Friday, September 28, 2007

It's Not Brain Surgery

But today it was.

I got to spend my clinical day in the operating room and got to see an actual brain surgery. The doctor was good enough to hold the brain hemispheres apart enough for me to see the optic nerve and communicating arteries. Oh yeah. That completely rocked!

It was a day of relying in communicating with mostly eye contact, since everything from the nose down was covered. Good thing I did my eyebrows before I left for clinicals this morning.

Ever since I have entertained the notion of being a nurse, I thought I would like to work in the OR. Working in the OR has several characteristics that I like.

1. The circulating nurse spends a lot of time on the computer and on the phone. For an office refugee like me, that's a natural transition.
2. It's freezing in there. I'm hot all the time, so the frigid atmosphere agrees with me.
3. Doctors like to listen to music while they operate. I like to listen to music while they operate. That's a win-win.
4. There are cool instruments to play with.
5. The patient is asleep.
6. The patient's family is in the waiting room.

The nurse plays two basic roles in the OR - scrub nurse and circulating nurse. The scrub nurse works in the sterile area with the doctor, sets up the table with all the instruments the doctor will need for a case, and then passes instruments back and forth and deals with used equipment that the doctor no longer needs. Nurses don't get to be in the scrub role very much anymore. Hospitals have found it cheaper to hire scrub techs for the job instead.

The circulating nurse sets up the room, tests the equipment to make sure it's working, monitors the room to make sure no one breaks into the sterile field, and basically runs errands so that people who are already in the sterile field can stay there. So after anywhere from a few minutes to an hour before the case, there is lots of frenzied activity getting things ready for the operation. Once the surgery starts, things quiet down and everyone gets down to business.

Notice that she's sitting down.

I love it.

I'm very much taken with the work environment, and I think work environment has a lot to do with how well you like your job. I'm trying to be realistic. I don't want to wind up quitting nursing after I've put so much time and effort into my education. Every time I ever go to the OR, it feels like such a good fit for me. This feeling never changes no matter how many times I go.

As for the patient being asleep and the family in the waiting room, I don't want to sound mean, but in my short time in nursing school I have found the most difficult thing to deal with in the nursing role is patient's families. There are difficult patients from time to time, but difficult family members outnumber difficult patients 10 to 1. Many times the patient and I are getting along just fine. He or she is clean, fed, medicated and comfortable. Next thing I know a family member comes in demanding that we "DO SOMETHING" for their family member who was perfectly content last time I checked.

Inside I feel myself screaming "let me do my freakin' job, okay?" I can do a fine job taking care of someone, making sure they are safe, that they are getting the right medication in the right dose at the right time, that they are clean, dry and pain free all without you giving me the hairy eyeball, telling me stories about how you got someone fired for not doing something the way you wanted it done. What is going through a person's mind when they threaten a nurse or student like that? If you're trying to impress me or earn my respect, you're failing in a spectactular fashion.

Over the summer I was taking care of a man who had knee surgery. I did my usual thing - check him top to toe, bathed him, made sure he was not in pain, made sure he was eating okay, had enough blankets, had fresh ice water in his pitcher and had everything he needed within reach. About an hour later I went in to check on him and half a dozen family members were swarming around the bed. One of them snarled at me "turn down the thermostat. It's too hot in here." There was no polite request, for example "can you please turn down the thermostat." No. This was an ugly demand. To top it off, she was standing within arm's reach of the thermostat. She could have turned it down herself if she would just bend at the waist. After being struck (momentarily) speechless I said "Oh, didn't the thermostat worked when you tried turning it down?" Her mouth feel open and an "uh" was uttered. Then I turned to the patient and asked "Is it too hot in here for you?" The patient said "No, I'm fine." So I said "let me know if there is anything I can do for YOU." and left the room.

Again, the media doesn't help. They regurgitate stories about how x-number of people were killed by medication errors, or how hospital infections are spread by unwashed hands. True and true, I don't deny it. What the media doesn't talk about is how nurses are given too many patients to take care of safely, and then they're pressured to not work any overtime. Naturally people compensate by taking shortcuts and unfornately this also leads to mistakes. I can appreciate you being there to make sure your family gets good care. But jeez. Can you at least be polite while you're there?

In the OR I can knuckle down and work. I like the role that OR nurses play - patient advocate. We are there to be the advocate for the patient when they are the most vulnerable of all - unconscious. In the OR it would be my job to make sure everything is correct - that they are doing the right surgery, that he is given the right medication, that he is positioned in such a way that his circulation won't be cut off, that no one who hasn't properly scrubbed goes near him. I like the feeling of responsibility that comes with that. But I feel better knowing I can do whatever I can for the person in that state without someone standing over me, making unreasonable demands over nit-picky details - like making sure the sun doesn't get in their eyes.

If your family member is in my care in the OR, I guarantee they will get the best possible care.I will do everything in my power to make sure they are safe and they'll come back to you pretty much all in one piece, even though a piece or two might be missing.

