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As a nurse, you’ve probably heard about the various roles within perioperative nursing. It can be a bit overwhelming trying to figure out where you fit in, especially if you’re a new grad or transitioning into a different field. One vital role that often flies under the radar is the circulating nurse. If you’re curious about what circulating nurses do, how they contribute to the perioperative team, and what makes their role different from others like OR nurses or PACU nurses, you’re in the right place.
Let’s dive into what it means to be a circulating nurse, their responsibilities, and how they play a crucial part in patient care.
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The Role of a Circulating Nurse in Perioperative Nursing
At its core, the circulating nurse is the team member who ensures everything runs smoothly in the operating room (OR). They are responsible for the broader environment rather than the sterile field, unlike scrub nurses or surgical technologists. Circulating nurses manage the non-sterile part of the room, coordinating with the rest of the surgical team, including the surgeon, anesthesiologist, scrub nurses, and surgical technologists.
In a nutshell, they are like the air traffic controller of the OR. While the surgeon and scrub nurse are focused on the patient and procedure, the circulating nurse ensures that all supplies are available, equipment is functioning, and the patient’s safety is a top priority. Their eagle-eyed focus on the room’s operation helps to prevent errors and delays.
Differentiating a Circulating Nurse From Other Perioperative Nursing Roles
In the operative world, nurses have many specialized roles they can fill. Let’s differentiate the circulating nurse from other types of nursing roles that you may have previously heard of.
Circulating Nurse vs. OR Nurse
You might hear the term “OR nurse” used interchangeably with “circulating nurse,” but technically, they aren’t the same. In a surgical setting, the “OR nurse” may refer to any nurse in the operating room, including both scrub and circulating nurses.
A scrub nurse, unlike the circulating nurse, is part of the sterile field. They assist the surgeon directly, handing instruments and ensuring that sterile techniques are followed during the procedure. The scrub nurse works closely with the surgical technologists and must maintain sterility throughout the case.
On the other hand, the circulating nurse does not work within the sterile field. Their role is broader, encompassing not only patient advocacy and safety but also documentation, coordinating with various team members, and problem-solving in real time. If something goes wrong with equipment or supplies run low, the circulating nurse is on it.
In summary, the OR nurse may be scrubbed in or may be circulating. A circulating nurse is never scrubbed in, but that doesn’t mean they’re less involved or less critical.
Circulating Nurse vs. PACU and Pre-op Nurses
Another distinction worth mentioning is how a circulating nurse differs from pre-op or PACU nurses.
Pre-op nurses are responsible for preparing the patient for surgery. They’ll verify medical histories, complete checklists, and ensure all the patient’s needs are met before they enter the OR. These nurses play a vital role in gathering and verifying information and keeping the patient calm before surgery.
PACU nurses (Post-Anesthesia Care Unit) care for patients after surgery when they are recovering from anesthesia. They monitor vital signs, manage pain, and ensure the patient regains consciousness safely. PACU nurses are hyper-focused on that critical immediate post-op period.
The circulating nurse, however, is present throughout the entire surgery. They see the patient before, during, and immediately after the procedure, but their main focus is on the intraoperative environment. They ensure that all the right conditions are met for the surgery to go smoothly and that the patient’s safety and dignity are maintained throughout the process.
A Day in the Life of a Circulating Nurse
So, what does a typical day look like for a circulating nurse? Like many roles in nursing, no two days are exactly the same, but here’s an example of what you might expect.
Pre-surgery Prep
Your day might start by reviewing the surgical schedule and prepping the OR. You’ll check that all necessary equipment and supplies are available, confirm that the correct instruments are ready, and make sure everything is functioning properly.
Before the patient arrives, you’ll complete safety checks and review documentation, consent forms, and patient history. Once the patient arrives, you’ll help position them and attach any non-sterile monitors while ensuring their comfort and safety.
Circulating nurses also help with the surgical team’s sterile prep, such as helping tie surgical gowns or opening sterile supplies without contaminating them.
During Surgery
Your role during the procedure is all about coordination. You’re watching the surgical team, ensuring they have what they need, troubleshooting any equipment issues, and documenting everything that happens in real time.
