Nurse's Career Insights: Life Behind Operating Room Doors

Operating-Room Nurse

Ever wonder what really happens behind those operating room doors? In this episode, longtime OR nurse Patti Columbia Walsh shares valuable career insights from her 40-year experience in one of healthcare's most high-stakes jobs. From anticipating every surgeon’s move to handling medical emergencies, she reveals the fast-paced reality and success factors of working in the OR.

If you’re exploring a career in nursing or considering a career change, Patti's real job advice and behind-the-scenes perspective offer practical tips and honesty about the profession’s challenges and rewards — including insights on making money in nursing.

Tune in to learn what it takes to succeed in this demanding job and how nurses navigate one of the most critical career opportunities in healthcare. Share this episode and leave a review to help others discover these career insights!

This show was first published on Aug. 5th, 2025

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Music credit: Kate Pierson & Monica Nation

Transcript

Welcome And Why The OR

Speaker 0:04

We have robotic surgery that we do with uh which I am fascinated by that the surgeon can be over here and the patients here and be doing the operation from the other side of the room. It fascinates me.

Mirav Ozeri - Host 0:15

Yes, we're going to talk about robotic surgeries and others. Welcome back to How Much Can I Make? I'm your host Miravozeri. Today I'm gonna chat with my friend Patty Columbia Walsh, who's been an operating room nurse for 40 years. I really want to know what it's like to work under high pressure in such a high-stake environment. I don't think I could do this. Can you? So let's find out what really goes on behind those OR doors. Patty, thanks a lot for doing it. Oh, thank you for having me.

Speaker 0:49

I appreciate it as well.

Mirav Ozeri - Host 0:50

First, let's start with how did you become operating room nurse?

Training Path And Early OR Lessons

Speaker 0:54

When I was in nursing school, I never liked the bedside with patients because I became attached to the patients, and it was very difficult for me to watch people who were sick every day. So I decided that the OR was for me because a patient comes in, we take care of him, and we never see him again. And that was more it was easier for me to become a nurse doing that type of nursing. And also I was told when I was going through a rotation of the OR in nursing school, I was told by an OR nurse that you should do not become an OR nurse, you're never gonna do it. And that also gave me uh a lot more inspiration of going into something that I was told I couldn't do.

Mirav Ozeri - Host 1:33

Why did they think they can you cannot do it?

Speaker 1:35

Well, it was my second day in the OR that I couldn't glove and gown myself, which is something we do. And it was the second day, and she just a typical OR nurse who the older nurses who eat their young. So wait, let's make up for a second. How many years did you have to study? I was in the school for four and a half years. Uh two for regular schooling and two and a half for nursing school. You don't go into a specialty until you graduate from school and you choose what specialty you want to be in. And you always wanted to be a nurse? Always wanted to no, actually, I wanted to be a school teacher, but Sister Miriam, and when I was in Catholic school, told me I did well in the sciences, I should become a nurse rather than a teacher. And that's exactly why I became a nurse. You have to listen to those nuns.

What OR Nurses Actually Do

Mirav Ozeri - Host 2:25

Okay, so what exactly do you do as a nurse in an operating room?

Speaker 2:31

So in the OR, uh, it's interesting. You know, we get the room ready for any particular case we have. Like uh, I do spine surgery and neurosurgery mostly. And the um setup for these particular procedures is quite a lot. Instrumentation, making sure the room has everything that the surgeon wants for the procedure. And then once all that's set, the patient comes into the room and literally I probably see the patient for literally about three or four minutes, and then they anesthesia puts them to sleep. I'm a circulator and there's a scrub nurse. So the circulator is is dirty. The scrub person is clean. What is a circulator? What do you do? So whatever the doctor wants or the scrub tech wants in the room, anything they need on the field, I get it, and then I give it to them in a sterile technique where I have a package that's not sterile, but then I open up the package and what's in the package is sterile, and then the scrub tech takes it from me. I used to scrub, but unfortunately my hands uh react to rubber now, so I can't scrub, but I actually enjoyed scrub. When you scrub, you mean you scrub the patient? No, no, no, I'm sorry. So you have to scrub your hands clean. Yes. From the top of your fingers all the way down to your elbows.

