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Tess:All right, we're ready. Welcome back to the Friends of Flo. This is a fun podcast about all things nursing and empowering nursing. And my name is Tess Judge-Ellis
Andy:Andy Witters here.
Rebecca:And good morning. It's Rebecca Porter.
Tess:We're really lucky we have a couple of guests today. I'm going to let Rebecca take that on.
Rebecca:We're really happy to welcome two nurses from the OR, at a big tertiary care hospital here. And the first one I want to introduce is Dawn Brue.
Dawn:Hi, my name is Dawn. I work in the OR as a nurse. I am the team lead for the neurosurgery department and I love my job.
Andy:Awesome
Rebecca:Awesome
Tess:And you work mainly with the kiddos, don't you?
Dawn:Yes, I work in the pediatric hospital.
Tess:Alright, great.
Rebecca:And the other nurse I want to introduce is Amos Schonrock. Good morning, Amos.
Amos:Good morning. My name is Amos. I've worked in the OR for about 19 years in various settings, community based academic medical trauma centers, and I currently work at a midwestern academic medical center focusing on OR quality safety and education.
Andy:Awesome. Welcome, you guys
Rebecca:That was great. Welcome. So my really big question for you is how did you get into OR nursing? Was it part of your curriculum? Um, how did you end up there?
Tess:Where are the OR nurses? They're like way down and the operating room, we never see them up in the operating room
Amos:Or down
Tess:It depends on where they're at
Andy:But it's a mysterious area of, of the hospital right. I mean it's behind closed doors. You have to wear like special, like scrubs. You have to have your ID
Amos:It's a secret society
Andy:Yeah, yeah, yeah, exactly.
Rebecca:What's the membership? How do you get in?
Amos:Would you like to go first Dawn?
Tess:And what are the quirks of the operating room nurse?
Dawn:There's so many. I don't have to pay for my scrubs. That's a big one. Yeah, that's right. I don't have to worry about how my hair looks in the morning because I'm going to put a hat on.
Amos:There's covert and overt. I transitioned from being a surgical technologist into being an OR nurse. So it was kind of a natural progression, but a majority of nursing programs don't have a traditional rotation in the OR like you would with pediatrics or geriatrics or med surge. That used to be the case way back in the day, but it's kind of fallen to the wayside. And I've tried to work in academia to have a renaissance, so to speak, of perioperative nursing because unfortunately when people arrive they either love it or they say, get me out of here. And there's no way to find that out unless they've had exposure ahead of time.
Rebecca:So Dawn how did you end up in the OR.
Dawn:So during my schooling I did not have any formal education in the OR. We learned about sterility, but we really didn't learn. We weren't allowed to go into the operating rooms during our clinicals or anything. So, after I graduated I, I had a nagging feeling that I wanted to go into the operating room, so I got ahold of a manager at the place I'm working at now and we set up a job shadow. I loved it and I kept going back to her and emailing her and I ended up getting a job there.
Tess:That was your first job in nursing?
Dawn:That was my first job in nursing, yes.
Rebecca:I love how you were so proactive that you didn't wait to see what job was posted but that you went and got what you wanted and that's so important. Can you, can you say what that was like?
Dawn:It was a lot of connections. I feel like things just lined up for me. Um, we do get a lot of new grads in the operating rooms, so don't feel like you can't apply to those jobs because they're always accepting new grads.
Andy:So what do you two like about being in the operating room? And for both of you, when you, when you first started, what drew you into the operating room?
Amos:Uh, for me, uh, there's a number of factors I knew that, uh, overall I wanted to take care of one patient at a time and in the OR you only have really one patient to focus on. I didn't want to go home at the end of the day and think, oh gosh, did I do that treatment? Did I get that med? Did I do that? The OR is a great demonstration of the team aspect. Everybody in the OR is there for one person, that patient, if they weren't there, we couldn't do our job. It's hands on. It's a quick return on investment and the benefits are immediate. So if someone breaks their arm, our goal is very specific for that patient. Not that we're not looking at the entire patient, but everybody's focused on that one initiative and I am convinced it is hands down the best anatomy lesson you will ever have in your entire life. There's no youtube video. There's no book, there's no illustration that's going to make up for holding the heart and your hand seeing parts of the brain that you're not supposed to see. But because of the patient's interruption in their life, we get a privilege to see that.
