Throwing open the doors on theater nursing: theatre nurses must cope with ever changing technology, but patient care remains at the heart of their work.
Subject: Surgical nursing (Educational aspects)
Perioperative care (Management)
Perioperative care (Educational aspects)
Nursing schools (Services)
Author: Anderson, Leigh
Pub Date: 08/01/2011
Publication: Name: Kai Tiaki: Nursing New Zealand Publisher: New Zealand Nurses' Organisation Audience: Trade Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2011 New Zealand Nurses' Organisation ISSN: 1173-2032
Issue: Date: August, 2011 Source Volume: 17 Source Issue: 7
Topic: Event Code: 360 Services information; 200 Management dynamics Computer Subject: Company business management
Geographic: Geographic Scope: New Zealand Geographic Code: 8NEWZ New Zealand
Accession Number: 266344843
Full Text: When I was first assigned to work in operating rooms (ORs) at Auckland Hospital, I was inconsolable. It was the last place I had wanted to work. Twenty years on, I wouldn't work anywhere else.

I graduated 20 years ago in the second to last hospital-based training class at Greenlane Hospital. Before graduation, we were asked to list our preference for job placements. There was no interview process--it was simply a matter of deciding where you wanted to be placed. None of my desired options were remotely related to surgery or ORs. Fate intervened and, along with five other classmates, I was allocated to work in ORs. Things were done very differently then. There was no structured education or orientation as we have today--new nurses were just expected to sink or swim.

On our first day we were told to stand by the wall and not touch anything. Gradually we were allowed to move into the centre of the operating theatre. Sometimes we got a teaching session, but that was rare, and sometimes a kindly nurse would explain something to you. Basically, you learnt by osmosis.

Slowly I began to enjoy working in ORs, eventually growing to love the specialty. Since then, I have worked in different settings, holding a variety of roles, including staff nurse, educator and now nurse consultant. I have worked in most of the theatre specialities, except for ophthalmology, cardiac and plastics. Theatre nurses used to do recovery--I did this when I worked at National Women's--but now this area has become increasingly specialised. Most of my career has been spent in transplant and vascular surgery.

These days, most larger hospitals run new-to-operating-room and new-to-post-operative-care-unit programmes. These vary but at the Auckland District Health Board (ADHB) these programmes are formal, 12-week orientation courses. A group on such a course would usually include new graduates, nurses returning to practice and ward staff who have been employed to work in theatre. Basically, participants work in a supernumerary capacity. They learn all the roles of the circulating, scrub and third nurse positions (the latter is often known as the anaesthetic nurse).

They also learn the methods and concepts surrounding instrument sterilisation. After learning the basics, they spend the next year working within the specialty areas, experiencing all three roles. They then meet with their manager and choose an area to specialise in.

We get inundated with applicants for these courses, as theatre nursing is a very popular area, for new graduates in particular. With the recession, however, we have few vacancies at ADHB, as our workforce is more stable now.

Theatre nurses are specialists who are required to approach their work in a different way to that of someone working in a ward environment. That doesn't mean we don't value the nurse/ patient relationship. When we meet our patients for the first time, in pre-op, they are at their most vulnerable and most terrified. You have to develop an empathetic relationship with them very quickly. Before they are anaesthetised, we have short, intense relationships with them, as we find out about their fears and do our best to allay them. We care a great deal about our patients and will often go and see them when they wake up. Being able to see an immediate difference in a patient's well-being also makes theatre nursing extremely rewarding. Unfortunately, however, we do not often hear how our patients get on back in the ward, unless they have to come back for further surgery.

Often when people think of theatre nurses, the scrub nurse role comes to mind but this is just one of the roles we undertake--we do so much more than this. Basic patient assessment before surgery starts and nursing cares are hugely significant parts of the theatre nurse's role. Once the patient is anaesthetised, they are not able to communicate their needs. They are very dependent on our skills for basic cares such as pressure area cares, maintaining fluid balance and normothermia. Often nurses are like choreographers--ensuring both the equipment and the inter-professional team are working together at the same place at the same time with the same person can be a real challenge.

Theatre nursing is an increasingly specialised area, with complex and ever changing technology to cope with. I believe it takes at least two years to find your feet in the theatre environment of a medium-sized hospital. The increasing use of computers, stereotactic and key hole surgery has certainly made theatre nursing more complex. We have a lot of ad hoc education sessions with product representatives and companies, as we learn what's involved with a new piece of equipment.

What I like most in the OR environment is the dynamic of the inter-professional team. I also find it less hierarchical than other areas.

Working so closely with your colleagues for long hours in a small room means you really get to know each other. You can end up spending more time -and very intense lime--with them than you do with your own family. Communication and team dynamics are terribly important. The surgical safety checklist, now being used in ORs throughout New Zealand, is helping to increase and improve communication among the teams, and leading to decreasing morbidity and mortality rates (see p16-17).

