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  1. ctsurgeryscrubrn

    Death on the Table

    @FurBabyMom - I so much appreciate your advice and your willingness to share your personal experiences. I think it’s important to remember that as far as medicine has come, surgery (at its core) continues to be extremely brutal for both patients and their providers. The growth of ‘minimally-invasive’ and ‘robotic’ techniques (which I think are wonderful when used appropriately) does not mean that often times, the best and safest way to the root of the problem remains a massive open procedure requiring saws, chisels, and large retractors. It’s not easy to explain to patients or their families. And when things go wrong in hearts (as I would imagine in neuro), they go wrong fast. Everybody on the team gives so much to try to restore life against many factors, time being the most critical. I never want to grow ‘numb’ to a death-on-the-table, but when you scrub on the high-risk aortic team, I am constantly reminded how we are often faced with uphill battles (the 2AM aortic dissection; the Open TAAA repair in a morbidly obese smoker; the Marfan’s patient who is for a re-do of a re-do of a re-do, etc.). But, they need us and in-turn...we need each other.
  2. ctsurgeryscrubrn

    Choosing an Operating Room Specialty

    Hi Julez! Belated welcome to the ORNurses ‘Fra-rority’. I am a second generation O.R. Nurse - my mom was a scrub nurse in hearts at Cleveland Clinic for nearly 20 years. I had a natural inclination to hearts after hearing so many interesting, dramatic, and exciting stories from her time at The Clinic - albeit, many did not have fairy tale endings. Entering nursing school, I certainly noticed that perioperative nursing was not encouraged and floor experience (either med/surg or ICU) was seen as the default ‘immerse yourself in the basics’ specialty. I had to basically fight for a perioperative rotation. I was able to gain great experience that enabled me to obtain a post-graduate perioperative nursing residency out of school. The residency was a 6-month program where we got to scrub and circulate nearly all of the specialties (Hearts, Trauma, Neuro, General, ENT, Vascular, and Outpatient). Hearts just felt right to me. Although I know many don’t like the repetition of cases, teams, etc., it suited me perfectly. I liked working with the same core team (surgeons, anesthesia, etc.) AND I loved the opportunity to scrub high-acuity marathon cases (our institution doesn’t have CSTs scrub hearts). It’s certainly not all ‘fun and games’ and there is more than a fair share of heartbreak, but it feels so right to me - I always say “I didn’t choose hearts; hearts chose me.” I think that’s cliche, but something we should all be on the lookout for - a specialty or niche where we feel completely in ‘our element’ even when put in high-stress, uncomfortable situations. Feel free to PM me, and I wish you all the luck and fulfillment in your perioperative career.
  3. ctsurgeryscrubrn

    Death on the Table

    We've had a couple younger patients expire on the table in the past couple weeks during high-risk aortic procedures (both were re-do's and we operated for 15 and 16 hrs, respectively, prior to expiration). It's been very difficult for me - scrubbing on the high-risk CVOR team comes with these types of outcomes and I know what I signed up for, but it is still heartbreaking. They always say that high-risk CT surgery is where you, as a practitioner, need to maintain emotional distance from your patients. However, I've never subscribed to that idea and believe that in order to be the ultimate advocate, you have to build relationships with your patients no matter what they'll be on your table for. Has anybody worked on a high-risk team where there have been more frequent D.O.T's than other surgical specialties? Any tips for coping and not facing emotional burn-out?
  4. ctsurgeryscrubrn

    Why are CV OR nurses "CV Queens"?

