Operation Theatre Nursing Roles
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Direct answer
Operation theatre nursing is the perioperative nursing role divided mainly into the scrub nurse, who is sterile and manages instruments at the field, and the circulating nurse, who remains unsterile and coordinates the room, documentation and patient safety. The scrub nurse sets the instrument table, passes instruments anticipating the surgeon, and performs counts of instruments, sponges and sharps with the circulator before closure and at the end. The circulating nurse positions and safeguards the anaesthetised patient, manages the WHO surgical safety checklist, opens sterile supplies and labels specimens.
What you must remember
- Scrub nurse: performs surgical hand antisepsis, gowns and gloves, arranges the instrument and Mayo tables, passes instruments and sutures in anticipation, and monitors the field for breaks in sterility.
- Counts of instruments, sponges, needles and sharps are performed aloud by scrub and circulating nurses together — at the start, when items are added, before closing any body cavity, and at the end; a missing count stops closure until found.
- Circulating nurse: checks equipment, positions the patient with the team using padded pressure points, applies the electrosurgical grounding pad over a muscular site away from bony prominences, and records tourniquet times.
- Patient advocacy: the circulating nurse verifies identity, procedure and consent (the "sign in" and "time out" of the WHO Surgical Safety Checklist), protects the anaesthetised patient's eyes, skin and nerves, and maintains normothermia.
- Specimens are labelled immediately at the field, in the patient's presence where possible, with the correct preservative, and their dispatch is documented — a lost specimen is an irreversible error.
- Positioning injuries the nurse prevents: brachial plexus stretch, nerve compression, pressure ulcers over bony prominences and corneal abrasion; padding and neutral alignment are the countermeasures.
- Diathermy safety: grounding pad with full skin contact over a muscular site, no spirit pooling (fire risk), no metal contact with the patient, and the alarm never ignored.
Common confusion
The counting duty is often attributed to the scrub nurse alone. In reality the count is a joint, audible, two-person verification with the circulating nurse, because only unsterile staff can move around and search; a miscount halts closure and triggers a repeat count and X-ray before the patient leaves theatre. The second confusion is glove change — the scrubbed nurse hands instruments glove-to-glove but receives assistance skin-to-skin.
Exam-focused takeaway
MCQs ask who counts instruments and when counts are due, who is sterile and who is not, the phases of the WHO checklist (sign in, time out, sign out), and the correct placement of the diathermy pad. Long answers expect the duties and desired qualities of a scrub or circulating nurse. A retained-sponge scenario is the classic patient-safety question.
Frequently asked questions
What are the main duties of the scrub nurse?
After surgical hand antisepsis and gowning, she sets up and guards the sterile field, passes instruments in anticipation, keeps counts with the circulator, and corrects any sterility break.
What does the circulating nurse do?
Remaining unsterile, this nurse checks equipment, positions and safeguards the patient, runs the WHO checklist, opens sterile supplies, documents times, counts, implants and specimens, and restricts traffic.
When are instrument and sponge counts performed?
Audibly and together by scrub and circulating nurses at the start, whenever extra items are added, before closure of any cavity and at the end. Any discrepancy stops closure until the item is found or an X-ray is taken.
What are the three phases of the WHO Surgical Safety Checklist?
Sign in before induction (identity, site, consent, allergies), time out before incision (team confirmation of patient, procedure and site) and sign out before leaving theatre (procedure recorded, counts correct, specimen labelled).