New to the OR: Five Ways That New Nurses Can Help the Surgical Team

The number one rule of the OR is to always maintain sterile technique. Preserving sterile technique begins with having the moral aptitude to identify and speak out on breaks in sterility. We call this surgical consciousness.¹ Perioperative nurses are often the first to identify breaks in sterile technique, which must be reported to the surgical team immediately. A break in sterile technique can be a life-changing event for a patient. A surgical site infection can result in a minimum of six to eight weeks of parenteral antibiotics and potentially the need for subsequent surgical interventions.² As a perioperative nurse, preserving a sterile OR should be the highest priority.

2. Be on Time.

As a new nurse, preparing for the first case of the day will inherently take longer than it does for seasoned nurses, which is OK. Perioperative nurses must complete many tasks before starting the first case of the day, such as prepping the OR, interviewing the patient, and changing into OR scrubs. Arriving at 7:00am for a 7:30am start may lead to rushing to complete these tasks and rushing leads to mistakes. Arriving 15 to 30 minutes before the shift allows some extra breathing room to have a successful day of surgery. It is always better to wait on the surgeon than for the surgeon to wait on the nursing staff.

3. Read the Preference Card.

Nurses who have worked in surgery for any length of time have heard this a million times! Preference cards are a “cheat sheet” for working with surgeons and surgical cases. Although they are not always accurate, nothing will irritate the surgical team more than not having an item used every time for that specific case. Reading the preference card is the easiest way that a new nurse can prepare for success in surgery.

4. Be Teachable.

Arguably, this is the most critical characteristic of any successful team member. As a novice perioperative nurse, mistakes are inevitable; however, mistakes do not always mean something was wrong or a patient has been harmed. It may just mean that a specific surgeon prefers tasks completed a certain way. Variability can be frustrating because five different surgeons may prefer to do the same task five different ways. The important thing is learning these unique nuances and doing it correctly next time. Moreover, being teachable means being receptive to instruction and constructive criticism. Never say “I know” when someone offers instruction; everyone has something to teach.

5. Communicate Effectively.

Every high-functioning team excels in effective communication. As a perioperative nurse, part of the job is identifying problems before they occur. For example, having more cases than instruments available is a common problem in the OR setting. Nurses can proactively identify this problem by reviewing the schedule for potential instrument shortages and communicating them to the surgeon or surgical team. It may be possible that alternative instrumentation can be used or surgical cases can be rearranged. Early communication about potential problems allows for team collaboration to find practical solutions. For example, the surgical team should be informed that a particular instrument is unavailable before the patient enters the OR. Timely and effective communication can facilitate surgical success. 

Conclusion

Perioperative nurses have the power to make a significant impact on the success and safety of each surgical procedure. By prioritizing sterile technique, being punctual, becoming familiar with preference cards, being teachable, and communicating effectively, you can contribute to a high-functioning and efficient surgical team. Remember, the OR is a dynamic and ever-evolving environment, and continuous learning and adaptation are key to your professional growth. Embrace the challenges and opportunities that surgery provides, and you will undoubtedly thrive as a perioperative nurse.  

References 

1. Seidelman JL, Mantyh CR, Anderson DJ. Surgical site infection prevention: a review. JAMA.2023;329(3):244-252. doi:10.1001/jama.2022.24075 
2. Beydoun N, Tandon S, Krengel S, et al. A retrospective chart review on the role of suppressive therapy in the management of spinal infections involving hardware. Open Forum Infect Dis. 2020;7(7):ofaa253. https://doi.org/10.1093/ofid/ofaa253