A day in the life... Of a public hospital CNS/RN first surgical assistant

1 April 2013

We look at a day in the life of Sue Glover - one of the country's new Registered Nurse First Surgical Assistants working with mostly children before, during and after their heart surgery.

NAME | Sue Glover 
JOB TITLE | Clinical Nurse Specialist / Registered Nurse First Surgical Assistant, Paediatric and Congenital Cardiac Services 
LOCATION | Starship Children’s and Auckland City Hospitals, Auckland District Health Board

05.00 AM 
WAKE
Alarm usually set for 5.15am but the cat jumps on my chest at 5am so that’s my day started! Up at 5.15am, cat fed and happy, partner still snoring! Ready and out the door at 5.45am.

06.15 AM
ARRIVE AT WORK
Traffic and parking are not an issue at this time and I like to get in early and spend the journey planning my day in my head!

I have been nursing for 32 years, the last 13 years within the Greenlane cardiac theatre team and for the past three I’ve been a clinical nurse specialist / registered nurse first surgical assistant (CNS/RNFSA) for the paediatric and congenital cardiac services. My position was the first official RNFSA appointment for the Auckland District Health Board and coincided with the first intake of the RNFSA course now being offered by the University of Auckland. RNFSA is a very adaptable role and in my case covers the complete perioperative journey as I see my patients preoperatively, assist the surgeon during surgery and am also involved with their postoperative care through to discharge and clinic follow-ups. Many of our children have staged surgeries throughout their childhood and it is a great privilege to be involved with them and their families.

Before heading to my office I review and chat with our adult patient in cardiovascular intensive care (CVICU) who had a pulmonary valve replacement and pacemaker/AICD implant yesterday.
Then to my desk to complete my preop preparation for today’s case, a two-day old 2.8kg baby with Hypoplastic Left Heart Syndrome having a Stage I Norwood procedure. I add the final touches to the preop summary sheet I have devised for theatre staff, check latest blood results, weight etc and ensure the blood bank has issued bypass bloods.

07.00 AM 
MEET THE FAMILY
Head to paediatric ICU (PICU) to check the baby has been stable overnight and everything is ready to go for surgery. This is also the time to introduce myself to the parents. I explain my role in today’s surgery, what the day will involve for them and their baby plus answer any further questions they have.

The preop visit is a very important link that I’ve worked hard to establish. Being involved from pre-op to discharge and follow-up provides parents with a constant person they are comfortable with, especially at the very daunting time of handing over their precious child to a team of “strangers” in the operating room. It’s also an important link between the operating room (OR) and ward teams.

07.30 AM
BABY TO THEATRE
Time to take baby through to theatre. I give the parents further reassurance before heading into OR to begin prep for surgery. Normally, if not in theatre, I do morning ward rounds and reviews with the consultant. As the surgical fellow is actually listed to be first assistant today I hand over to him when he arrives and head to PICU to catch up with my consultant. Then another quick change of plans when she requests that I be first assistant today! So I hightail it up to CVICU to confirm that patient’s plan, make a quick stop at the paediatric ward to explain I’m now in theatre for the day and am back to OR in time to scrub and complete the prepping and draping of patient before the consultant arrives to start surgery.

2.30PM
SURGERY COMPLETE
After seven hours in the OR and a very successful surgery, baby is transferred back to PICU with chest left open and a duoderm patch secured to the wound to allow the heart to recover and swelling to subside before the sternum is wired shut and the chest closed (about one to two days post-surgery).

3.00PM
ANOTHER BABY TO REVIEW
After handing over to PICU staff and completing the paper work I head with the cardiology registrar to review a baby who was discharged four days prior but has been extremely unsettled. Clinically there are no indications for his extreme distress and the wound shows no signs of active infection so I remove the drain sutures and redress the wounds. The child settles within five minutes of having dressings done and some panadol - parents think I am a miracle worker! Arrange admission of baby for observation and spend time reassuring parents. Then it is off to follow-up other phone messages and I carry out several more wound and drain reviews then liaise with the coordinator over the weekend patient plans as I am on call.

5.00PM
WEEKEND SURGERY ALERT
Consultant calls me to do a ward round with the on call consultant for the weekend. It’s at this point I hear we will be operating tomorrow morning on a three-week-old, 2.1kg premature neonate for a hypoplastic arch repair.

6.00PM
MORE PREP
So begins again my usual preop preparation – liaise with theatre team, surgeon, anaesthesia and perfusion to confirm case. Discover there are no bypass bloods issued so resolve this with blood bank. Liaise with NICU to confirm theatre start time and fasting times and check notes to ensure all relevant documentation is present. I will introduce myself to the parents tomorrow as it has been a rather mammoth day for them and they need to spend precious time with their baby tonight.

7.00PM
OUT THE DOOR…NEARLY
Head back to finalise a few things at the desk for tomorrow’s case, check on my patients in the adult and paediatric wards and the PICU before heading out the door

8.00PM
HEAD HOME
Finally on the way home, definitely takeaway dinner tonight! Hmmm now I think about it, whatever happened to breakfast and lunch today?? And looks like my partner and the cat will be looking after themselves this weekend too…

9.00 PM
HOME
Feed cat, eat dinner, sit on the couch to rest for five minutes…Wake up a lot more than five minutes later - thank goodness for MySky and I can watch that program again some other time!!

10.30 PM
TO SLEEP
Time for bed and another day closes on my busy but very rewarding working life. Put aside the guilt about no exercise again today…and takeaways…tomorrow is another day!