Require the successful completion of cognitive and didactic testing through written examinations and skills checklists. Testing may vary according to the type of specialty unit at each MTF but may include but not be limited to the following tasks: Critical care medications (monitor, mix, administer, and titrate); dysrhythmia recognition; arterial blood gas interpretation; hemodynamic pressure interpretation; assist with synchronized cardioversion; perform emergency defibrillation; administer thrombolytic agents; perform the postoperative recovery and discharge within established criteria; perform arterial punctures; draw blood from invasive monitoring lines; demonstrate use and operation of defibrillator; assist with temporary pacemaker insertion; apply noninvasive external pacemaker; obtain hemodynamic variables; provide intensive nursing care to critically ill patients of all ages with medical and/or surgical problems and/or AIDS-related problems; administer prescribed medications to include multiple medication drips and intravenous push drugs; care for patients on ventilators; operate hemodynamic equipment safely and effectively.
Preoperative Phase: initiate a nursing assessment on every patient having a surgical procedure in the operating room (OR). The assessment will be recorded on the preoperative record.
Formulate a plan of care for the patient based on the assessment. The plan will include appropriate nursing interventions and expected patient outcomes. The plan will be discussed with the patient and recorded on preoperative record. The plan will include involvement of the family and/or significant other(s) preoperatively with teaching, intra-operatively by keeping those individuals informed as the surgical procedure progresses, and postoperatively with assisting the patient.
Prior to surgery, the nurse will review the patient history and physical and ensure that it matches the surgical consent. Review the operative consent form; SF522, to ensure informed consent has been completed for the planned surgical procedure.
Review Procedure and Site Verification Record (MEDCOM Form 741-R) to ensure that the first and second verifications are completed prior to the patient being brought to the OR. The verification will include the right patient, surgical site, and procedure. The verifications will be completed by the operating provider and anesthesia provider in addition to licensed nursing staff in the preoperative holding area prior to the patient receiving any pre-op medication. NPO and allergy status will be noted. The nurse will also quickly review the Preoperative Checklist, DA Form 1924 to ensure all necessary preparations have been completed, and check that appropriate lab work has been done and results are on the chart. X-rays should be available if needed for the procedure.
Intra-operative Phase: Circulating RN is responsible for delivery of nursing care during the intra-operative phase of the surgical intervention. Prior to the incision, the final “time out” third verification of the patient ID, surgical site, and procedure will be completed by the entire operative team and documented by the OR nurse on the 741-R.
Ensure the patient is safe and the principles of asepsis are upheld. Perform necessary sponge, needle, sharps, and instrument counts; provide appropriate positioning aides; ensure proper use of electrosurgical units; and document all interventions on the intra-operative record. Basic scheduling, reporting, and tracking information for each case will be documented electronically using the S3 (surgical scheduling system). Responsible for effective management of nursing personnel assigned to the room. Dialogues with family/significant other(s) informing them as to how the case is progressing particularly during lengthy procedures ( >2.5 hours). Close out any perioperative nursing issues and documents on the intra-operative document at the conclusion of the procedure.
Postoperative Phase: conducts a brief postoperative evaluation and documents any findings on pre-op/post-op document.
Able to walk extensively, stand for long hours at a time, lift object greater than 30 lbs, and move freely for extended periods of time.
Geriatric Operative Patients:
Ensure that the body temperature of the patient is maintained by increasing the OR temperature to that of 72 degrees F, through the use of the K-thermia pad on the bed and warm sheets.
Assist anesthesiologist in monitoring fluid balances for the geriatric patients by placing sponges within view of anesthesia for blood loss estimation.
Place padding on prominent body areas of patients and a pillow should be offered to the patient for placement under the legs during surgery.
Ensure patient safety when moving the patient on and off the gurney by providing physical guidance to the patient because of physical and sensory defects.
Pediatric Operative Patients:
Use appropriate language that the pediatric patient will understand (age appropriate language), i.e., ambu bags are referred to as balloons and the term anesthesia is replaced with going to sleep.
Employ age appropriate safety measures, hold or stand beside the child during induction (preferable to placing a safety strap across the child’s body).
Ensure that the body temperature of the patient is maintained by increasing the operating room temperature to a level high enough to prevent hypothermia (72-80 deg if necessary). Body temperature can also be maintained through the use of warming lamps, Bair Hugger, and warm sheets.
Closely monitor blood loss. If anesthesia request that sponges be weighed, they will be weighed immediately upon removal from the surgical field.