Monica is a Advanced Practice Certified Registered Nurse First Assistant (CRNFA) and one of the lead scrub nurses on one of the prestigious Trauma Resuscitation Unit (TRU) teams at the R Cowley Adams Shock Trauma Center in Baltimore, Maryland.
Monica grew up in the Bay Area and attended Duke University where she obtained her BSN, MSN (ACNP-BC), and Doctorate of Nursing Practice degrees. Monica started as a staff nurse in the Operating Room where she scrubbed on a variety of services ranging from trauma to general to vascular surgery. She credits this exposure with helping her identify where her passion in the Operating Room was. She applied and was selected to be a Lead First Assist on one of the Trauma Resuscitation Unit’s Surgical Teams at the world-renowned Shock Trauma Center. In her role, Monica scrubs in on surgery for the most critical patients who have suffered injuries from gunshot wounds to car accidents to other catastrophic disasters. Monica finds beauty in the chaos of operative resuscitation - a fine tuned symphony as she calls it when everyone knows what they need to do, how they need to do it, and in what order they need to do it with few words spoken.
Monica is greatly affected by patient outcomes and given the acuity of the cases she scrubs on, is always deeply affected when a patient doesn’t make it off the table. However, she has learned to channel her full energy towards the patient without becoming ‘sterile’ to the fact that it is always a person under the drapes with a family, friends, hopes and dreams. Monica is deeply rooted in her Christian faith as views it as a cornerstone of her work as a surgical practitioner. She views her talents in the Operating Room as merely a vehicle for His hands of healing.
What is your role on the Trauma Surgery Team? As a CRNFA, I am usually either first or second assist during the case, which means I am scrubbed-in and in the sterile field. In trauma surgery, many times we do not know exactly what the injuries are when the patient is opened so it is quite chaotic and intense. For example, if it’s a GSW to the torso, we may open the abdomen first but find that fragments have caused damage in the chest - in that instance, you end up doing a laparotomy and a thoracotomy. My job is to help control bleeding, help get self-retaining retractors to establish the field(s), and work with the surgeon(s) to identify what needs to be fixed and start helping sew. Sometimes I will be simply trying to get the exposure we need to either find or fix the injury - this can include removing ribs, cracking the sternum or manual retraction. It is not for the faint-of-heart - it is not uncommon to open an abdomen and have huge amounts of blood that has been pooling from vascular injuries pour out. In the worst of cases, I may be helping actively resuscitate the patient via external chest compressions or internal heart massage as the surgeons try to fix the underlying injury.
What is the most common misconception of an Operating Room Nurse? Unsurprisingly, it is that we just pass instruments to the surgeon - sure, there are times when everyone does that including other surgeons who may be assisting, but that is usually the role of the scrub tech. Operating Room Nursing has unfortunately been more and more limited to the “circulator” role, which is a nurse who is not in the sterile field and helps facilitate the needs of the team in the field. I have great respect for circulating nurses as they have a critical role on the team, but it was never for me - I hate to use this cliche, but I love being ‘elbows-deep’ helping to fix the patient with my hands.
