An Operating Room Nurse’s Perspective

When a child needs surgery, it’s undoubtedly a whirlwind for parents. From clinic visits, to lab tests and phone calls, they arrive at the American Family Children’s Hospital on the day of surgery, anxious about nearly everything.

They sit in the preoperative holding area or up on the floor, waiting with their hungry (and probably cranky) baby or child. When it’s finally time to go back to the operating room, I go introduce myself to the parents as their child’s OR nurse. They will only interact with me for 5-10 minutes, but I will care for their child during the entire surgery, as if he or she were my own.

What happens back in the operating room is a mystery to most people.

Along with the surgeon and my nursing and anesthesia colleagues, we will perform something akin to a well-orchestrated dance.

Perhaps weeks ago, I coordinated getting special equipment or implants for the child’s surgery.

Perhaps I had multiple conversations with the surgeon and other physicians about special labs we need to draw or biopsy specimens we need to take.

I talked with the pharmacist about a medication earlier in the morning. I had a conversation with my surgical technologist about the surgeon’s instrument preferences. I talked with my anesthesia colleague about how we would position the child on the OR table.

I warm the room up, mostly to keep the child warm, thereby reducing the chances of hypothermia and postsurgical complications. But secretly, I do it for the parents’ comfort, too.

After the induction of anesthesia, we place IVs and possibly arterial lines. We talk about the need for blood products. I do a thorough skin assessment, and make judgments about how best to protect the child’s skin and nerves during surgery. I place a catheter, if necessary.

Our entire team positions the child under the surgeon’s direction. My anesthesia colleagues and I speak up if we see something that could potentially be an issue. We make sure the child is kept safe, warm and comfortable.

Finally, it’s time for the surgery to begin. Once we make an incision, my first instinct is to send a page to the parents to let them know everything is OK, because I I could see the worry on their faces.

After that, I keep an eye on vital signs, make sure the equipment is functioning properly, and anticipate problems before they arise. A good OR nurse has what we like to call “OR ears,” meaning we have one ear on the surgical field at all times, and hear the surgeon request something and are up to get it even before the surgical technologist has a chance to ask for it.

I make phone calls to make sure the nurses are aware of where the child will go postoperatively. I coordinate lab studies and pathology specimens. I electronically document everything that happens in the OR, from who is present in the room to medications used to the dressings we put on. I answer pages for the staff surgeons.

Occasionally, our intraoperative plan of care changes. We are ready to for those changes and can plan and execute them flawlessly. Data consistently show that patients who are cared for by certified nurses have better outcomes. I can proudly say that our OR nurses have a very high certification rate.

Keeping up our certification means taking many continuing education credits. We are abreast of the current practice recommendations and standards of care. All of this translates to safer care for every child.

As a tertiary care and Level I Trauma Center, we tend to see the most complex and challenging surgeries. We are very good at them, but I don’t perform my job in a vacuum. I have an amazing team of anesthesiologists, surgeons, surgical residents, anesthetists and nurse anesthetists, surgical technologists, nurses, and multiple types of support staff who are critical to a good outcome. We never take our jobs lightly.

I care for each child as if they were my own, knowing the parents can’t be there. I comfort each child if they cry when waking up. Sometimes I pick them up and comfort them like I know the mom or dad would. I rejoice in small victories for every parent and grieve deeply when life throws them a curveball and their child’s disease has progressed. Every once in a while, I go home and cry for them.

They likely won’t remember my name. And that’s OK. We’ve got this.