A Day In The Life of... A (Mature) Student ODP
Released on - 25/11/2021
Working in perioperative care can lead practitioners to roles in a wide range of environments, from clinics and lecture theatres to day surgery centres and field hospitals. At AfPP, we are passionate about sharing real-life stories that inspire practitioners to explore all options available to get the most out of their career!
Your perioperative career path can be varied, challenging and hugely rewarding. Today, we are taking a look at a day in the life of a Student ODP working in Anaesthetics and Recovery.
The below account is written by Lisa Donaldson, a mature Student ODP studying at the University of Teesside, about her day spent covering obstetrics.
06.30: My alarm interrupts another disturbing dream; I have been having a lot of these lately. At least this one didn’t involve large sections of my own bowel! On this occasion, a (usually staid) surgeon is adorned in tartan scrubs, elbow-deep in a patient and singing Bay City Rollers ‘Shang-a-Lang’ while the circulators dance along waving swabs in unison.
07.00: Leave the house (and my sad-looking Shih Tzu) and drive to work on another dark winter’s morning. I prefer commuting at these times to avoid traffic congestion, even though it will be dark again when I drive home in about 10 hours. Plus, as a bonus, I always get a parking space.
My shift doesn’t start until 8am but I like to get there early when the theatre department changing rooms are less crammed. I can get an early look at the board, see the lists and spot any procedures I haven’t seen before, or any paediatric surgeries (I’m ever conscious of the practice competencies I need to get signed off).
08:00: I’m in Anaesthetics and Recovery this month and I have a great mentor; I’ll call him V. He is always here early, and his middle name should be Oracle. What he doesn’t know, you could … well it’s not happened yet.
I’ve shadowed him for a while now and he’s a great teacher. They say “see one, do one, teach one”. But, as I’m from a non-medical background, I think "see five, do 25, teach one” is more appropriate. V lets me have a go at a bit more each time, which is great for reinforcing understanding. He is encouraging, funny, supportive and doesn’t seem to mind hundreds of questions. He sings a lot and that helps.
08:15: Find out V isn’t here. Argh. This happens quite often and is unavoidable. The team leaders do their best to re-allocate you, but at the start of the year, there are lots of students about. I am fortunate today as there’s an anaesthetic practitioner with 20 years of experience who invites me to tag along. I’ll call her P.
I am thrilled to discover P is covering obstetrics today and there are three elective Caesarean sections! We go up to the sixth floor and start preparing emergency drugs, fluids, spinal anaesthetic equipment and check the machines, circuits and emergency trollies.
After a long week my legs and feet ache like never-before - will I ever get used to this? But I’m in my element accompanying patients from the maternity ward down to theatre, sharing their excitement and calming fears with reassurance.
I watch the drugs preparation, then observe three spinal anaesthetics as I open the multiple packets aseptically. Once everything is in place and everyone is happy, I’m invited to move around to the scrub side as they prepare the skin and drape.
The surgeon asks for the WHO checklist to be passed to me.* He says, “Lisa’s in charge today, she will do the checklist.” I’m thrilled and scared in equal measure as I take the form for the first time. I’ve studied this form carefully and read Atul Gawande’s ‘The Checklist’ recently so I know how important this is for patient safety. I’m ready for the Time Out. But then someone reminds him, it’s my first day in this theatre. The checklist is taken from me. I console myself - it can only be my first time once.
09:30: I watch all three Caesarean sections, standing just feet away. What an incredible experience - the incisions, the careful separation of layers, the gushing of waters breaking, the rummaging and tugging, and the babies held aloft as cords are cut.
I must’ve got something in my eye when I saw the first baby pulled free. As they were cleaned and wrapped up snugly, it took me back to the birth of my own three daughters. I congratulated the mums and dads before watching the careful, painstaking stitching of all the layers. I’ve seen a baby girl and two baby boys born! What an absolute privilege.
Still pinching myself that I’m allowed to be here, I ask the observing medical student if he is feeling okay as he looks very pale; he admits he’s not had any breakfast but will be fine. Top tip right there - always have breakfast before theatre.
I watch the instrument and swab counts and study the form filling. I check the placentas with the scrub practitioner (I’m surprised how much smaller and grittier the placenta of a patient who smokes is). Then I help move the patients on white pat slides back onto their beds. I’m glad we practised these moving and handling skills at uni first!
The scrub practitioner’s pen drops to the floor from her back pocket and rolls to land just behind her foot. She hasn’t noticed and it’s a trip hazard, so I tell her, and say I’ll get it. I pick it up and am just inches away from placing it on the scrub table for her when I remember the sterile field. There’s an orchestra of sharp intakes of breath; I back away slowly… pen still in my hand… to relief all round.
My mentor P and I take the ladies back to recovery and start their observations. I take temperatures, record their obs and make sure the mums are as comfortable as possible. Once the spinals start wearing off, I check the levels of sensation with a cold spray.
