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What do I do as a Surgery Center/PACU Nurse in Fertility Care?

Nurses' week 2019 is officially over! And I still find it crazy that it's been almost two years since becoming an official registered nurse.

My thoughts on being a nurse...

Sometimes, I don't feel like I am a real nurse. Anyone else feel that imposter syndrome?? 🙋🏻‍♀️ I think a big part of why I feel this way is because I work in a very specialized field.. I work in fertility care in the surgery center. I don't work in a big name hospital on the floor, so I often times can't relate to the 12 hour shifts (although I have been working 10 hour days at work lately with barely a lunch break 😅). But I realized what I do really does matter to my patients. Working in fertility care is interesting. A good amount of our clientele pay thousands of dollars out of pocket to achieve their goal of pregnancy. This can be seen as a privilege. Those with money and difficulty naturally conceiving get to wave their credit cards and go through cycle after cycle to get pregnancy. On the other end of the spectrum, young women who have been diagnosed with cancer have the chance to undergo fertility preservation so that they can undergo cancer treatment without risking the quality of their oocytes. This is HUGE. This way, women diagnosed with cancer are able to take control of their fertility and make their own reproductive decisions. Fertility preservation as an option for cancer patients can often be rejected by health insurances (BS to me), but through nonprofit organizations (ex. Chick Mission, a few docs I work with are medical officers for the organization), fertility treatments can be fully funded for! How awesome is that!

What is my role as a nurse in a fertility center?

>>In the surgery center, I see the patients after their 10ish days (plus or minus a few days) of fertility treatments which include daily subcutaneous hormone injections. By the time I see them in the surgery center, their ovaries are highly stimulated and have several follicles that contain oocytes (what we want to retrieve through the surgical procedure!).

>>I am usually admitting and recovering patients before and after the egg retrieval procedure. These patients come in, are often very nervous (both about the procedure itself and the outcomes -- we are all hoping for a good number of eggs, and HIGH QUALITY!). I get them to change into a gown, get them nice and comfortable into the stretcher with a warm blanket (yes, we have a warmer just to warm blankets and IV fluids like lactated ringers and normal saline). I get a good baseline vital sign reading and ask them a few questions like past surgeries, problems w/ anesthesia, last time they ate and drank, etc. Then, together, we go over some next steps and review the consent one more time that they filled out with the docs. And we go over discharge information so that they hear all of this information before they get put under the effects of anesthesia. The anesthesiologist comes in and does their part with more questions and signing of papers, and they place in the IV and hook them up to some warm fluids.

>>Once the doc is ready for her, I'll take the patient to use the bathroom one last time (an empty bladder helps visualize the ovaries better) and walk her into the operating room. Her partner who is producing a fresh sperm sample that same day will go back into the waiting room where an embryologist will later call into a room where they'll go and "do their thing." And by that, I mean..yes, masturbation.

Back to my territory, I can sometimes be found in the operating room as the circulating or scrub nurse. If I am in the operating room, I would settle the patient into the operating table, anesthesiologist will administer the anesthetic (if you're familiar with colonoscopies, the drugs administered are really similar! -- our clinic mainly uses propofol, fentanyl, zofran, ancef (or other antibiotics if indicated) and toradol (or other pain medication if indicated)). We get the patient's legs to go into the leg holders, and then I do my part and wipe down the patient's vulva with some cleansing solution. The patient's vaginal canal and cervix also gets cleansed with sterile lactated ringer solution. I would be accompanied by the surgical tech who gets gowned up and dons sterile gloves. Yes, this is a sterile procedure! We're working with really delicate material here! As for me, I can just wear clean gloves. We all wear bouffants and a mask. I call the time out (stating patient name, DOB, any allergies, the procedure being performed, the surgeon performing the procedure, the antibiotic that was given prior to procedure, and call time when procedure starts). There's also a lot of documentation of other things that I won't go into depth here. One of the most nerve wracking things about I do in the OR is when the surgical tech passes me the test tube that is filled with the follicular fluid and I have to pass it over a few feet to the embryologist. I get so nervous because that one test tube could literally contain the highest quality of eggs that that couple desperately desires! Their future child could be in the test tube I am in charge of grabbing from one set of hands to the next! Maybe I'm a dork, but I am always amazed by it all -- science is kewl.

>> Once the procedure ends, the patient gets transferred back onto the stretcher and rolled back into the PACU (post anesthesia care unit). The OR needs to get cleansed with hydrogen peroxide wipes, the floor wiped down, all surfaces wiped down, etc. You get the deal. Things need to be clean for the next patient, we only have one OR! The surgical tech manages the sterilization of various instruments that are essential for an egg retrieval.

((side note: there are other procedures besides egg retrievals that go on! the docs can also perform hysteroscopies to visualize inside the uterus and perform biopsies...and sometimes dilatation and curettage (D&C) procedures are performed for women who have missed abortions 😞))

>> In the PACU, my role would be to recover the patient, get vital sign sets every 15 minutes and make sure she wakes up fine. I would assess her pain level and can administer some pain medication if needed (oral tylenol, IV tylenol, oxycodone if really necessary) based on standing orders. The anesthesiologist is also nearby in case we need them for anything.

>> Once the patient is a little more awake, I'll see if her partner is done with his contribution (sperm sample) and can bring him back to keep the patient company as she recovers (for about 45 minutes). At my clinic, I take vital signs every 15 minutes, always assessing pain level. Based on their pain level, I could administer the analgesics that are standing orders -- oral extra strength tylenol, IV tylenol, oral oxycodone... Assessment, assessment, assessment! We want to make sure she is not in excruciating pain and can urinate before she leaves us. We also call the patients the next day for a follow up phone call to make sure they are recovering well. Nurses communicate closely with the docs if there is anything alarming in their recovery process.

Welp, that's essentially what I do in a nut shell! Pretty fascinating medicine. Do you know anyone who has undergone fertility treatment? Or works in infertility?

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