On April 16, 2019, Washington State Senator, Maureen Walsh, disparaged millions of nurses with her comments that “nurses probably play cards for a considerable amount of the day.” These comments not only maligned our entire profession, but they also displayed an enormous amount of ignorance from Sen. Walsh.
Nurses don’t “play cards.” We aren’t lounging around all day, doing nothing but collecting a paycheck. Last I checked there wasn’t a poker table in the break room, and they don’t stock decks of cards in our central supply.
No, we’re on our feet, day after day, shift after shift, hour after hour. Oftentimes going without breaks, without meals, and staying well past the time our shift should have ended. We’re over-worked, under-staffed, and continually have extra charting or paperwork added to our responsibilities. And yet, we deal with all of that and more while trying to do the one thing we care the most about – caring for our patients.
Why? Because caring for people is our passion. It’s what we do best.
I invite you, Sen. Walsh, and anyone else who is interested, to come behind the red line of the operating room with me. Let’s pull back the curtain. The nurses in the O.R. don’t get seen that often – we show up to meet and interview our patients before their surgery, and then we roll them away into the O.R. – out of sight from family, and then quickly forgotten by our patients due to the amnesia of anesthesia medications.
So what are we doing? What goes on during our shift that no one else ever sees? Walk with me through an average day I had working with a very busy plastic surgeon, and let me show you.
The day begins…
- 0600 – I’m already at the time clock. I have a busy day ahead of me and a lot has to get set up before cases start at 0700. I grab scrubs from the scrub dispenser, and head to the locker room to change.
- 0610 – Dressed and ready for the day, I head to the charge nurse’s desk to grab my schedule.
- I have 7 patients scheduled in my O.R. suite today – the first case alone will take about 6-7 hours. All of the following cases are about an hour each – give or take. It’s going to be a long day.
- 0620 – My O.R. was left disorganized from the night before, so my scrub and I have to clean up the room, then wipe it down, and gather our positioning equipment and other supplies. I quickly run out to pre-op so that I can meet our patient, confirm her allergies, and confirm our procedure. Then I grab the medications that I need and go help my scrub set up for the case. Once everything is set up and my scrub has everything she needs, we do our first count, and we’re ready to go.
- 0650 – I head out to pre-op with our CRNA. I answer any questions that our patient may have, I make sure the family knows where the waiting room is, and I assure them that I will keep them updated during the procedure. After a few more questions we’re ready to roll back into the O.R.
- 0700 – We roll into the O.R. and I help to get our patient onto the O.R. bed. We make her comfortable with warm blankets and pillows and secure her safety strap. Our CRNA begins putting her to sleep, and I stand nearby, ready to assist if needed.
- 0730 – Our patient is asleep and now we begin getting her ready for her procedure. A foley catheter for her bladder, a pillow for under her knees, foam to pad her heels and elbows, and a special gel headrest are just the basics of what we need for positioning. Since we’re working on her face, there are special considerations for the endotracheal tube as well. We also need to keep her warm, so a warming blanket is applied. I wash her skin with a special solution to prepare it for the procedure, and I ensure that nothing is contaminated during the prepping and draping process.
- 0810 – Our patient is finally properly positioned, prepped, and draped, and we’re ready to begin the procedure. We perform our time-out and then the surgery begins.
- 1235 – Another nurse is free and comes in to check on me. I haven’t gotten to leave my O.R. – except to run for supplies or instruments – since I rolled into the room at 0700. I’m starving, and I really need to pee. I give her a quick report, and she takes over my case for the next 30 minutes.
- 1420 – We’re getting ready to put on dressings. The surgery went smoothly and quickly. With any luck we’ll be starting our next case by 1500…
One case complete, 6 more to go…
We are expected to have 15-20 minute turnovers between cases. So, not only do I need to get my patient to the recovery room, give report to the nurse, and close out my chart, I also have to help my scrub get set up for our next case. And we have to get set up for it quickly.
The same process as this morning starts all over again. I check my patient’s chart and talk to them to confirm their identity, procedure, surgeon, and allergies. I help set up for their procedure and make sure we have everything in the room that we will need.
And so, for the next 6 hours, one patient after another rolls into our O.R. and then rolls out. Each case is quick. And as soon as one patient rolls into the recovery room, we’re expected to quickly turn over and get ready for the next one. No breaks, no stopping, no sitting down.
My shift is {technically} over…
- 1900 – It’s 7:00 pm, and I’m tired from a long day and ready to go home. But we have two cases left to go, and there’s no one to relieve me. The charge nurse lets me know that I’m going to have to stay, so I call my husband and let him know I’m going to be late.
- 2145 – Our last patient is in the PACU, our O.R. is cleaned up, and we’re finally at the time clock, ready to go home. As I swipe my badge, I look forward to going home, eating a very late dinner, and collapsing into bed.
- 2300 – I’m finally in bed, exhausted. The day was long and I have to be at work again tomorrow. Hopefully, I’ll fall asleep quickly.
- 0500 – My alarm clock rings. I roll out of bed, and the cycle starts all over again…
O.R. nursing isn’t for the weak.
Our days start early and often end late. We’re constantly short-staffed, yet we’re still expected to get cases into and out of the operating room doors as efficiently and quickly as possible. We bear the brunt of a surgeon’s frustrations and we’re the ones that are getting yelled at, even when we’ve done nothing wrong. We’re still the ones that take the heat. And when an emergency arises, it doesn’t matter if we’re finally getting a break, we’re running to go help. We’re in that O.R. right alongside everyone else, helping take care of the patient, because we all want to see our patients have a good outcome.
So, no, Sen. Walsh, nurses don’t play cards. We aren’t laying around our units, biding our time until it’s time to leave. We’re really, really busy. We’re expected to provide error-free care, meeting the needs of our patients and fulfilling all of the job requirements that sometimes burden us down, every. single. shift. Even though we’re tired, we’re hungry, and our feet ache from being on them all day long.
We rise to the challenge, and we meet those expectations. We exceed them, more often than not. Because nursing is our passion. Caring for patients is our mission in life. And we’re not going to skip out on that for a game of cards.
And when the day comes that you need an operation, those nurses are going to give you their very best as well.
Melanie
This is only a small slice of what an O.R. day might look like. With trauma cases, emergency add-ons, and other emergencies, things can change very quickly. One of the benefits – and challenges – of the operating room is that every specialty requires a unique knowledge base and skill set. So while our days in the O.R. might look different, we’re all focused on one goal – to provide the best care we can for our patients.