Surgery

Primary Purpose: To assess, plan, implement, and evaluate the care of all patients assigned to the operating room, recovery room, and outpatient surgery, as well as to manage the supplies and equipment in the OR/RR/ASU, and to provide pre and post-op education.

Formal Policy-Setting Responsibilities : Formally responsible for providing input into policies associated with the jobs purpose and essential responsibilities.

Routine Decision Making : If pre-op lab and results are sufficient; surgical case schedule; if patient meets criteria for discharge from PACU/ASU.

Formal Supervisory Responsibility : No formal supervisory responsibility.

Unusual Working Conditions: Risk of blood, body fluid contamination.

Age Specific Competencies: Provides care for birth to pediatric (birth-2 yrs.), pediatric/child patients between (2 yrs-12 yrs); adolescent patients between 12 to 18 years of age; adult patients between 18 to 64 years; and geriatric patients 65 years and older.

Essential Responsibilities and Tasks

Assesses, Plans, implements and evaluates patients receiving high risk specialty procedures. (40% of time)

- Performs pre-procedure interviews per paper/computer correctly on all patients, evaluates the information obtained, and formulates a plan of care prior to the patient procedure.

- Identifies the patients using two patient identifiers prior to the procedure 100% of the time.

- Performs a comprehensive nursing assessment on patients and documents completely including appropriate signatures, times and dates. Revises plan of care as indicated from the assessment.

- Interprets physiological information from technical equipment, on each patient and applies this information to the plan of care.

- Documents the findings from all assessments, evaluations and implementations on the patient record where, when, and how daily.

- Reports all critical abnormal assessments and lab values to the physician, per hospital policy and implements further orders immediately and documents details on the patient record.

- Adequately assess and reassess pain. Utilizes appropriate pain management techniques. Educates the patient and family regarding pain management.

- Utilizes AIDET (acknowledge, introduce, duration, explain and thank) initiatives to include managing up with each patient.

- Utilizes only approved abbreviations in patient documentation.

Provides patient education. (15% of time)

- Provides pre-operative and post-operative teaching to all patients.

- Evaluates patient learning ability and motivational levels. Implements alternative learning measures, as evidenced by patient or caregiver verbalization or return demonstrations, as documented on the patient record i.e.; effectively communicates.

- Effectively communicates discharge instructions to patient and responsible party at the time of discharge, per departmental discharge policy.

- Explains all procedures and medications to patients prior to implementation.

Maintains a safe and comfortable environment. (25% of time)

- Removes malfunctioning equipment from unit immediately upon discovering problem.

- Complete requisition for repair or malfunctioning equipment by the end of shift.

- Cleans and stocks supplies within the department, as needed.

- Effectively communicates the plan of care on each patient to ancillary departments, case management and pharmacy staff as indicated by the orders received, patient diagnosis or condition.

- Ensures all required documents are on the chart prior to going into the procedure room (H&P, informed consent, test results if applicable).

- Evaluates the effectiveness of the communication, as evidenced by the preparedness of the patient and takes appropriate actions, including notifying performing physician.

- Demonstrates thorough knowledge of location, care and operation of all departmental equipment.

- Accurately records, handles and labels specimens; demonstrates care of specimens.

- Ensures alarms on any assigned area are audible to alert staff.

- Assists with the cleaning and care of surgical instrument.

- Assists with terminally cleaning of OR rooms and documents on cleaning schedule.

- Positions patients on operating table to facilitate surgical approach and to ensure patient safety for each case.

- Uses padding on any boney prominences for each patient and documents on operating room record.

- Applies cautery pads on muscular areas close to surgical site and away from any implants on each patient and documents on record.

- Applies safety belt to each patient having surgery and documents on record.

- Checks code blue carts each shift and upon using the cart, ensuring it has an intact tag attached.

- If assigned as the scrub nurse, is fully responsible for care of instruments prior to, during and after the surgical case including appropriate transporting to decontamination.

