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Each month, HospitalSoup.com will feature a health care professional in our monthly series: "A Day in the Life." The series aims to provide readers with a realistic view of what working as a health care professional entails, and provides an inside view and opportunity to get to know some extremely talented and dedicated health care professionals.

A Day in the Life.....
An Interview with Tammera Glenn, Operating Room Nurse Manager
Written by: Patrice Shields

Background: Tammera Glenn is a graduate of William Jewell College. After graduation in 1985 Tammera enlisted with the Air Force. As an Active Duty Air Force RN Officer Tammera spent time in San Antonio, Germany and Maine. In the Air Force Tammera went through a selective internship, working in a variety of areas within the nursing profession. In San Antonio she specialized in surgical trauma, in Germany, as a staff development officer in a multi -service unit, and in Maine coming off of active duty, she was a charge nurse. After the military, Tammera went directly to the reserves as a civilian and became an operating room nurse.

Q. What drew you to become an Operating Room/Post Anesthesia Care unit (PACU) Manager?
T.G. During my last semester in college, I worked in the Operating Room (OR), three days a week with a physician. I absolutely loved it. Since I had a lot of nursing experience from being in the military, I knew what happens to a patient before and after surgery. This helped me provide better care for patients. Since I've worked in so many different areas in the military, I became comfortable and complacent with a lot of areas in nursing. I still haven't experienced that complacent feeling in OR nursing. Working in the OR is an ongoing learning experience, and I love the challenge of it. Managing multiple departments provides for different responsibilities. As a manager, I have the best of both worlds. I oversee several departments and participate in patient care, normally at least twice a week. I enjoy working with patients, and it gives me a break from the office.

Q. Specifically, as an OR/PACU Manager, describe what you do.
T.G. On a week to week basis, one of my responsibilities is staff scheduling. Should some staff members be on vacation or otherwise absent, I have to take that into consideration when planning staffing for that particular time period. Sometimes I fill in if we are short on staff, enjoying the opportunity to do patient care. On the management side, my responsibilities are in four departments, the Operating Room, Post Anesthesia Care Unit, Sterile Processing and Anesthesiology. I help budget these areas, to ensure that we have all the necessary equipment to make these units run effectively. I also perform employee evaluations and spend time as a manager troubleshooting as needed in my respective departmental areas. Additionally, I spend time participating in many committees, and go to staff scheduling meetings to make sure things run well. At least one week out of the month is dedicated to administrative work. Paper work is plentiful! I have enough paper work to last to the year 2001. Many days, I end up taking a lot of paperwork home with me to complete.

Q. Give us an example of what a typical day on the job might be like as a staff OR nurse.
T.G. Usually, the day before, you'll know what types of surgeries are scheduled for the following day. A nurse may be assigned to be either a scrub or a circulating nurse for a procedure. The Association of Operating Room Nurses (AORN) describes the role of both scrub and circulating nurses in the following fashion. Scrub Nurse: "The scrub nurse works directly with the surgeon within the sterile field passing instruments, sponges, and other items needed during the surgical procedure. The sterile field is the area closely surrounding the OR table, and the Mayo stand, or instrument tray. Surgical team members who work within the sterile field have scrubbed their hands and arms with special disinfecting soap and wear surgical gowns, caps, eyewear, gloves, and shoe covers. " Circulating Nurse: "The circulating nurse's duties are performed outside the sterile field. The circulating nurse is responsible for managing the nursing care within the OR. The circulating nurse observes the surgical team from a broad perspective and assists the team to create and maintain a safe, comfortable environment for your surgery. The circulating nurse makes sure each member of the surgical team performs in a united effort."

Before entering the surgery or pre-op areas, nurses put on scrubs, talk to the patient, answer any final questions that they may have prior to surgery, and make sure that the patient understands the procedure and has signed all the appropriate consent forms. The nurse also reviews the patient's chart, and finalizes preparations for the patient's surgery. Sometimes a patient will have a tongue ring or item that's been overlooked and needs to be taken out. As perioperative nurses, we have to be certain that the patient does not have anything on which could possibly interfere with the success of their surgery. We also have to be aware of all the state laws, rules, and regulations of hospitals, and those rules change frequently.

