By Rachael Tolliver-Public AffairsMarch 4, 2015
Editor's note: While this story highlights OR nurses, I recognize that many of the experiences and routines are common to nursing as a whole. It is to those professionals I dedicate this piece.
When we see them on television and in movies it's usually in support roles. And while we can identify them by their uniforms when we see them in public, we don't usually give them much thought--they are just people standing with us in the grocery line or getting gas.
But these are nurses, and nurses are anything but support personnel--especially when they are operating room nurses.
"Our patients are asleep and we know they will never remember our names, they will never remember how we positioned them to keep them safe from injury, they will never remember that we were the ones who prepped their limb to keep them from having an infection," explained Valerie Haddle, a registered nurse who works at the Ireland Army Community Hospital. "But we watch over everything about their prep, surgery and right up to the handoff at recovery."
Haddle's been a civilian operating room nurse for 11 years, most of that as cardio, thoracic and vascular OR nurse. And like her supervisor, Lt. Col. Edwin Maniulit, a registered nurse and the chief of perioperative services, takes her role very seriously.
"In nursing you have to have compassion, understanding and empathy. But the highest pinnacle, or attribute of an OR nurse, is what is called patient advocacy," Maniulit said.
He added that nurses practice advocacy in other areas as well, but he said he feels OR nurses, much like pediatric nurses, reach advocacy's highest apex in support of their patients who are totally dependent.
"When you position a patient even the minute balance is important … so they don't wake up with, for example, a sore shoulder," the chief explained. "If they are positioned wrong, we have to redo it and make it right. If we have to do prepping, we have to do it right--our patients can't fend for themselves."
Once the patient enters the room, said Sgt. Robert Larkin, an OR nurse tech at IRACH, anything else that is going on is, "out the window." He said that, like with most jobs, bad days happen and disagreements with co-workers occur. But, he added, everything can wait until after the surgery is over and the patient is safely delivered to the recovery ward.
"If that was you or your family member on that table that is what you would want," Larkin said. "I train Soldiers that way--imagine if that was you or your family member on that table. You put away anything else you have going on in your life right now because nothing else matters. You can come back to it--it's about the patient now."
And according to Maniulit, while the surgeon is the captain of the ship and everything revolves around him or her, everyone is an advocate and can stop a surgery to address something they see is not right, "…in fact Sgt. Larkin did that very thing just the other day," when he saw something out of place and acted to correct it, but first stopped the procedure.
"And just because you are asleep," Haddle added, "my professionalism and my empathy and my caring for you does not go out the window."
If there is such a thing as a normal day for an OR nurse, Larkin, Haddle and Maniulit haven't seen one, but they do have "average days."
An average day for Larkin has many moving parts, he said. Those parts include everything from a non-compliant patient, to finishing work from the previous shift that they didn't get to--which only adds to his team's load.
On those days, he said, he tells himself, "…it's about the patient. No matter how hard it is--it's not about me. But my favorite part of the average day is making the patients feel as comfortable as possible and making them laugh," he added.
The nursing staff also uses humor among themselves as another "instrument" in their medical kit.
Maniulit said that like any profession, nursing has its inside jokes, often about the day, the job and people with whom they deal.
"I know people can sometimes misconstrue our humor as carelessness or rigidity. It is definitely a coping mechanism for us," Haddle explained.
She said that because they see physicians on a different side than the patients, that plus the responsibility of advocacy and anything wrong that may happen weighs heavily on their shoulders. So to get by she said they may say things that sound inappropriate.
"That's the way we get through our day to not take the stress of that seriousness home," she explained.
For example, disrobing in the OR is not necessarily a SHARP complaint.
"I had a surgeon whose pants fell during surgery and he said, 'Hey Ed, can you pull my pants up for me?' said Maniulit. "I told him 'NO--you have to stay that way forever.'"
Of course, Maniulit said he was joking.
"I've had to de-pant surgeons in the OR because they were covered in blood," Haddle added. "I've had to crawl under the drapes--see, that's where you get things like, 'Can you crawl under the drapes and undo my gown….can take my pants off under the drapes….' That's the kind of stuff we work with."
And if the casual visitor was to sit in the nurses break room on any given day, they probably wouldn't eat lunch just based of the conversation.
"You go from being in some type of rectal case or something and ten minutes later eat lunch," Larkin said. "You can be in a room where you smell burning tissue, and anyone else might have to leave to throw up but we'll go eat our lunch no matter what it is."
