“The ladies’ shower is blocked again!” a doctor says as she goes past the theatre sister, just after morning briefing. “It seems to be happening every other week now…”
I look at the theatre sister and wonder if she has to deal with the problem. I had joined the sister and her team to see what was involved in the role of being a theatre nurse. There were twenty or so milling around the operating theatre reception at 7.30 in the morning. It was a transport strike day, so they’d just been given new information about local car parking availability – useful for those on shifts
At the briefing, the sister confirmed which operations were happening and any changes to who was in which theatre, according to the large display screen showing the detail of operating theatres, personnel, patients, and procedures. I noticed everyone was relaxed, cheerful, but with a sense of purpose.
After the briefing we split up. I went into the operating theatre with the ‘circulating nurse’– a crucial role, responsible for making sure everyone works together for the benefit of someone undergoing a life-critical operation, making sure the patient is managed, checked, and monitored, and everything is properly accounted for. “Hi, hi, hi – hello everyone!” she said warmly, meeting the four other members of the team in the theatre.
The theatre nursing team is the oil in the machine, making sure that despite the pressure, everything goes smoothly, that there are no issues, no unforeseen obstacles, that potentially disastrous problems are sorted. The multiple processes they follow to ensure this are set out in precise detail by specific guidelines, often based on internationally-set standards.
Counting is particularly crucial, and is the job of the scrub nurse, who is in charge of the theatre trolley. There is equipment and scores of surgical instruments laid out on it in a particular pattern, in some cases 20-30 identical items, sterilised and ready for use. Each set has to be counted and logged on a form. Swabs and syringes are opened from new packets and counted and logged too. There is an initial count, a first count, and a final count. Any mismatch between the numbers means something is unaccounted for, which cannot be allowed to happen.
Something catches my eye. An A4 ring binder with dozens of pages listing what are called ‘surgeon’s preferences’, labelled with the surgeon’s name. The file includes everything from which instruments the named surgeon uses most, and in which hands, to whether or not they like to operate in complete silence, or with music. “Some don’t like to talk at all, others like noise – they’re all different,” says the circulating nurse. “We keep the list updated.”
Then there is the five-step safety checklist that happens as the patient, once anaesthetized, is about to be brought in. Again, every step is crucial, and logged, and all to a very strict timetable. A lost minute is as unacceptable as a lost swab.
In short, the theatre nurse team is managing a defined list of risks that start with the very obvious – like the wrong patient – to more minor, but in their way just as important, ones – like the wrong lights being switched on at the wrong moment. I found myself wondering if choice of music was important too.
Once the operation is under way, everything is conducted calmly, professionally, with a quiet focus. “You’re going to ace it!” I notice the duty registrar says to the scrub nurse, who seems nervous. I concluded she was relatively new and had not been in charge of many trolleys before. She did indeed ace it. Even when the surgeon’s facemask slipped slightly and the area he had been operating on needed to be swabbed with iodine as a precaution.
“Yes it’s a lot, it’s pressure,” says another theatre nurse to me afterwards. “But every patient is different and the job is very satisfying.” It has to be. With tough training, antisocial hours, and low pay, there had to be a reason all the people around me were smiling, making jokes, enjoying their work together.
In fact, not once during that morning shift did I see any member of the team looking stressed, or uneasy, or just tired. Shifts are nine and a half hours long, with half an hour for lunch. I’d only be there for half the shift, and was already knackered. And I wasn’t multi-tasking with someone’s life in my hands.
“It’s good that you get to see patients discharged, successfully operated on,” said the theatre sister. “It makes nursing worthwhile. But the job can be tough, and it has got more complicated over the years.” So how would you sum it up in one word? I asked. “Teamwork,” she says, without hesitating. I had to agree. It’s the main thing that had struck me during the shift – how well everyone worked together.
“But you do sometimes also have to just be a general dogsbody.” I later checked in with her on the shower situation. Of course it’s not the theatre sister’s job to sort it, but she knew whose job it was and the status of the job and I realised why she’d been asked about it in the first place. It was a problem, and she’s a nurse, and that’s what they do – sort out problems. As simple as that.