Job Title: Circulating Nurse

Location: Valentine NE

Position: Full-Time

Benefit Eligible: Yes

Report To: Operating Room Manager

Cherry County Hospital is seeking an experienced Operating Room Registered Nurse to join our surgical services team in our critical access hospital located in Valentine, NE. This position is ideal for a confident, adaptable RN who thrives in a collaborative environment and is prepared to respond to a wide range of patient procedures and emergent situations.

The OR RN functions at the level of RN circulator, providing direct patient care to pediatric through geriatric populations. On-call responsibilities are shared and rotated with equitable distribution of weekends and holidays.

Key Responsibilities Include:

• Providing safe, high-quality perioperative nursing care as an RN circulator
  
• Collaborating with surgical technologists to assemble, open, and manage sterile supplies and equipment
  
• Managing the non-sterile field and monitoring the sterile field throughout surgical procedures
  
• Assisting with endoscopic and arthroscopic procedures and troubleshooting equipment as needed
  
• Responding effectively to surgical emergencies and changing patient needs
  
• Practicing within AORN standards and State Board of Nursing rules and regulations
  

This is an excellent opportunity to practice broad-based perioperative nursing, develop strong clinical autonomy, and make a meaningful impact in a supportive rural healthcare setting.

Candidate must demonstrate aptitude for proper operation of OR equipment/technology in multiple specialties

• Individual must be well organized, with exceptional skill in planning and preparation for expected events
• Knowledge of surgical procedure and ability to access and research appropriate knowledge bases for information
• Ability to quickly adjust to changes in patient focused events
• Solid understanding of patient safety and precautions
• Candidate must possess general clinical competency in circulating nursing for Ophthalmology, Orthopedics (total joint replacements and arthroscopic procedures), Urology, ENT, General Surgery, GI (Endoscopy), Podiatry, Pediatric Dental procedures, Cesarean Sections and related OB/GYN procedures
• Experience in Post Anesthesia Care and Recovery of surgical patients preferred
• Current Nebraska Registered Nurse license; ACLS & BLS required certification, PALS preferred or competent in the care of

Essential Duties and Responsibilities – Pre-Operative: Procedures

Standard Procedures

• Follow standard procedures for surgical/procedural intervention, adapting for surgeon and anesthesia preference.
• Adapts procedures to meet individual needs of pediatric, adolescent, adult, and geriatric patients.
• Verifies all patient information; name procedure, equipment, allergies, implanted devices, implants, correct position, side and surgical site
• Use preference cards, as needed, updating regularly as changes occur.

Readiness

• Ready and prepared consistently for assigned cases; does not cause delay of case; minimize turnover time.
• Assists in opening surgical supplies in a sterile fashion, observes sterile field for breaks or contamination and assists the scrub personnel to be gowned and ready for patient arrival.
• Assures that the surgical scrub is prepared with appropriate instrumentation, medications and surgical counts are completed

Pre-Op Care and Preparation

• Ensure pre-op checklist is complete and all consents are signed, lab results are documented, site is signed-if appropriate, review history and physical and confirm it is within 30 days of procedure before patient is taken into surgical suite.
• Confirm availability of blood products if ordered
• Coordinate and supervise patient care; provide patient and family with teaching/education as necessary. Approach patient/family in a kind, gentle, and friendly manner while protecting patient sensitivities and right to privacy.
• Compassion and caring should be demonstrated at all times.

Essential Duties and Responsibilities – Intra-Operative: Initial Assessment

• Brings patient to the OR suite and introduces patient to staff, assists patient to OR table and completes initial timeout.
• Demonstrate knowledge of anesthetic drugs, actions, and side effects; and knowledge of
• IV conscious sedation/or medications (actions and delivery). Understands induction process, complications of anesthesia, malignant hyperthermia risks and treatment.
• Identifies induction and intubation supplies used and their location. Stays with patient at head of bed, assisting with anesthesia until released from duty by provider.

