Behind the theatre doors


The Lamp scrubbed up to see what perioperative nurses get up to behind those operating theatre doors, in our ongoing series on specialist nursing.

To most people outside the perioperative world, surgery is a bit of a mystery behind the closed doors of the operating theatre. It conjures up images of nurses and doctors in their scrub greens, poised over a patient with their internal organs exposed, while machines and medical instruments beep and whirr with the patient’s vital signs.

But it’s no mystery to Phyllis Davis, who is the nursing director of the operating suites at Prince of Wales and the Sydney Children’s Hospital and has worked in the field for over 21 years.

She says it’s a multi-skilled and highly disciplined specialty. ‘As a perioperative nurse, you’ve got to be able to care for an unconscious patient – they could be two-years-old or 98-years-old. You’ve got to understand the complexities of surgery, you’ve got to understand the equipment because we’re in a technological age,’ she said.

Attracted by the drama and cutting-edge technology, perioperative nursing is now one of the most popular choices for new graduates. It gets a good profile on hospital TV shows and on the news, which helps attract new recruits.

Prince of Wales allows new graduates to specialise in perioperative straight after graduation, rotating through anaesthetic, scrub and recovery nursing throughout the year.

The drama is definitely there, as accident and emergency victims can arrive at any time needing major, life-saving surgery.

But Phyllis says it’s only one facet of the job. ‘Yes, it is dramatic when you have a trauma or emergency but at the end of the day there’s always a person that we’re caring for. Sometimes we try and save a life and sometimes we can’t. But there’s always a patient there, and a family as well,’ she said.

Perioperative nurses are often accused of not getting to know their patients very well. But according to Phyllis, this is one of the myths associated with the specialty. ‘I think perioperative nurses get to know their patients in different ways. We certainly see our patients in the holding bay, so we actually do get to talk to our patients,’ she said.

She points out that perioperative nurses also have a fair amount of interaction with patients’ relatives, who are sometimes in shock to find their loved one needing life-saving surgery. ‘It is more profound in a trauma or an acute situation, where the relatives might need a lot more support.’

Surgery is, of course, an unpredictable event and there is always the potential for patients to rapidly decline for no apparent reason.

‘You do learn how to get the job done and keep it together and keep the team together for the well-being of the patient,’ says Phyllis.
While nurses must keep their cool in the operating room, debriefing is important to reflect on the sadness of losing a patient.

‘If something sad has happened, perhaps a child has died, we get together and talk and I say, we must cry for this patient and their family because the day we can’t cry for our patients is the day we’re not giving 150% care.”

Phyllis jokes that, as nursing director, she’s now in the ‘ivory tower’ of management. ‘It’s big picture stuff: managing policies, budget, and a team of operating theatre managers, meeting with staff.’ But she’s well placed to manage the team, having worked for years in the theatre herself. She’s an active member of a number of professional operating theatre groups, and is also helping Papua New Guinean nurses in Port Moresby set up their own operating theatre group. Papua New Guinea is a developing country and equipment is very basic, says Phyllis. ‘But they have an enormous thirst for knowledge – they want to do things the best they can with what they’ve got.’
Surgery is a remarkable accomplishment of modern health science, something not lost on most perioperative nurses.

‘I think it’s a fabulous specialty,’ says Phyllis. ‘There’s variety, there’s drama, you’ve got to constantly challenge yourself to keep up with procedures and equipment, you’re constantly teaching someone, you’re constantly learning and working in a team. The whole team is there for the patient.’