Behind Restricted Doors. 9 questions with Scrub Scout Enrolled Nurse Susan

Behind Restricted Doors

Q&A with Scrub Scout Enrolled Nurse Susan

Introduction

My name is Susan and when I was 10 years old, I witnessed my mum having some form of a stroke. I dialled 911 and saw the Paramedic team resuscitate my mum back to life. It was that incident that moved me to become a healthcare professional. My parents being Vietnamese refugees and with 4 children, I had to seek a medical career that I could instantly support myself financially and contribute medical aid to the community.

After graduating high school, I was offered an athletic scholarship to play tennis for my community college of which paid for my first degree—Associate Applied Science in Surgical Technology. This degree is a vigorous, detailed 14 months program designed to provide surgeons with an allied healthcare member to help scrub surgeries.

From understanding how to maintain sterility of the surgical environment, donning and doffing PPE, learning hundreds of instruments and its functionality, executing and setting up various surgeries, comprehending the steps of each surgery, attending placements to obtain the required hours to passing the national Surgical Technologist exam before one could practise.

At the age of 19 yrs old, I was assisting surgeons of all specialities, scrub surgeries. I, then completed a Bachelors degree in Leadership Management as my goal was to get into a Masters program to become a Physician Assistant. However, I fell in love with an Australian man and uprooted my life from Kansas, America to Gold Coast, Australia.

While classified as an international nurse, it was financially impossible to pick up where I had left off nor did the Australian institutions accepted my credential as American studies are vastly different. After some more studying, I am now an International Enrolled Nurse Scrub Scout with aspirations of becoming a Registered Nurse once I gain permanent Australian residency.

What is a Scrub Scout?

A Scrub Scout or also known as a Theatre Nurse is one who works in the operative environment setting by providing specialised skills to the surgeons as well as help care for the patients through their surgical procedure. A Scrub Scout can be an Enrolled or Registered nurse, and depending on one’s credential determine the roles and responsibilities. Due to the dynamic and complex nature of the operative environment, Theatre nurses carry and execute many duties.

Describe the role of a Scrub Scout!

When people ask what I do at work, I tell them that I am the person who passes the scalpel to the surgeon, however, my role as Scrub Scout goes way more into depth. According to the Australian College of Perioperative Nurses (ACORN), a Scrub Scout need to understand the knowledge of and safely demonstrate the following:

• surgical scrubbing, gowning and gloving.
• aseptic technique and opening skills.
• name of instruments and its functionality.
• use and handling of instruments, sharps and equipment.
• countable items and carrying out the surgical count.
• surgical set-ups
• “time out”
• positioning, prepping and draping the patient in accordance with the procedure and surgeon’s preference.
• common surgical procedures to anticipate the surgeon’s next need of a surgical instrument.
• labelling of solutions.
• documentation
• discarding and handling waste and
• handing over to the recovery team about the patient and procedure.

Is there a difference between a Scrub Scout Enrolled Nurse or Registered Nurse’s scope of practise in theatre?

The scope of practice of Enrolled and Registered nurses vary from states and facilities such as public or private. An Enrolled nurse work under the supervision of a Registered nurse because RNs have more in-depth knowledge, critical thinking skills and overall a greater overview of patient’s management and assessment. This is due to the length of study between an EN and RN—An 18 months program for EN and 3 yrs for RN.

While the role of a Scrub Scout stays the same between an EN and RN, in an emergent situation, say a Code Blue or a major bleed from the procedure that requires a blood transfusion, it is in the scope of practice for the RN to assist the surgeon and anaesthesiologist via handling airways, medication and injection management.

I have been in a situation where I was scrubbing for a cardiac procedure and the patient started coding. My role was to push the table of instruments aside to make room for the team and remain sterile in case the Cardiologist needed to continue with the surgery or needed my sterile instruments to revive the patient. Can you imagine being stuck, helplessly watching everyone put all of their efforts into saving the patient? Sadly, a body bag, 3 identification name badge and patient transfer to the hospital morgue occurred at the end.

A day in the life of a Scrub Scout Enrolled Nurse!

A Scrub Scout day actually starts at the end of each shift. Once finished with the surgical list, we look at the roster for the next day to see which surgeon we will be assisting because we have to prepare, gather and organise all the “countable/consumable” items that will be needed for the operation for the next day. Every surgeon has a “preference card or book” that outline what all is needed for that particular surgical procedure, which provides immense help.

However, there is not a card for all surgeries, and if this was the case, then I would find a card that is similar to that procedure to help pull all the items that I need. The following day arrives and I get dressed in the hospital’s theatre attire. I appear at the nursing station to get my temperature check during this time of COVID-19 and look to see if I am still in the same list because this can change for various reasons such as a staff called in sick, surgery got cancelled or surgeon request for a particular scrub scout.

By this time, my other scrub scout, usually an RN arrives. We would push the trolley(s) of consumable items into the operating room and leave to Central Sterilising Department to gather our surgical instruments. We cannot pull these instruments along with the consumable items at the same time because these instruments must remain in a specific temperature and controlled environment as well as for other staff if needed in an emergency situation or procedure.

There are days where I would end up with hundreds of surgical instruments and consumable items. Once our room is organised with the right instruments, medication, patient positioning equipment and various solutions such as surgical prep, irrigation and cleansing, then I would put on a face shield mask and perform my 5 mins surgical hand wash while my Scout nurse opens the instruments and consumables, so I can prepare for the surgery. At the same time, the anaesthetic nurse would bring the patient into the room and we do our patient greetings as I am collectively organising my table.