Surgical Knowledge

• Demonstrate thorough knowledge of location, care, and operation of surgical equipment/instruments.
• Positions patients safely; pads and protects bony prominences and protecting nerves.
• Performs skin shave and prep according to surgeon preference, observes and assists surgical scrub to drape correctly for all procedures. Carry out medical and surgical asepsis all procedures.
• Has a strong knowledge of procedure and is able to anticipate needs of the surgical team.
• Communicates calmly and professionally to the entire staff at all times.
• Monitors placement of equipment, fire hazards, observes for maintained sterility of field, back table and surgical personnel throughout the procedure, professionally addressing any breaks and takes immediate action to remedy equipment or instrumentation concerns or issues.
• Documents and initiates counts at appropriate wound closure and immediately addresses any discrepancies.
• Documents intra-operative care in EHR; be clear, concise, accurate, and timely. Note unusual occurrences and initiate variance report if required.
• Collects, labels and documents all specimens. Fills out all laboratory paperwork and takes to lab in a timely manner.

Post Procedure

• Verifies implants and chargeable goods used with surgical scrub,
• Assists with dressing and securing with appropriate material, tape.
• Documents intakes and outputs, foley, drains and specimens.

Essential Duties and Responsibilities – Post-Operative:

• Demonstrate competence in preparing and cleaning of OR suites before and between cases and after terminal cases, based on patient's infection class.
• Gives thorough report of patient's intra-operative condition to PACU nurse, if necessary, performs duties as PACU nurse.

Essential Duties and Responsibilities-PACU Nurse

• Observe patients for side effects of anesthesia
• Monitor and record patient vital signs as per protocol
• Monitor, record and report s indicated, incisional drainage, bleeding, urinary, NG and drain output
• Monitor patient’s level of consciousness throughout recovery
• Recognize condition and status that deem need to administer oxygen, pain management initiatives and document, monitor response to treatments
• Perform post-operative tasks, such as administering medication or change/reinforce dressings per provider orders
• Document and update patient files, charts and medical records
• Collaborating with surgeons, anesthesiologists, physicians and other members of the patient’s care team any changes in patient status from preoperative, anticipated recovery progress or decline in patient’s condition
• Providing comfort and answering questions when patients wake from sedation

Essential Duties and Responsibilities – General: General Nursing Care

• Competent in IV skills and general nursing skills such as foley and nasogastric tube insertion. Care of Chest tubes, drains and recognizing emergency signs such as but not limited to cardiac events, embolism-various types and signs of deterioration of patient status. Able to care for immediately post-cesarean section patients.

Emergency Situations

• Recognize and respond to emergency situations in an appropriate and timely manner, including but not limited to cardiac events, malignant hyperthermia, hemorrhage, changes in LOC, fire and weather emergencies

Information Processing: Language Use Skills

• Skill in language use, including reading and comprehending instructions, short correspondence, and memos, constructing correspondence, and presenting information in one-on-one, small group situations, in person and electronically.

Computer Use

• Appropriate and timely documentation in the EHR, surgical and procedural tracking books and delivery summary.
• Use computer to perform department functions, i.e. forms, data entry, e-mail.

Interpersonal Skills:

• Professional Image
• Follow dress code.
• Project a pleasant and professional image per company policy.
• Wear identification while on duty.
• Come to work projecting an attitude that welcomes patients.
• Communicate name and role to patient.
• Flexibility/Stressful Situation
• Respond with flexibility to changing work load and/or assignments.
• Stay organized and function under stressful situations.

Working Relationships

• Ability to establish and maintain effective working relationships with physicians, co-workers, and the public, that harbor a friendly, yet professional interaction.
• Demonstrate willingness to readily interact with other staff members and department leaders.
• Initiative
• Exhibit initiative and self-directed behavior.
• Accept responsibility for own professional growth and personal conduct by seeking knowledge in work specific areas, taking advantage of opportunities at work to observe and volunteer.

Independence

• Ability to work independently, make decisions, and solve problems.
• Other Duties
• Perform other duties as directed/required by the OR manager
• Participates in sterile processing, case preparation and restocking.

Adherence to Facility/Departmental Policy: Confidentiality

• Observe confidentiality of information in regards to patients, physicians, and fellow employees; ability to maintain confidentiality under HIPAA standards.
• Attendance/Punctuality
• Maintain a good attendance record and arrive to work punctually.
• Utilize established time clock system appropriately.
• Overtime
• Able to substantiate overtime, minimize overtime and adjust hours as needed.

