In March 2020, Pennsylvania Governor Tom Wolf ordered a statewide, temporary freeze on all non-emergency surgeries in an effort to mitigate the impact of the novel coronavirus (COVID-19) pandemic.
At the University of Pennsylvania Medical Center (UPMC) in Wellsboro, Pennsylvania, OR Clinician Manager Shelia Holleran and the crew in her surgical unit found their normal routines put on the shelf for a month-and-a-half. Without their typical roster of mostly elective surgical patients – about 200 to 225 cases per month across specialties like general orthopedics, ophthalmology, and obstetrics and gynecology – Holleran and her team were asked to pivot to a new assignment.
They were put in charge of developing a process for collecting COVID-19 specimens in the temporarily shuttered surgical unit. Patients entered the hospital emergency room through a separate, outside entrance, where they were then screened in a negative-pressure room and decontamination room to avoid exposing them to the broader hospital population.
Together with staff nurses Jodi Vandergrift and Sterlynne Young, and same-day surgery nurses Melanie Pierce, Traci Wood and Timothy Mosher, Holleran’s group was tasked with cohorting symptomatic and asymptomatic patients, properly employing personal protective equipment (PPE) for those involved, and safely performing nasal swab exams on those who visited the facility.
They had to do all of it while mitigating their own risk factors and exposure to the virus, which included isolating themselves from friends and family members throughout the process. Over the course of a month and a half, the team tested patients all day, every day, working overtime on weekends, and hoping they were going to be safely isolated from the worst of things.
“It’s a close-knit, small OR,” Holleran said. “We’re all very close with each other. We work well together, and it’s a very happy place to be.”
Even so, operating under those conditions “was kind of stressful,” she said, not least of all because the test for COVID-19 involves a deeply uncomfortable insertion of a specimen collector into the patient’s nasal cavity.
“People hate it,” Holleran said. “I had one lady grabbing my hand and trying to pull my hand out, and in our pre-surgical area where we’re doing patients, we had a few refuse.”
From about April to May, the team at UPMC-Wellsboro collected specimens from 85 patients who were actively symptomatic, had been exposed to COVID-19-positive patients or had traveled to COVID-19 hotspot areas of the world. Fortunately, the small, rural, central Pennsylvania hospital didn’t see a significant number of patients sickened by the virus, and had not suffered a COVID-19-related fatality through early July 2020. Even though the suite is now open to elective surgical procedures again, Holleran is still in charge of pre-surgical specimen collections for its asymptomatic surgical patients.
“Our facility right now is not requiring surgical patients to have the test, so if they opt out, that’s OK as long as they’re not having symptoms and they pass our screening questions,” she said.
Unlike other hospitals in the country, Holleran said her staff never suffered for want of equipment to battle the pandemic, including ventilators and things necessary to create negative-pressure rooms for patients. Only one of her staff members was tested for the virus, and only because the staffer suffered from allergy symptoms and had traveled out of the area; and the staffer tested negative. Overall, Tioga County, where UPMC-Wellsboro is situated, only saw 30 COVID-19 infections and two related deaths between March and July 2020.
Despite her unfamiliarity with the virus and the fortunately relatively low risk of contracting it in her area, Holleran counts the specimen collection activity among those circumstances that have shaped her time as an OR professional.
“I had no problem doing it,” she said. “I’m a go-with-the flow, whatever-needs-to-be-done-type person. I learned a lot from it, and it definitely gave me some better experiences.”
That seems to be par for the course for a woman who began her OR career as a surgical technician and advanced her skills mostly through training while on the job. After Holleran completed her education to become a medical assistant, she was offered an opportunity to become a registered nurse. She returned again to earn her bachelor’s degree, and then a Certified Registered Nurse First Assistant (CRNFA) that allowed her to assist in surgery. Recently, Holleran was asked whether she would like to step into a leadership role because her supervisor of 20 years, who is the hospital OR director, will retire in the next four years. So once again, Holleran is preparing for a return to school to earn a master’s degree.
“The three leaders above me have always been very supportive [of my career],” Holleran said. “They’ve pushed me to go back to school when I wanted to give up. I wouldn’t have done it without them and their support.”
“It’s stressful, and many times I want to quit,” she said, “but in the medical field, information is constantly changing. Everything I know expires in five years. Continuing your education constantly is a way to keep on top of the latest and greatest.”
Persisting in her education is one of the things that Holleran has enjoyed about her OR career; so, too is the pace and variety of the job, as well as the impact it offers people who want to make a difference in the lives of others. She’s looking forward to the chance to ascend the ranks in her department, but she wouldn’t ever want to leave the surgical environment completely.
“I love everything about the OR,” she said. “I love the fact that you never have the same day twice. You get to see patients get through some of the most difficult times of their lives, and see them come out better.”
“I have no intentions of leaving the OR,” she said. “I still take calls for some of my staff members if they’re sick. Not everybody is suited for it, but if you enjoy it, it’s definitely something to stick with.”