Registered Nurse - Surgery

Status - Full Time

Shift - Days

Schedule - Monday -Friday no weekends or holidays

Hours - 6AM to 6PM variable depending on surgery schedule

Provides direct and indirect care of patients in preoperative preparation area, surgery suites and recovery room. Provides nursing care according to the physician or surgeon’s orders complying with hospital policies and procedures and in conformance with recognized nursing techniques and procedures. Helps maintain and update physician preference cards as necessary. Packages and processes instruments and supplies in the central sterile area as directed and as necessary.

Knowledge & Experience

Skills-

• Demonstrates ability to give and follow instructions accurately
• Demonstrates effective interpersonal skills necessary to interact with various levels of health care personnel

Knowledge-

• Hospital administrative and nursing policies and procedures
• Perioperative and central sterile procedures

Education-

• Graduate of accredited school of nursing
• Current registration as a Registered Nurse with the state of Indiana Health Professions Bureau

Experience-

• Minimum of two (2) years of related experience preferred

Authority and Accountability

• Extensive exposure to confidential information or matters
• Frequent contact with various persons or groups within and outside of the hospital including employees, department managers, physicians, patients, visitors and outside agency personnel
• Must be able to work with and communicate with different types of people

Aptitudes

• Must be able to prioritize, utilize critical thinking, and adjust to change
• Must be able to reason and use logical problem-solving skills
• Performs duties that require some latitude for independent judgment and initiative in handling situations out of the ordinary
• Must be self-directed, flexible and willing to assume additional responsibilities as needed

PHYSICAL AND MENTAL EFFORT

• The physical and mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Regular requirement to sit, stand, bend, kneel, crouch, and move intermittently; use hands to handle, or feel; reach with hands or arms; talk; and hear
• May have prolonged periods of standing
• Frequent requirement to lift 25-35 pounds
• Occasional requirement to assist with lifting 35-100 pounds
• Specific vision requirements include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to focus
• Speaking and listening skills are essential; must be able to hear and be understood on the telephone
• Must be able to work under a moderate amount of stress

ENVIRONMENTAL AND WORKING CONDITIONS

• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
• The noise level in this work environment is usually moderate
• Work is performed in a clean, well-lighted and ventilated building
• Could be subject to infectious diseases, cuts, abrasions, burns, and punctures
• Work schedule may vary – mostly day shift
• Participates in call rotation schedule as assigned

ACCOUNTABILITY

• Reports to the Surgical Services Manager

QUALITY ASSURANCE-KEY RESPONSIBILITIES

• CIRCULATOR RESPONSIBILITIES

1. Demonstrates knowledge of procedures – checks physician preference cards and updates as needed
2. Cleans room prior to and between cases
3. Opens supplies as needed utilizing sterile technique
4. Checks room and equipment prior to case – ensures it is in the room and is available and working
5. Receives patient – identifies patient (ID band; asks in layman’s terms what is to be done; checks for jewelry and prosthetic devices (false teeth); checks patient record for consent and patient signature, lab reports, EKG, chest x-ray, and history and physical
6. Demonstrates proper positioning of patient

• final positions are accomplished after anesthesia has been induced check to insure that the patient is protected against pressure on nerves or impaired circulation – skin must not touch metal of table
• has equipment ready for use
• arms are secured by draw sheet or arm board
• cautery pad on patient
• catheter bag is in accessible place
• knee strap secure but not too tight and placed above the knees
• operative site exposed
• adjusts light

1. Preps patient – knows area to shave if necessary and prep
2. Assists with draping as necessary
3. Demonstrates proficiency with duties at start of case

• helps rearrange back table and ring stands as needed
• arranges step stools or sitting stools as necessary
• notes time of incision
• attaches suction and/or cautery
• has sterile warm saline and water in proper basins
• arranges floor drape and/or kick bucket to receive used sponges

1. Demonstrates proficiency with duties during case

• remains within hearing distance at all times, unless relieved tells scrub where he/she is going if he/she can’t see circulator
• guards safety of patient, watches for and corrects any factor that could mean harm to the patient (fire, electrical, contamination)
• controls traffic and noise in the room – avoids unnecessary movement and conversation
• watches the field – anticipates needs of the sterile team - replenishes supplies before they are depleted – adjusts light as needed
• keeps room in order – collects equipment used and puts in one area ready to be removed at one time
• has sponges ready for count at any time – makes sure no counted sponges leave the room
• does not remove any sponges, instruments and needles from room until all counts are correct

1. Keeps accurate and legible records

• pre-op and post-op diagnosis
• identifies procedure
• completes all records

1. Prepares specimens for pathology

• correctly identifies specimens obtained
• has labels and containers ready
• completes log book
• identifies exempt specimens

1. Prepares charges in an appropriate and timely manner
2. Demonstrates anticipation of completion of case

• dressings ready to place on sterile field following final count
• tape ready
• drainage bottles, cast material as needed
• sponges may be disposed of after the final count and are cleared with anesthesia

1. Demonstrates proficiency in duties at completion of case

• notes time of end of case
• removes drapes and secures dressing
• obtains stretcher and assists with transfer of patient
• takes all records and chart with patient to room or Recovery Room
• places original copies of the operative record and anesthetic record on patient’s chart
• documents all orders received during the surgery on Doctor’s order sheet

1. Conscious sedation – monitors patient

• Sets up monitoring devices
• Obtains medications, sets up, and labels as needed
• Keeps reversal agents available
• Documents needed information
• Constant observation of patient
• RECOVERY ROOM RESPONSIBILITIES

