The role of the circulating registered nurse in communicating and fostering relationships and the impact on time spent in the operating room Open Access

Haythorn, Kent (Spring 2022)

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The role of the circulating registered nurse in communicating and fostering relationships and the impact on time spent in the operating room

By Kent Wadley Haythorn



           The aims of this study were to describe the relationships and communication patterns in the operating room and understand the role of the circulating registered nurse in relation to surgery case length duration. Despite numerous attempts to decrease errors in the operating room, they continue to occur. Longer surgical cases are associated with increased numbers of surgical errors, possible infection, and time spent in the operating room. The circulating registered nurse role in managing surgical case length duration is not well documented in the literature; the focus tends to be on the surgeon. The CRN is the critical role linking the surgical field to everything happening outside the surgical field necessary for success. What is unique about the role of circulating registered nurses is that they have a more global perspective than the surgeon of events that may affect surgical case length.

           To investigate this complex environment and the CRN’s role within it, two novel approaches were used. The Relational Coordination theoretical framework was used to survey operating room staff to gain understanding of communication and relationships in the operating room. Social Network Analysis was then used to analyze data gathered by directly observing surgical procedures. This provided a deeper understanding of the roles in the OR and how they communicate with each other during surgery.

What was discovered is that there were 16 different individuals with roles that were important to surgical procedures. Of those, five were present in all the surgeries observed. Sociograms elegantly described communication patterns. Sociograms that had more distinct clusters (higher modularity, lower density) with a single leader directing the team appear to spend less time in the operating room. For most of the cases, the surgeon and the circulating registered nurse share prominence and are key roles for communication both inside and outside the surgical field.

           This study is important because it utilized two different approaches to investigate issues with communication and relationships in the operating room including a unique analysis of real-time surgeries using social network analysis. These results also help highlight the critical role of the circulating registered nurse in managing time and safety in the operating room.

Table of Contents



ABSTRACT                                                                                                                          iv        


ACKNOWLEDGEMENTS                                                                                                  vi

LIST OF TABLES                                                                                                                viii

LIST OF FIGURES                                                                                                              ix

Chapter 1: Introduction                                                                                                         1

Chapter 2: Background                                                                                                          7         

Chapter 3: Significance                                                                                                          18

Chapter 4: Research Methods                                                                                               29       

Chapter 5: Results                                                                                                                  38

Chapter 6: Discussion                                                                                                            64



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