Before the
first cut

In 2017, the United Nations published the Human Develop­ment Index, which assesses the life expec­tancy, the level of edu­ca­tion, and the income of the residents in var­i­ous coun­tries. The higher these three fac­tors, the higher the index value. Norway, one of the smal­ler coun­tries in Europe, is in the top spot. Norway has been and remains a text­book example for health­care when it comes to its 5.34 mil­lion resi­dents. And this despite the country’s chal­lenging geo­graphy: The thinly settled northern sec­tion of the country needs the same quality of medi­cal care as the popu­lous region around Oslo, the capi­tal city. In addi­tion, the weather con­di­tions some­times cause difficul­ties as does the poorly developed infra­structure outside of the metro­politan areas.

Norway deals with these chal­lenges with a well-developed net­work of general practi­tioners, who are the first point of con­tact for patients with any type of symp­toms. In con­trast, hospi­tals repre­sent central hubs where patients can go for treat­ment both in acute situa­tions and for scheduled, routine opera­tions. Norway’s most impor­tant treat­ment center is the Oslo University Hospital (OUH), the largest hospital in Scan­di­navia. The OUH is an emer­gency clinic for all of eas­tern and south­ern Norway, cover­ing a large majority of Norway’s popula­tion. 

The Ortho­pedic Clinic has nine oper­at­ing rooms at Rikshospitalet where more than 150 types of surgi­cal proce­dures are per­formed using various meth­ods. The depart­ment focuses on pediat­rics, hand sur­gery, and spinal sur­gery. Nearly 30 OR nurses and assis­tants take care of the patients here and attend to the schedule of events and medi­cal tech­nol­ogy. 

Heidi Garberg is the depart­ment’s head OR nurse. She has been a nurse for over 25 years and, follow­ing stints in the army, in sterile services, and as an inter­nal auditor, she has returned to the opera­t­ing room. “In the end, a hospi­tal ward is a large logis­tics enter­prise,” says Heidi. The pre­cise plan­ning of the prep­a­ra­tions for an oper­a­tion is criti­cal. For example, every day, together with the doc­tors, she deter­mines which mobile X‑ray machine will be needed when and where. Each physi­cian has certain pref­er­ences and favorite sys­tems, she notes. “The hand sur­geons, for instance, prefer a com­pact sys­tem such as the Ziehm Solo FD,” says Heidi. When­ever pos­sible, she attempts to satisfy the surgeons’ individual preferences.

If you walk down the corri­dors that connect the indi­vid­ual oper­at­ing rooms, it quickly becomes clear how impor­tant mobile X‑ray systems are to intra­opera­tive pro­ce­dures because C‑arms are parked on both the left and the right, waiting for their next use or a pro­fes­sional cleaning. There are five sys­tems with various equip­ment available for ortho­pedic surgery alone. A cru­cial criterion is the com­pact­ness of the devices, which have to be easily maneu­verable but, at the same time, not take up too much space. 

Heidi’s col­league Trude Rosvold, an OR nurse who has manage­ment respon­si­bil­ities, gives the nursing team the sched­ule each morning. She coordi­nates the staff and equip­ment in the various operat­ing rooms and even, if neces­sary, moves the X‑ray sys­tems her­self to wherever they are currently needed. “We have numerous instru­ments and sys­tems that not only cost a great deal of money, but also have to be pre­pared according to detailed speci­fi­ca­tions. After all, an oper­a­tion starts long before the sur­geon makes the first inci­sion. For us, it starts hours earlier, when we begin the prep­a­ra­tions,” Trude explains.

For this reason, there’s a lot going on already in ortho­pedic sur­gery at seven in the morn­ing. The corri­dors are full of nurses and assis­tants, who are preparing all of the operating rooms for the pro­ce­dures. “The OR nurses are on their feet for hours every day doing hard, physi­cal labor. That’s why it’s so impor­tant to us that the C‑arms can be so easily inte­grated into our daily schedule. And we mean light in the most literal sense: We love our C‑arms because they are flexible and easily maneu­verable,” says Trude.

When the prepa­rations are finished, the OR staff run the mobile C‑arms during opera­tions. The physici­ans have to be able to rely one-hundred per­cent on the nursing staff’s know­ledge of the sys­tem, so they not only have to learn about and practice using the highly tech­nical equip­ment, they also have to be able to prove their skills.

Jorunn Hommelstad is respon­sible for the initial and advanced train­ing of the OR nurses. In her office are end­less rows of binders that hold certif­i­cates and doc­u­men­ta­tion. In order to be allowed to work with the C‑arm in the oper­at­ing room, the nurse or assis­tant must com­plete in-person as well as online train­ing to learn how to handle the equip­ment properly. In a test, Jorunn asses­ses both the results of the training and system manual know­ledge. Those who can­not answer the ques­tions must take the train­ing again. “We have also devel­oped a short summary of the best tips and tricks. Because all of the Ziehm Imaging C‑arms have the same user inter­face, the OR staff only has to be trained on one sys­tem. If you under­stand one, you under­stand them all. Of course, that makes our work much easier,” says Jorunn.

In addition to pre­paring the oper­a­tion rooms and deal­ing with the devices, the OR nurses and assis­tants are primar­ily con­tact part­ners for patients and relatives. In com­par­ison with the rest of Europe, this allows a very high ratio of OR nurses to patients in Norway. For this reason, the OR staff has more time to take care of the needs of indivi­dual patients. Espe­cially in the ward for ortho­pedic sur­gery, where oper­a­tions are per­formed on even the young­est patients, it is impor­tant to take time with the child­ren and their relatives. 

The Norwegian health­care sys­tem supports an inten­sive relation­ship bet­ween nurs­ing staff and people. Because of the national health­care sys­tem, the pressure regard­ing per­form­ance and cost is lower; there is hardly any com­pe­ti­tion among hospi­tals for patients. This allows the nurs­ing staff to invest more time in each person’s situa­tion. And that’s impor­tant to Trude as well, who has experienced many depart­ments and hospi­tals in her long career. But one thing has always stayed the same: “Being an OR nurse is a fantastic, but very demand­ing job. Our nurs­ing staff has had the best train­ing; they must not only be pre­cise, struc­tured and reliable in their work, but also physi­cally fit. In the end, we can never forget that it’s all about the people. People who are in extra­ordinary situa­tions and who are afraid. And this is exactly the ten­sion that makes our every­day work so excit­ing. It’s always differ­ent and there’s always some­thing going on.”