Registered Nurse, Surgical Services

This position prescribes, delegates, and coordinates safe and effective perioperative care to patients undergoing surgical procedures through the nursing process of assessment, planning, intervention, implementation, and evaluation. Employee interacts with patient, significant other’s and health care team members, while maintaining standards of professional nursing.  This position also performs safe and effective patient care by passing and setting-up instruments to the Surgeon and protecting the sterile environment for the patient in the Surgical Services Department.  This position is responsible for cleaning, setting up, and stocking the operating room as well as sterilization of equipment, to ensure a safe and sterile environment for the surgeons and support staff.

Essential Functions:

• Performs scrub duties in accordance with established regulatory guidelines and Surgical Services policies and procedures.
• Acts as technical assistance to the Surgeon by passing and setting-up instruments.
• Assists in the transport and supervision of patients.  Ensures that adequate staff are available for transportation of infant, child or adolescent patients and that assistance is available to ensure the patient is not left unattended.
• Plans and organizes appropriately for surgical cases by selecting and preparing proper equipment and supplies.  Ensures surgical instruments are clean, sterile in accordance with established regulatory guidelines to include packaging prior to use.  Ensures that all instrumentation for the surgical cases are in the operating room prior to procedure and ready for use.
• Maintains inventory of supplies for the Surgical Services Department to facilitate, coordinate, and ensure charge capture of supplies as well as orders, as necessary in accordance with the hospital’s policies and procedures. 
• Coordinates specialized equipment needs with the surgical team and/or ancillary departments prior to the commencement of the surgical procedure
• Uses patient care equipment safely according to established competencies and organizational policies   Reports any identified equipment breakdown or malfunction by hospital policy.  .
• Verifies planned surgical procedure and surgical site,
• Organizes appropriately for each surgical case and Surgeon.
• Controls the surgical site environment to include instruments and item counts in the surgical services environment in accordance with AORN standards, departmental and hospital policies and procedures.
• Completes reports when there is an unusual occurrence and documents a description of what was seen on the variance report.
• Participates in the decontamination, cleaning and sterilization/high level disinfection of surgical instruments and endoscopes. 
•  Operates, monitors and maintains the Autoclaves, Instrument Washer, Ultrasonic washer, scope re-processor, endoscope drying cabinet and Sterrad per manufacturer’s instructions.
•  Examines supplies meticulously to ensure they are properly cleaned and sanitized.
•  Maintains records of sterilization/high level disinfection procedures, sterilized items, equipment maintenance, and supplies.
•  Tests and reports any issues or problems with the sterilization equipment.
•  Participates in sterilizing, preparing, wrapping, and organizing equipment into instrument trays for use during medical procedures.
•  Helps with controlling the inventory, reordering supplies, and checking expiration dates.
•  Participates in all annual education and competencies.
•  Demonstrates understanding of Joint Commission Safety Goals.
• Follows guidelines for performance improvement and demonstrates understanding of participation in the Core Measures for Lakeside Medical Center   
• Utilizes protective padding specific to patient’s skin integrity status and position necessary for surgical procedure.
• Answers call for after hours emergency surgical procedures, reports to OR unit within thirty (30) minutes of receiving call. Complies with staffing and call rotation.
• Oversees validation of all new methodologies introduced to the surgical services area in relation to scrub techniques.
• Attends and participates in in-services as required.
• Performs duties in compliance with the Surgical Services Department’s and hospital’s policies and procedures.
• Collaborates with other members of the surgical care team to ensure patient receives appropriate, safe and effective patient care.
• Participates with team members and manager to identify opportunities for improvement in patient care processes. 
• Works as a team with other care providers; utilizing good communication skills, critical thinking, and checkpoints for team work.
• Participates in the orientation and mentoring of new staff members recognizing importance of bringing new staff into a friendly and supportive work environment.
• Demonstrates professional growth in continuing education which is applicable to the unit assigned.
• Delivers nursing care for identified patient population and scope of service directly, ensuring that all care- givers within area of responsibility do the same.  Demonstrates personal patient care to provide comfort and well-being to the patient, acknowledging their physiological and psychological needs.
• Delivers patient care within defined hospital and patient care standards for assessment, care planning, interventions and reassessment, and delegates care appropriately to other team members and support staff.
• Performs pre-operative, Phase I, II, and III recovery and circulating duties following the Surgical Services Department’s policies and procedures, as well as ASPAN and AORN standards of patient care.
• Interviews patients in preparation for surgery.