There’s long-standing confusion regarding the overlap of skillsets between the roles of ODP and Nurses. I remember being dismayed and frustrated to read someone saying ODPs are all about the theatre equipment, technology and pharmacology, as opposed to nurses who care for the patient. Well, they couldn’t be more wrong. The patient is at the heart of everything an ODP does. The sheer variety of the ODP role, specifically caring for patients and advocating for their safety throughout their perioperative journey, is its raison d’être (reason for existing) and its joy.
13:30: Usually we have half an hour for lunch, but afternoon team briefs start at 13:30. So, when the morning list overruns lunch is a quick sandwich and a loo stop.**
This afternoon I’m working with a different mentor in our main recovery area, so I have time for a cuppa as well. There’s often a lull in recovery just after lunch as many of our 12 theatres start the afternoon lists at the same time. You never really know how long procedures will take, and recovery can be like the proverbial buses… nothing for ages and then lots at once.
Being a supernumerary student is quite blissful in this respect, as you can always find things to do to help other theatres when they need it and broaden your experience at the same time. Feeling helpful as a new student is priceless when you spend a lot of time asking questions of very busy staff and slowing them down as they teach you.
I tidy the recovery area after a patient is discharged back to the ward, and another ODP asks for some assistance in the anaesthetic room with an older patient who has dementia. The patient is very distressed and is lashing out at the staff trying to help.
When I arrive, he has pulled out his cannula and is shouting at the anaesthetist and ODP. He keeps trying to get off the bed and exposing himself in the process. This is a very complex and difficult situation.
The patient has a broken hip so the thrashing about must be excruciating and scary. He isn’t still enough to allow the anaesthetist and ODP to cannulate him. So, I sit next to him and hold his other hand. I speak gently, close to him, using a familiar version of his name and introducing myself. I try to explain calmly that the Doctor is going to try to stop his hip from hurting, and this gets his attention. He stops moving and looks straight into my eyes searching for sense. I stroke his arm and he visibly relaxes. I repeat what I said and ask him gently if he can lie back down and reassure him constantly. It works.
He’s still confused but as he lie back down, he allows me to cover him and I stroke the hair away from his eyes. His frown lines disappear - he is still looking searchingly at me - but I think he feels safe now. It gives the team the time they need to cannulate and anaesthetise him. I leave the room, reflecting on the experience and hoping we had made it less scary for him. The anaesthetist catches up with me later in recovery and says, “You were really great with that patient - you made the procedure possible - well done.”
This is one of the reasons I love working with the theatre staff at my hospital, they tell each other (and students) when they’ve done a good job. This is hugely motivating in what is often a challenging role.
16:00: I help extubate a patient who is very sleepy and slow to come round. His bed is raised to sit him up a little, but he is snoring very loudly. After checking with my mentor, we use a Guedel and I am asked to perform a jaw thrust. He has two carers sat with him from a special needs placement, and they keep shouting loudly at him to wake up. They are trying to help, but I’m very aware that they are scaring and disturbing the patients on the other side of the curtains. I politely explain this, and they stop. I maintain the jaw thrust for about 20 minutes and my arms ache, but he starts to wake up properly.
Suddenly, he is shouting and swearing, and I’m grateful his carers are here. He is a very strong young man but when his carers speak to him, he calms down quickly. This makes me realise again how every patient has very individual needs and experiences and we need to be ready for anything. ODPs need to be flexible and adaptable!
18:15: My last patient today is a 91-year-old gentleman who has undergone a bowel procedure. I sit with him in a (much quieter) recovery bay, one to one, recording his obs. My mentor remains in sight but takes a back seat.
The patient keeps waking up and asking me what time it is. After a general anaesthetic, I don’t think you’re aware that you’ve been asleep in the same way you are when you wake up in bed. It’s like the blink of an eye, not several hours later. Each time he wakes up - every few minutes - he asks me what time it is.
One of the things on our discharge criteria is a pain score of less than three. I ask him what his pain feels like on a scale of 0-10, where 0 is no pain and 10 is the worst he’s ever had. He says 10. I am shocked. Nobody has ever said 10 before! Crikey. I call my mentor over and we organise some pain relief.
While that is being prepared, he dozes off again and it makes me think about pain perception. He wakes a couple of minutes later. His face is contorting, and his eyes screw up in pain - he’s still at 10. He turns to me and says, “What time is it?” I reply with a big smile, “Sir, it’s still 6:30pm and you asked me that less than a minute ago. Have you got a hot date tonight that you can’t miss?” And now I know that a gentleman with a pain score of 10 can sometimes still giggle. It made my week.
18:50: I realise my shift ended 20 minutes ago, and head for the changing room. It’s a dark walk back to the car park and my poor, blistered feet are rebelling. I have heaps of research to do for my care study on knee replacement surgery tonight as well, but I’m smiling. I know I made a difference to my patients today, and that’s why I’ll do it all again tomorrow.
Notes from AfPP
* We advise that the WHO checklist time out is completed prior to preparing the skin and draping.
** We advise that all perioperative practitioners make full use of their contracted breaks.