There is no doubt that operating theatres department is one of the important parts in any healthcare institution if it is not the most important one; either in private sector or in public OR considered as critical care area needs a special skills in both sides technical and managerial.

Technical or clinical part is divided into three roles in OR, these roles could be imagined as the leggings base and stability manner for any thing needs to be in place safely.

1.Nursing role. 2.Anesthesia role. 3.Surgery Role.

Nursing role in OR specially the technical part which we are talking about always come first among the other three roles, because all the pre-operative, intra-operative and post operative activities if we take it in quantity are belongs to the nursing staff. Having said that, starting from receiving the patient in the holding area through the preparation area to the OR table, then driving the patient either to intensive care unit ( ICU ) or post anesthesia care unit (PACU ). All this process with all steps has a nursing input which is making the nursing part one of the main.

In a study been done in the secondary care hospital in china in 1998, they recorded the total nursing time with patients in OR according to the following criteria: •The total OR time starting form arriving the holding area til the patient moved from PACU = 180 minutes

-Holding area period = 20 minutes average. (Nursing time). -Anesthesia period = 30 minutes average (induction ex-tubation). -Scrubbing period = 90 minutes average (divided between nursing, anesthesia and surgery). -PACU period = 35 minutes average (divided between nursing and anesthesia). -Handing over back = 5 minutes average (Nursing time).

The group sample been surveyed for this study were 648 patients. The nursing time calculations were done as follow:

NG. Time = Holding area (receiving) scrubbing time PACU Period Handing Over back. 32

NG Time = 20 33 17.5 5

Comparing this time to: -Anesthesia time which is in total about = 70.5 minutes (39% of the patient time in OR). -Surgery time which is 33 minutes as a share in the total OR case (average) is 18 % of the patient time in OR.

Based on the random study which does not reflect the actual time concept in OR we can see the nursing time is the major part. Adding to the above idea if we will take the nursing staff as a number for sure they will be majority comparing to the anesthesia staff and surgery staff because mostly if it is not always PACU nursing staff under the umbrella of the OR nursing management and the holding area as well. That's why such areas (critical care areas) in many places all over the world are staffed with highly qualified and well experienced personnel who we call then a subspecialty in nursing.

Managerial Part in OR: The role of this part is variant from institution to another or from country to another, in some places the OR management comes under the umbrella of Anesthesiology department, but in other places it comes under the surgery department. In both ways I can see the OR management role is always been played by the nursing management in Operating theatres. Here where it comes the experience and the qualification of the OR head nurse or the OR manager to run such place with a minimum level of stress and interdepartmental conflict which is normal in those areas which we have mentioned. Besides that the Head Nurse or the Manager should know the ins and outs of utilizing the resources and the time utilization, it is all over the world the OR head nurse who roles the daily OR schedule and the OR suites distribution, because at the end any surgeon would prefer to do his case and finish it early and any room in OR regardless of the space limitations or the preparations always needed by the nursing part to perform their job. Always mismanagement in Operating Theatres creates serious problems and ends up with a stress and conflict in the atmosphere. The best guidelines and standards to be applied in OR is the airlines strategies and protocols, because airlines always should have a mistake value of ZERO because they are dealing with lives, and the same concept in OR as well, besides the booking policies as first come first reserve and delay goes to the end of the list and cancellations should analyzed promptly and accordingly to be on the top of each issue arising in OR. Finally:- All the activities we have been through are the responsibility of the nursing staff either clinical – nursing activities or Management activities. In other words the OR nursing staff has the major role in managing the department, of course with a full respect to other clinical services shares the OR time and with all respect to the nursing staff in other units (General nursing units ), because we did put the spotlight on OR nursing staff this doesn't under estimate the other services or locations all over the Healthcare institution.