Extreme Nursing: Kalispell Edition

Day in and day out in operating rooms at the Medical Center, professionals put heroism on display

The Daily Inter Lake

Imagine holding a slush-covered human heart in place with your hand for as long as an hour while a cardiac surgeon operates.

Try standing for 12 hours straight while a neurosurgeon completes a complicated brain surgery. Could you select the right instrument out of 3,000 for a spine surgery?

Janet Palo, Margaret Morris and other perioperative nurses accomplish those feats day in and day out behind the red line in the operating room at Kalispell Regional Medical Center.

In spite of the physical demands, Palo and Morris love their work.

"When I went into nursing school, this was all I ever wanted to do," Palo said.

Morris found her calling in the operating room after a tour of duty as an intensive-care nurse. Morris and Palo say they thrive on the adrenaline rush when a life depends on the surgery team functioning at the top of its game.

They say the rewards outweigh the long and often unpredictable hours.

"Most of the time, you're fixing people," Morris said.

No case was more memorable or dramatic than the day the operating room doors flew open with Olympic medalist Bill Johnson on the gurney. He had suffered a horrific head injury while attempting a career come-back on Big Mountain.

Karen Lee, director of surgical services, recalled the call coming into the O.R.

"Dr. [Rob] Hollis said he was probably going to have to open his head," she said.

Lee said that procedure requires a complicated and typically time-consuming set-up. But the team had the room ready in record time under the glare of national media attention.

"When ALERT landed, it was like poetry in motion," she said.

She has no doubt that the competency of the physician and operating-room crew pulled Johnson through. Lee said she has never worked with a better crew than that at Kalispell Regional Medical Center.

She said the team functions like a family, including occasional spats. Perioperative nurses provide constant feedback and reinforcement for one another.

"A lot of nurses need that response from patients," Lee said. "O.R. nurses never get that. They get that from each other."

"Perioperative" covers scrub nurses and circulating nurses. A scrub nurse selects and handles instruments and supplies, while the circulator manages the overall nursing care in the operating room.

"A circulator is like the O.R. mom," Morris said. "She's the patient's advocate."

Palo, a circulator and scrub nurse, takes pains to put the often frightened patients at ease as they prepare to go to sleep for surgery. She said she tells them that the team will take good care of them and they will see her face first thing when they wake up.

"I always tell them [that] I know that's scary," she said with a laugh.

Palo and Morris spent years attaining a level of proficiency that allows them to assist surgeons perform at least 30 procedures. They maintain preference cards to accommodate individual differences, such those of the two neurosurgeons.

"Dr. Hollis does some things one way while Dr. [Douglas] Griffith does them another," Morris said.

With a shortage of nurses in general and preoperative nurses in particular, Kalispell Regional Medical Center created an in-house training program to fill the gap expected to widen as the work force ages.

Sharon Morris, O.R. manager, said the average age of perioperative nurses at the medical center is 46, and even older nationwide. As an incentive for new recruits, the training program offers a year of paid training.

"We like to have a graduate nurse with at least a year on med-surg, ICU or ER," Lee said. "But if they don't have it, it's not a deal breaker."

A selection committee looks for candidates who can take criticism and stress without crying or whining. They must be assertive, yet fit in with the rest of the operating-room crew.

Then there's the stand test. Morris said surgeries often require hours of standing, sometimes wearing a lead apron.

"I've done 12-hour head traumas," Palo said. "I've worked at the hospital for 27 years and this [O.R.] is the most physically demanding."

Lee said the training takes a year. Nurses selected for the program spend full-time learning with the guarantee of a job at the end of the 12 months.

Nursing jobs pay from $18.77 to $27.22 an hour, depending on years of experience. They also receive $4 an hour for time spent on-call, just for carrying a beeper.

Even after a year, a new perioperative nurse continues climbing the learning curve to proficiency. Lee said a year brings them only up to rookie status.

Morris said the medical center has a goal of training nurses for smaller areas of Montana.

"We trained two nurses for North Valley [Hospital]," she said.

With a finite number of perioperative professionals, the nurses said the hospital must train people for the operating room. Morris says that she can't pull a floor nurse into the O.R.

Lee judges the hospital's program for perioperative nurses an unqualified success.

"Our future, and the future of this hospital, depends on the competence behind the red line," Lee said.

Reporter Candace Chase may be reached at 758-4436 or by e-mail at cchase@dailyinterlake.com.