In charge of OR Nowlin keeps surgical services humming

Friday, March 4, 2011 9:23 PM
Journal/Sam Green
Heather Nowlin poses in an operating room at Southwest Memorial Hospital.
Journal/Sam Green
Heather Nowlin discusses a tray of parts used to determine sizes of joint replacements for patients.

In the bowels of the hospital, Heather Nowlin opens a cabinet full of tools used to drill, saw and grind human bone.

“When you start getting into orthopedic surgery, it’s more like wood shop,” she said.

Across a yellow line of reflective paint representing the point at which special clothing is required to maintain sterility, the operating room is one of the most rarely seen parts of Southwest Memorial Hospital.

Nowlin is the director of surgical services.

While television dramas portray operating rooms as centered around a small group of surgeons, the Southwest Memorial Hospital operating room features a plethora of cast members. From surgical technologists to a housekeeper, each role is crucial in preventing the exposure of the patient to outside infection.

Such shows do not give an accurate portrayal of the OR, Nowlin said.

“The focus in those shows is always on the doctors and not the rest,” she said. “You don’t see the scrub techs, you don’t see the nurses you don’t see the housekeepers, you don’t see the (central sterile technician), you don’t see everyone else behind the scenes who really keeps everything going.”

Besides six surgeons, the operating room relies on a dedicated housekeeper responsible for keeping 12,000 square feet clean, a central sterile technician to sterilize all the instruments used in an operation, anesthesiologists to sedate patients, surgical technologists (otherwise known as scrub technicians) to make sure the operation area is prepared with all the required instruments and nurses who fill a variety of roles.

Nowlin said she orchestrates the OR, attempting to keep patients, staff, doctors and administration satisfied.

“My primary focus is a team approach,” she said. “We work together to improve patient care.”

Nowlin also oversees the department budget and is in charge of keeping the operating room and staff in compliance with regulations.

“It’s a highly specialized area,” she said. “You can’t just walk in off the street. Even as a nurse, you can’t just come in here and pick up and go. It takes about a minimum of six months to get to the point where you can start to function independently. After that, it still takes probably at least a year where you feel pretty good on your own.”

A graduate of Dolores Schools, Nowlin studied athletic training at Fort Lewis College. She said she decided she wanted more contact with patients and went to nursing school at the University of Colorado.

Another challenge for Nowlin and staff is keeping up to date on changing procedures and technologies. She said she saw a report on CNN about a procedure involving the injection of radioactive isotopes into the lymph nodes of breast cancer patients which prevents the more invasive removal of tissue formerly required.

“They were talking about it as being a new procedure,” Nowlin said. “We’ve been doing it for seven or eight years now. It’s neat because we’re a small little rural hospital, but we really do a good job with keeping up with the latest technology and staying advanced.”

While many procedures used to require large incisions, newer minimally invasive procedures utilize a laparoscope, which is inserted through smaller incisions and allow surgeons to view their work on a high-definition television screen.

“Things that used to require large stem to stern incisions, we can now just make a small incision with little portholes and we can do the same thing,” she said. Laparoscopic procedures result in smaller scars and less recovery time for the patient, she said.

To make room for surgeons to maneuver their instruments, the abdomen of the patient may be inflated like a balloon with carbon dioxide.

“The challenge is that you’re actually moving backwards,” Nowlin said. “So if you want to move right, you move to the left. It’s a little bit of a challenge because it’s a different mindset.”

The high definition video viewed through the laparoscope often provides a better image than the naked eye, she said.

Nowlin said one Southwest Memorial surgeon practices a new incisionless surgery, which utilizes the body’s natural orifices.

Common procedures performed at the operating room include eye surgeries, breast biopsies, colonoscopies, trauma surgeries, orthopedic procedures for carpal tunnel treatment, cesarean sections, total joint replacements and removal of organs such as tonsils and gall bladders.

The entire environment is designed to prevent infection. Operating rooms are pressurized so that air flows out when a door is opened, preventing outside air from coming in. One operating room even features laminar flow ventilation designed to scrub the air.

Instruments used in an operation are inserted into a high-tech cleaning and sterilization machine in one room, and removed from the other side into a sterile room where they are re-packaged for the next operation.

The hardest part for OR staff, Nowlin said, is being on call all hours of the day.

“And when you get called in, you get called in,” she said. “You might be at your kid’s program. You might be at a movie, you might be at a nice family dinner. It could be Christmas, it could be Thanksgiving. It could be your child’s birthday and you have to leave. You’re expected to respond at all hours of the night and the day. And that’s what we do.”

Nowlin said the OR staff at Southwest Memorial perform approximately 2000 procedures annually — which averages out to about 5.5 per day.

“I think what’s interesting for our OR in particular,” she said. “Is that people are given the misconception that because we are a small rural hospital that we don’t have the latest technology or perhaps we’re not as skilled or better care can be given in a larger facility. That’s just simply not true.”

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