Circulating Nurse Responsibilities

The Student Nurse must receive the patient with the staff nurse. Upon receiving the patient please
record the following:

 Name: ____________________________________
 Age: ________________
 Address of the patient: _________________________________________

 Verify consent (signed)

 Verify that the patient has been on NPO status. Check if oral medications have been
administered prior to OR.
 Time patient was received
 Any attachment on the patient (IV, NGT, Catheter and others)
 Accompany patient as he or she is wheeled to the OR (Time: ______)

Upon reaching the OR Suite, Get the following information:

 Patient details
o Allergies: _________________________
 Patient Pre op medications: _______________________
 Type of Anesthesia: ______________________________
 Time Anesthesia is Inducted: _______________________
 Availability of blood:

Names of the Surgical Team:

 Surgeon: ________________________
o Asst: _____________________
o Asst: _____________________
o Asst: _____________________
 Anesthesiologists: _________________
o Asst: _____________________
o Asst: _____________________
o Asst: _____________________
 Scrub Nurses: ____________________
o _________________________
 Circulating Nurse: _________________
 ________________________________
During DRAPING:

Student Nurse: Good morning everyone, our patient today is ___________________________

(name), aged _______, is from _____________________, in for __________________________
(name of operation). Patient is inducted with _________________ as anesthesia, pre op meds given
______________________________(specify the meds). Surgical Team Members, kindly introduce
yourselves and your roles.

 Surgeons
 Anesthesiologists
 Scrub Nurses
 Circulating Nurses

Student Nurse: Dr. _____________ (surgeon), what are the critical and non routine steps, how long
will the operation take and what are the specific concerns?

Student Nurse: Dr. _____________ (anesthesiologist) are there any patient specific concerns?

Student Nurse: Scub Nurses, has sterility been confirmed?

Student Nurse: (make sure to check equipment prior to OR (suction, and cautery) There are no
equipment issues we can now proceed to the baseline counting of instruments.

 Baseline count

Student: Dr. __________________(surgeon), Dr. ________________ (Anes), and the rest of the
surgical team, baseline counting of instruments sponges and needles done, we now proceed with
our prayer:

Prayer: GOD, THE GREATEST MASTER OF HEALING ARTS, BLESS US AND GUIDE US.
MAKE US YOU INSTRUMENT IN ALLEVIATING THE PAINS OF YOUR AILING
SERVANTS. MAKE OUR EYES ALERT, OUR HAND SKILLFUL AND SENSITIVE AND
FILL OUR MENTAL FACILITIES WITH KEENNESS TO MAKE RIGHTEOUS JUDGMENT
SO THAT OTHERS MAY LIVE… AMEN.

You may now begin.

After initial counting: Dr. __________________(surgeon), Dr. ________________ (Anes), and the
rest of the surgical team, Initial counting of instruments sponges and needles done and complete,

After Final Counting: Dr. __________________(surgeon), Dr. ________________ (Anes), and the rest
of the surgical team, final counting of instruments sponges and needles done and complete,