What is a scrub nurse – and could you be one?
Perioperative practitioners, or theatre nurses, work in anaesthetics, surgery or recovery and ensure patient safety. They are also known as a scrub nurse.
Jo-Racel Casanova Eviota (pictured below) is a perioperative practitioner at King’s College Hospital NHS Foundation Trust, London. Here she explains what her job as a perioperative practitioner involves.
What is a perioperative practitioner?
The perioperative environment has three main areas: anaesthetics, surgery and recovery. A professional who works in these areas is called a perioperative practitioner and is either a nurse or an operating department practitioner (ODP).
Roles include theatre nurse, anaesthetic assistant or anaesthetic nurse, and recovery nurse.
Perioperative practitioners work with a large multidisciplinary team, including surgeons, anaesthetists, theatre coordinators and managers, and support workers or healthcare assistants. They provide a safe environment for patients who need surgery, coordinating responsibilities to ensure the theatre list runs smoothly and patient safety is maintained before, during and after an operation.
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What does the role involve?
As a perioperative practitioner – specifically a theatre nurse – I could either be a scrub nurse or a circulating nurse.
As a scrub nurse I assist the surgeons during surgery and am part of the ‘sterile field’. This means I have to prepare for the operation by washing my hands aseptically for 3-5 minutes, wear a sterile gown and gloves, and keep myself sterile as I hand the instruments needed for the operation to the surgeons.
Before surgery starts I check that the equipment and instruments needed for the operation are complete and available. During the operation I do a series of surgical counts of instruments, swabs, needles, equipment and all the accountable items in the sterile field.
This is a prime responsibility of the scrub nurse as it is a ‘never event’ to unintentionally retain any instrument or swab during surgery.
As a circulating nurse I perform safety checks with the patient and the rest of the team when the patient arrives in theatre. I mainly assist the sterile team and open anything they require such as needles, swabs, extra instruments, gloves and implants.
I cannot touch anything from the scrub nurse’s table with my hands or clean gloves, as this will contaminate the sterile field. I am also responsible for documentation during surgery and count all the instruments, sets and accountable items with the scrub nurse – these should be documented and announced as complete before the closure of the skin to make sure that nothing has been left inside the patient’s body cavity.
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What types of patients will I work with?
There are many different specialties in theatres, including paediatrics, obstetrics and gynaecology, urology, general surgery, trauma, orthopaedics, plastic surgery, neurology and cardiac.
I mostly work in paediatric and emergency – or CEPOD* – theatres. I have worked with newborn babies who need surgical intervention to close underdeveloped abdominal muscles, or those who are born without an oesophagus. These complicated cases need urgent intervention to increase the child’s chances of survival.
The CEPOD list is for patients requiring emergency surgery. This could include a patient with a broken jaw that needs repairing, a patient needing surgery for a perforated appendix or a child who has swallowed a coin.
We have a variety of shift patterns in CEPOD theatres so we can provide a 24-hour service.
What skills and qualifications do you need for the role?
Perioperative practitioners need to be highly organised, flexible and able to prioritise effectively. Situational awareness and good interpersonal skills are important qualities for the role, as is the ability to stand and concentrate for long periods of time, as some operations can take hours to complete.
You also need to work well in a team and be able to respond quickly in an emergency, such as cardiac arrest or excessive bleeding.
There is a variety of roles available in theatres, including for newly registered nurses, with many NHS trusts providing training and preceptorship programmes. Training is also provided for more experienced nurses who move into this field.
What band/salary is the role?
I started in the UK as an overseas nurse from the Philippines, working as a support worker at band 3. Once I passed the objective structured clinical examination (OSCE) and obtained my UK nursing pin I went up to band 5.
Now, as a theatre team leader at band 6, I coordinate and manage theatre lists and support new starters. Theatre nurses can move up to band 8 as a clinical lead or head of nursing.
What should I do if I am interested in a role like this?
Seek out a nurse already working in this area and ask them about their role, and find out what training and education is available in your organisation to enable you to transition to theatre nursing. Consider what transferable skills you have that you can bring to the role, such as good communication, teamwork and organisational skills.
The perioperative environment is a great place to work. It can be exciting, stressful and beautiful all at the same time, so if you are ready for a new challenge, like an active job and do not mind being on your feet, then theatres could be for you.
Just one word of advice – invest in comfortable shoes, your feet will thank you for it.
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*Theatre lists for emergencies during normal working hours were introduced into UK hospitals in the early 1990s, following the recommendation of the National Confidential Enquiry into Perioperative Deaths – now the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) – that a dedicated emergency theatre should be available at all times. These lists are commonly known as CEPOD lists.
By Jo-Racel Casanova Eviota, a perioperative practitioner at King’s College Hospital NHS Foundation Trust in London.
This is an abridged version of the article What does a scrub nurse do – and could you be one? which was first published in Nursing Standard.
