Seize the moment: the role of scrub nurses’ proactivity in microsurgical operating-room collaborations

The required skills for medical personnel in surgical operating rooms are not confined to medical and technical expertise. To understand how scrub nurses perform their critical role, cognitive, social, and collaborative skills are at the centre of interest. To navigate in a life-critical environment and react both appropriately and in a timely manner to the surgeon's actions, nurses need to have a fast and accurate understanding of the situation. We present how this reading of the situation is conducted during microsurgeries, where a surgical microscope takes a central role in the treatment. We employed contextual observation, gaze-tracking, video recordings, and interviews to describe the reliance of the surgeons’ work on the microscope, as well as the situation-understanding strategies of the nurses in such a setting. Also, we present pieces of evidence of anticipation strategies that the nurses exploit in the face of challenges due to the main surgeon’s lack of attention toward them because of the constant use of the microscope. To ameliorate these circumstances, the scrub nurse proactively employs a set of mechanisms to obtain and maintain situation awareness. Lastly, we present the implications of future technologies for operating rooms aiming to improve collaborative microsurgical work and patient safety.