After all this, we take the patient into the surgery room, help put them to sleep, position them according to the surgery performed and prep the patient. Once surgery is done, the patient is taken to the Post Anesthesia Care Unit (PACU) Nurse where they will begin their post operative recovery. Then, we finish charting and finally, start the process all over again with another patient. In the middle of our normal surgical routines, we could have a trauma, which would change our whole assignment quickly. There is a high amount of stress in the Operating Room. The patient's life is in the hands of the surgeon and surgical team. It's important to be flexible and to understand that in the OR, we are all really there to provide care for our patients.


Q. What type of education is necessary to prepare for a role as an OR staff nurse?
T.G. Nurses must graduate from an accredited nursing program. Programs range from two to four years in length. Entry level nursing education may be obtained through either a two year, associate degree program, a two to three year diploma program, or a four year university program. Educational components are comprised of both classroom instruction and clinical experiences that are supervised. Once the educational component is completed, in order to become licensed as a Registered Nurse one has to pass the NCLEX-RN licensing exam. At our hospital here in Lebanon, Oregon, we have training for new nurses that helps them become competent and proficient in the OR.

Q. What is the most positive aspect of your job?
T.G. Working with people. I have a great staff and they work very hard. When we have an emergency or are short staffed, employees come into my office and ask me what they can do to pitch in and help. We have a wonderful team, and I can't say enough of my staff. Furthermore, I love the area, and get a lot of joy out of being with the patients. Throughout my nursing career I've had some great experiences. I used to work a lot with pediatrics. Being able to comfort a baby or child was wonderful. I love talking with patients and making children feel better.

Q. What is the most challenging aspect of your job?
T.G. Also working with people. Physicians all have different requirements and it's a juggling act sometimes to try to meet everyone's individual needs.

Q. Are there growing opportunities for OR nurses?
T.G. Absolutely. One can decide to practice as a staff RN, or go into an area of management, education, surgical specialist, RN First Assistant, or nurse anesthetist.

Q. How about room for advancement?
T.G. Definitely. You can basically decide how far you'd like to advance your nursing career. There are many different areas of nursing and advancement opportunities are plentiful.

Q. What's the average salary for a nurse educator?
T.G. It really depends on the area one is located. Rural vs. urban impacts how high one is paid. The average starting pay for an OR nurse in a smaller community is $12 to $13 an hour, yet other hospitals can pay up to $20 an hour. The overall average for an OR nurse is $16 to $17 an hour. For the management side, it really depends on level. A nurse manager makes an average of $50,000 a year. Our salary can go up to $80,000 to $90,000 depending on how large the hospital system, and the number of staff one supervises.

Q. What types of changes in nursing have taken place since you started?
T.G. There have been changes in technology that has made it a lot easier on the patient's recovery following surgery. Salaries have improved. Since 1990, pay has increased by 47%. There is a shortage of nurses now and the boundaries of nursing responsibilities have increased. I think that nurses are being hired without enough education and experience because of this shortage. The advancement in technology has made it easier on patients but more difficult on health care professionals. Nurses and physicians must continually broaden their scope of knowledge due to new advancements. Laproscopic surgery has helped patients shorten their recovery time. Patients are having their gallbladders removed and leaving for home the same day. Surgery cases may be more complicated. For one case of surgery, there is a table full of instruments and monitors. This is just for one case. Each case generally has a different set of instruments and monitors, so there is a broad base of knowledge that one must have to work in the perioperative environment. Furthermore, in the OR, we have representatives continually teaching new procedures and we must learn new equipment as it is introduced.

Q. What would you tell someone who was interested in becoming a nurse educator?
T.G. Talk to people. Come see it, watch the process. Understand that coming to the OR as a career, means being on call. There are times when I have been called in at nine thirty at night, gotten home at one o'clock in the morning and been called again at five o'clock a.m. on the next day. Although it can be tiring, you understand that you must be available to provide care for the patients. And that means being on call because trauma cases or emergencies happen 24 hours a day. Additionally, I'd recommend that someone who is interested in perioperative nursing take a lot of classes, and obtain the best training that they can, and preferably shadow (which means to follow and observe someone as they work on the job) an OR staff nurse who is passionate about the job.

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For more information about perioperative nursing visit the AORN web site. AORN is the professional organization of perioperative registered nurses whose mission is to promote quality patient care by providing its members with education, standards, services, and representation.

This concludes HospitalSoup.com's interview with Tammera Glenn, RN, BSN, CNOR. HospitalSoup would like to thank Tammera for contributing her time, knowledge and experience for this article!

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