As a theatre nurse, I sometimes get the impression from others that we just pass the instruments to the surgeons. And that’s it. Full stop. Whilst we don’t provide bedside care to multiple patients, we have to ensure the best possible care we can give to our perioperative patients the minute they arrive in the Operating Theatre Suite. The job entails great attention to detail, good organisation skills and ability to handle high pressured situations.
I am Mariel. I am a Theatre Practitioner in one of the NHS General Hospitals in the UK, working as a scrub and an anaesthetic nurse. Ever since I qualified as a nurse in the Philippines, I have always worked in Theatres or should I say an Operating Room (OR). I have worked as an OR nurse for two years after graduating and finally made my way to the United Kingdom in 2009 as a Theatre Nurse. This particular field of nursing is highly specialised and I must confess, some of the things I have learnt from nursing school are not routinely applied here. But at the end of the day, I still feel fulfilled, whether it’s from properly organising an elective list or getting the surgery done for acute patients coming in the Emergency Theatre or after I have composed myself rushing to help deliver a baby during a Category 1 Caesarean Section. I must say it is a highly demanding role and within a snap, critical situations may arise.
My day starts with getting changed into my scrubs, not to get comfy but to start organising a list on whichever Theatre I am allocated. Being in a general hospital, we don’t do massive and complex cases so it might be a different story for those working in bigger Trusts. However, I am confident that the basics of theatre nursing is the same across all the hospitals.
We have to prepare the environment for the safety of our perioperative patients. Hence, we do a “cockpit” checklist to ensure all our standard devices such as diathermy, operating table, theatre lights etc are working and safe to use. As I check the operating list, I have to ensure that all the surgical sets, supplementaries and equipment needed are in place to avoid wasting time looking for instruments that are normally used in a particular procedure. We do a lot of anticipation of what the surgeon will ask for and adequate preparation can contribute to the efficiency of the running list.
Prior to starting the list, the theatre team will convene and do a preoperative briefing or popularly called “huddle” in Theatres. This gives an overview for everyone in the team to know the plan of care for each patient on the list, any critical or unexpected steps that we must prepare for as well as an opportunity to speak up for any concerns.
Every team member plays a valuable role to the success of the operation. We work interdependently with each other and being a team player is paramount to achieve our end goal, to keep the patient safe at all times. The ODP or the Anaesthetic nurse collects the patient from the holding bay and once the patient is anaesthetised and safety checks (consent, patient identity, allergies, presence of metalwork etc) has been done, the surgical team will proceed with the procedure.
As a theatre practitioner on the surgery side, I will either be a scrub or a circulating nurse. Working as a scrub warrants attention to detail to ensure that all accountable items are counted correctly. All the swabs, sharps and instruments used must not be left on the patient’s cavity. Otherwise, leaving behind anything (except for special circumstances such as packs) is a NEVER EVENT. Apart from keeping everything sterile, we anticipate what the surgeon will use that definitely eases the flow of the surgery. We are also meticulous on sterility as we hate the thought of our patients experiencing surgical infection post-operatively.
This is just a small part of the big picture that is happening in an operating theatre. Most of our patients are on general anaesthesia and it’s vital that we act as advocates for them. Are the pressure points okay? Is the position of the patient safe? Are we employing thromboprophylaxis especially for long cases? Is it safe to use the diathermy? Hence, we use checklists that also enhance the communication within the team. Instrument checklist, theatre checklists, WHO surgical safety checklist, you name it. These checklists are an absolute necessity to make sure that we don’t miss any step to keep the patient safe during surgery.
Post-operatively, after ensuring that the patient is in optimal condition to be transferred to the Recovery Room, we prepare for the next operation and ensure good time management within the team to facilitate smooth running of the list.
Working during the pandemic
The pandemic changed the way we work in Theatres. Elective lists were postponed, some of our colleagues have been redeployed to ITU and we only attended to patients needing emergency surgeries, obstetric emergencies, and cancer pathway patients. Our guidelines on Personal Protective equipment changed since Aerosol Generating Procedures (AGP) are routinely done in theatre. Safety precautions have also been stricter on the normal surgeries we used to do such as laparoscopic surgeries.
Two theatres each have been allocated for general and obstetric emergencies. One for regular emergency cases and another theatre for patients who have tested positive with Covid-19 in order to avoid cross contamination and ensure deep cleaning of theatre post-operatively. Everyone in our department was absolutely brilliant in adapting with all the changes that took place to keep all of us and our patients safe. The pandemic has been a difficult time for every department in the health sector. Nevertheless, the quality of care is still the top priority and being a theatre nurse still fulfills my satisfaction as I’m able to help our perioperative patients.
What are the Career pathways of a Theatre Nurse?
Theatre offers a great opportunity to work across different specialities. You can work in General, ENT, Orthopaedics, Urology, Ophthalmology, Gynaecology, Obstetrics, Maxillo-facial and other sub-specialties that will surely test your anatomy and physiology knowledge. Other Trusts offer more advanced procedures such as robotics, cardio-thoracic and transplant surgeries. Some trusts only do elective cases but for those that offer emergency services will most likely have an Emergency Theatre and Obstetric Services.
Different areas of specialism require diverse equipment and skillset. For instance, Orthopaedic surgeries require more instruments and can be labour intensive than other surgeries. In contrast with this, Ophthalmic surgeries demand focus and speed whilst handling intricate instruments. Some operations may take 15 minutes and others for 6 hours or more which may require you to hold your pee and avoid scratching an itch. Special skills, eh? Surely, as you explore various specialities in theatre, you will find your sweet spot where you will feel passionate about.
As a registered nurse, you will start on the surgery side and will allow you to shadow senior colleagues to get a grip of the routine procedures and nursing interventions. New nurses normally start to familiarise themselves with the circulating role and build confidence with the scrub role with the support of skillful colleagues. There are lots of learning opportunities as a theatre nurse. If you want to work as an anaesthetic nurse, a course is available for experienced perioperative practitioners. Once you qualify, you can work on both surgery and anaesthetic side but will still depend on the protocols of the department.
You can also advance your career as a team leader of a particular speciality (Band 6) or to be a Band 7 as a line manager and work your way up the ladder to Band 8 (theatre matron). There are also opportunities to progress in extended roles such as Surgical First Assistant (SFA), allowing you to assist a surgeon during surgery or Advanced Surgical Practitioner, where you can perform minor procedures and carry out pre and postoperative care under supervision of a senior surgeon.
Being in theatres may not be a traditional role for nurses, but this is a varied, rewarding job that is dear to my heart. You will not be only handing a knife to the surgeon to make an incision, but you will also make a difference to the lives of surgical patients whilst working with a dynamic team. If you are looking for a unique nursing experience and curious about learning different surgical fields, then Theatre Nursing might be for you.
About the Writer:
Mariel is a theatre Practitioner in one of the NHS General Hospitals in the UK, working as a scrub and an anaesthetic nurse. She has been working in the UK for over 10 years. Mariel is also a mum to a beautiful toddler and has a great talent in photography.