Roles and Responsibilities of Scrub Nurse and Circulating Nurse in Operating Room

This case study discusses the roles and responsibilities of scrub nurse and circulating nurse in the operating room. It covers topics such as promotion of safe environment, patient rights and dignities, aseptic technique, nursing knowledge of interventions, professional communication, and examination of legal aspects of operating room.

Case study- operating room
Name of the Student
Name of the University
Author Note

Placement at operating room- case study
I was placed for a week in emergency theatre as a part of 12 weeks programs. As I was a
part of orthopaedic theatre, I had got to observe hip and knee replacements. Registered nurse
working as the scrub nurse assists in surgical procedures by setting room before operation.
Scrub nurse work with physician as well as the patient till moved to recovery room (Niu et al.,
2017). It is the duty of the circulating nurse to ensure that everyone works as team right from
the preoperative to postoperative care. The nurse may pay strong attention to detail and act as
patient advocate, reposition the patient and address the family concerns (Aholaakko & Metsälä,
2015). I have selected the roles and responsibilities of scrub nurse and the circulating nurse
when assigned to attend the hip surgery of Mrs. X 69 year old lady, who has suffered a major fall
and injury.
Promotion of safe environment
According to competency- 4 of the perioperative registered nurses the scrub and
circulating nurse are responsible for eliminating the potential danger to the patient. They were
accountable to maintain safe environment (Ammouri et al., 2015).
As a scrub nurse I have used personal protective equipment, performed hand hygiene
(effective hand hygiene), and adhered to the trust’s safe management and handling of specimens
in operation room. It will protect from infections like HIV and others. Further, I have maintained
the positive patient interaction by meeting the emotional and spiritual needs in operating room.
The patient was positioned in the operation theatre to ensure ideal visualization and has no
physiological compromise and better access to surgical site. It was made sure that the
positioning did not cause any harm to the patient’s skin and joints. After safe transfer of patient

the skin preparation was the next step. I have tested the skin integrity and have documented the
same ((Kang et al., 2015).
Any drug related concerns in Mrs. X is addressed by circulating nurse before moving
patient to operation theatre. A complete head-to-toe assessment was conducted as a role of the
circulatory nurse. It includes airway assessment followed by neurovascular and pain assessment
for informing surgeon. To reduce the patient’s anxiety I had discussed with the patient in
presence of surgeon about the recovery and rehabilitation plans. It relieved the patient from
anxiety and stress that caused due to outcomes of surgery. As Mrs X was anxious about the pain
after surgery. I had assured her that on adhering to care practices and medication she would soon
recover and resume independence soon. I had explained her as to how the postoperative pain
would be managed. To be effective in professional communication I had maintained positive
body language and ensured that my words match the tone of voice while giving psychological
support and when interacting with family members (Kang et al., 2015).
Patient rights and dignities respected
The scrub nurse is also responsible to maintain patient’s dignity. Mrs X’s consult was
taken when assisting her for change of clothes and toileting before surgery. It was necessary as
Mrs. X had strong concern for her modesty (Northcott & Wilson, 2016). Addressing her concern
maintained patient’s dignity. I had effectively communicated with the patient, her husband and
elder daughter about the ongoing procedure. I had updated with every process being taken before
surgery as it is there right to know.
When communicating with Mrs. and family it is the role of circulatory nurse is to
maintain patient rights and dignity. I used polite tone as during initial interaction I have observed

that the family believed in polite, relatively informal and being tolerant. Mrs X is Buddhist and
she was strict vegetarian. She initially refused medication as it would consider the animal
protein. However, she later agreed when I explained about her critical care and importance of
medication before surgery. Maintaining the religious beliefs and the cultural values during
hospital stay greatly impacts the care process (Ku, 2016).
Application of aseptic technique
It is the role of the scrub nurse to maintain sterile environment in operating room before
surgery. One of the primary duties in operation room is selecting and passing instrument
(Ammouri et al., 2015). During the operation I have maintained sterility throughout the
procedure. I remained adhered to the policy regarding the surgical needles. I have arranged all
the instruments on the back table before surgery. Instruments were passed to sturgeon in
decisive and positive manner. From the sterile field, excess instrument were removed and the
aseptic technique was followed as per the hospital policy. I have ensured that all the medical
equipment is intact by detailed examining. I have checked availability of the instruments sets. I
have ensured that the operation theatre was decontaminated and set up accordingly. I have tested
the functioning of the overhead light, diathermy and suction machine. The equipments necessary
for positioning the patient was kept ready. Upon consulting with other senior circulating and
scrub nurse, I have restocked the supplies such as disposables, gowns, swabs, drapes, and others.
In line with this the expiry date of the supplies were scrutinised. After the entry of patient, the
surgical site was also scrubbed with betadine. These measures will help promote patient safety.
After the entry of surgeon, I had stayed away from operating table as a circulatory nurse
to assist in case of need of additional instruments that needs to be arranged. After operation the