Andy:Yeah. And it is a privilege I liked the idea of it is a privilege to, to work with a person's anatomy. I mean...
Rebecca:To think that you've had your hands, somebody had their hands inside your body, as a patient is really quite an amazing feeling. I also think that how you would teach surgical nurses or postop care, knowing what was done in the OR and the specificity of every surgeon's approach really does impact that post surgical care. So the fact that OR nursing is not included in the curriculum, I think really hampers the quality of nursing that should be done after surgery. What do you think of that?
Amos:I would agree. I've worked with nurses that were working with med surge nurses on postoperative pain, for instance, and this one nurse did a quick assessment of what position do you think your patient was in during surgery? And about 65 percent of the time those nurses misidentified what position their patient was in. Therefore, when they complained of having pain on their back or their sacrum, but their procedure wasn't done on their back, the nurses are like, I don't know why you having back pain, you know, so there may be a failure to treat that because they don't associate it often with what's being done.
Rebecca:Or expose the patient to unnecessary tests, ex-rays, procedures to investigate why they're having pain in the back.
Amos:Correct
Andy:What are some of the biggest safety issues for patients in the OR in your experiences?
Dawn:I believe positioning is a big safety factor with the patients. We go prone quite a bit for neurosurgery and it's just making sure that where you're padding all of the pressure points, like the Iliac crest and the chest.
Rebecca:How did you learn about that, Dawn?
Amos:Well, Amos taught me quite a bit, he was my instructor when I first started. Um, and also just being with the surgeons and helping them position has really taught me a lot as well.
Tess:So I think that's an interesting question because I think it goes to like, why does the nurse need to be there? Why does there need to be a registered nurse in the operating room and you know, I always think about the cornerstone of nursing being relationship and that that's engaged with like verbal connection or some sort of other connection with your patients are often, you know, not able to communicate by the time that you see them where it's very short, short window. So talk about, I guess that's a couple of different topics is you know, the one thing nursing has in common with everybody is the relationship with their patient.
Amos:Right
Tess:And then the other question I guess is why do you have to be there then? How does that articulate into a place where mainly your quote unquote looking after the surgeon, you know, kind of
Rebecca:So why did you go from being a surgical tech...
Tess:Yeah, that's a separate question.
Rebecca:I'm sorry, it's so exciting.
Amos:To speak to your point, I view perioperative nursing like there needs to be a nurse in every room because you have that unique lens and it really is a form of advocacy for the patient. The patient doesn't have a voice, they can't move, they can't respond, but they have needs. So that nurse is literally looking at the big picture as well as supporting the surgical team with the supplies and equipment they need. But they're the one voice that concern like, Hey, don't forget, like you might be leaning a little bit and their arms are under there, like they're looking at that big picture. The downside to OR nursing, which is a drawback for some individuals is there isn't as much patient, direct patient interaction. But I always say I'm the voice for the patient. I'm the arms for the patient. I'm speaking on their behalf when they can't. So part of being that vigilant guardian is being that nurse in the room.
Tess:I want you there. I'm glad because the times that I've had to have surgery, imagine, you know, you do want that nurse, you know, and you want to know your nurse. Do you introduce yourself to the patient?
Amos:Absolutely
Tess:How does that go typically?
Amos:How do you use that Dawn?
Dawn:So I always start by introducing myself and what I do in the operating room. I asked them questions about their NPO status and there are many times where they tell me they want something done a certain way in the operating room. For example, if they want the report left accessed, uh, it's a lot easier to do it while they're sleeping because it's really painful for the patient. Uh, so I always tell 100 people back there and I advocate for them to leave that port accessed.
Rebecca:How do you support in pediatrics there must be even more people to support mom and dad and grandparents and it's very scary to think that your child is going to have brain surgery.
Dawn:We always take care of the patient and the family. It's, it's a lot more people to look after and a lot more people to kind of reassure.
