Who Works In The Operating Room?
The OR team can get quite confusing at times with multiple people involved and in and out during different parts of the case. Let’s look at who you may find in your operating room.
The surgeon is, of course, the doctor performing the surgery. This is the person who is responsible for seeing the patient and writing the history and physical or consult note, explaining the actual surgery and the consent, and for performing the surgery. He or she may also have another surgeon assisting them with more complicated cases and would be considered either a “surgeon consult” or “surgeon assist” depending on their role in the case. A consulting surgeon is one who is typically brought on for their expert opinion or skill that the primary surgeon does not have. For example, a general surgeon may call in a plastics doctor after the removal of an area of cellulitis that needs additional plastic surgery.
You could also have a physician’s assistant, a nurse practitioner, or a certified first assist working alongside the surgeon. The physician’s assistant (PA) or nurse practitioner (NP) is able to also round on patients and help the physician in clinic. On the other hand, first assists are experts in surgical skills and have many hours of surgical experience before becoming first assists, but can only work in the operating room and under the direct supervision of the surgeon.
This person can either be the anesthesiologist or a certified registered nurse anesthetist (who is supervised by the doctor). Depending on what state you practice in and type of facility, these roles will vary. A CRNA is an advanced level registered nurse who most likely has ICU experience and then a minimum of a master’s degree in anesthesia (although this is trending toward becoming a doctorate). They are typically supervised by an anesthesiologist although some states allow them to practice on their own in certain situations. In other situations, only MDs will provide anesthesia.
Certified Surgical Technologists
Those scrubbed in the sterile field are mostly certified surgical techs (CSTs). These team members are typically scrubbed into the sterile field, running the mayo stand, passing instruments, and retractor holding, along with many other important functions. CSTs are side by side with the surgeon and play an important role. They are required to know many different types of surgeries, instruments, and equipment. They are the right-hand person of the doctor and must be knowledgable and confident. CSTs go to school for about 2 years to receive their certification and many obtain an associate’s degree.
You may also have medical company representatives, or “reps”, in your room. This is often seen in orthopedic or neuro cases with lots of instrumentation or implants, but reps can be present during many types of cases for all kinds of products or special equipment that the surgeon needs. Tissue products, mesh, other implants, or robotic cases, for example. The reps are there to help and should never be in the way of you or other team members. They are an important part of the surgical team, but they do not work for the hospital or facility they are visiting so they must be mindful to follow the rules and try to be as respectful as possible.
Certified Radiology Technicians
Many times you will also involve radiology technicians for any type of fluoroscopy needed. RTs can operate a variety of machines, such as a C-Arm, O-Arm, or flat plate x-rays. They are crucial to many cases and an important team member.
Some cases may also have specially trained staff to run certain equipment, such as bypass pumps for heart surgery and nerve monitoring machines for neuro cases.
There may also be residents or students in your room, learning from the surgeon and experienced staff.
And don’t forget you, the RN! Typically the RN operates as the circulator, coordinating all the parts to keep the surgery running smoothly, the patient safe, and making sure everyone has what they need. To understand more about what the circulator actually does, read this article.
Phew! It can get crowded in the OR, but everyone is an important and essential member of the team to give the patient the best care possible!