Speaker 1 3:41

Okay.

Speaker 3:41

And then once you then you go in with a sterile towel, you dry your hands off, arms off, and put on a gown and gloves, and then at that point you're sterile.

Speaker 1 3:49

Okay.

Speaker 3:50

I prefer doing that. So, yes, that's the intro you have to know every name of every instrument, which is pretty impressive because we have six different services, vascular, GYN, every one of them has a different instrumentation that they use that you have to have the knowledge of when the surgeon asks you. First of all, he's not a lot, he's not supposed to turn around and ask you for an instrument. All he does is this. Sometimes if you're very good at what you do, you know what he wants before he even asks for it when you've been doing it for a while. So initially when he puts out his hand, you were supposed to know what instrument he needs. Yes, you should you should know. Like if you're doing vascular surgeon and there's a bleeder, he wants a clamp, he shouldn't ask for it. You should give it to him. And if you see that he's cutting a suture, you give him a scissor, you don't he doesn't have to ask for it. You should know that.

Mirav Ozeri - Host 4:31

So you watch every step of the surgery?

Speaker 4:34

You have to. As a scrub person, as a scrub uh nurse or tech.

Mirav Ozeri - Host 4:37

Okay.

Daily Workflow And Turnover Pressure

Speaker 4:38

You have to be in the operation. You can't be looking around, you have to be present the entire time. And how long did you have to go through training? So six months. I actually had a phenomenal training at Westchester County Medical Center when I became a nurse. And for six months, you go through multiple services: general surgery, urology surgery, GYN surgery, neurosurgery, vascular surgery, and all these six services we were trained each month in a different service in order to learn it. So, what is a day in your life like at work? It's pretty hectic because in the operating room, the surgeon wants you to move as quickly as you possibly can. So they want to get in the room, they want to make sure everything in the room is there for the procedure. And they don't like to wait. It's important that before I go into the room, that there's a sheet that tells you everything that the doctor wants in the room. That you have to be sure that you have that in the room before you're permitted to bring the patient back. Once you have everything set, that's when you bring the patient back. So you'll get the the list the day before. There's a list, no. So every morning when we get into work, there's a cart that's filled with the instrumentation and everything that you need for that procedure. So there's central supply, which picks the cases of this list that we get every morning. They pick everything for the case. When we get the case, we make sure that everything they picked is in that cart because they don't get yelled at, we do. So we make sure everything that is supposed to be in that cart is in that cart. And then once we realize that, we go into the room and we set up the room.

Mirav Ozeri - Host 6:09

So you work closely with the anesthologist, with a surgeon, well, who else?

Speaker 6:14

The anesthesiologist, we help once the patient they're starting to put the patient to sleep, we stand with the anesthesiologist to help hold the endotracheal tube before they place it. We make sure it's placed before we even, you know, start prepping the patient for the surgery. And then I work with the surgeon and with the scrub tech and anyone else who happens to be in the room that might be needed for the procedure. Do you ever cringe when you see them opening up somebody? I don't cringe when I see surgery. I do cringe when I see patients that have allowed themselves to have growth on their body for a year and then they come into the OR and they're massive, and you can't imagine that these people actually were living with this.

Mirav Ozeri - Host 6:57

Wow.

Emergencies And Life-Or-Death Moments

Speaker 6:57

That's very difficult for me to watch because I cannot, for the life of me, understand why anybody would do that. I don't know if it's because they don't have health insurance or what the reason is, but I it's scary sometimes for me.

Mirav Ozeri - Host 7:09

Does it ever happen that uh in the room you have an emergency situation? Yes. What happens then? Tell me.

