When we’re asleep in the operating room, the entire surgical team is working. They all have jobs to do, and whether they are giving us a new hip so we can regain mobility, repairing our perforated bowel, or performing a mastectomy with breast reconstruction, what happens in the operating room is about careful preparation and attention to detail. Everyone from the surgeon to the anesthesiologist to the scrub tech knows exactly what they need to do at all times. They are watching the monitors, focusing intently on the parts of the body on which they are working, and making sure everything is going according to plan.
But there’s a person in the room whose eyes are intently trained on us and whose job it is to advocate for us while we sleep. Is the room warm enough for us? Is everything properly hooked up and attached? Have we been in one position for too long? While everyone else in the room is working on our behalf, the operating room nurse is our eyes and ears.
Today, we are at Capital Health Medical Center – Hopewell for a hip revision. The circulating OR nurse is Lauren Krosnick, RN, who has been working in the operating room at Capital Health since Christmas Eve 2013. Her green eyes are bright and focused, and she’s a whirlwind of activity, buzzing around the room with certainty and efficiency.
Alongside the scrub tech, she starts prepping the OR at 8:03 a.m., readying the instruments for our procedure that’s first on the OR schedule today. There’s an energy in the room as the minutes tick down to go time. Krosnick pulls out a binder with our case information and checks the doctor’s detailed plan for the surgery again, ensuring that they have all the equipment that will be necessary to execute it. She and the scrub tech move around the room, making every surface sterile and putting everything is in its proper place.
Other members of the team come trickling in—the anesthesiologist, the X-ray techs, the physician assistant, and finally the orthopedic surgeon. Like coaches huddling before a big game, they consult, going over any last-minute details. Then it’s time, and they wheel us into the room to prepare us for surgery.
And suddenly Krosnick’s buzzing ends, and she comes to a stop at the gurney, directly in front of us. She met us for the first time at check-in, when they went over everything we can expect and gave us a chance to ask any questions or express any concerns. That’s when Krosnick confirmed any allergies we have, which will impact what is used—and not used—in the operating room. But her job is also to provide comfort, especially if she can sense we are nervous or confused about any part of the surgery or our recovery.
We are at ease with Krosnick, and when the anesthesiologist is ready to administer the spinal anesthesia, the nurse helps us sit up, places all 10 fingers on the skin of our back, and lets us place our head on her shoulder for support and comfort. While the needle goes in and she offers the human touch, Krosnick’s body is still, but her eyes are scanning the room, as she once again takes inventory and makes sure nothing is missed.
When the anesthesiologist is finished, Krosnick inserts the urinary catheter. Then, she and the team move us to the operating table and strap our feet in boots that look like they might be used for skiing, which will help the team maneuver our body seamlessly throughout the surgery. When we have slipped out of consciousness, the team begins draping our body with sheets to create a sterile field for the surgery.
Now that they are ready to begin, Krosnick moves to the foot of the operating table and commands attention from everyone in the room as she performs the “Time Out,” which the OR nurse conducts before every surgery. She verbally records the time and then calls out each member of the team one at a time, asking the doctors and physician assistant for our name and the details of the surgery they are about to perform. It’s her job to make sure, one last time, that everyone is on the same page, to protect us from any possible confusion.
Now, at last, they are ready to start the surgery. And Krosnick will see us again when we wake up.
Cut Out for the OR
They say nurses who are drawn to the operating room never leave it. While many other nurses may want to shift disciplines or try a variety of aspects within the medical profession, OR nurses often stay put. They crave the fast pace, the energy of each surgery, and the every-day-is-something-different mentality. And Stella Donnell, RN, who has worked as a nurse for Capital Health for her entire 25-year career, is a case in point. She works as an OR nurse and team leader at the Capital Health Medical Center – Hopewell, and she can’t imagine
doing anything else.
Donnell was the kind of kid who, to her parents’ dismay, would bring home birds that had fallen from their nests and baby possums stranded by the side of the road, so she never doubted that she wanted to be a surgical nurse. After getting her nursing degree from Trenton State (now The College of New Jersey) in 1990, she started working for Mercer Medical Center as a floor nurse, while she waited for an OR position to open.
“I knew when I graduated from Trenton State that I wanted to get into the OR. But at the time, nurses didn’t leave the operating room. When they went there, they stayed because people loved their jobs,” Donnell says. “So I started on the floor, but luckily for me a position opened up about 7 months after I started. So I got in and I’ve been there ever since. And I love my job.”
Donnell says that when a new nurse starts, she can often tell if he or she is going to be a fit for the operating room over the long term. “The OR is an incredible challenge, but it’s just not for everyone,” Donnell explains. “We have a new surgical tech here who is so excited, and you can see it on her face. You can just tell. Either someone has the personality and they are really into it, or they’re not.”
Krosnick is one of those nurses: Before the surgery even begins, you can read on her face that she’s exactly where she wants to be. Like Donnell, she knew from a young age that she wanted to be a nurse (she regularly helped her parents care for ill relatives who lived at her childhood home), and the OR presents a daily challenge that suits her. “I love the challenge of the OR—the surgical aspects, learning the equipment and the instruments, and anticipating what comes next,” Krosnick says.
Being quick on your feet is certainly a requirement, Donnell says, but organization is key, a refrain she’s often reminding new surgical nurses. “You have to know how to anticipate what’s coming,” she explains. “You have to be constantly forward thinking so you can prepare for any scenario.”
Getting the surgical room sterilized and ready is a significant part of the job, but during surgery, it’s all about recording information, changing the patient’s positioning when necessary, and doing whatever needs to be done to help execute a successful surgery. “You do everything from hooking up the instruments to scratching someone’s nose,” Donnell says. “Once the procedure is started, you’re kind
of running around doing everything and charting when you get a minute.”
Excelling as a nurse in the operating room is about more than hitting the procedural elements on target. Although many of us associate operating room nurses with a steely, unflappable demeanor, he or she also must have another skill set. As the guardian of a patient’s physical and emotional state before and during surgery, an OR nurse must be a caretaker in the truest sense. This is especially the case for surgeries like mastectomies, in which a patient is in the throes of a battle with breast cancer and is about to face a body-altering surgery.
Capital Health has made a significant investment in its breast center, and Donnell is the team leader for plastics in the OR, which means she works on a lot of mastectomies and reconstructive surgeries. In addition to helping the doctors prepare for and execute the entire procedure, including the reconstruction and placement of the tissue expanders, Donnell pays close attention to the patient’s emotional state.
“When the patient first comes into the operating room, I let her know that I’m there and I’m going to take care of her. I don’t like to be running around doing things. I’m there with her until she falls asleep,” she says. “You have to get all the business done, but in the end, it’s all about compassion. I want to be there holding her hand, keeping her warm, with my hands on her. It just makes her feel better because she is in this room with all these lights, and everyone else is multitasking.”
Seeing that transformation from the beginning of the surgery to the end is a part of the process Donnell still finds amazing, even after 25 years. “For patients that come in knowing they have cancer and need to have a mastectomy, but are having immediate reconstruction and when they wake up they’re going to have breasts, to help them through that and have everything the doctor needs, it’s very rewarding,” Donnell says.
Some of these surgeries—including bilateral mastectomies/breast reconstructions with latissimus dorsi flaps, in which back muscle and a smaller area of overlying skin and fat are transferred to the mastectomy site—are physically demanding and require the nurse to frequently reposition the patient throughout. “That surgery requires a lot of position changes, and I always feel proud of myself when they go smoothly and the doctor is happy as well,” Donnell says. “Having it right on—when they go smoothly I feel really proud of that.”