OR Nurse: Scrub vs Circulating

An Operating Room Nurse (OR nurse) is a special type of practicing nurse. They are specially trained to handle the fast-phasing environment with accuracy while maintaining a professional approach towards patient care. These nurses are packed with complete existence in all corners of the operating room. Their knowledge and skills are constantly challenged depending on the demands of the procedure and their surgical teammates.

They are applying their theories while on extreme physical exertion (prolonged standing during operations), also, with the mixture of the presence of mind is their ultimate weapon in their day-to-day performance. Above all, they are the masters of application of operating room techniques and holistic approach in the sterile complex; this is the reason why most health care facilities recognize them as “superior nurses” within their institution.

An operating room nurse can perform either of the two roles at a time, a scrub nurse or a circulating nurse. A scrub nurse is also called “sterile nurse”, “instrument nurse”, or “assist nurse”. This is because he/she performs multiple tasks during an operation/procedure. They are completely responsible in the maintenance of sterility of the sterile area and materials. They can also have direct access within the immediate surroundings of the operative site.

A circulating nurse, on the other hand, is also called the “unsterile nurse” or “facilitating nurse”. They are called either of the above-mentioned names because they are the facilitators of sterility but are not actually sterile during the conduction of an operation/procedure. They play an important role away from the sterile surgical team and operative site by providing necessary help, materials, and equipment that cannot be accessed by the sterile surgical team.

All in all, an OR nurse, either scrub or circulating is vital in the success of each and every operation/procedure. Despite the differences in their roles and functions, still, a scrub nurse is the other half of the performing machine and vice versa.

The concept of perioperative nursing is very broad. It covers from the time the client was diagnosed and accepts the idea of surgery up to the time that the client comes for follow-up check-ups. There are three basic phases of perioperative nursing. The first one is called preoperative; this is the time when the patient accepts surgery up to the time when he/she is on the lobby of the operating room complex. The second phase is called intraoperative; this is the time when the client is on the lobby of the operating room complex up to the time when he/she is in the lobby of the Post Anesthesia Care Unit (PACU). The last phase is called postoperative; this is the time when the patient is in the lobby of PACU up to the time when he/she is discharged from the hospital and does follow-up check-ups. As these phases of operation rolls, the role of the nurse evolves. Along with this, the operating room nurse comes into action during the intraoperative phase.

The intraoperative phase covers 3 distinct stages; wherein the role performance of the operating room nurse logically changes to meet the demands of his/her role.

Before the Operation

Right after the client arrives at the operating room lobby, the function of the OR nurse starts. By this time, both the scrub and the circulating nurse may or may not perform the same tasks. This is most of the time institutional in nature.

From the time of arrival up to the time before the incision, either of the nurses; or both of them can perform these activities:

1. Receive the endorsement (client, chart, and supplies) and note the time;
2. Counter-check the client’s identity and procedure/operation to be done;
3. Recheck the operating room checklist, it must be completely carried out;
4. Review laboratory results for any that has significant impact on the operation;
5. Recheck the consent form for completeness;
6. Remind/check the schedule of the assigned surgeon and other members of the surgical team for availability;
7. Prepares the operating room table (bed), tables, materials, equipment, and needed machines;
8. Ensures functionality of everything to be used;
9. Prepares emergency kit;
10. Reinforce knowledge on what to expect during and after the procedure/operation;

The scrub nurse

1. After these/at this time, the scrub nurse can now perform surgical hand-washing, gowning, and gloving while having strict adherence to the operating room technique;
2. He/she can now serve gloves and other sterile materials to the surgeon and other members of the sterile team;
3. He/she can now also prepare sterile materials and equipment on the mayo table, in an arrangement he/she is comfortable and facilitate speedy performance;
4. He/she may or may not start initial and tentative counting of sponges, needles, sharps, and other tiny materials that will be used;

The circulating nurse

1. As the scrub nurse moves to perform his/her role, the circulating nurse will continue handling the client by establishing or re-checking vital signs;
2. Recheck administration (time, dosage, by whom) and effects of the pre-anesthesia agents;
3. Ensures safety while transporting a patient from the lobby to the OR table/bed;
4. Assists in positioning the client in the induction of anesthesia, note the time of induction;
5. Assists in positioning the client in the desired position for operation/procedure;
6. Place straps, restraints, and other protective materials for safety;
7. Assists in dressing (gowning) of the sterile nurse;
8. Calls for any other request and corrections among surgical team members;
9. Prepares/put anticipated additional materials within accessible areas.

During the Operation

Right after the surgical scrubbing of the sterile team, the distinction of being a scrub nurse or a circulating nurse begins. The scrub nurse will focus his/her attention on the performance of role beside/near the operative site; taking care of the sterile field, materials, and other sterile team members. On the other hand, the circulating nurse focuses on relevant activities and materials distal to the sterile field.

The scrub nurse

1. Assembles the mayo table in an arrangement that both holds accessibility and comfort while it could maintain sterility (an example is making “pillow” to maximize space within the table);
2. Charges parts of instruments and materials like a blade to blade holder to make a “knife” or scalpel;
3. Serves additional antiseptics to further cleanse the incision site (if requested);
4. Serves sterile draping materials like towels, clips, eye sheets, and others;
5. Serves the “knife” or scalpel and note the time of incision (formal start of the operation);
6. Serves sponges and other ligating materials to stop or minimize bleeding;
7. Anticipates needed materials to be used next;
8. Anticipates physical help that can be rendered like retractions and positioning of “tied” materials;
9. Keep on organizing the mayo table to prevent dropping and contaminating instruments and materials;
10. Continuously monitoring the number of tiny materials that may be left inside the body or misplaced;
11. Monitors dropped materials for tallying and possible replacements;
12. Collects the specimen tissue and put it in container for possible laboratory workouts;
13. Serves suturing instruments and materials;
14. Notes the closing time which marks the ending of the operation;
15. Collects all instruments, materials, and equipment that are exposed to body secretions and fluids.

The circulating nurse

1. Notes the incision time;
2. Records the quantity of every material to used or prepared;
3. Anticipates the serving of additional materials;
4. Assists the anesthesiologist and other unsterile team members;
5. Maintains communication among members of the surgical team, and surgical team to other offices like the laboratory and surgical ward;
6. Continuously monitors dropped materials and document it, prepares possible replacements;
7. Does the documentation of everything done and happened during the operation/procedure in chronological order;
8. Assists in the final counting of sponges, needles, blades, and tiny materials used;
9. Notes the time of closure;
10. Assists in transferring the client from OR table/bed to the stretcher;
11. Ensures safety of transport from the operating room to PACU.

After the Operation

After the closure of the operative site, the roles of the scrub nurse and the circulating nurse will gradually meet to a common point. They will both focus on the synonymous concept, the “aftercare”.

1. The scrub nurse’s contribution to the aftercare focuses on handling used materials that are exposed to body secretions and fluids. The circulating nurse is on unused materials together with putting the machines back in place;
2. Another is the scrub nurse returns used materials to the central supply for re-sterilization while the circulating nurse assists the client to the PACU for endorsement;
3. After their role performance, both will go back to the vacated operating room to final check the arrangement of every details; returning it back to their original places, keeping it ready to cater to the next operation.

The presented roles of operating room nurses, whether scrub or circulating, are realistic and can be appreciated in the Philippine setting, but, are not limited to this list. There are some variations in every stage within the intraoperative phase, depending on the demand of the operation/procedure, surgical team members, and the institutional policies circulating in the operating room complex.