Speaker 7:15

So we do a procedure that's called a lift, an anterior lumbar interbody fusion where you go through the abdomen and you have a vascular surgeon and the spine surgeon. The vascular surgeon is responsible for getting access to the lumbar wherever we're in the spine that we're operating on. And because you have a vascular surgeon opening up to get to the lumbar area for the spine surgeon, there's a lot of vessels that are very, very important that you don't nick. And I have been present where you've surgeons have nicked the vessel and the patient starts bleeding profusely.

Mirav Ozeri - Host 7:49

What do you do then?

Speaker 7:50

Literally, there is a button in the operating room that you have to push when something like that happens because then everybody who's available within the operating room suite will come run in and help out with getting blood, with uh doing whatever it is that's needed to save the patient. Wow. It's happened to me probably two times in my career. Were you scared? Oh, petrified. Petrified because uh, I mean, even when you when you're petrified and you look at the surgeon and he's like he's beside himself because the the bleeding is unbelievable. It scares you because he's scared. He's the one that's responsible for I mean, all of us in the room are responsible for saving the patient, but in reality, it's really his technique that's going to save that patient.

Mirav Ozeri - Host 8:32

Wow. So you worked with many different surgeons. Everybody. Do you have favorites?

Pay, Unions, And On-Call Realities

Speaker 8:37

And yes, Dr. Solari. He's a spine surgeon. I call him my boyfriend. No, he's wonderful. I've worked with him for 11 years. I am always in his room. If I'm not in his room, he gets upset. So when I take off today, I work he works on Mondays, so I'm not there today. And I'm sure he's asking, where's Patty? But no, him and I work well together because I know his speed and we work very quickly together. What's the average time of an operation? So it depends on the operation, but in in the hospital, which is very difficult for nurses and techs, is that we are required a certain amount of time to get the next patient in the OR. So, in other words, if a case ends, we have 30 minutes, less than 30 minutes to get the next patient in, setting up the entire room for, and some of these cases, we have 15 instrumentation that we have to open up in a sterile way in order for the person that's scrubbed to take it from us. And it takes time. But the cases, it depends on what the case is. Like a um A-lift uh anterior lumbar interbody fusion takes anywhere from an hour and a half to two hours. How many surgeries can you do a day? Uh, depending on the speed of the surgeon, four to five. Wow. A day. So it's go, go, go from the time. It's no, no, you get 45-minute lunch and that's all you get. You move constantly, you're in movement. And it's an eight-hour shift? It's an eight-hour shift, yeah. Seven and a half hours and we have a 45-minute lunch, so they don't pay us for a lunch.

Mirav Ozeri - Host 10:05

They don't pay you for a lunch?

Speaker 10:06

No, they don't. They're not very nurse-friendly.

Mirav Ozeri - Host 10:08

Is your job a union job?

Speaker 10:10

No, it's not. So they can literally change whatever they want for if like we were getting paid four hours for call time. They took an hour away from us. If we got called in, we would automatically get paid four hours. They took an hour from us. What do you mean? If you on call? So if you're on call, you get paid five dollars an hour on call. Every hour you're on call. And if you get called in, you get time and a half. If you're there for two hours, they would pay you for four hours, but they took an hour away from us. So now we only get paid if we go in for just three hours.

Mirav Ozeri - Host 10:41

Why would you be on call if you are on on on every day for you have to you have to take call.

What's the Pay?

Speaker 10:46

It's part of your job. You have to. You don't have a choice. So that's after work hour the call, or if usually I take it on the weekends because I'm not Monday through Friday, I prefer not to work right after my shift is over. If they want me to stay, I prefer not to do that. So I take call. You take the call yourself. You choose to take what you want as long as it's available. And I usually take it on a Saturday or Sunday. So you have to negotiate your own salary? When I went in, when I first w went to work there, I told them I wanted to get the salary I was getting in New York, because Jersey does not pay nurses the way they do in New York. And they gave it to me. What's the average salary of a nurse? When I started nursing, I was getting paid for the first job I ever had $11.50 an hour.

Mirav Ozeri - Host 11:27

What?

