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Sunday, 12 June 2005
HealthCare Traveller by: Henry R. Alejo, BSN Student - SPCFI
Mood:  flirty
The healing touch of a nurse's hands lends more than just a quick overview of a patient's status. Rather, it conveys caring and comfort, especially to those who are seriously ill. In the high-tech surroundings of a critical care unit, where there are the constant bleeps and beeps of monitors and pumps, this professional's understanding and empathy can make a world of difference to patients and their families.

















In the OR: Focus on travelers in Neuro, Ortho, Peds, & CV

Thinking about practicing in the operating room (OR)? Perhaps you're an OR traveler interested in gaining experience in a new subspecialty. Whatever the case, if you're looking for a high-energy, fast-paced career that provides a multitude of opportunities, perioperative nursing is it. Minimally-invasive surgery, robotics, and the rapid rise of ambulatory surgery centers continue to transform life in the OR. But one thing hasn't changed: the need for skilled nurses to assist patients before, during, and after surgery.

Here, four traveling nurses discuss what it is like to work in some of the most popular OR subspecialties—neurology, orthopedics, pediatrics, and cardiovascular. From where to be trained, to new cutting-edge techniques, to how to put patients and families at ease, they provide insights on making the most out of a short-term assignment in the operating room.

NEUROSURGERY,
With her strong background in neurology and orthopedics, Giovanna Goodwin, BS, RN, CNOR, a mobile nurse with NovaPro Staffing, based in Tampa, Florida, frequently lands her pick of traveling contracts. "I would guess 60 to 65 percent of all procedures performed in the OR are orthopedic-especially when it comes to those scheduled after hours. But my combination of skills seems to be in demand at many hospitals. It also helps that I've been assigned at a few Level I trauma facilities," says Giovanna, who worked as a surgical technologist for 4 years before becoming an RN 8 years ago. "The fact that I can scrub and circulate is another bonus."

Traveling since 2002, she is on assignment at Mt. Clemens General Hospital in Mt. Clemens, Michigan. Still amazed at the differences in policies and procedures between facilities, she notes, "At some organizations, I work with an anesthesiologist in the room, at others, certified registered nurse anesthetists are at the table. Every surgeon, regardless of setting, approaches the condition in a distinct way. Supplies and terminology vary from region to region, as well. To be successful, travelers should learn as many different names for instruments and packaged goods as they can."

One of the biggest benefits, Giovanna explains, is the opportunity not only to encounter diverse equipment and management approaches, but also to observe new procedures and work with specialists from all over the country to improve patients' functionality and quality of life. It is not uncommon, for instance, for individuals to require surgery because of disorders or injuries affecting the brain, spinal cord, and peripheral nerves-including carpal tunnel syndrome, aneurisms, and epilepsy. In treating these conditions, Giovanna is particularly impressed with the latest technology, including the minimally invasive neuro spine procedures. "These techniques cut down on post-op pain and enable your patients to become mobile much more quickly."

Although she is often involved in complex spinal cases requiring surgery for disc problems or tumors, her most remarkable memory is when she first saw a brain during a craniotomy. "What continues to strike me is that this little object is so powerful and yet so delicate. It can be so irreversibly damaged by carelessness."

What has been her largest challenge as an OR traveler? "As a circulator, it takes time to locate the tools. Plus, there are different prepping procedures at each new facility. Usually, it takes two weeks to get used to a new assignment." She adds, "The toughest part about traveling as an OR nurse is that you have to earn the trust of your coworkers and learn to trust them. Teamwork in the OR is so imperative."

Still, Giovanna knows she's in the right place. "I absolutely want to stay in the OR. While it can be stressful at times, it is very exciting. With all the innovations and new techniques, there is still so much to learn."

ORTHOPEDICS
Catherine (Cathy) Kranske, BSN, RN, a traveler with Cirrus Medical Staffing, located in Charlotte, North Carolina, practiced general OR nursing for 4 years at a Level II trauma hospital before working in the office of an orthopedic surgeon in her hometown, Chatanooga, Tennessee. "He was trained in total joint replacement. I really learned a lot from him about what happens before and after the patient has the operation. It was a valued perspective that most OR nurses don't receive. In the OR setting, we don't have the opportunity to see the full continuum of care. The patient coming in needs our immediate attention and that's our focus."

