Nurse Found Her Calling In The Operating Room

DeEtte VonEssen has spent nearly her entire career as a surgical nurse at Nebraska Medicine (University of Nebraska Medical Center), a facility that’s earned a reputation for being a trailblazer in several areas of medical treatment and research, including transplants and infectious disease.

“I’ve been in the OR (Operating Room) for 26 years. It’s an area of medicine I’ve enjoyed being a part of,” VonEssen, a Glenwood resident, stated. “In the last 26 years, we (Nebraska Medicine) have just grown exponentially as far as the kind of cases we do and the number of surgeons we have on hand.”

Over the course of her career, VonEssen has participated in thousands of surgeries in numerous areas, ranging from transplant and emergency to general and outpatient procedures.

“GYN/Urology has kind of been my niche, which is a lot of robotic cases,” she said.

In the operating room, there are two types of nurses, VonEssen noted – scrub nurses and circulating nurses. Typically, scrub nurses provide direct assistance to the surgeon during a procedure, while circulating nurses are responsible for monitoring the patient and staff and making sure the operating room remains sterile.

“There are some nurses that don’t scrub in, nor do they ever want to scrub in. I can do both because I’ve always enjoyed doing both,” VonEssen said. “I primarily circulate the room. I help set up the robot and prepare it. You’re giving supplies to the sterile field as they are needed during the procedure. You’re taking care of the patient – positioning them for the procedure and that kind of thing. “You’re kind of overseeing the whole room and doing charting on the patient. I enjoy scrubbing, too, I just don’t get to do it as much because we hire scrub techs – all they do is hand instruments to the surgeons.”

Nursing wasn’t her dream job growing up as a child in Glenwood, VonEssen admits. She loved animals and actually had interest in becoming a veterinarian. She even shadowed Dr. William Rishel at the Glenwood Veterinary Clinic for a time, but knew the profession required many years of schooling. She also remembered a conversation she had with Rishel.

“Doc Rishel asked me, ‘Why do you want to be a veterinarian?’ I told him because I love animals. He said, ‘You don’t become a veterinarian because you love animals. Being a veterinarian is more about taking care of the owners and the people than it is the animals.’ That kind of stuck with me.”

When VonEssen enrolled at the University of Iowa after graduating from Glenwood Community High School in 1988, she entered a field of study many of her friends were pursuing – business.

“I started off in business school – that seemed to be the thing everyone was doing,” she said. “I hated every class I took. It was painful.

“I thought, if I can’t take care of animals, I guess I’ll take care of people, so I went into nursing.”

Her decision to specialize as a surgical nurse came during the summer between her junior and senior years at Iowa while she was doing a 12-week internship in the OR at Nebraska Medicine – then known as UNMC.

“I loved it and they offered me a job before I left,” she said.

After starting her career at UNMC, Von Essen took a brief break from the operating room to work in public health while she and her husband Brent started a family. She enjoyed meeting the patients she encountered as a public health nurse, but missed the operating room. She eventually returned to UNMC, initially working in an outpatient clinic before returning to the “main” operating room.

It comes as no surprise to VonEssen that her hospital has been at the forefront of treatment for the COVID-19 coronavirus over the past few months. The facility and its biocontainment unit have earned national and international acclaim for treatment of infectious diseases in recent years, including care for Ebola patients in 2014. The Nebraska Biocontainment Unit was one of only three across the country selected to care for Americans evacuated from Africa with the Ebola virus. In February, the facility was among the first in the country to provide treatment to Diamond Princess cruise ship passengers who had contracted COVID-19 during a sailing from Japan to several Asian ports, including the coast of China, the country where the virus originated.

Once the pandemic was under way and the first cases of COVID-19 were confirmed in the United States, VonEssen knew the role of many employees at the hospital could change.

“Because of the biocontainment unit, we’re one of the leaders, not only in the community, but in the nation,” she said.

“Other hospitals look at Nebraska Medicine as a model.”

Elective medicial procedures have been put on hold temporarily since the COVID-19 outbreak began, but urgent and emergent surgeries are still taking place at Nebraska Medicine. VonEssen remains in the operating room, but over the past several weeks, she and other surgical nurses have been receiving training on ventilators and doing online testing in case they’re needed in treatment of COVID-19 patients. A “flex care plan” was put in place and surgical nurses were given the option of “moving to the floors” or staying in the OR.

“There for awhile, it was kind of a rollercoaster of how they were doing things,” VonEssen said. “No one saw this happening, so at first they were preparing everyone to go on to the floors, but then I think they kind of came to the realization that for someone like me - I’ve been all 26 years in the operating room - to try and do a crash course on ventilators and how to take care of very sick patients is probably not going to be the best thing for the patient, myself or anyone else.”

She said COVID-19 “has turned everyone’s world upsidedown, even in the operating room.

“We have very different types of intubation and extubation (breathing tube) techniques – things we have to do and have in place,” she said. “We had to get creative because obviously with this being a respiratory virus, intubation-extubation is a very critical time when we’re doing surgery. We actually have an intubation-extubation team – that’s what they do. They come around and do your intubation and extubations on any patient that hasn’t been tested (for COVID-19) because even though they’re not tested, you have to possibly assume they could be carrying it.”

VonEssen said coming to work means getting a daily update on the availability of PPE (Personal Protective Equipment) and regular discussion of new procedures and protocol.

She believes patients will be better served if she remains in the operating room during the pandemic, but VonEssen is prepared to assist in the COVID-19 units if a surge in the virus overwhelms the hospital.

“If it comes to a situation like New York, where all hands are needed on deck, throw me up there and I’ll do my best,” she said. “I can’t imagine what they’re going through out there (New York). There are people out there in very difficult situations.”

VonEssen added that employee forums at the hospital have included discussion about what the work environment could be like after the pandemic is over.

“How do you reopen after a pandemic? There’s no blueprint out there,” she said. “These are uncharted waters in modern time. It’s not going to be the same normal it was before.”