Nursing roles

The anaesthetic nurse is the assistant to the anaesthetist. They:

• prepare the environment and equipment for the patient
• prepare equipment for administering the anaesthetic
• receive the patient into the operating room and establish rapport with the patient by asking and answering questions and checking identification and consent
• communicate relevant patient information to the other members of the intra-operative team, both nurses and doctors
• assist with intra-operative patient monitoring and ensure the patient’s safety, comfort and warmth
• assist the anaesthetist at the end of the procedure as the patient emerges from the effects of anaesthesia.

Knowledge and skills

The anaesthetic nurses requires:

• good assessment skills
• a knowledge of anaesthetic methods, anaesthetic agents and equipment
• an understanding of fluid balance and respiratory monitoring, cardiac monitoring and haemodynamic monitoring, and the ability to identify any changes that may have impact on the patient
• knowledge of airway anatomy and physiology, airway management strategies and anaesthetic complications. 

Education pathway

This role is suitable for both registered nurses (RNs) and enrolled nurses (ENs). ENs need to be able to administer medicines in this role which they can do unless they have the notation ‘Does not hold Board-approved qualification in administration of medicines’ or ‘May only practise in the area of mothercraft nursing’ on their registration. ENs administering medications shall have the competence and confidence to administer medications safely, regardless of when the initial education occurred. ENs administering medication shall be supervised by an appropriately qualified RN, in accordance with the NMBA Enrolled nurse standards for practice. In addition, an EN undertaking the anaesthesia nurse role shall have access at all times to a named and accessible RN for assistance and support. This RN shall be a suitably qualified and experienced anaesthesia nurse.

Colloquially referred to as ‘scout nurse’, the circulating nurse is a non-sterile member of the team. They:

• coordinate the activities in the operating room
• implement the nursing plan of care, supply the sterile team as needed and document all care the patient receives
• advocate for the patient and ensure a safe environment
• undertake and document the count of all accountable items, together with the instrument nurse
• consistently monitor the intra-operative environment and the aseptic status of the sterile team using their surgical conscience. 

Knowledge and skills

The circulating nurse requires:

• critical thinking skills
• the ability to adapt to any change in the patients’ condition
• a good knowledge of applied anatomy as it relates to various surgical procedures
• an understanding of intra-operative complications and their management
• technical knowledge relating to surgical instruments, supplies and equipment required for the surgery
• the ability to anticipate procedural needs in a timely manner to support the surgeon
• very good communication skills.

A good circulating nurse is always aware of what is happening, listens to the operative conversation and thinks ahead to ensure the needs of surgical team members are met.

Education pathway

This role is suitable for both registered and enrolled nurses. Registered nurses need to complete a Bachelor of Nursing degree and a postgraduate degree that focuses on intra-operative nursing roles. Enrolled nurses need to complete a Diploma of Nursing that includes medication administration.

Colloquially referred to as ‘scrub nurse’, the instrument nurse is a member of the sterile team who scrubs, gowns and gloves for the surgical procedure. They:

• are responsible for setting up and handing sterile supplies and instruments to the surgeon
• maintain an accurate count of all accountable items throughout the procedure
• consistently monitor the intra-operative environment and the aseptic status of the sterile team using their surgical conscience. 

Knowledge and skills

The instrument nurse requires:

• critical thinking skills
• the ability to adapt to any changes in the patients’ condition
• a good knowledge of applied anatomy as it relates to various surgical procedures
• an understanding of intra-operative complications and their management
• technical knowledge relating to surgical instruments, supplies and equipment required for the surgery
• the ability to anticipate procedural needs in a timely manner to support the surgeon

• the ability to be constantly aware of what is happening, to listen to the operative conversation and to think and plan ahead to ensure the needs of the surgical members of team are met
• very good communication skills.

A good instrument nurse is always aware of what is happening, listens to the operative conversation and thinks ahead to ensure the needs of surgical team members are met.

Education pathway

This role is suitable for both registered and enrolled nurses. Registered nurses need to complete a Bachelor of Nursing degree and a postgraduate degree that focuses on intra-operative nursing roles. Enrolled nurses need to complete a Diploma of Nursing that includes medication administration.

The Post Anaesthesia Care Unit (PACU) nurse receives the patient into the PACU (also known as the recovery unit). They:

• undertake respiratory, cardiovascular and neurological assessment and monitoring as the patient recovers from the effects of anaesthesia and surgery
• monitor emergence from anaesthesia, dressings, intravenous lines and drainage tubes
• implement and document post-operative treatment regimes including pain management.

Knowledge and skills

The PACU nurse requires:

• a strong knowledge of and ability to manage post-operative complications and respond to patient deterioration quickly and efficiently
• advanced airway management skills
• the ability to quickly recognise respiratory compromise and take necessary action
• excellent assessment skills
• a strong knowledge of pain management methods and medications
• excellent communication skills
• the ability to work as an effective member of a multidisciplinary team.

Education pathway

This role is suitable for both registered nurses (RNs) and enrolled nurses (ENs). ENs need to be able to administer medicines in this role which they can do unless they have the notation ‘Does not hold Board-approved qualification in administration of medicines’ or ‘May only practise in the area of mothercraft nursing’ on their registration. ENs administering medications shall have the competence and confidence to administer medications safely, regardless of when the initial education occurred. ENs administering medication shall be supervised by an appropriately qualified RN in accordance with the NMBA Enrolled nurse standards for practice.

These nurses work in day surgery units and pre-admission departments. Admissions departments are both challenging and busy, as all types of surgery from minor to major can be admitted on day of surgery. Pre-admission activities occur prior to surgery where nurses work collaboratively with doctors to assess patients’ health care needs for the planned procedure or operation.

This nursing role has one of the highest levels of patient contact in the perioperative nursing field and involves a mix of teamwork and autonomy that many find appealing and rewarding.

Pre-admission nurses:

• are the first point of contact when the patient is preparing for surgery and when the patient arrives on the day of their surgery
• ensure patients are fully informed and have completed an informed consent form
• ensure patients are prepared for surgery and that it is safe to proceed with surgery
• are responsible for assessing patients presenting for surgery and ensuring they have made the necessary preparations
• substantiate data relevant to the patient's readiness for surgery
• communicate pertinent information to the surgical team. 

Knowledge, skills and attributes

Pre-admission and day surgery nurses require:

• compassion and empathy to help allay any anxiety the patient or their family may be feeling
• attention to detail
• good communication skills
• good assessment skills
• critical thinking ability
• the ability to identify potential problems and communicate these to the perioperative team to ensure safe, positive patient outcomes.

Education pathway 

This role is suitable for both registered and enrolled nurses and requires the completion of, respectively, a Bachelor of Nursing or Diploma of Nursing that includes medication administration.