Speaker 11:28

That's I know I couldn't even live on it. It was ridiculous. And now I do do well now. Uh do I think I should be making more? Absolutely. But the newer nurses coming in, brand new nurses are making $73,000 a year as a brand new nurse. With all the benefits and everything. With all the benefits. When I was in New York, I worked under unions all the time and they were great because they got us better health insurance, better vacation times, sick time, where this is a battle every day for all of us. They could take whatever they want away from us.

Mirav Ozeri - Host 11:57

Wow. Do you see a change now that a lot of uh hospitals are becoming corporations or part of a corporation?

Speaker 12:04

Well, that's why exactly. So when I was telling you the way they want to move, move, move, it's not, it's not about patient care anymore. To be honest with you, it has become a factory. I mean, there are surgeons that are doing 14 total joints like in 27 minutes. It goes, it's it's ridiculous. And we cannot move fast enough for these men. We're always being told why isn't the patient in the room yet? It's it's ridiculous. It's it's not it's a factory now. And it breaks my heart because it's not about a person, it's about get them in, get them out. Get them in, get them out.

Mirav Ozeri - Host 12:37

Is that because you're in a big hospital? You think it's not a good idea?

Speaker 12:40

No, I I think it I think what you said, it's a corporation now, and it's all about making money. It's not about patient care anymore. When I walk through the ER, there are people, it looks like a mass unit, that are out in the hallways. I mean, I'm talking 50 p patients because there's not enough room. They just keep on taking them. It's a it's a business, it's a corporation. It is not about caring for the patient anymore.

Mirav Ozeri - Host 13:01

Many times they say, Oh, you know, the doctor sent me and said I need surgery. I don't really need they want the money. Do you see cases like this when people come in, they open them up, and then oh, you don't need to be here.

Unnecessary Surgeries

Speaker 13:12

I have a well, I have a problem when there's a 96-year-old man coming in for a major vascular surgery. I have a problem with that because uh first of all, it's almost a six-hour surgery, and there's no there's no guarantee it's going to work. So why put a 96-year-old man through that if it's not necessary? I've I've seen it that I don't think it's necessary, but you know, uh as much as they'd like us to be patient advocates, they don't want us to be patient advocates. No. They want us to be quiet, do our job, and go home.

Mirav Ozeri - Host 13:42

And do you think the doctors feel it's really bad also?

Speaker 13:45

The surgeons and oh, I think the surgeons, the only thing the surgeons are feel bad about or are bothered by is that we don't move fast enough.

Mirav Ozeri - Host 13:53

Really? Wow.

Speaker 13:55

You can you can actually talk to any nurse that I've ever worked with that would say the exact same thing I'm saying.

Mirav Ozeri - Host 14:00

Do you see more and more operation moving to automation, to AI doing some of it?

Robotic Surgeries

Speaker 14:06

We have robotic surgery that we do with uh which I am fascinated by that the surgeon can be over here and the patients here and be doing the operation from the other side of the room. It fascinates me. But we're doing a ro a lot of robotic surgery now with knee surgery and mostly general surgery, GYN surgery. So in that case, who gives the instrument, the robotics itself? So no, so the the machine that we use, the robot that we use, we set up with the different instruments on the robot arms. So all the arms have the the uh instrument that's needed, and the surgeon is over to the side controlling it with arms or you know, remote controls that they could do from the other side of the room. It's really fascinating. This can take a job away from them. This can take a job away from a nurse, yes. Wow, yes, yes, because basically when they put once the scrub tech has put all the arms on the robot, they're just waiting for the procedure to be done, just sitting there waiting for it to be done. But they need somebody to set that up for them, so they're still wanted. You would love so. Yeah. What's the biggest challenge of your job? It's working faster. Really? It's just you just can't move fast enough. You can't make that that's my biggest challenge is the speed that no matter how fast you work, it's not fast enough. And every OR nurse knows exactly what I'm talking about. That's the challenge. You mean to give the instrument fast enough? No, no, no, to turn over the rooms. So, in other words, when I say turn over the rooms, you do an operation, get that patient out of the room, start cleaning up for the next case, get the next one in. Get that one in, pass them out, get the room ready, get the next one in.