Nursing in the OR may appear to be shrouded in secrecy, bur the only reason we work behind closed doors is because of the importance of infection control--and of course patient privacy! We can't just throw open the doors and say "come on in, have a look around", although we would love to do that. However, we do hold an annual perioperative nurses' week, which we hope helps take away some of the mystery.

Nurse consultant role

I have been in my current role as nurse consultant for ORs for three years. This is a relatively new role that developed in 2002 when ADHB amalgamated its five OR suites. Within the suites are 36 ORs, employing around 800 staff, the majority of whom are nurses.

When Greenlane, National Women's and Starship Children's Hospitals' OR suites combined, the main focus of my role was to align policy and procedure, as we were all doing things slightly differently. Since then, the role has developed to one focusing on quality improvement, the management of trends with incident reports; auditing; and the creation and introduction of new policy or procedure across the ORs.

To achieve this, I work very closely with the OR management teams and educator group. I find my role at work meshes very well with my role as chair of the Perioperative Nurses College (PNC) NZNO, especially as it widens my group of contacts. Ir also involves teaching at the University of Auckland. When we are looking at changing policy at ADHB or in the college, I can consult nationally to find out what happens in various practice settings, as well as looking at current research.

Changing models of care

In these times of economic uncertainty, the PNC's main concern continues to be discussions around changes to models of care within the perioperative spectrum. Some organisations have adopted overseas staffing model, eg the use of an unregulated workforce. These models may, at first glance, appear to save money but, on closer inspection, do not serve the best interests of our patients and may put some at risk. We need to be extremely careful when considering adopting a new model in its entirety. We need to question how the model should be adapted to work best in our context. One exciting development is the expanded role of the registered nurse (RN), eg the introduction of the RN first surgical assist role and the postgraduate course now available.

This year will always be remembered for the impact the Christchurch earthquakes has had on the local and national community. The college's national conference this year was to have been held in Christchurch. But, like so many others, this event was a casualty of the damaged city (see report, p 41).

Varied college membership

Joining the PNC benefit nurses right across the perioperative spectrum. Our members include nurses who work within theatre, post anaesthetic care, medical imaging and aesthetics.

In a practical sense, the college provides an excellent resource for nurses wanting to consider a range of clinical issues and questions. We have an excellent education committee that can field these queries and the college provides education opportunities at regular times around the country. There are nine national regions, each of which co-ordinates evenings or study days. These also provide precious professional development hours for the maintenance of registration.

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The college has recently revamped its standards document. The education committee has put an enormous amount of work into revising our standards, which will be available to members through the PNC pages on the NZNO website (www.nzno.org.nz/groups/colleges/perioperative_nurses_college). Members will soon be able to access the American OR journal via the PNC website--another exciting development.

Our national conference provides real benefits to our members. This annual event is hosted by one of our nine regions and there is always an excellent line-up of national and international speakers. Non-members can also attend but registration is considerably more expensive. Members can also apply for a range of scholarships and grants to attend conferences, travel and study. These awards are generously sponsored by industry partners and have supported many members to attend international conferences and to undertake research and postgraduate study.

Members also receive our excellent bimonthly journal, The Dissector, which presents and discusses current clinical practice issues. This began publication in 1974. Its contents will soon be available online through the Gale Cengage learning academic databases, thus giving The Dissector international access and readership. To join the college, please visit the website above or email pnc.sec@xtra.co.nz.

The college also provides a link for perioperative nurses here with the International Federation of Perioperative Nurses (IFPN). The college chair represents perioperative nurses on the IFPN board, a body that meets with the International Council of Nurses (ICN) and the World Health Organisation (WHO). In the last three years, the IFPN has made real progress with the ICN and WHO to ensure the voice and issues of perioperative nurses are heard.

In May this year, I attended the IFPN AGM in Johannesburg, hosted by the South African Theatre Sisters' congress. As usual, this was a very stimulating event, though it was a shock to see so many public hospitals lacking some very basic equipment, and families having to bring sheets and food in for the patients.

Nursing heroes

When I am asked who my nursing heroes are I always blush, as I cannot deny my first nursing heroine was Hot Lips Houlihan from the television series M*A*S*H. When I was a child I thought she was the bee's knees, as she seemed to be able to run the entire hospital and save the lives of soldiers, all while looking good and having a great time. I'm sure that, on some level, she influenced my decision to apply for nursing school, but I'm not sure whether I really should be admitting this publically. However, it didn't take long for reality to hit home and for me to learn that nursing school in no way resembled an American comedy series set during the Korean War.

The truth is we are surrounded by heroes and heroines every day within nursing. These are our colleagues who are working in a wide variety of settings. They constantly strive to provide an excellent standard of patient care, white keeping up to date with current developments and knowledge, always asking questions and seeking ways to improve the quality of care.

* Additional content by co-editor Anne Manchester

Leigh Anderson, RN, MN, is nurse consultant, operating rooms and anaesthesia, Auckland District Health Board. She chairs the Perioperative Nurses College, NZNO.
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