1. Has all emergency equipment, supplies and drugs ready and available for use
2. Provides optimum quality of post-operative care
3. Maintains record of vital signs and recovery record
4. Provides for physical and emotional support for the patient
5. Demonstrates ability to recognize basic cardiac rhythms and arrhythmias

• SCRUB NURSE RESPONSIBILITIES

1. Demonstrates knowledge of procedure - checks physician’s preference card
2. Demonstrates surgical scrub, gown and glove closed technique
3. Sets up back table
4. Drapes and sets up Mayo stand

• Utilizes Mayo cover appropriately
• Arranges instruments – varies with individual

1. Sets up basins in ring stands
2. Gowns and gloves team
3. Assists with draping – holds drape high so don’t they drag or touch field, watches his/her gown when handling drapes across field, keeps on top of drapes and drops into place, never pulls drapes up to area of incision (once in place it should not be moved), lets circulator remove contaminated drapes, cuffs drapes over gloved hands

• Foot drape
• Head sheet
• Square off towel
• Fenestrated drape
• Steri drape

1. Sets up and is ready to go when surgeon is ready
2. Demonstrates knowledgeable of instruments and their use
3. Obtains appropriate suture and knows its usage
4. Observes for breaks in sterile techniques and corrects them
5. Counts sponges, needles, and instruments according to procedure
6. Keeps sterile area together
7. Passes instruments and suture to surgeons in appropriate manner
8. Demonstrates that he/she has developed a “sterile” consciousness
9. Anticipates surgeon’s needs
10. Demonstrates organization with mayo and instrumentation/ back table
11. Upon completion of case

• Demonstrates proper removal of knife blade and disposal of needles
• Clears room following completion of case
• Puts all instruments, etc. in sink for cleaning
• Checks to make sure all instruments and clamps are off of linen
• CENTRAL SUPPLY RESPONSIBILITIES

1. Demonstrates knowledge of cleaning procedure for instrumentation
2. Demonstrates proficiency in instrument inspection and counting of trays
3. Demonstrates appropriate wrapping of supplies

• Packs
• Instruments
• Trays
• Linen
• Stainless steel items

1. Autoclave operation

• Vacuum cycle
• Gravity cycle
• Flash

1. Record keeping for sterile processing
2. Biological indicators
3. Knowledge of event related policy
4. Loading of autoclave
5. Preparation of air removal pack
6. Folding and inspection of linen

• ENDOSCOPIC CLEANING RESPONSIBILITIES

1. Leak test and precleaning of gastroscope and colonoscope
2. Use of automatic scope cleaning unit

• CHEMICAL DISINFECTION / STERILIZATION RESPONSIBILITIES

1. Mixing of solution / outdate and disposal
2. Uses – soak times / timer

• STERRAD RESPONSIBILITIES

1. Biological
2. Wrapping / Packaging
3. Documentation
4. Processing
5. Disposal of cartridges

• OUTPATIENT SURGICAL PREP AREA

1. Places pre-operative calls to scheduled patients
2. Prepares chart prior to patient admission

• Preoperative laboratory reports
• Radiology reports
• History and physical
• Physician orders sheets
• Allergies
• List of medications

1. Identifies physician preference requests
2. Demonstrates proficiency in starting IV’s
3. Has all emergency equipment, supplies and drugs,
4. Provides optimum quality of post-operative care

• Maintain record of vital signs and recovery record
• Provide for physical and emotional support for the patient

1. Demonstrates competency in use of equipment

• Vital signs monitoring

1. Performs catheterizations – straight and foley
2. Provides discharge instructions to patients
3. Maintains procedure book utilized in OPS
4. Distributes charges and records upon patient discharge
5. Transfers patient to medical/surgical unit

PUBLIC RELATIONS

• Maintains effective channels of communication with other employees and patients
• Takes appropriate action in problem situations to offset adverse effects
• Projects a professional and positive attitude regarding the hospital

OTHER RESPONSIBILITIES

• Demonstrates competency in use of equipment
• insufflator
• printer
• camera for laparoscope
• automatic tourniquet
• cystoscope
• colonoscope
• gastroscope
• bookwalter retractor
• slave monitor
• cast cart
• anesthesia machine monitoring
• Contributes to and supports the nursing department and hospital’s mission and strategic goals
• Serves as a change agent, assisting all staff in understanding the importance, necessity, impact, and process of change
• Demonstrates competency in use of computer documentation
• Scheduling / preference cards
• Chart documentation
• Order entry
• Charges
• Performs other duties as assigned
• Attends 70% of departmental meetings held during the year
• Attends mandatory in-service and educational offerings
• Observes hospital dress guidelines and wears ID badge
• Provides proper notification for absence and tardiness and is punctual for start of scheduled work time
• Maintains equipment assigned to department and reports malfunctions appropriately
• Participates in emergency procedures, fire drills, evacuation procedures and internal/external disaster plans and procedures in accordance with departmental responsibilities

CONTINUOUS QUALITY IMPROVEMENT

• Participates in the Continuous Quality Improvement Program (CQI) to meet stated goals and objectives of the CQI Program by:
• Bringing potential problems to nursing leader’s attention
• Assisting in data collection
• Suggesting solutions to problems
• Emphasizing, supporting and committing to CQI practices and processes
• Taking action to assure CQI within areas of responsibility