• Ensures patients are prepped for surgical procedure and performs positioning practices to the anesthetized patient.
• Confirms the availability of the Surgeon prior to the induction of patient by anesthesia.
• Administers medication, IV, blood, and blood products according to regulations and policy.
• Confirms verbally with the Surgeon the procedure and site for the operation to be performed.
• Communicates immediately with the OR Nursing Manager regarding any changes in surgical procedure or patient conditions and potential harm to patient or delays in the surgical procedure.
• Performs out-patient procedures and stress tests.
• Assesses and charts patient’s vital signs and notifies physician of abnormal ranges as well as any significant changes.
• Serves as back up for radiology as needed.
• Evaluates clinical/diagnostic reports and reports variances to the physician and documents same.
• Administers treatments as ordered and appropriate.
• Evaluates patient’s care status frequently.  Reports variances in care and/or medication administration for quality improvement.
• Uses the nursing process  to assess, plan, implement, and evaluate patient care. 
• Ensures appropriate handling and labeling of all specimens, cultures and blood draws according to the department’s policies and procedures.
• Functions as a clinical preceptor as required.
• Ensures that care is delivered by those who are competent and trained to do so according to the patient population, level of technology required, complexity of care needs and age of the patients.
• Performs duties with a clear understanding of the JCAHO Safety Goals and delivers care with patient safety as a goal.  Follows hospital policies guiding compliance with National Patient Safety Goals.
• Performs duties in accordance with pathogen transmission practices; i.e., follows hand washing procedures and utilizes protective equipment effectively.
• Delivers patient care in accordance with established infection control standards for patient placement, IV therapy, medication administration and the performance of all patient procedures.
• Observes patient confidentially and ensures the staff does as well.
• Follows guidelines for administration of high risk drugs, patient identification, documentation and taking telephone orders with read back and communication of critical values/diagnostic results.
• Is responsible for the appropriate administration of medications as outlined in the Florida Nurse Practice Act, specifically ensuring the identification of the right patient, right route, right medication and right site. Evaluating the patient’s response to the medication and ensuring complete and timely documentation of activities. Documents the administration of medicines including dosage, medicine route, medicine site and patient’s response as required in the documentation system
• Participates in continuing education and in-services to ensure competencies and skills are current for the position.
• Co Responsible for the appropriate delegation and supervision of nursing care according to the Florida Nurse Practice Act and organizational standards.
• Responsible for the establishment and implementation of a nursing plan for the care and comfort of individuals, the prevention of illness and the education, restoration, and maintenance of health. 
• Utilizes SBAR communication during patient handoff and when communicating with team members. 
• Delivers patient care in accordance with established infection control standards.
• Ensures that unit equipment is maintained and stored appropriately. Utilizes patient care equipment appropriately and safely, following hospital policy and procedure, as well as appropriate competencies.  Reports any identified equipment breakdown or malfunction by hospital policy. 
• Coordinates clinical and patient care support activities within the scope of authority.
• Participates in performance improvement activities.  Follows guidelines for performance improvement and demonstrates understanding of participation in the Core Measures for Lakeside Medical Center, and for documentation review and restraint review process.
• Communicates effectively with other patient care providers and team members for efficiencies and safety of care through appropriate ordering procedures, preparing patients for surgery and other procedures, communicating fall potential and other risk identifiers.
• Provides a complete, concise report to oncoming nurse when being relieved during a procedure or at the end of a shift.
• Completes and adjusts patient assignments so that care is delivered in a timely, cost-effective and clinically efficacious manner.
• Ensures that unit equipment is maintained to promote optimum operations and a pleasant physical environment.  Utilizes patient care equipment and patient restraints appropriately and safely, following hospital policy and procedure.  Reports any identified equipment breakdown or malfunction by hospital policy. 
• Anticipates needs, problems, and crises before they occur and develops a reasonable action plan to make course corrections that reduce the likelihood of problems going unattended.
• Delegates and supervises patient care appropriately to LPN-Surgical Technicians and Surgical Technicians with follow up and feedback procedures to ensure quality of care.  Initiates appropriate actions as needed.
• Documents and maintains patient care records, including patient assessment, care plan, intervention and evaluation of care; and, related required documentation according to policy and regulatory guidelines.  Maintains records and communications with respect to patient’s privacy.