Care of Environment, Equipment, & Supplies: Clean, Neat, Safe Environment

• Maintain a clean, neat, and safe environment for patients and staff, including personal work areas.
• Reports defective equipment and immediately puts out of service, reports to OR manager findings and initiates repair/report to appropriate department ie: maintenance, IT etc.
• Office Equipment Skills/Malfunctioning Equipment
• Utilizing correct/safe technique when using equipment and notify manager of malfunctioning equipment.

OTHER JOB DUTIES: Operating Room Supervisor may assign other duties to perform. To stay current in this field attends continuing education programs. Assist in the emergency room when called upon by provider, charge nurse or anesthesia for a mass injury or high level acuity that is a potential surgical case. Knowledgeable of, and committed to practicing Corporate Compliance policies and procedures. Complies with Cherry County Hospital personnel policies.

EQUIPMENT AND WORK AIDS: May include, but is not limited to, the following: Patient carts, wheelchairs, step stools, surgical instruments and equipment, patient transfer devices, mops, writing aids, OR table, blood pressure equipment, pulse oximeters, cardiac monitoring, thermometers, autoclave, sealer, computers, calculators, telephone, resuscitation equipment, and etc.

SKILLS AND ABILITIES:

• Skills: Understands principles of asepsis and its application. Knows the care, sterilization and all other supplies used in the operating room. Knows the care and safe operation of equipment such as cautery, monitoring devices, laparoscopic, endoscopic and arthroscopic and other special equipment. Is aware of the experience level and limitations of nursing and auxiliary personnel. Understands and applies sound teaching and learning principles. Understands and practices safety measures to prevent injuries to patient and personnel. Knows what procedure to following in case of an emergency. Can recognize and correct technique breaks. Understands the meaning of each operative procedure. Knowledge of obstetrical nursing. Knowledge of endoscopy procedures, patient care, the care and use of the endoscopy equipment. Knowledge of physical organization of hospital as well as administrative objectives, policies and procedures.
• Interests: Interested in continuing professional growth. Keeps abreast of new trends and developments in the field of nursing. A preference for working with the public and other staff. Desire to be responsible for and manage other staff.
• Temperament: Possesses personal qualities which enable maintenance of good interpersonal relationships. Examples of these are good judgment, understanding, loyalty, respect for the person as an individual, and empathy. Possession of poise and tact, uses good common sense in all situations charged with emotional overtones, ability to handle occasions which could arise in which tensions and anxiety are present.
• Dress Code Requirements: Street clothes with Cherry County Hospital nametag, surgical scrub outfit provided and laundered by the hospital. Surgical cap, mask and shoe covers as provided by the hospital. All shoes must be clean with a closed top, if shoes are kept in the surgery department personnel are not required to wear shoe covers. On call personnel called in to help in the ER may wear a scrub top or cover up jacket.

PHYSICAL DEMANDS AND WORKING CONDITIONS: Work is physically and emotionally demanding, involves lifting, positioning, sitting/standing for long periods of time and bending as required. Positioning and operating surgical equipment, cleaning and mopping operating room, transferring, transporting patients to and from operating room via wheelchair or cart. Must be able to move carefully around patient and equipment with ease and be agile. Repetitive use of hands, arms, and eyes could result in strain. Environment requires working in close proximity with others in a clean favorable area. Dexterity is needed to operate equipment and other tasks as required to meet patient care needs. Employee must be able to physically and mentally meet patient needs in an expedient and efficient manner. Working hours are flexible depending on surgery schedule and has a possibility of overtime hours and callbacks during evening hours and weekends. Be available to take 24-hours of call as scheduled. Job regularly involves the potential for exposure to hazardous material such as contaminated body fluids, anesthetic gases, cold sterilization fluids, and other decontaminants.

QUALIFICATIONS: Graduate from an accredited school of nursing and possession of a license to practice as a registered nurse in the state of Nebraska. ACLS and BLS certified.