eryone has a preference card that is unique to their surgical approach. I make sure this is updated after each case. I check what they might need before I go into the room. I strive to be prepared for all outcomes and stay one step ahead by anticipating their needs.”
Q: How do you create a welcoming work environment, especially for new team members?
A:“ I always try to have a bubbly attitude so that new team members feel welcomed in the OR. I ask how they are doing and try to get to know them before I ask about their level of training. This builds trust and allows me to teach to their level and encourage their independence where they feel comfortable. I never want to make anyone feel anxious or overwhelmed. We love to see students who have a positive attitude and want to learn. Additionally, I always say it is not about what you say, it is about how you say it. If your words are caring and respectful, it will be better received than if you speak bluntly or rudely.”
Lethia Collins
Circulating Nurse and First Assistant at the Veterans Affairs( VA) Hospital. Retired in February 2025
Q: How did you come to a career as a circulating nurse and first assist?
A:“ I started volunteering at a hospital in New Albany, Indiana, when I was 13 years old. I loved it and naturally gravitated toward nursing. I earned my associate degree in nursing from Indiana University Southeast in 1978. With that degree, I was mostly limited to technical nursing roles. Eventually, I decided to go back to school and got my bachelor’ s degree from Spalding University in 1989. Part of the program required me to complete a research project on diabetes, and I really enjoyed that experience. I went on to earn my Master of Science in Nursing in 1997, which allowed me to become a nurse practitioner. I was certified as a first assistant in 2001.
I found my way to the OR after a local surgeon asked me to work with him, instead of staying in the Emergency Room, where I’ d begun working as a nursing assistant when I was 17. At that time, there wasn’ t any formal training to transition nurses from floor work into the OR. An experienced nurse took me under her wing, and even then, it took almost five years to feel comfortable with all the different instruments, patient positioning and preparation involved. I used to read Alexander’ s Care of the Patient in Surgery to learn everything I could about patient care in the OR.”
Q: In your experience, what team member qualities make a team member most effective in creating a safe, efficient and enjoyable work environment in the OR?
A:“ First, clear and concise communication is essential. As a circulating nurse, we receive a schedule of the surgeries and are responsible for reading patients’ charts, understanding the indication for the procedures and sharing relevant information with the rest of the team to ensure that the appropriate equipment is available. If the OR schedule changes, it is our responsibility to communicate with the front desk and relay information to everyone involved.
Second, you must be able to anticipate the surgeons’ needs, especially if the case changes during the procedure. Being familiar with the patient’ s history is necessary.
Third, it takes time, but you learn how to stay calm and focus on the patient in a crisis. It is our job to keep conversations at a minimum so that the surgeons can concentrate, while still advocating for both the patient’ s and the surgeons’ needs. Lastly, you must trust that every team member is doing their part to prioritize the patient’ s safety and well-being.”
Q: Can you describe attributes necessary to handle challenges as a team in the OR?
A:“ You must understand and follow protocol because it exists to prioritize the patient’ s safety. It is important to take ownership of your actions and to not blame others.”
Q: During your time at the VA hospital, you taught numerous medical students how to scrub, gown, glove and maintain sterility. You also generously volunteered your time outside of work to teach nursing, physician assistant and medical students skills and proper OR etiquette at Dr. Morton Kasdan’ s Surgery Skills Clinic. What inspired you to take on this teaching role, and what has it meant to you?
A:“ I have taught medical students the last nine years of my career at the VA. I embraced the opportunity to teach others because I did not have that support early on in my career. You learn from those who have gone before you. We are not born knowing how to gown and glove. Maintaining sterility is an important part of the team’ s responsibility, and I can help students learn this.
It has been so meaningful to volunteer to teach students. Being in the OR and asked to scrub and suture can be intimidating, especially with others watching. You can tell when students have attended Surgery Skills Clinics on Sundays with Dr. Morton Kasdan. He has done so much for the nursing, physician assistant and medical students in the community. It has been an honor to work with him.”
Emily Major, Sydney Herold and Chelsea Fathauer are third-year medical students at the University of Louisville School of Medicine.
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