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 job’s 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 day’s 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 physician’s 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.