Mirav Ozeri - Host 15:41

It's like So you have to clean the room or do you No, we don't have to clean the room.

Speaker 15:46

We have a lot of ancillary help. MSTs, uh medical uh surgical staff that will get the equipment that we need for the room, and environmental services will clean the room. Then we just go into the room and that's where we do all of our setup. You you do go out between cases because you get to get the dirty instruments out and you have to make sure the patient goes to recovery room and you hand in your papers and chargers to the front desk. So you get like 10 minutes out of the room. But then you have to scrub again. Then you have to hurry up and start all over again. It's repetitive, basically.

Mirav Ozeri - Host 16:17

What would you say that uh the character trait or the skills that one needs to have in order to be a nurse in an operating room?

Speaker 16:23

You have to be have the ability to be yelled at, and you have to be strong with that because surgeons, and I get it, they're under a lot of stress. You know, they're operating on somebody, they, you know, trying to either save that person or, you know, help them in any way they can. And they're under a lot of stress, and and I understand that. So when you don't have something there for them or they hit something that they shouldn't hit, they start losing their mind, yelling at you, and you literally have to just it's not you, it's not personal, it's just that's the way it is in the operating room. And you have to be fast. And if you're not fast, a mover, then the operating room isn't isn't for you.

Mirav Ozeri - Host 17:03

Do you also see uh kids being operated on?

Kids in Operating Room Making a Diference

Speaker 17:06

No, I don't do children that often, but when I see them in the holding area before they have surgery, I go over and fist pump them just to make them smile.

Mirav Ozeri - Host 17:14

Is it emotionally more difficult to work on a kid than work on a depends on what the surgery is.

Speaker 17:19

I mean, if it's something that like a brain tumor or something that's uh, you know, catastrophic, I I yeah, I have a hard time with that. With any patient that you come in and you know, we do frozen sections on people who are having breast surgery. Frozen section is you take a the specimen of the the cancer that they found and they send it for frozen, and the frozen section, they'll call you and the pathologist will tell you exactly what they found. And if it's cancer and they're 32 years old and it's metastatic, it breaks your heart. You're in that room and you're it you feel it. You feel it in your heart. And although I told you that I don't like to be on the floors because I don't get attached to patients, in the OR, it's it's not as you don't get as attached, but it does affect you when you hear bad news about a patient's life, you know. Oh, when somebody dies on the operating room? In that or if they have uh metastatic cancer or something like that. It's it's hard to hard hear. You know, your your heart sinks, you know. Did it happen to you that somebody died in the operation? I I years ago at Westchess County Medical Center. A young girl, 18, was in a motor vehicle accident and uh she got hit in the side. Beautiful girl, I'll never forget it. She was gorgeous. I was fairly new in the operating room, and they were giving her all blood blood products to try and save her, and unfortunately she died, and it was devastating to me. And the room was filled with people, and then you know, people are laughing, you know, we're wrapping the young girl's body, and they're laughing, and I just stopped for a minute. I go, You guys, this woman's dead. How do you do this? How can you laugh? Where's humor in this? And you know what they said? If you're gonna let this affect you every time when this happens, you're never gonna make it in the OR. This is how we survive. Wow. And that's exactly what they said, and they were right. And that when they told me that, that is exactly what I learned because I lost a lot at Westchester County Medical Center, it was the number one trauma center. We were losing patients all the time through motor vehicle accidents, you know, ATV accidents, just multiple things. And it was it was hard.

Mirav Ozeri - Host 19:16

So how do you come out of this at the end of the day? You come home and you have all these images in your mind.

Speaker 19:22

You just yeah, you just you just say a prayer for them and that's it. That I mean you just you just learn to live with it. You know, it does bother me. I can remember I can remember names of patients that I took care of that died in the OR that uh broke my heart. But you know, it's as sad as it may sound, it's it's a job, you know, unfortunately. But it does affect me. I'm not gonna lie and say it doesn't affect me. But I can't let it affect me all the time because I never go to work.