Everything will be fine as long as you don't ask me to turn down the thermostat.


nurse mama said...

I am also interested in OR. Reading your blog makes me excited to start clinicals!!

Lorelei641 said...

Hi there - it's Laura from QW -
Yanno, I went to the OR for the first time last week, and I was just FASCINATED. Was an Ex Lap for a girl who had been in a horrible car accident. It was the first time I'd seen any of this first-hand. You wonder how you'll deal with it - the first time you see, other than in pictures, what is inside the human body. How the heart looks when it beats, how big the intestines really are. Just amazing. Was really proud I didn't get sick or pass out.

As a future PA, I guess I'll have to choose where I want to work - I'm pretty sure trauma isn't it. But my God do I respect those who have the physical stamina to do that.

Sounds like the OR is really right up your alley. That's really cool. Do you ever look at the rest of your class and mentally go... "I could have given birth to you, and you, and you...LORD I'm old" ? haha

License Pending said...

Nurse mama, clinicals are a challenge. You'll be fine, but I have to say it's my least favorite part of nursing school.

Hey Laura!!! I'm so glad you came over to check me out. Yeah, surgery is fascinating. I was so interested in what was happening I didn't have time to feel weirded out. As a PA you can do whatever you want. I'm with you; trauma isn't my thing, but at least with an education you can choose pretty much whatever you want to do.

they call me "Doc" said...

im a navy hospital corpsman, which means that if im not in iraq with the marines i am in the hospital as a nurses assistant...or an extra set of hands...or someone that just gets in the way. but i hear you on the patient care thing. familys (as great as they are to have) should do their best at letting us do our jobs. all i care about is making the patient comfortable. not the patients family.your example of lack of courtesy on the familys part was an excellent way to show what we have to deal with EVERY DAY. hospitals have a funny way of bringing out the very best and very worst sides of humanity.

License Pending said...

Yeah, weird isn't it?

What I can't figure out is why families think being a jerk will get better care for their families? Where does that come from?

Anonymous said...

Are there a large number of male nurses in this field?

Nurseknowpp said...

Do you mean the surgery field?

I don't know actually. You could pose that question over at They have a forum for male nurses and for OR nurses. You could ask in both forums and see what you find.

I'm curious as to why gender is important. A nurse is a nurse no matter the gender.

Anonymous said...

I agree, to a point. As a male, I would be very happy with a nurse of either gender to do whatever they need to do to help me, as long as my private parts are covered. If they need to be uncovered for some reason, any female would need to leave.

Anonymous said...

I have a question, you said "I was taking care of a man who had knee surgery. I did my usual thing - check him top to toe, bathed him...".

What type of knee surgery was it that he needed to be checked from top to toe and bathed? I've had two knee surgeries and (as far as I know) I was never checked from head to toe and certainly never needed (or would have accepted)help bathing. It must have been serious. Is it possible I was checked from head to toe while unconscious?

Why was it necessary to check him from head to toe? How are the head, back and genitals relevant to a knee surgery?


Nurseknowpp said...

"I agree, to a point. As a male, I would be very happy with a nurse of either gender to do whatever they need to do to help me, as long as my private parts are covered. If they need to be uncovered for some reason, any female would need to leave."

Very often when I do catheter care on a male patient I have to lift up their gown and hsi genitals will be exposed. I look up and see their female relatives looking expectantly at me as I get ready to do this. I ask them to leave. Maybe they've seen it before, maybe they haven't, but I try to respect the patient's privacy no matter what.

Nurseknowpp said...

"Why was it necessary to check him from head to toe? How are the head, back and genitals relevant to a knee surgery?"

That's because I'm doing an assessment. It's part of regular nursing care when you see a patient for the first time you assess the person from head to toe. In my case that day it was also because I was being graded on my assessment skill and I had to make sure every eyelash was in place or I'd get dinged.

Another reason is that changes in Medicare have made it so they refuse to pay for any wound care that comes from skin breakdown or wounds that happen while the patient is in the hospital. Depending on how bad the wound is that can be expensive. So it's incumbent on a nurse to very carefully every inch of a patient's skin for any changes to they can intervene sooner and keep it from getting worse.

When I was a nursing student I got a great education on assessment from a nurse. During her assessment she turned the patient over and assessed his back - I'd never seen a nurse do that before - and there, down by his tailbone, was the tiniest of tiny wounds, smaller than a pencil eraser, that every nurse who had taken care of this patient all week, had missed. It was a vaulable lesson to me.

Anonymous said...

I've asked around and nobody I've talked to (even a nurse) has ever heard of a nurse giving a full-body assessment to someone like your knee surgery patient.

I would love to see a nurse try to do that to me. She would have to have four or five guys holding me down and then prepare her defense in court.

Nurseknowpp said...

How sad.

Anonymous said...

Nurseknowpp, what would you do if a male patient asked you for a male nurse to check his catheter or to give him his bedbath?