American Nurse in a UK Operating Room

We’ve made a move across the big pond and I started a nursing job in the UK. I’ve been a nurse in the US for about 5 years and have gotten qualified in the UK at the end of last year.  I’m so happy that my job is in the Operating Room since it was my most recent job from the States. My only other OR experience came from Vidant Medical Center in North Carolina. Even if you just switch hospitals in the US, there will be plenty of differences between the 2, and likewise is true within the UK. So my comparisons are based on 1 hospital in the US vs. the 1 I’m working in the UK, so it’s good to keep that in mind. Other hospitals in the UK could be different, just to be clear.

1. Consultants

This is equivalent to what we call attending physicians. Consultant is not reserved for surgeons though, just any senior hospital-based physician or surgeon that have completed the training in their specialty. A primary care physician/family medical doctor, is a GP (General Practitioner) here.

2. Mr. and Mrs.

When a doctor comes to a certain level through their surgery rotations (now when that happens, I’m not exactly sure), they are referred to as “Mr.” or “Mrs.” Prior to this level, they are “Doctor.” This dates back in time when surgeons were untrained barbers and butchers that did not go to medical school. It was usually just an apprenticeship. The tradition stuck, so now a surgeon looks forward to not being called a doctor again! How ironic huh? I introduced myself to a surgeon and I asked if he was “Doctor Smith” (for example), in which his response was “Yes, I’m Mister Smith”. In this beginning time of my job here, I did not know about this difference!

3. Anaesthetist

This is the anesthesiologist. These guys do all the intubations, stay in the room the whole time, and there is one to every OR. An anesthesiologist at home would have 4 or 5 OR’s they were responsible for, but have a Certified Registered Nurse Anesthetist (CRNA) in each room.

4. The Scrub Nurse Role

The scrub takes care of the specimen at the end of the case, finishes documenting the name of the procedure, how much local, type of dressings, etc AND gives report to PACU. Most scrubs are nurses, but health care assistants are able to scrub if they have taken an extra course. Circulators are nurses and healthcare assistants. Most of the time when someone is scrubbing for the case, they do not get relieved for a break usually, they just stay scrubbed until the case is finished and eat after.

5. Operating Room Practitioner (ODP)

An ODP is a different degree that we don’t have in America. Likewise, they don’t have CRNA’s here. An ODP works in perioperative care, so they can assist the anesthetist, scrub, or in the post anesthesia recovery units. When they are assisting anesthesia, they are the ones that bring the patient into the room, confirm the consent is signed correctly, and ask the interview questions such as the last time they have eaten/drinken, allergies, any metal work in the body, etc. I do miss meeting the patient and doing my own assessment prior to the patient rolling into theatres. The circulator and scrub roles don’t usually get to see the patient while they are awake still.

6. Charge Nurse

Each theatre has a scrub nurse “sister” in charge, plus another scrub and a circulator. Usually 3 staff minimum are in each theatre + an ODP that assists the anesthetist. What we would call the Charge Nurse at home, is called the Coordinator for the day, as in they are not assigned to a room but manage all of them. Scrub nurses rotate scrubbing for the cases too, one person does not do all the cases for the day.

7. Anesthesia Room

Instead of the patient going straight into the OR to be put to sleep, there is a room connected to the OR called the anesthetic room. Once they’ve been put to sleep and all the lines have been placed, they are rolled into theatres. This benefits the patient in that the room is smaller with less equipment, so it’s not as daunting. When the operation is finished, they exit through another set of doors, so it’s always a one way flow in that they enter through one and exit another. The only downside of this to me is that it requires more manual handling, because we always have to move the patient over. If they are able at home, they slide themselves over prior to being put to sleep.

8. OR Start Times

The early shift begins at 8AM, and the idea is to get the patient in by 8:30 AM vs. the 7 AM shift and in the room by 7:30 AM at home. The later start gives the doctors and anesthesia time to do rounds on the patients without being there so early. In America, I feel like OR mornings are super early compared to here! I enjoy the sleep in as I wake up over an hour later than if I were at home.

9. OR Masks

Only the people that are scrubbed, or in the Orthopedic OR, wear masks. I felt like my face was naked without one during cases at first, but now I’m used to it.

10. No Kick Buckets

The scrub nurse keeps the dirty sponges on their table. The sponges come in packs of 5, and when 5 become dirty they can be thrown into a clear bag, sealed up and removed from the count. If it’s a bigger more emergent case, they can be thrown into a basin bowl on a stand. One positive side to no kick buckets is the circulator doesn’t have to bend down to sort out sponges in a sponge counting bag.

11. Swabs

Sponges. I had to get used to this term because when I first hear “swab,” I think about culturing something, which they use the same term for. Small swabs are our 4×8’s/raytex, long swabs are a bigger version of a 4×8, and Abdo (Abdominal) swabs are a bigger version of our Lap sponges.

12. Gowning and Gloving

No gowns are opened onto the sterile table for staff  that are scrubbing in. There is a clean area with sinks inside the OR where you do all gowning and gloving. Also interesting is that the doctors gown themselves! Are American surgeons too spoiled?

13. Time Out

Often referred to as the “WHO”. When it’s time for the “time out” to verify the correct details, I always hear “Shall we do a WHO?”. It comes from the World Health Organization Surgical Safety Checklist. Another difference is that this is done before prepping or draping the patient.

14. No Case Carts

Instrument sets and trays are pulled by us, the OR staff. When we are finished with the case, there is a dirty room connected to the theatre with a cart that all the trays are placed in. Someone from Hospital Sterilisation and Decontamination Unit (HSDU) come to collect these directly from each OR. If your sets are open and preparing for a case in the OR, no one should be coming in and out from the dirty hallway.

15. Full Counts

The instrument recipe sheet that comes with the instrument set is what we use for our counts. Even if it is a case that it would be impossible to lose anything, the full set is still counted…even for an eye case!! The small counts are written on a dry erase board so the scrub nurse can easily visualize as well.

16. Tucking Arms

The arms are tucked for about all the cases I’ve seen, unless we need access to the arm for the operation. At home they would always be out on the arm boards if it wasn’t necessary to tuck. Arm boards aren’t even kept in the rooms or on the OR tables. When the arms are tucked, a draw sheet is not used, but a Chux incontinent pad is.

17. No Charging for Supplies

No matter what you open for the case, there’s not a consumption page that you have to update to charge the patient, because the supplies are already paid for. This is due to being a public hospital though. I like not having to keep up with this part.

18. Flying Squad Blood

This refers to O negative emergency blood. We keep a few units in a small fridge in theatres for life threatening cases.

19. Flowtrons

SCD’s (sequential compression devices).

20. Plate

A plate is the bovie pad. Sorry, if you don’t work in the OR you probably don’t know what I’m referring to. It’s the sticky pad we put on patients that connects to a machine for diathermy to help control bleeding.

21. Tea Breaks

The Brits take their tea breaks very seriously. It doesn’t always happen, but usually we get a proper morning and afternoon break in addition to our 30 minute lunch. With 3 staff to a room usually, it makes it easier for each room to manage this without someone coming in to relieve us.

Which is the most interesting? I hope those of you from the OR will enjoy this one!

If you want to read more about nursing differences, check out 25 Differences for an American Nurse Working in the UK, and the process it took to get my license in the UK.

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