Nursing is a broad field with plenty of opportunity for specialisation. This week nurses in the operating room of King Edward VII Memorial Hospital are raising awareness on the work they do.Perioperative nurses are seen by most of us in hospital dramas, passing scalpels and other surgical instruments to the surgeon. Unlike many nurses, their patients most often don’t get to meet them. This is because their patients are usually unconscious while they are working.There are 27 perioperative nurses at KEMH, four of whom are male. At least three are required for every procedure in the operating rooms at KEMH. There is a scrub nurse, a circulating nurse and a nurse who is responsible for assisting the anaesthetist.The scrub nurse is responsible for securing and handling all the surgical instruments required for the procedure. The circulating nurse is responsible for all documentation associated with the procedures in the room and also for obtaining any additional instruments required once the procedure has started.While the operating room team usually has an idea of how long a particular procedure is going to take, they can never be certain. KEMH perioperative nurses Ria Outerbridge and Michelle Evans said each case is unique. The suspense-filled medical dramas where people are waiting six and seven hours for the end of an operation, don’t really happen in Bermuda.Ms Evans and Ms Outerbridge said KEMH procedures typically take between 30 minutes and two hours. Emergency cases can take longer.“We may see trauma cases going over three hours,” said Ms Outerbridge.Such cases happen maybe once a month, she added.Within the speciality of being a perioperative nurse, Ms Evans further specialises in orthopaedics. This means she does surgeries involving bone adjustments like hip replacements, knee repair and sporting injuries.She said many procedures in her field are the more lengthy ones at KEMH. A total hip replacement for example, typically lasts over an hour and requires at least ten surgical trays — that’s well over a hundred surgical instruments.On TV it looks so simple, the nurse passes the scalpel when the surgeon asks for it. With ten trays of equipment, you can appreciate that the duties of this nurse do require a great deal of skill and know-how.Ms Evans said efficiency during every procedure is paramount and the scrub nurses have to almost anticipate what instrument the surgeon will need next.“The surgeons rely heavily on us to know the instruments,” she said.Perioperative nurses cannot spend several minutes searching for the instrument requested. They must be able to put their hands on it almost immediately.And what if they get tired or need to use the bathroom? There must be a scrub and a circulating nurse in the room at all times whilst a surgery is underway. When a nurse has to leave, he or she is replaced.“We have a way of handing over,” said Ms Outerbridge. In fact although they try to schedule surgeries to start and finish within one work shift, there are times when a shift change happens during a procedure. Ms Outerbridge said there’s an established way this is done at KEMH as well.“But we try not to have shift changes in the middle of a procedure,” she said.