wastes were segregated using appropriate colour coded receptacles while making sure the
instrument count is correct along with other scrub nurses. Once again the whole area was
decontaminated for nest surgery (competency 4; competency 1, ORNAC 2012; Wistrand et al.,
2018).
Nursing knowledge of interventions
The role of the scrub nurse is to keep the records of the surgical site status alongside
collaboration with circulatory nurse before surgery. I cleaned the surgical site with betadine to
prevent infection and ensure that after surgery, the site has no bleeding (Kang, Massey &
Gillespie, 2015).
As a role of circulatory nurse, the patient’s airway assessment is conducted so as to
maintain the safety prior to administration of the anaesthesia. The patient is assessed for drug or
food allergy. I made it sure by confirming with the surgical team that all the vital checks are
conducted. On discussion with the physician, I have instructed about the eating, drinking and
medication to be taken before surgery. The patient was treated with patient centered care and
psychological support was given to reduce anxiety and stress before surgery (Kang, Massey &
Gillespie, 2015).
Discussion of current ORNAC standards for perioperative registered nursing
In my role as scrub nurse I had implemented the knowledge of nursing, humanities and
science. I had created a respectful environment for patient before and after surgery to reduce
stress and anxiety which is in accordance with first standard of ORNAC. I had adhered to the
standard policies and precautions to prevent infection. To adhere to standard 5 of ORNAC I have
coordinated the resource availability at the department level. Throughout my placement I was

ethical, open, honest and transparent in communication with professionals as well as patient
(Standard 8 ORNAC) (ORNAC, 2012-).
As a circulatory nurse I had ensured effective clinical decision making by conducting
regular patient assessment, discuss the concerns and address the same on coordination with
physician as per the second standard of ORNAC. The patient data was collected in accordance
with surgical goals. As per standard 3 of ORNAC, I was responsible for accurate documentation
of patient’s health data (ORNAC, 2012). Therefore, I had practiced patient safety and promoted
advocacy. I was engaged with surgical team and ensured adequacy of instruments. I had
collaborated with anaesthesiologists prior to shit of patient for surgery. In accordance with the
standard 9 I had meet the preoperative health needs of the patient and family as well as surgical
team (ORNAC, 2012; Niu et al., 2017).
Examination of legal aspects of operating room
The role of the scrub nurse is to maintain the legal aspects of operating room. On the
patient’s arrival the use of surgical safety checklist as mentioned by the World Health
Organisation as vital practice in the operation theatre. As a scrub ensure I had ensured that
surgical site is scrubbed with solution like betadine to prevent infection. The safety of providing
the anaesthetics is verified. I have personally verified the anaesthetic equipment, and drugs
related concerns (competency I- professional practice). I was instructed to collect specimen of
Mrs X. The role of the scrub nurse before doing so, is to confirm with the surgeon about the
specimen type and the location to be sent such as microbiology and histology. I had adequately
labelled the container with the patient details along with date and type of specimen (ORNAC,
2012).

The patient Mrs X would be identified by circulatory nurse with the anaesthetist along
with the practioner in the operating department. I have confirmed with them about the surgical
procedure and the surgical site. The confirmation is taken and the consent is checked. It will
prevent operating on the wrong patient. Followed by this, the site to the surgery is marked
(competencies of perioperative registered nurses; ORNAC, 2012). As a role of circulatory nurse,
I removed the specimen by taking consent from the surgeon. As I was in direct exposure to
blood, body fluids and secretions I had adhered to the standards of infection control in hospital
and WHO’s five moments of hand hygiene. I had also ensured good record keeping, as it plays a
significant role in legal and professional incidents. Therefore, I had made all the entries and
documentation work legibly and accurately. After the surgery I had got the documentation
checked by senior sub nurse (COMPETENCY 1 and 2: role of circulating and scrub nurse role,
ORNAC, 2012).
Professional communication
As a scrub nurse I gave my best to cooperate with other nurses in the surgical team. I did
communicate all the information of patient prior to the surgery effectively. I had collaborated
with scrub team to learn the effective instrument count process before and after surgery. It was
initially difficult for as I was not aware of many surgical instruments initially. Further exposure
to this area will make more efficient with surgical count process. Effective communication
helped overcome chance of miscommunication. Excellent communication skills were
implemented to assist surgeon with his needs in operation room (Oelke, Wilhelm & Jackson,
2016).

I did not assume anything for my work as a circulatory nurse. I had implemented the
WHO checklist to collaborate with my team mates. My actions were based on information
sharing with multidisciplinary team and shared decision making when undertaking the role of
circulatory nurse. I had discussed with surgeon before patient positioning. I had coordinated
with the other theatre practioner (Oelke, Wilhelm & Jackson, 2016; Niu et al., 2017). It helped
me in successful and safe transfer of Mrs. X.
Self-evaluation of role
Upon self evaluation I had realised gaining more confidence than previous experience of
operation theatre. This placement has improved my knowledge, skills to act on professional
manner. The one area of improvement for me is the maintaining patient rights and dignity. I
need to develop my cultural awareness of different patients. as I was nervous when dealing Mrs
X. Therefore, I could learn about interdisciplinary communication, problem solving and critical
thinking with this placement, where I could under take both the role of scrub and circulatory
nurse on alternate days.

References
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