5 Invaluable Lessons I've Learned in 15 Years of Nursing

In the 15 years since obtaining my BSN, I started as a CVICU Nurse and then transitioned into the Operating Room. Woven in between, I obtained my MSN (AGACNP-BC), CNOR / CRNFA Certifications, and then my DNP. Throughout my clinical and educational journey, I have learned a lot about myself, the nursing profession, and the value-add that advanced-practice nurses can bring to the perioperative specialization. Here are 5 things I have learned in my 15-year journey from entry-level ICU nurse to staff perioperative scrub serving multiple specialties to my current role as a DNP CRNFA First Assist on a high-risk cardiac surgery team.

Sponsorship Is Everything

The ability to find the area of nursing that is 'your calling' and to actually live it out on a daily basis is all about sponsorship. I was lucky - I found out early on that the Operating Room was where I wanted to spend my career, specifically in the 'operative field.' Putting in the extra time to learn the procedures, instrumentation, how to anticipate the needs of surgeons, and understanding exposure and potential complications, enabled me to build sponsorship with surgeons who valued me as a "scrub nurse." They requested me on their cases, sought my input on areas of career development, and helped me 'shrink the size' of a sizeable surgical service at a top-tier academic institution.

Knowing What You Want Out Of Something Before Venturing Into It Was Essential For Me

Right now, there are a lot of nurses pursuing advanced degrees, which I think is great. One thing I learned before I went after my MSN was to understand what I hoped to get out of it. I knew I wanted to stay in the O.R., so I chose a program that offered a track with an Acute Care Certificate combined with a Registered Nurse First Assist (CRNFA) certification add-on. Knowing that an advanced degree with an add-on certification would only elevate my role in the Operative Field was essential to finding the right program and understanding the 'sponsorship' I would need coming back in order to utilize my additional education. Before I enrolled, I discussed this heavily with one of our Cardiothoracic Surgeons, who offered to sponsor the development of my surgical skills and really learn how to be a "First Assist" (very different than a scrub nurse) in high-stakes cardiac surgery.

Learning To Explain Your Value Is As Important As Demonstrating Your Value

At an academic institution, Residents and Fellows often serve in the First Assist role in Cardiothoracic Surgery. That's the reality that often discourages CRNFAs from pursuing positions at these types of institutions, and it made me question it as well. That said, being able to explain and demonstrate why the continuum of care matters (from operating table to post-op acute care) has bought me a lot of credibility. The hand-off process between the CVOR team and the CVICU team is far more important than it is given credit. I was both encouraged and now known for creating a very detailed, documented, and articulate process for handing-off patients to post-op care - this includes any complications experienced on the table, particular red flags to watch out for, and any unusual pathology encountered has been a huge part of my value. But, doing it is one thing - making sure others understand the value in it (in a tactful way) really empowers your role.

Building Your Brand Matters

Having a great attitude is wonderful, but coming to cases as prepared as possible becomes a 'brand differentiator.' There are a lot of talented perioperative nurses out there; what makes you different? The best advice I have for the next generation of perioperative nurses is that showing up and being proficient with what is asked will likely enable you to retain your job, but it won't differentiate your brand. Brand is not about your Instagram page or how many colors of Figs you have; it's about your performance. That's what I love about the Operating Room - the difference between the merely proficient and the truly excellent (for all roles) is huge. I was lucky enough early on to understand that coming to cases knowing exactly what would be needed to outperform expectations based on my own preparation would 1) get noticed; and 2) open more opportunities to expand my skills - the ole saying, "you can never be over-prepared" has never failed me and I would encourage any nurse entering the perioperative specialty to understand the size of the gap between proficient-to-good, and good-to-great, which will define your brand.

Those Who Do Not Ask Very Rarely Receive

As a leader now, I often speak with some of our perioperative nurses who have chosen to leave as part of their exit interview process. The first and most obvious question is, "why are you leaving?". While there are many who have figured out the Operating Room is simply not for them, which is understandable, I am often shocked by how many nurses I hear from who love the Operating Room but were not getting the experience they desired.  My first response back is, "Did you ever ask or try to obtain more experience in the area of perioperative nursing that you enjoyed the most?". Unfortunately, I often get responses similar to the following:

• 'Institutional barriers are preventing my growth';
• 'I have no power';
• 'It is just the way things are'; or,
• '[So and so] does not like me.'

While I acknowledge that some institutions are very firm in the way they utilize perioperative nurses and may create a ceiling for development, I also know (based on my 15 years) that the individual has far more influence on his / her career trajectory than is often acknowledged - Does it take time? Yes. Does it take initiative? Yes. Does it take 'brand' and 'sponsorship' to obtain the opportunities you seek? Yes. But above else, it takes the courage to ask for what you really want.

Whether you are a first year OR Nurse or a 15-year veteran in the specialty like myself, identifying the type of work that speaks to you, asking for the chance to build your experience and brand in the areas that align with your operative passion, and preparing yourself so when those opportunities present themselves you are more-than-prepared will make all-the-difference between those who define their careers with excuses of what 'could have been' versus those who showcase their careers with a strong brand, backed with amazing experiences serving others during their most vulnerable times.

I am proud to be an Operating Room Nurse because I have created a path I can call my own. Now, it is my turn to pay it forward by teaching and demonstrating these invaluable lessons to the next generation of nurses that taking ownership of one's career is the key to obtaining the opportunities one yearns for.