Mirav Ozeri - Host 19:47

Any case that sticks out in your mind more than others?

Worst Memory

Speaker 19:50

A little boy at Westchester County Medical Center, there was a terrible bus accident, and his he had a skull fracture and his the brain was coming through the skull. And he was only um seven years old. And he he died. And another young man, he was crushed by a fire truck in between a fire truck and a car. He was 19. We did like six surgeries on him, and he lost from his pelvis down. Oh my god. His he kept on getting gangrene from the um from the accident. Gangrene was gangrene is when the tissue starts dying. Ooh. And uh we can't we removed b both of it from his hip, his legs, his from his hip down, and we actually did a penectomy, if you can imagine. And what is that? It they removed his his penis, yeah. And uh that that crushed us all, and he ended up dying as well. Because the the gangrene just kept on going up. He was 19. Oh yeah. Marshall was his name. Oi. And that was, I'll tell you, that was about 30 years ago. And I've never forgotten the kid. It was very that was the the that was another difficult. He died because we saw him all the time. Every time we saw him, we were doing a procedure on him. So that's not something that we normally do, see them so often, but him, because he had so multiple because of the gangrene, we actually had to keep on removing the gangrene from his body.

Mirav Ozeri - Host 21:03

Wow, well, that's a terrible story. Do you ever run into ex-patient or family member out on the street or anywhere?

Speaker 21:11

There are patients that I'll be out somewhere and they said, Oh, you took care of me in the OR. And I'd be like, How do you even recognize me? Because we can't even recognize each other with the hat on and the mask and everything else. He said something about you, I just recognize you, and he said thank you, and that made me feel wonderful. But not all the time. Because they don't remember the OR, they remember the holding area. The OR, you get medication that causes amnesia before you go in to relax you, make you feel less anxious. So they don't remember anything, and then they go to the recovery room. So the OR never like holding area will get gifts and cards, recovery room will get gifts and cards, not the OR because nobody remembers us. And maybe that's a good thing. I don't know.

Mirav Ozeri - Host 21:50

It's funny. Yeah. So what advice would you give somebody that wants to break into nursing and become an operating uh room nurse?

The Rewards

Speaker 21:58

Of all the nursing, I think the operating Room is the best. Well, really? Why? I really do because for multiple reasons. I think it's a it's a real specialty. You really get to know the human body from head to toe and literally see it. You know, all the nurses are together. We're we work together, we work well together. And I think that's a little different on the floor, maybe, because we could be in rooms next to each other and we could just help each other out. I I love the OR. I would never leave. And I've never wanted to be in management. I I never wanted to not be in the OR. So I enjoy being present. You like the adrenaline ration? Absolutely. Love it. I love running around. I might complain that we have to move. Like I like that, but not everybody, not a lot of people like that. But I understand that they pretty much run us into the ground. So what is the biggest reward of your job? Seeing people who are in the holding area before they go into the operating room and they're crying because they have breast cancer, any type of cancer, they're scared, and just holding their hand and making them laugh is that's the most rewarding thing for me. I love to see them smile, laugh. I just want to take that anxiety away from them and I get how they're feeling. I mean, I've been there with breast cancer, so I know they're frightened. I understand that. And just to have them smile or just makes makes me happy, makes you know, makes them feel better. And they're really very appreciative too when they feel that you understand them.

Closing And Listener CTA

Mirav Ozeri - Host 23:25

All right. And on that note, thank you so much for doing it. Thank you, Murav. I appreciate it. It's interesting to speak to somebody that actually lives it and not just on TV.

Speaker 23:34

Yes. And the surgeons aren't as good looking as they are on TV. Just saying. Closing statement. All right, thank you. Thank you, Muraf.

Mirav Ozeri - Host 23:47

That's it for today. Thanks, Patty, for the behind the scene look inside the room. If you enjoyed this episode, please like, share, and follow. I'll see you next week on How Much Can I Make.