Circulating duties

AORN Journal, July, 2007 by Sharon Giarrizzo-Wilson

QUESTION: As a newer emptoyee at my facility, I have noticed nurses performing other duties while circulating on a procedure. For example, they receive training on a new computer program from clerical personnel or leave the room to select supplies and equipment for the next procedure. My supervisor says there is nothing wrong with "multitasking" as long as it does not result in harm to the patient. I disagree. What is AORN's position on performing other tasks or training while circulating on a procedure?

ANSWER: The perioperative nurse's first responsibility is always to the patient. There may be times when multitasking is necessary; however, the perioperative nurse needs to use critical thinking as well as clinical judgment to provide safe patient care. During a procedure, the circulating nurse should refrain from performing activities that draw his or her attention away from the procedure and essential patient care. The circulating nurse is a vital member of the surgical team whose central focus must be on the needs of the patient and perioperative team members. An anesthetized patient is dependent on the circulating nurse as a source of protection during this vulnerable time. The nurse's responsibility does not stop or pause when the surgeon makes the incision.

As the patient's advocate, the circulating nurse has a duty to assess and implement appropriate patient care throughout the procedure. The nurse should remain vigilant to anticipate the needs of surgical team members and deliver necessary supplies to the sterile field before the supplies are requested by the surgeon or scrub person. (1)

Should an untoward patient event occur as a result of the nurse not providing an intervention because his or her attention is drawn to an unrelated task, the nurse may be found negligent during litigation for not "being dutiful." The nurse is liable for his or her behavior. (2) Case law (Adams v Cooper Hospital, 684 A.2d 506 [NJ 1996]) identifies allegations of negligent conduct against nurses for "improper monitoring or assessment." (2)

Additionally, individuals who are not trained in OR protocols (eg, aseptic technique) should not enter the patient care environment unless this is necessary to avert patient harm (eg, a biomedical engineer performing a needed equipment evaluation). Having a clerical person train nursing personnel on a data entry program during the intraoperative phase of patient care is not appropriate. Qualified individuals should perform this type of education and training outside the immediate patient care setting. Intraoperative troubleshooting of equipment or program functions related to patient care is acceptable when staff members providing these functions are familiar with and are appropriately credentialed to enter the patient care environment.

REFERENCES

(1.) Phillips N. Berry & Kohn's Operating Room Technique. 10th ed. St Louis, MO: Mosby, Inc; 2003:52-53.

(2.) Brent NJ. Nurses and the Law: A Guide to Principles and Applications. 2nd ed. Philadelphia, PA: WB Saunders; 2000:58.

SHARON GIARRIZZO-WILSON, RN, MS, CNOR