An RN since 1991, Cathy eventually tired of office politics and decided 1997 was her year to hit the road. First stop: Sentara Norfolk General Hospital in Norfolk, Virginia. "It was a huge, Level I trauma facility. I was introduced to a number of procedures that I had never seen before, from dilation and curettage to sex-change operations. This institution provided a solid learning experience for me in orthopedics, which—in addition to joints—involves treatment of musculoskeletal disorders affecting bones, muscles, ligaments, tendons, nerves, and skin." She states that she had the chance to work with transplant patients, as well. "I definitely increased my skills and abilities while there."

Further assignments in Wilmington, North Carolina; Newton, Massachusetts; and Brandon, Florida, only strengthened her confidence. "I gained experience in neurosurgery and large urology procedures at Fletcher Allen Hospital in Burlington, Vermont." Recently finishing her third assignment there, she is currently en route to Presque Isle, Maine, for another contract.

Cathy says other benefits to the mobile lifestyle include working in different sized ORs, with specialized patient populations, and with renowned surgeons. "Every facility does things a bit differently. With operating rooms becoming more high-tech, and a number of institutions providing team-oriented specialized services, I look forward to learning new approaches and equipment. I've gained experience in pediatrics and plastic surgery, as well. At one assignment, I even worked with a surgeon who founded a procedure to correct sunken breastbones laparoscopically.

"While I am capable of working on all types of operations and enjoy general surgery, I really like the time I've spent in orthopedics. The instrumentation used during most procedures is similar to that found in your father's workshop—hammers, nails, screws, drills, and saws." When asked about the cement used to adhere metal objects to bone, she laughs, adding, "I am sure I am not the only one who doesn't appreciate the smell of cement mixing, but it goes away pretty quickly."

Admitting she can't see herself doing anything else but OR nursing, Cathy says she chooses her assignments based primarily on locale, but size of the OR department may play a role. "I enjoy working in large teaching hospitals where there is more time to learn and experience new procedures, but smaller facilities have nice attributes, too." Her advice for others? "If you show the willingness to learn, the staff has the willingness to teach you. For instance, I circulate but was never trained to scrub in school. Thanks to traveling, I was taught how to scrub on assignment and even asked to assist on occasion, pushing my professional limits and helping me to become a more active player in the OR."

PEDIATRICS
Linda Cummins, BA, RN, CNOR, a traveler with Health Force, located in Cincinnati, Ohio, knew the OR&and pediatrics—was for her since the beginning of her nursing career 28 years ago. An LPN for 13 years, she worked in peds and spent 6 years in the OR as a scrub tech, becoming an RN in 1989. "I love taking care of people, and I love my job. In particular, I like the fact there is a beginning, a middle, and an end to OR nursing." Another catalyst was more personal. "I had kidney surgery when I was 17 and my mother had lung surgery 15 years ago for two types of lung cancer, so I know that surgery can produce miracles."

A lack of openings locally prompted her foray into traveling in 1990. She accepted her first assignment—lasting three years—at West Virginia University, often working with a renowned pediatric surgeon who specialized in scoliosis. "With children's spines, unlike those of adults, you can immediately see a difference. They can be really curved when they come in and be perfect within a few hours. It is so rewarding. In the past, these kids had to lie on rotating beds for 3 to 6 months after surgery. Now they are out so quickly."

Linda says that 15 years ago, pediatrics was considered a somewhat elite specialty not often open to mobile professionals. "But that has changed quite a bit. Many large hospitals now welcome these travelers."

Given her experience, she usually focuses on ortho-neuro and spine surgeries wherever she is assigned. "At one hospital, staff requested that I perform head of the spine service, which is unusual for a traveler. I agreed as long as I could train a permanent staff person to carry out the responsibilities when my contract ended. Five months later, the young RN I mentored was ready to take over."

Another operation with which Linda is familiar corrects gastroschesis, a rare congenital defect where an infant's intestines are outside its abdomen. But, she states, there is one commonality with any peds procedure. "While the OR is known to be cold, it gets really hot when you're caring for these patients," says Linda, noting that warming lights and warming blankets are always placed on the child.

Currently on assignment in ambulatory surgery at 6-OR Grant OSC in Columbus, Ohio, Linda accepts contracts around the Virginia-Carolinas area, as well. "My husband, who also is an RN, and I traveled together for 5 years, but he's accepted a management position in Buckhannon, West Virginia, an hour from home. I try to stay in the surrounding areas to be close to him and to my mother."