Although, deep down inside I am slightly panicking and hoping that everything goes well. Next, I would perform a “surgical count” to ensure throughout the whole procedure that nothing gets retained in the patient. A “surgical time-out” is then performed to state that we have the correct patient, operative site, signatures, time, date, surgeon, allergies, medical history and patient consent to giving blood or resuscitation if needed. Then, the patient gets prepped, draped and the procedure begins. As I anticipate every step of the surgery, my Scout nurse dictates the operating room. If I am missing an instrument or the surgeon requests additional items, my Scout nurse runs to grab the item. The Scout nurse ensures all documentation is correct and organises the next operation. The Scout nurse is the Scrub nurse second pair of eyes and brain. Before closing the wound, myself and Scout nurse count every piece of instrument and consumable item to make sure nothing is left in the patient’s body. Appropriate signatures are documented, the patient is cleaned and either the Scout or Scrub nurse would handover to the Recovery nurse all aspects of what the theatre team have done to the patient.

The room is cleaned and turned over for the next surgery. It may look like chaos, but it is organised chaos. Every person in the operating room has a specific role. There is a lot of teamwork and communication.

What are the challenges and positives about working in the operating room as a Scrub Scout Enrolled Nurse?

Every day is different in the theatre. The operating room is dynamic and can be challenging; therefore, being flexible and adaptable to change, while remaining in a calming manner are all traits that a Scrub Scout should carry.

There is a lot of pressure for Scrub Scouts. They must have a vast knowledge of the human anatomy, surgical procedure and instruments to preempt the surgeon’s need. At the same time, Scrub Scouts maintain a sterile environment, educate medical students about sterility and ensure the surgical count is correct all of which are vital to safe and high-quality patient care.When scrubbed in, the procedure can be long and this can be tough on your body because you cannot un-scrub to use the toilet, grab a quick snack or have a break.

There are big personalities in theatre – One must take criticism as an opportunity to learn and not personally because some surgeons can be difficult. Despite the challenges, being a Scrub Scout is very rewarding. When you get a critically ill patient where the patient needs to be cut open to find the bleed and stop the patient from dying, you can visibly see the patient come back to life—It is an indescribable feeling. Essentially, you are helping the surgeon physically save a person’s life. There is a lot of collaborative efforts in the theatre environment, whether it is a bad or good situation, everyone works together to ensure the patient is safe and the operation is successful.

Any advice on how to become a Scrub Scout?

There are several ways you can be a Scrub Scout, however, do not be discouraged if some of this advice does not work! When there is a will, there is a way!

• You either need to be an EN or RN first.
• If you are a nursing student, try to have your placement in the peri-operative environment and keep in contact with some of the nurses for future reference.
• Take a peri-operative course if you are currently studying. This will show your initiative and desire to work in theatres.
• Say you want a career change from being a ward nurse, contact the NUMs from theatres to see if there are any scrub scout program that you can apply.
• There are many Scrub Scout nursing programs available throughout Australia institutions that can help you gain the certificate you need to be able to apply for a Scrub Scout position.
• Research the facility you want to work at and see what specific requirements are needed to be a Scrub Scout.
• Look into agency organisations as some have their own Scrub Scout program or buddy system to help you become a Scrub Scout.

How different is being a scrub scout in America compared to Australia?

It is very different! I thought that with my knowledge and background, I would easily pick up where I had left off. I was completely wrong. Everything from the metric system, spelling and pronunciation, medication, medical abbreviation, surgical instruments, surgical hand wash, education standards culture, people, foods and

Aussie slang is immensely different! I had to put 6 years worth of knowledge to the side. Luckily, human anatomy, sterile techniques, physiology of medication and scrubbing the surgeries are universal, so I did not have to put my focus on relearning them.I have had to learn that liquid solutions in Australia are measured in MLS and not cc, adrenaline and not epinephrine, fractures are written as # and not fx, OD means Once Daily and not right eye and my favourite difference of them all is a surgical instrument named Tendon Retriever, but it is called an Ibis in Australia!

Not knowing what an Ibis is made it difficult for me to understand what the surgeon needed that day. My first placement was in an Aged Care facility and my AIN buddy asked me to get the cordial from the fridge. I looked at her with a confused face and said what is cordial? She laughed and asked where I was from, I told her America and she said, oh well I think you call that fruit punch in America.

We both laughed. Lastly, in America, a Scrub Scout is called a Surgical Technologist and you were hired to ONLY scrub, not scout. In Australia, when hired as a Scrub Scout, everyone scrubs and scout. This is much easier on the human body.

Discuss a cool procedure or surgical instrument!

Orthopaedic is my speciality and as mentioned above, I will talk about the Tendon Retriever or also known as the Ibis and what surgery is it most commonly used in. A lunate wrist replacement is where one of the eight small carpal bones in the wrist loses its functionality due to avascular necrosis.

This is a rare disease called Kienbock and usually occur in men aged 20-40 years old. When there is no blood supply to the lunate bone, the wrist collapses. There are various ways that this can be fixed, but for this Orthopaedic surgeon whom I worked with replaced the lunate bone with a durable prosthetic.

The wrist mechanism requires several ligaments to be intact for wrist stability. In this case, a tendon retriever was used from an already made incision to grasp and pull the tendon through to the wrist rather than making a very long incision in the arm to cut out the tendon. This was where the surgeon asked for the Ibis and I frantically looked at my Scout and asked what is an Ibis?

I was shown later that day what an Ibis look like. You can see the resemblance between the two. After the procedure was complete, the surgeon said, “This patient now has a black diamond in his wrist and can use it again.”I hope you really enjoy ed reading about my Scrub Scout journey and understand what great honour it is to be able to help people at the most vulnerable stage of their lives.Are you an Aussie healthcare professional who would like to write about your area of speciality, unqiue experiences or other nursing related content then please email Jackson at thenursebreak@gmail.com to discuss further or check out the Write for TNB Info Page