Celebrating Year of the Nurse & Midwife: The Essential Roles of our Nurses

Editor’s Note: Alongside the World Health Organisation, Operation Smile is excited to celebrate 2020 as the International Year of the Nurse and Midwife. We recognise that a strong nursing and midwifery workforce is critical to the achievement of both universal health coverage and our vision of a future where health and dignity are improved through safe surgery. Currently, nurses and midwives account for nearly 50 percent of the global health workforce. However, there is a critical shortage of health workers globally, and nurses and midwives represent more than 50 percent of the current shortage. For all countries to reach U.N. Sustainable Development Goal 3 on health and well-being, the WHO estimates that the world will need an additional 9 million nurses and midwives by the year 2030. Through the platform of the International Year of the Nurse and Midwife campaign, Operation Smile seeks to inspire the future generation of nurses by highlighting the leadership, innovation and dedication to patient safety of our volunteer nurses, who have been and continue to be instrumental in the healing of hundreds of thousands of Operation Smile patients. By sharing their stories and celebrating their selflessness, creativity and compassion, we aim to contribute to the conversation on strengthening the profession so that we can work toward a healthier future for all.​

Post-anaesthesia care unit nurse Patricia Meireles tends to a young patient at an Operation Smile medical mission to Fortaleza, Brazil. Photo: Paulo Fabre.

One may not think that a medical mission site and an auto mechanic’s shop would have much – if anything at all – in common.

That is unless you’re Jeanne Kille, an Operation Smile volunteer operating room nurse.

“Growing up, my dad was an auto mechanic, so a ‘well-oiled machine’ was something our family could all relate to,” said Kille, who lives and works in Utah. “On my last medical mission, I was a Clinical Coordinator in China and I described my nurses as the grease that makes this machine of Operation Smile run – nurses are what makes this organisation run smoothly and efficiently.”

Out of the 51 volunteer positions on an Operation Smile international medical mission, 19 positions are filled by nurses. Currently, nurses represent 36% of our medical volunteers.

Operation Smile nurses are also the only medical volunteers who actively provide care for patients through every stage of the surgical process.

During patient screenings, nurses assist with comprehensive health evaluations, which determine if patients are healthy enough to receive anaesthesia and surgery. Operating room (OR) nurses manage the equipment needs of the surgeon and ensuring that sterility is never compromised. Post-anaesthesia care unit (PACU) nurses carefully monitor patients as they awake from anaesthesia before post-operative nurses tend to patients with wound care and educate their families about the healing process prior to being discharged.

Deidre Fenner, operating room nurse from Australia, at work during an Operation Smile medical mission to Cebu City, Philippines. Photo: Jörgen Hildebrandt.

Regardless of their subspecialty, Operation Smile nurses’ knowledge of paediatric principles and their diverse abilities ensure that every patient receives the exceptional care they deserve.

The pre-op and post-op nursing duties are combined into a single role, which requires physical stamina and sharp decision-making skills amid the bustling mission or care centre atmosphere.

“(Pre/post-op nurses) are adept at multi-tasking as they admit and assess new patients while monitoring those already on the ward,” said Ann Campbell, Operation Smile’s Senior Director of Medical Oversight. “They’re always using their critical thinking and assessment skills to recognise a change in the patient’s health status.”

PACU nurse Florence Mangula consults with a patient's father during an Operation Smile surgical training rotation in Ethiopia. Photo: Jörgen Hildebrandt.

In the pre-op role, nurses prepare and monitor our patients ensuring that they are physically ready for anaesthesia and surgery. They support the patient and family with information and emotional care while maintaining a time-sensitive workflow with the OR staff.

Next, OR nurses control the logistics and workflow of the operating room, often managing two surgical tables simultaneously.

“The role of an OR nurse is patient safety first,” said Bryn Frazier, a volunteer OR nurse. “We ensure that the correct procedure is to be performed on the correct patient prior to induction of anaesthesia… At the end of the case, we provide safe patient care with the anaesthesiologist as the patients wakes up from surgery.”

OR nurse Bryn Frazier (right) prepares a young patient for surgery during an Operation Smile medical mission to Tegucigalpa, Honduras. Photo: Jasmin Shah.

This is leads into the PACU, also known as the recovery room, where the patient is monitored as they return to consciousness after surgery. PACU nurses are responsible for monitoring the patient’s vital signs, assessing their airway and breathing, and must be ready in case the patient experiences any complications. They also make sure the patient is adequately hydrated and that their pain levels are controlled. As are all Operation Smile nurses, PACU nurses are trained in life support skills to respond to these potential emergency situations.

“PACU nurses play a very big role because they are the bridge between the OR staff and the paediatric (post-op) ward staff. In fact, they are the first people to see patients come into the ward before their parents see them,” said Florence Mangula, a PACU nurse from Kenya who has served on more than 30 Operation Smile missions. “The nurse then monitors the patient until they are fully awake… We also check for any bleeding or swelling from the operation site and report that to the (PACU physician).”

PACU nurse Chen Wei cares for a patient during an Operation Smile medical mission to Dafang, China. Photo: Zute Lightfoot.

Like all Operation Smile medical volunteers, our nurses are a diverse group which hails from around the world – a factor that presents communication challenges they do not face at work in their home countries.

“I have been in the OR with seven people and no one speaks the same language,” Frazier said. “Because of our commitment and knowledge, the cases run smoothly – we are all on the same page.”

Campbell added: “That’s what makes nurses great. We don’t stand around looking for someone to figure out the answer to a problem. We just link arms and jump in to get the job done.”

While the roles vary between subspecialty, the common thread between all Operation Smile nurses is their calling to serve those who need their attention and skill the most.

“We do missions in our home countries, we travel long distances to other countries, we learn new things from the other international volunteers or even the local hospital nurses and we teach new updated things to the other volunteers and local hospital nurses. It’s like a global knowledge exchange,” said Yazan AbuAlfa, a PACU nurse from Jordan. “We don’t change only the patients’ and their families’ lives, but our lives are changed too.”

PACU nurse Yazan AbuAlfa (centre) consults with a patient alongside surgeon David Chong during an Operation Smile medical mission to Tegucigalpa, Honduras. Photo: Rohanna Mertens.