• Explains all procedures and care plans to patients, and as appropriate to family.  Ensures patient and/or family are educated according to the needs identified and appropriate health maintenance.
• Collaborates with all members of the health care team to ensure patient care is safe, following protocols as applicable.
• Identifies and develops opportunities for performance improvement in patient care processes.
• Obtains and transcribes physicians’ orders in a timely and accurate manner ensuring all tests are ordered appropriately and efficiently.
• Ensures procedures and supplies are charged appropriately.
• Communicates effectively with manager, supervisor, and others regarding the changing status of the unit.
• Utilizes good communication skills, critical thinking and checkpoints for teamwork.  Provides patient information timely and effectively during shift report and with patient’s hand-offs.
• Resolves problems on the unit in a timely and appropriate manner.
• Performs duties consistently to meet the hospital’s published customer service and quality standards.
• Adjusts interpersonal approach to others in order to achieve the best results that produce the desired outcomes.
• Demonstrates the ability to motivate the team and produce quality patient care outcomes.
• Complies with staffing and call rotations.
• Includes the patient and the family in the plan of care as appropriate.  Develops patient focused goals with the patient and family as appropriate,
• Provides teaching and training to staff members as needed.
• Participates in the orientation and mentoring of new staff members recognizing importance of bringing new staff into a friendly and supportive work environment.
• Utilizes and ensures staff uses supplies efficiently, following infection control procedures, avoiding waste and follows patient charging procedures.
• Follows ACLS protocol for patients as indicated.
• Serves as an example for team members in cost saving practices.
• Participates in the hospital Utilization Management Program by assisting with discharge planning, reporting to case managers, and keeping patient, family, physician, and other personnel informed.
• Demonstrates understanding and commitment to hospital’s mission, philosophy, standards, policies and procedures.  Recognizes all staff, physicians and visitors, as well as, patients as customers and provides courteous and respectful service.
• Documents and reports any complaints from patients, physicians and visitors to supervisor as guided by hospital policies and procedures. 
• Participates in the cleanliness of the work environment.
• Demonstrates an understanding of responsibility of emergency plans and is available for patient care as needed or scheduled when hospital emergency preparedness plans are activated.
• Serves as a leader for change, positively promoting new systems and changes implemented which improves the hospital and the service provided to its patients.
• Participates in hospital community activities and helps portray a positive image of the hospital in the community.
• Observes cardiac rhythm and initiates or ACLS protocol as indicated.
• Completes assessments and documentation of new admissions and discharges including the interim plan of care.  Completes discharge instructions with information regarding food and drug interaction.
• Performs specialized patient assessments as needed.
• Defibrillates patients safely in accordance with regulations, policy and accepted procedure.
• Performs monitor/defibrillator checks each shift.
• Conducts inventory checks, including all medications administered at the time of administration.  Reconciles the count with oncoming nurse at the end of the shift. 
• Ensures availability of age appropriate supplies and equipment.
• Checks code cart and emergency box each shift.
• Assesses lung sound in patients.
• Starts IVs and delivers IV medications to patients as needed.  Runs and calculates IV drips.
• Performs NG tube insertion and performs gastric suction per hospital policy and procedures.
• Evaluates pulmonary status by auscultation.
• Performs port flushes, injections and blood transfusions as needed.
• Helps with code assistance.
• Performs respiratory care assessments and specimen collection using the appropriate techniques.
• Completes pre-operation check-list and time out checklist.
• Witnesses consents for surgery, anesthesia and special procedures as per hospital policy.
• Transports patients to appropriate care locations.
• Accepts additional nursing care assignments and performs duties under the direction of the Surgeon and/or Anesthesiologist.
• Demonstrates the necessary skills and knowledge to provide care for patients according to OR unit competencies.
• Demonstrates the ability to handle emergency situations in a prompt and professional manner.
• Dresses patient wounds as needed.
• Completes control tests on Accu Check machine daily.
• Floats to other units as required.
• Emergency duty may be required of the incumbent that includes working in special needs or Red Cross shelters or to perform other emergency duties including, but not limited to, responses to threats or actual disasters, man-made or natural.

Education:

• Associate’s, Bachelor’s, or Diploma in Nursing from an accredited nursing school required.

Experience:

• One (1) to two (2)years experience preferred.

Certification:

• Current BLS is required. ACLS and PALS are required within three (3) months of hire.  Advanced certification such as CNOR, CPAN, CAPA, CRCST  preferred.

Licensure:

• State of Florida Registered Nurse license required.

Health Care District of Palm Beach County is proud to be an Equal Opportunity Employer and Drug Free Workplace. We embrace diversity and do not discriminate based onrace, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.