- Follows manufactures instructions for the sterilization equipment; knows responsibilities and the necessity for biological/chemical monitoring.

- Able to accurately see and read color changes to biological and chemical monitors.

Demonstrates utilization of the nursing process through planning for patient care. (10% of the time)

- Pulls supplies for next days cases daily from departmental supplies according to physicians preference cards.

- Orders special equipment as requested by physician or on preference card to have prior to surgery start time.

- Updates preference cards to meet physicians preferences so surgeon does not need to ask more than once.

Develops and promotes hospital/unit initiatives and professional relations. (5% of the time)

- Establishes and maintains effective communication and good working relationship with co-workers for the patients benefit.

- Utilizes initiatives; strives to maintain steady level of productivity; self-motivated; manages activity and time; does not waste.

- Participates in planning ways to solve problems and make improvements in the department as needed.

- Represents the organization in a positive and professional manner.

Other duties as directed. (5% of the time)

ESSENTIAL PHYSICAL REQUIREMENTS

- Heavy Work: Lifting 100# maximum with frequent lifting and/or carrying of objects weighing up to 50#.

PHYSICAL DEMANDS

- Lifting: Raising or lowering an object from one level to another (includes upward pulling).

- Carrying: Transporting an object, usually holding it in hands or arms or on the shoulders.

- Pushing: Exerting force upon an object so that the object moves away from the force (including slapping, striking, kicking, and treadle actions).

- Pulling: Exerting force upon an object so that the object moves toward the force (includes jerking).

- Hearing: Ability to determine audible communication.

- Stooping: Bending the body downward and forward by bending the spine at the waist.

- Kneeling: Bending the legs at the knees to come to rest on the knee or knees.

- Crouching: Bending the body downward and forward by bending the legs and spine.

- Crawling: Moving about on the hands and knees or hands and feet.

- Reaching: Extending the hands and arms in any direction.

- Handling: Seizing, holding, grasping, turning, or otherwise working with the hand or hands (fingering not involved).

- Fingering: Picking, pinching, or otherwise working with the fingers primarily (rather than with the whole hand or arms as in handling).

- Feeling: Perceiving such attributes of objects and materials as size, shape, temperature, or texture by means of receptors in the skin, particularly those of the finger tips.

- Speaking: Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.

- Seeing: Obtaining impressions through the eyes of the shape, size, distance, motion, color or other characteristics of objects.

- Acuity, near - clarity of vision at 20 inches or less.

- Depth perception - ability to judge distance and space relationships so as to see objects where and as they actually are.

- Field of vision - area seen up and down or to the right or left while eyes are fixed.

- Accommodations - adjustment of the lens of the eye to bring an object into sharp focus.

- Color vision- the ability to identify and distinguish colors.

WORKING CONDITIONS

- Inside: Worker spends approximately 75% or more of time inside.

- Wet: Contact with water or other liquids.

- Noise and Vibration: Sufficient noise, either constant or intermittent to cause marked distraction or possible injury to the sense of hearing and /or sufficient vibration (production of an oscillating movement or strain on the body or its extremities from motion or shock) to cause bodily harm if endured day after day.

- Hazards: Situations in which the individual is exposed to the definite risk of the bodily injury.

- Fumes: Smoky or vaporous exhalations, usually odorous, thrown off as the result of combustion or chemical reaction.

- Odor: Noxious smells, either toxic dust, fumes, gases, vapors, mists or liquids which cause general or localized disabling conditions as a result of inhalation or action to the skin.

Qualifications

Education and Certification/ Registration required for the Position: Two to four-year RN degree; currently licensed in the state of Missouri; ACLS/BLS required; PALS preferred.

Required Knowledge : A&P; disease process; sterile technique; standards set by Association of Operating Room Nurses Association (AORN); functions and mechanism of multiple operating room equipment.

Required Skills and Ability: Computer skills; good communication skills; good organizational skills.