"Yeah," Maniulit confirmed. "They'll smell some (burning technique) ….and someone will say, 'I'm hungry. I feel like BBQ.'"
While deployed to Iraq, Maniulit said while he was in surgery they could hear mortars exploding downrange. Every time the mortars exploded the surgeon's hands started shaking.
"I thought it was funny, but I said, 'Hey doc we are so far away from the mortar rounds,'" he recalled. "So what we did, just to make sure we finished that case, I called everyone from CMS and had them put their vests on and we circled the surgeon and I said, 'You are going to be safe now. We're going to die first, but you'll be safe.'"
The moments when humor can't ease the emotional burden associated with the job, the nurses rely on their own personal coping mechanisms.
Haddle said she practices the two Ps--Pray and Prioritize. And Maniulit said he copes by thinking of his deployment days, and everything seems easy compared to that.
But coping and job aside, nurses are people and while Haddle said she loves her job, and loves being a nurse it doesn't define who she is.
"I don't think people can separate that," she said. "When people see you out having fun and having a good time--I am not talking reckless behavior--but they are like, 'is that really how a nurse should act?' I am a person, I love what I do but I am also a human being.
"I like to have fun and I like to get together with friends and do things like that, but sometimes people judge you based on your profession and not you as a person."
Larkin said that when people find out what he does when he is out having fun, they ask him the same question.
"'Are you ready for what's coming up Monday?'" he said they'll ask. "Well yeah. It comes with the job. You learn and you research like anything that you might want reassurance on before your assignment--it comes with any profession. You separate the two--you don't let your work define you."
Larkin also doesn't bring work home with him as a self-preservation technique.
"I need to be able to empathize with the patient, but then let it go so it doesn't affect my home life," Larkin explained. "I do a brain dump."
While not every day requires coping mechanisms, and some days are routine, a nurse's day is anything but average.
"The average day can be hectic. You have to always be one step ahead," Haddle said. "The patient is under anesthesia so any delay can be bad and you really need to be on your game."
For Haddle and Maniulit an average day can depend on the type of service they are in, what the case load is like, and difficulties that arise concerning their patients. For Maniulit who fulfills administrator duties, his day also includes assessment of the OR, safety of his personnel and the safety and satisfaction of the patient.
Larkin starts his day with military physical training three days a week, and because he is a "Soldier first and nursing staff second," he has military training sometimes--then he starts his with his duties. But as a civilian nurse, Haddle is on a different schedule.
She said there are differences in working at a military hospital and a civilian one. For example, there are procedures that a civilian isn't used to.
"And there's the rank you aren't used to. Not that you treat anyone any different--but here, rank is an important part of how they function," Haddle explained. "The policies are different, but the functioning of the OR is the same--the red tape is different. It isn't bad, not negative, just different ways of doing things."
Another difference is the service--or specialty--in which she works. IRACH has a full range of services and the OR nurses float in and out. Haddle is the service nurse for ophthalmology and podiatry, but said she is able to perform every service.
"Where I came from in the civilian sector we were on a team and I did cardio, thoracic and vascular surgery. It was a little different set up … you had a team and you did the same thing every day," she said. "It's good because you do have a routine but it does get monotonous and you hope the times you are excited isn't at the patient's expense."
But at IRACH Haddle said there are a wide variety of cases in which to be involved however, there are uniqueness in each--starting with different mindsets and moving to the more obvious.
"Every day you come in, even if you switch from orthopedics to general, you use different positioning aids--the patient will be positioned differently--and use different instrumentation," Haddle explained. "You are using different equipment (around) the room and you have to be knowledgeable of all that in order to make your patient safe."
There are some cases requiring a different level of knowledge.
Maniulit and Larkin have all seen some unusual things. From popcorn and playdough in kids' noses, to objects stuck in other orifices. But Maniulit's weirdest takes the prize.
"It was a car accident with a patient impaled by a fence post through his chest--a live 'Dracula,'" Maniulit recalled. "The stake missed the heart and the patient recovered, in fact he was walking the next day."
Bad days, strange days, and 14-hour work days aside--nurses do what they do because they want to help people. All three said they wouldn't be doing anything else. Maniulit had the chance to go pre-med but decided to stay in nursing, and Larkin is preparing for a long-term career somewhere in the nursing field.
"I was striving to be in OR," Haddle said, "and now I am there, I am happy. I don't want to do anything else."
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