Perioperative ENT Nursing: Interview with Mary Anne Hattemer, RN, CNOR, CPAN

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Perioperative ENT Nursing: Interview with Mary Anne Hattemer, RN, CNOR, CPAN

Caring for hearing-impaired surgical patients

By Keith Carlson, RN, BSN
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Mary Anne Hattemer, RN, CNOR, CPAN,  Manager, Doheny OR and ICU, St. Vincent Medical Center, Los Angeles

Please share with us a little about your nursing career.   
I graduated in 1970 with a nursing diploma from St. Vincent College of Nursing. I’ve been employed there since that time, with an 11-year break to raise my four children. I met my husband at St. Vincent and he has also worked there full time since 1970 as an RN in the main OR department. St. Vincent is like our home.

Following graduation, I began in the cardiac surgery unit and also worked two years in the cardiac cath unit, returning to cardiac surgery until 1979, when I left to have my second child. In 1981, the director of the operating room offered me a job in the PACU [perioperative anesthesia care] unit, working in the Doheny OR with the House Ear Clinic physicians, Drs. William House and Howard House. It proved to be my favorite job of my nursing career. Taking a leave of absence in 1983 for the birth of my third child, I did not return until 1994, when my youngest was 6. As soon as a position was available in the Doheny operating room (where the House Ear physicians operate), I transferred back to the Doheny PACU.

As I found myself working more in the operating room, I took a course in perioperative nursing and temporarily filled in as supervisor when that position was vacated. When the opportunity arose again, I applied to become the supervisor of the Doheny OR and subsequently accepted the position of manager of the Doheny OR and ICU, where patients undergoing skull base craniotomy surgery receive care.

I recently stepped down into a lead RN position — charge nurse — so that a new manager can come onboard before I retire, allowing me to help the new manager become integrated into the position.

What do your credentials of CNOR/CPAN stand for?
CNOR is a definition, not an acronym. The Competency and Credentialing Institute [] defines CNOR certification as “the documented validation of the professional achievement of … an individual registered nurse providing care for patients before, during and after surgery.”

CNOR means that you have demonstrated the knowledge and skills that denote competency in the specialized field of perioperative nursing. CPAN stands for certified perioperative anesthesia nurse, working in the PACU (or recovery room, as it was formerly known).

What sparked your interest in ear, nose and throat nursing?

The House Ear physicians at St. Vincent are among the best in the world. I’ve been privileged to see both doctors perform surgery, and Dr. Howard House was one of the foremost doctors in stapedectomy surgery (middle ear surgery intended to improve hearing), a procedure that he continued to perform into his 80s. His brother, William House, developed new and safe ways to remove acoustic neuromas and was also a pioneer in cochlear implants.

Howard House started the House Ear Clinic so that doctors could be trained in the care of patients with hearing problems. The title of his book, For the World to Hear, clearly reflects his aspirations.

Taking care of hearing-impaired patients from all over the world is a great privilege. We have acoustic neuroma patients who do exceptionally well. We treat stapedectomy patients under local anesthesia who are then able to hear immediately while still on the table, an experience that sometimes moves us all to tears. Seeing a child with a cochlear implant who can hear and speak flawlessly is almost a miracle.

What changes have you seen in ENT care in the last few years?

Cochlear implants continue to evolve. We offer bone-anchored hearing appliances, which help single-sided deaf persons identify where sounds are coming from. The removal of acoustic neuromas without post-surgical facial nerve involvement has become the norm. In earlier days, patients frequently had significant facial paralysis following acoustic neuroma surgery and would require additional surgeries to enable their eyes to close. The psychological impact of facial paralysis is significant.

Please share with us the challenges of your specialty area.
It’s a small unit and requires the teamwork of a small group of dedicated staff and understanding doctors. Our schedule fluctuates greatly from day to day, and I’m extremely lucky to work with a great group of nurses and techs who consistently rise to the occasion.

What about your work feeds your spirit and keeps you coming back?
As I said, it’s a great privilege to work with doctors who are the best in their field. We have visiting physicians from all over the world who just come to watch the experts in action. Also, taking care of basically healthy patients and giving them a better life is incredibly rewarding.

Can you share a story about your work that illustrates what you love about it?

It’s been a number of years, but one specific instance was a high school music teacher who came in to have a stapedectomy. When the prosthesis was implanted and he was able to hear again, he burst into tears, causing everyone in the room to cry.

Another incredible case was a woman who arrived from Southeast Asia in a wheelchair. She was very weak and needed to have a very large acoustic neuroma removed. She left the hospital walking, returning to her job as a teacher shortly after returning home. Interestingly, she was a Muslim patient who received care from Jewish doctors and had her surgery at Christmas. It was a wonderful time.

What are your broader career plans?
I am planning to retire in two years, so I have no career plans other than to help a new manager love their job and this wonderful department as much as I do.

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