My Specialty

Director of Perioperative, Infusion and Specialty Services, Bonita Aceto, Redlands Community Hospital

Caring for surgical patients at their most vulnerable

Please describe the trajectory of your nursing career.

I’ve been a nurse for 30 years — I received my ADN and became an RN in 1989. I came to nursing with eight years as an OR scrub tech under my belt. After graduating from nursing school and becoming licensed, I came to Redlands Community Hospital (RCH), where I’ve worked ever since.  In 1997, I earned a bachelor’s degree in business.

At that time, I was being mentored by a director who was having me learn the business of healthcare so I would be able to examine contracts and take on other aspects of the nonclinical side. I learned even more while serving as department educator and manager. I then earned my RNFA in 2000, my BSN in 2012 and my MSN in nurse management and organizational leadership in 2014.

Did being an OR tech inspire you to become a nurse?

Back when I was an OR tech, there were fewer requirements and restrictions on doing that kind of work without specialized training or certification. (I worked specifically in neurosurgery.) As a scrub tech, I watched the nurses. They inspired me because they knew exactly what to do and did it effectively and with great compassion.  This motivated me to go to nursing school; I wanted to be a part of that culture. I was 100 percent set on becoming an OR nurse before I even applied to nursing school.

What was it like being a novice OR nurse?

I was already comfortable in that environment, but it was a challenge to step into the RN role. At that time, it was unusual to be a new grad in the OR. There was a push by my instructors to have new nurses complete at least a year in med-surg before specializing. However, I knew I loved the OR and wanted surgery to be my career path.

RCH is one of a very few hospitals with a new grad program specifically for the OR. It’s a comprehensive program that enables novice nurses to rotate through all roles: assembling trays, wrapping and unwrapping instruments and knowing the function of each instrument and its application.  Our interns learn to “scrub in” so that they clearly understand the importance of maintaining sterility and safety. The program also educates nurses on taking a holistic approach to the surgical patient.

RN Career Events

Please describe the structure and hierarchy within your OR.

We have a patient-focused team approach. RCH believes that the staff closest to the patient know best how care should be delivered. That means our OR nurses have a voice and are actively engaged in projects and initiatives to improve all aspects of their roles.  We’ve adopted a program called TeamSTEPPS [Team Strategies & Tools to Enhance Performance & Patient Safety], developed by the federal Agency for Healthcare Research and Quality (AHRQ) to improve collaboration and communication among care teams.

Nationally, poor communication has been proven to be the greatest obstacle to safe patient care, so TeamSTEPPS is designed to change that.  Nurses are the strongest advocates for the patient under anesthesia. One of the AHRQ safety tools we use is CUS, which is an acronym for “Concerned, Uncomfortable, Safety issue.” When someone broaches a concern in this way, all care providers stop and examine the concern closely.

Tell us a little about the RN first assistant role.

This is a specialized certification that allows a nurse to ligate, clamp tissue and suture, acting as an additional set of hands for the surgeon. These duties used to be performed by a second surgeon, but with the advancement of nursing practice, nurses have stepped into the role.  It takes about two years of surgeon precepting to become an RN first assistant. There is a didactic portion and then experience in the field.

What do you love the most about your specialty?

The new technology! The surgical specialty is changing rapidly, so there is no chance of having a boring day.  As technology advances, surgical procedures will continue to become less invasive. With minimally invasive surgical approaches, patients experience less pain, fewer complications and shorter hospital stays.

Surgery and radiology are increasingly partnering with artificial intelligence (AI). So, you can now look at a three-dimensional image through your surgical console as you remotely direct a robot. I see AI increasing in its use and effectiveness — that’s the future in which we find ourselves.

Do you have any concerns about the rise of technology in healthcare?

There is great risk in losing the human interaction to the world of technology. At RCH, we’ve adopted Jean Watson’s Caring Science to guide our practice and keep nurses grounded in caring. The goal is “creating a healing environment for the physical and spiritual self which respects human dignity,” which means creating a healing environment for both patients and the entire team.

Nursing Education

No technology can change the importance of the nurse-patient connection in establishing patient trust. A surgical patient has lost all autonomy and is at their most vulnerable. They need to feel they are in good hands.

How do you keep your nurses healthy, ontrack, satisfied and up to speed?

I try to stay focused on staff well-being. If an RN is stressed, their ability to make good decisions can be jeopardized. Our management team will step into the case to allow the staff member time to refocus and center themselves.  We encourage nurses to come talk to us if they feel the need. Maybe something is going on at home or at work. We will ask, “Are you okay today? Is there some way I can help?”

As a leader, it’s important to have a personal rapport with the nurses and be clued into what’s happening in their lives. Staff deserve engaged leadership and we strive to deliver it.  We also debrief on intense situations, growing team-building and critical thinking skills.

What qualities do you look for in your OR nurses?

High-level clinical skills are necessary, but you must also have passion and motivation. We support the novice new grad in learning the skills needed to excel, so I love hiring a nurse who’s enthusiastic and energetic. Through behavioral interviewing, I also assess an applicant’s ability to handle stressful situations. The OR can be a life-or-death environment and therefore a very stressful place.

OR nurses can’t be complacent — there’s no room for that in surgery. Complacency occurs when we rely on rote learning and always doing things the same way, even where better procedures and approaches are clearly available.  Nurses must enter each surgery mindfully and patient-centered. This sets the stage for successful and safe outcomes.

What are your goals and plans for the future?

Currently, I am focused on increasing our OR suites from eight to 12 rooms, providing additional opportunities for our community to receive state-of-the-art care. We are also providing expanded services such as enhanced vascular, neuro-interventional and minimally invasive surgeries. My nursing team and I are proud to have been a part of this expansion. It has been a challenge and a pleasure for me. Nurses need to be involved in construction projects, as this is where we will practice. Clinically, as a team, we’ve dedicated ourselves to providing the best care, and we succeed. That’s where I thrive.


Keith Carlson, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996 and has maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at www.nursekeith.com.


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