    I think sometimes the institutions create this persona. I'm at a place where the CVOR team is hand-picked for specific roles. For example, I was hand-picked to scrub on our high-risk aorta team where we only do certain types of cases such as aortic arch repairs, re-do of re-do AVRs, ruptured TAAs, open thoracoabdominal aortic aneurysm repairs, Marfan patients, etc. And you do get a very strong sense of routine - the etiology may change, but our team is always usually the same. We only have RNs on the team - no CSTs. We do lose more patients on the table than other services b/c of our patient population, which naturally builds a strong kinship with others on our CVOR service. I certainly don't believe I am better than someone else because of what I do, but I can see how some might perceive that attitude. I think we all need to be more self-aware and supportive of each other because we always can learn and collaborate more effectively.
  5. When I was notified about being hand-picked as a scrub nurse on our high-risk cardiothoracic surgery team, I was very excited, but also nervous. As most would, I sought counsel from many - some that worked in the O.R., and others that had very demanding careers outside of healthcare. My one question to them was, "Would accepting this job end up defining my life?" High-risk cardiothoracic surgery is as intimidating as it sounds and for those that knows what those rooms are like can attest that it requires all team members to give everything 'day-in and day-out' to get patients through the most trying times in their lives. When approached about the potential opportunity, the lead attending was very clear about his expectations for being on the team: Timeliness is everything - ensuring on-time starts for cases is not about efficiency; it's about keeping the team in rhythm. The structure is essential and anything less is unacceptable; Preparation is key to results - everybody in the sterile field is expected to show up every day with a thorough understanding of the patient's presentation, potential pitfalls and complications, and a firm understanding of the patient's anatomy and etiology. This means studying the night before cases, reading through many chapters in texts and recent studies, etc.; Your position is not guaranteed - offers to be in the field on the high-risk CT team is a privilege and it is revocable at any time. There are not always second chances because mistakes in these cases cost time, and time can mean the difference between life and death, paralysis and full function, and whether a patient is burdened for life with irreversible neuro damage. Accountability is everything - everybody on the team was chosen and therefore, everybody is expected to know what to do without being asked - this goes from anticipating the next move by having the instrument ready and in a position where the field remains clear to knowing everything that needs to happen during the prep. I was beyond intimidated but after talking to so many, I realized that this was a chance of a lifetime where I could work with the best and be exposed to rare cases not just in our institution, but in the world - cases that are written up in studies and textbooks. The first year was beyond rough - I felt that so many things that made up my identity left me - I lost touch with my friends; I stopped dating; hobbies I enjoyed went on the back-burner; and, I felt that my identity became exactly what I dreamed of: "I hand-picked to be a part of the high-risk cardiothoracic surgery team." By month 14, I was ready to quit. I began suffering burnout; my nights were spent studying for the next day's cases; and, I became one-dimensional. I told the attending who selected me of my thoughts and he advised me to take a couple weeks off.' So, I decided to go somewhere in nature and spent 10 days in Yosemite. I was able to hike everyday, not think about work, read the books that had alluded me, make phone calls to old friends, and ask myself, "is this all really worth it?" When I left Yosemite, I decided that I still loved what I did, but I needed to make changes: I was able to work out a schedule that provided me more downtime between long days in the O.R.; i committed to a new exercise routine that included a personal trainer and yoga sessions; I committed days to see friends - for the first time ever, I planned out days that would be only for me and my personal relationships; and, I committed to monthly meetings with the attending to talk about how things were going and whether additional tweaks were needed. i really committed to all of these things for a full year. During that time, I learned very important lessons about career and its role in my life: Our identities can't be one-dimensional because when something isn't going well in that one thing (such as a career), then what do you have to turn to; You can give your all in service of another without losing service to yourself; You have to pick the things that make you happy and show the discipline needed to make them 'fit' in your life; The word 'balance' is dangerous - it implies that to be good at one thing, you have to sacrifice your commitment to something else; and, Diversity in your life is accretive to your mental well-being, and your mental well-being is accretive to your career performance. And so here I am, a proud scrub nurse on the high-risk cardiothoracic surgery team. But, you know what else I am? I am a fiance; I am a yogi; I am a baker; I am a friend; and, I am a daughter and sister. The list goes on and I am as proud of what I do as of who I am. High-stakes healthcare requires commitment. But that commitment presents a choice: We can be defined by that one thing. Or, we can choose to be many things. It requires discipline and self-reflection, but in the end, it creates an enriching life that allows us to find multiple forms of love. I love all that I am today and it has never taken away from the tremendous love I have for being a nurse in cardiothoracic surgery. Don't feel cornered into the idea that love is a finite, zero sum game, and that becoming many things takes away from your passion for serving others.
  6. The term Advanced Practice Provider ("APP") has usually been limited to advanced practice registered nurses in a medical context. I believe recent trends and the efficacy of care is starting to really contemplate what that term can mean in surgical care. Nurses that go on to pursue advanced degrees such as an Acute Care Nurse Practitioner ("ACNP") bring years of high-stakes critical care knowledge and a level of independence that can only be accretive to the performance of a surgical team. As they progress in their abilities to manage the critically ill, why should that stop at the O.R. doors? I firmly believe that in the next 5 - 10 years we are going to see something that already has momentum start to really take effect, and that is the use of APRNs, ACNPs, and other advanced-level nurses take a larger role in the Operating Room as first assists. I think it is very exciting that UAB is offering an ACNP program with an RNFA certification. I work with some wonderful surgical PA's, but there is a gap between the model in which they've been taught and the nursing model + nursing experience. There are tremendous synergies that can be obtained by having someone like an ACNP be involved in the full lifecycle of acute care surgery - from consult to pre-op to first-assist to recovery. I think a lot of institutions are starting to see that...and patients want it. Continuity of care is often discussed as important for patients to follow. Well, I think it's equally important that healthcare professionals reciprocate that continuity. Historically, NPs haven't really pursued intraoperative roles, and I think many want to [i acknowledge some do not]. So, I think it's time that they receive the appropriate training to become valuable members of the intraoperative surgical team. I think they bring a wealth of knowledge to very complex cases and can take what they see on the table and help calibrate the recovery off of what they see...not off of an operative dictation or chart. There's an amazing article about an ACNP / RNFA named Trisha Hutton who is living this new reality as a Cardiothoracic Surgery First Assist and I think her interview provides an invaluable backdrop as to why this is not about 'personal interest', rather, 'in the best interest of the patient.' It has truly inspired me to reach further, explore more possibilities, and take pride in the experience of nursing that cannot be taught. We are the lucky few who have been in the trenches working as partners with residents, fellows and attendings before and after surgery, so why should we be left out of the middle part - "during surgery". As a teenage cardiac surgery patient, I got to know my advanced practitioner nurse very well - she was the glue of my care. When I asked if she would be able to help me in the Operating Room, she said, "no, there are plenty of amazing hands in there to heal you." And she was right, but is that right? Being a patient and now working on a cardiac surgery team, I understand the value of these amazing nurses who can do everything, but aren't often given the opportunity to prove just that. The debate between going to nursing school and eventually becoming an NP versus going to PA school is often debated. But, they shouldn't be. Nursing is a very special and unique experience, and we need to show others why that experience is valuable in ALL aspects of care...including in the Operating Room. PAs may be able to assist in surgery, but can they care for post surgery acute care patients after? Would it be beneficial if there was a practitioner that had the aperture to bridge the two? I think undoubtedly the answer is, 'yes it would be.' Advancing a profession is not about crossing lines of proficiency. Advancing a profession is educating others about the value of proficiency that inherently exists.