Amos:Right. But the family is pretty much the second patient and that's almost always indicative of a pediatric care. There's times that you need to do more reassuring with a family member or a parent or guardian than you actually do with the patient.
Andy:That's a great way to look at it. And on the same lines as patient advocacy, and we were actually talking about this, Amos and I were talking about this prior to, to this, to the shoot. It was about informed consent. All right? It's, it's this analogy that Amos brought up of this. It's the golden ticket to get into the operating room theater. And so can you guys speak to the idea of what it means to get consent and how that leads to better advocacy for the patient.
Amos:For me, that's an outward declaration that I can confer with to make sure that all things line up by, this is what we have listed, that we're doing this isn't, was the patient hasn't verbalized to me most importantly, that we're doing. And does it match with what they signed that the surgeon said they discussed it with them like until those three meetup, if they're not congruent than I need to stop the line right there.
Rebecca:And how do you feel about stopping the line? Have you ever stopped the line?
Amos:Definitely, I fortunately have worked in settings where staffing the line was just like snapping your fingers. You did it and it was never questioned. Now there are different team dynamics and personalities that definitely waned. But I just always think in the back of my head, what if I don't? Who will? So...
Tess:I want Amos to answer the question that you posed about what made you go into nursing then after having been a surgical tech versus like when a medicine or something like that.
Amos:Right. I think I probably should have done nursing all along and just found a different pathway there. I speak of it being a natural progression. Medicine wasn't necessarily a draw. I was a biology major before I did nursing. So I could of adapted to that. But I guess I liked the aspect of what I saw my other nursing colleagues do and there's a lot of variety in nursing even though I work in one sector, you know, you could do 300 different things with a nursing degree and not all of them involve being at the bedside. So...
Tess:What else is going on in nursing in the OR, I mean anything else before we shift to a different topic about what is so cool about nursing in the OR. Because we have a lots of young nurses and students that listen and they don't get a chance.
Dawn:One of my favorite parts of being an OR nurse, you said you were a surgical technologist is actually scrubbing the case. I love being up there and handing them the instruments and getting the medication's ready and actually getting to hold parts of the brain that they dissect. It's one of my favorite parts of being in the operating room.
Amos:The other added benefit to the OR that's kind of unique is it's in demand. It's universal and it's global, meaning that there's nurses that I worked with 15 years ago in Iowa, that have gone onto work in France, Dubai, Japan, various prior to the United States because the OR is very much based on a Western model of healthcare. Not that we haven't been doing the surgery for well over a millennium, but the same parker retractor in Des Moines, Iowa is the same parker retractor in Australia. So there's some universality to it.
Rebecca:So what's your best advice? I guess, Dawn, when you think about a student being kind of overwhelmed by all that there is to a nursing book, healing Amos, what's your best advice for knowing what your fit is?
Andy:That's a loaded question.
Dawn:There's a lot of personality I think if you like to talk to your patient and hold their hand and be with them. I really don't do that a whole lot in the operating room, but I do feel like I advocate for my patient a lot and I remind them to give the local if I have it up and if they ask for it at the beginning of the procedure. So...
Amos:Right. Again, it's an interruption in the patient's life. It's a phase of care. Most often, oftentimes in the oe or the patient isn't coming there for good circumstances. Sometimes they are and that's great, but you're really getting a snapshot. So one downside is that you don't see what happens afterwards. Sometimes I'm not to say that you don't know you're doing good, but I'm going to click. It's just like, wait, I get it. I know what this is supposed to be. Now you can anticipate what's going to happen.
Rebecca:So it's sort of finding where your own zone is. I think Andrew and Tess and I are able to articulate when we know that we're in the zone where we're supposed to be. It sounds like you and Amos and Dawn can really do that too. That you are in your zone. I think this is a great podcast. So thanks for showing up to Friends of Flo.
Andy:Amos, Dawn, thank you.
Amos:Thank you.
Rebecca:Thank you Amos and thank you dawn, it's been a great conversation today. Thank you.
Tess:All right, signing off. This is Tess Judge Ellis, keep your eye on the patient.
Rebecca:This is Rebecca Porter, be kind.
Andy:This is Andy Whitters of Friends of Flo telling you to innovate, agitate, educate.
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