If a sterile item is dropped or an instrument isn’t working correctly, it’s your job to correct it quickly and efficiently. Your focus is on ensuring the surgery proceeds without interruption or compromise to the patient’s safety.
You may also be the one stepping out of the OR to communicate with the patient’s family and update them on the surgery’s progress.
Post-surgery Wrap-up
After surgery, you ensure that the surgical counts are correct (instruments and sponges must be accounted for before closing the patient). You might assist with transferring the patient to the PACU or post-op area, making sure the handoff to the PACU nurse is smooth. Finally, you’ll complete all necessary documentation and clean up the OR to prep it for the next procedure.
Working With Surgeons
One of the most critical relationships for circulating nurses is with the surgeon. While surgeons are focused on the task at hand, the circulating nurse supports their needs without disrupting the sterile field or the procedure. A good relationship with the surgeon is essential—knowing their preferences, anticipating their needs, and quickly solving problems allows the surgical team to work seamlessly together.
However, this relationship isn’t without its challenges. Surgeons can be under tremendous stress, and tensions can run high in the OR. Circulating nurses need to remain calm under pressure, advocating for the patient and facilitating the procedure without becoming overwhelmed by the high-stakes environment. Assertiveness is a key skill for any nurse to develop, but it’s especially essential for a circulating nurse!
Types of Circulating Nurses
While circulating nurses generally have similar responsibilities, there can be some variation depending on the type of surgery being performed. Here are a few examples:
• Orthopedic Circulating Nurses: These nurses work in ORs where orthopedic surgeries, such as joint replacements or fracture repairs, are performed. They become very familiar with the specialized equipment and instruments needed for these procedures.
• Cardiovascular Circulating Nurses: In this specialty, circulating nurses support complex heart surgeries, working alongside perfusionists, scrub nurses, and cardiovascular surgeons.
• Trauma Circulating Nurses: In a trauma setting, circulating nurses must be quick on their feet. They are often assisting in fast-paced, high-risk surgeries where minutes can make a difference in patient outcomes.
• Pediatric Circulating Nurses: Pediatric surgeries require extra attention to patient comfort and anxiety management, both for the young patient and their parents. Circulating nurses in this field need to have specialized knowledge of pediatric care.
Naturally, the availability of these specialized circulating nurse positions depends on the size of the hospital and the location. In larger urban areas, these opportunities are more common. If you are located in a more rural area, the options would be more limited.
It is also critical to be aware that more specialized roles are more challenging to land. It might not be realistic to aspire to work as a circulating nurse in a specialized area right out of nursing school. If you’re interested in this career path, consider applying for jobs in the perioperative area to get exposure to the role itself and build rapport with people who could become great recommendations for when you apply for a circulating nurse job.
Certifications and Specializations For the Circulating Nurse
Once you have acclimated to your role as a circulating nurse, you can obtain a specialty certification to further your professional development.
The Certified Perioperative Nurse (CNOR) certification is one of the most recognized credentials for nurses working in the OR. To obtain the CNOR certification, you must have a valid RN license, two years of experience in perioperative nursing, and meet the exam requirements.
Your hospital might also have a clinical ladder program, which outlines ways to increase your expertise and knowledge at your specific hospital. Finally, you can also choose to further your education.
Final Thoughts on Becoming a Circulating Nurse
Circulating nurses are critical to the successful functioning of an operating room. While they may not be scrubbed in, their role is just as critical in ensuring the procedure goes smoothly. They balance technical expertise, patient advocacy, and team coordination, all while keeping a cool head under pressure.
If you’re a nurse who enjoys working behind the scenes, solving problems, and supporting the entire surgical team, then becoming a circulating nurse might be the perfect fit for you. With plenty of opportunities for specialization and growth, this unique nursing role can be both rewarding and challenging, offering a vital contribution to patient safety and care.
So, if you’re considering a career as a circulating nurse, take heart in knowing that your work matters in a big way, and you’re a crucial part of the perioperative puzzle.
More Resources
- What Do Perioperative Nurses Do? An Interview with an OR Nurse
- What Do Nurse Anesthetists Do? (CRNA)
- What Do Emergency Nurses Do?
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