Perioperative nursing is so complex that every member of the team portrays a valuable role. One of the reasons why I love being a Theatre nurse is the variety of roles that I can do. With the necessary training, extra qualifications and years of experience, I can be on the scrub side, in the bays of recovery, or handing a laryngoscope to the anaesthetist.
My name is Jenny, I am an ENT Theatre Sister in one of the NHS Hospitals in the UK. Wearing different hats can be challenging but at the same time I also find it very rewarding. As an Anaesthetic Nurse, I provide skilled assistance to the anaesthetist, attend cardiac arrest calls if I’m holding the bleep and most importantly, keeping the patients safe before,during and after anaesthesia induction. Take note that this is only one aspect of the wide array of responsibilities within the perioperative area.
I started to work as a recovery nurse here in the UK and I have had limitations in terms of practice as a theatre nurse . Even though I had experience with both scrub and assisting the anaesthetist in the Philippines, I can only assume the scrub or recovery role as a theatre practitioner. In the UK, anaesthetic assistance is usually carried out by the Operating Department Practitioners (ODP) who have received specialised formal training in Theatre practice. As years passed working as a recovery nurse, I asked my manager that time for further training and I was finally given the opportunity to take the anaesthetic course to become a qualified Anaesthetic Nurse. I thought it would be a breeze to perform this role as I have already worked in the theatre setting but there were still challenges that made me realise the entirety of the whole perioperative department.
My day starts with checking which list I’m allocated and then I will perform a series of safety checks before starting the list. I will start checking the anaesthetic machines and vital signs monitor to ensure that they are fully operational before using it for anaesthetic induction. The breathing machines need to be functional and any failure on checks should be addressed and rectified. Next would be my anaesthetic trolley, where all the airway equipment and adjuncts are available. Different sizes of laryngoscope, endotracheal tubes, Igels, laryngeal mask airway (LMA), guedels, nasopharyngeal airway should be present as complications in anaesthesia may arise and it can happen really quickly. I must also ensure the integrity of the equipment and ensure that they are functioning properly. We all know how precious our airway is and making sure that all the possible equipment that we may need should an airway crisis happen are readily available. Oxygenation and ventilation is our top priority.
Once I’m happy with the checks and all the equipment I may need are working and ready to be used, it’s time to look at the operating list and anticipate the possible items that will be used according to the procedure that will be performed. For instance, if I’m allocated in the Emergency Theatre and a patient will be having a Laparotomy, I will prepare for rapid sequence intubation (RSI), IV fluids, insertion of arterial line and possibly central venous catheter, bair hugger to keep the patient warm, flowtron boots for thromboprophylaxis and ensure we’ve got the emergency drugs on hand to maintain patient’s physiological homeostasis whilst under anaesthesia. In contrast, a quick turnover elective list just calls for using LMAs or Igels to deliver oxygen and ventilate the patient without intubation (provided it is appropriate for the patient). Every surgical patient has unique needs and planning of care must be based on the nature of the procedure, health status of the patient and other patient factors must be taken into consideration. Elective surgery patients, for example, usually have lower risk of complications than emergency patients as they have been appropriately fasted therefore lesser risk of aspiration; are more relaxed as they have set their minds about the surgery and have been pre assessed and optimised prior to surgery.
Surgical patients can also be so anxious prior to their operation (who wouldn’t be anyway!). I always aim to relieve their apprehension by exploring their feelings, distracting them from their negative thoughts and sometimes throwing a joke on the side to lighten the mood. The Anaesthetic Practitioner is the first person that the patient meets before surgery so it’s crucial to establish rapport and provide reassurance. I will also perform the pre-operative checks which includes counter checking patient’s identity; that he/she signed the consent form and understands the procedure that will be performed including its benefits and risks; and other important safety checks such as fasting status, presence of any metalwork, dentures, lose teeth, caps or crowns that may not be safe if we proceed.
As I’ve mentioned, anaesthetic complications may arise suddenly and time is surely not on our side when this happens. As an Anaesthetic Nurse, I have to be vigilant and serve as a second pair of eyes to the Anaesthetist. Situational awareness is paramount for this role. A patient on Igel may not ventilate properly and may need intubation, a pregnant lady for Caesarean Section on spinal anaesthesia might lose significant amount of blood during surgery and may need transfusion, a Urology patient might have an arrhythmia after a TUR syndrome. Now, do you see the logic why we need to keep all the devices ready and functional even though we don’t intend to use it for a particular list?
Once the patient is anaesthetised, I will make sure that the patient is safely positioned and pressure points have been secured with pressure relieving devices. During the operation, continuous monitoring is critical and any deviations on major indicators of cardiac, respiratory and nervous system functions should be reported to the anaesthetist. Bear in mind that anaesthesia suppresses the physiologic functions of the body. Apart from ensuring normal vitals, normothermia and thromboprophylaxis should also be given attention too. Within this stage, I also act as an advocate for patients ensuring their safety intraoperatively.
Finally, once the surgery is finished, we have to prepare the patient to be in optimal condition whatever type of anaesthetic has been induced. The goal this time is to ensure the patient will regain control of their airway reflexes and maintain stable cardiorespiratory functions for safe transfer to the Post Anaesthesia Care Unit or Recovery area.
My role also extends to helping the anaesthetist for airway management for acutely ill patients in A and E and other wards of the Trust I’m working at if I’m the anaesthetic bleep holder. It also includes transferring an intubated patient from one area of the hospital to ITU or to other specialised hospitals. In addition, I also have to perform more trolley checks such as the difficult airway trolley, cardiac arrest trolley, portable ventilator (oxylog) and paediatric trolley. They all need to be ready to use and fully stocked up at any given time.
This is only a gist of my typical day. I can vouch that as an Anaesthetic Nurse, no two days are the same. Cliche as it may be, my day is really unpredictable and very fast-paced. There will be steady days but there will also be high pressure emergency situations that require immediate intervention. Nevertheless, I find this role very satisfying and fulfilling as we work to deliver the best care in achieving a positive patient outcome no matter how difficult it may be. If you’re thinking of getting further qualification as a Theatre Nurse to become an Anaesthetic Nurse, you must possess good communication skills, prepare yourself for a lot of studying and revision, be prepared to deal with high risk cases and a compassionate attitude towards patients. Take this onboard with you and I know you will succeed to become a full-pledged Anaesthetic Nurse.