What has she learned from her travels? "Working with children requires a unique combination of technical and communication skills. Children tend to be more open than adults; they're very trusting. While they may experience separation anxiety from their parents at times, kids are extremely resilient." Part of Linda's success on the road can be attributed to developing relationships with patients' parents. "Creating a bond with family members, if only for a short period of time, is imperative. It is very hard for them to lose control of their child and to trust that I'm going to take care of their youngster the way they would." Establishing a rapport with the patients themselves is also crucial. "It's so important that children—of any age—understand the OR nurse, have the opportunity to talk with her or him without the mask, and develop that trust."

CARDIOVASCULAR
Eileen Bethel, RN, an OR traveler with Denver, Colorado-based FASTAFF, wasn't sure what she wanted to do when she became an RN in 1989. So, she answered an ad for a 6-month OR internship at Albany Medical Center, a Level I trauma facility in Albany, New York. "I knew right away that I liked it. While I was at the institution, I learned to scrub and circulate. That education gave me a great foundation."

In 1994, Eileen started traveling-mainly as a way to escape from the Northeast's harsh winters. Recalling her first assignment at St. Joseph's Hospital in Providence, Rhode Island, she comments, "It was a smaller OR so I thought it would be much less hectic. But that's not how it worked out. At a big teaching facility like Albany, you have residents and medical students who do a lot of the work. But in the smaller facilities, the circulator does everything. It was a real eye opener and kept me challenged."

After several more assignments, Eileen returned to Albany, New York, for family reasons and took a permanent position in open—heart at St. Peter's Hospital. "At that time, I didn't have much experience with hearts. But the staff thought I was strong in general OR and was willing to train me. Of course, this is not the type of education you get while you're traveling-anyone interested in working in this subspecialty must take a staff job to get the proper experience."

Training involves learning about the world's most common procedure, coronary artery bypass surgery. Approximately 500,000 patients undergo this operation each year. But the latest medical buzz is utilizing the daVinci robot to make bypass surgery minimally invasive as the surgeon directs its arms to enter the chest through several key-hole size incisions. "The procedure is performed on a beating heart, as opposed to using a heart-lung machine," explains Eileen. "It is so exciting." She reflects, "The first few times you're in open-heart surgery, it is pretty amazing. You're thinking, look, that is an actual heart. It is unbelievable."

But looking is not all you do, Eileen soon learned. "Being a heart holder is really something," she remarks, describing how the heart may need to be lifted so that the surgeon can sew on the correct side. "It is always surprising how cold a human heart is. Your fingers are always freezing, so you hope the doctor sews fast. When I first started specializing in cardiovascular procedures in the mid '90s, the hearts were kept in cold, saline slush, but now it is a little different."

In addition to the work being exhilarating, it provided an added bonus—open-heart tends to pay more than general surgery. "Heart surgeries are much more intense," comments Eileen. "The surgeons are incredibly focused, and there is a more serious atmosphere."

After a year, she took her new skills back on the road and was welcomed with open arms at Stanford University Medical Center in Stanford, California, known for its heart transplant program. Eileen states that she has considered accepting a staff position to gain experience in this area.

"I never worked on heart transplants, but I have experience with liver and kidney transplant cases at other facilities. In my travels, I've noticed that several hospitals are very happy to utilize mobile professionals' skills on any of their transplant teams." Still, she admits, "I chose the OR and traveling because I like the variety. I'm always ready to observe different procedures and experience new places."

More good news: Salaries are on the rise. According to the 2003 AORN Compensation Survey, the median OR salary for permanent staff is $50,700 per year, with annual average incomes in Alaska, Washington, Oregon, California, and Hawaii ranked the highest at nearly $61,000. The study also revealed that facilities with five or more ORs are significantly more likely to utilize travelers' services.

In addition, roles continue to expand beyond the traditional OR nursing responsibilities of scrub nurses, who pass instruments and work side by side with surgeons, and circulators, who manage the overall nursing care in the OR. Growing opportunities exist for RN First Assistants, who function more like residents by actually suturing and participating in the surgery. And newly emerging positions, including those of case managers, advanced practice nurses, and consultants make it possible to utilize surgical skills outside of the OR.

"There will always be opportunities for traveling OR nurses," predicts Giovanna. "It is such a growing field. Technology continues to become more and more complicated, with increased laparoscopies, new electro-surgeries, and GYN ablations." She concludes, "From general, to ortho-neuro, to CV and ENT, there is constant innovation."







Posted by henryalejo/thesaint at 12:01 AM EDT
Updated: Sunday, 12 June 2005 5:54 AM EDT
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