surgical nurse – from a surgeonScrub nurse tips When I read Rachael’s new post on how to be a better scrub nurse, it got me [...]

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