My Specialty

Same Day Surgery, Karla Marshall, Huntington Hospital

Bridging the gap between ambulatory and extended stay surgical care

Please share the story of your nursing career.

My healthcare career began in June 1980, as a nurse’s aide on a neurosurgical thoracic unit. At the same time, I pursued my nursing education. Upon graduation, I worked in the cath lab for 22 years and neonatal for three years. In addition, I served as a nurse educator, conducting new grad training and new employee orientation. Although I enjoyed helping new nurses, I missed working directly with patients, so I began my current position in same day surgery.

What attracted you to same day surgery?

Since cath lab patients went to same day surgery on a regular basis, I already knew quite a few of the same day surgery staff and had grown to respect them and the unit. Also, I felt my prior nursing experience would help me be effective in this environment. Working directly with patients and seeing them through the entire surgical process, from intake to post-op and discharge, is extremely rewarding.

What happens in your same day surgery center?

We admit patients undergoing a variety of surgical procedures, which may include joint replacements, vascular surgeries, open heart surgeries, cholecystectomies, gastric bypass, bronchoscopies and many more.  It is important to understand that we are not an ambulatory surgical center. We offer coordinated pre- and post-operative care for both same day and extended stay procedures.

As is common practice today, many patients are sent home on the same day they have their surgical procedures. These same procedures used to require multiple days of inpatient recovery. However, patients who have more complex operations may need to stay in the hospital until they have recovered enough to be discharged.

Our patient population’s ages range from 1-month-olds to centenarians. Our hospital contracts with Shriners Hospitals for Children, which allows us to help serve pediatric patients, many of whom are from outside the United States, for congenital medical issues such as cleft lip or palate and orthopedic interventions for scoliosis or osteogenesis imperfecta.  We admit these children through our pre-op testing area, where they meet with an anesthesiologist and a nurse for preparation and education. After their surgery, they transfer to the pediatricunit for further care.

Nursing Education

Over the course of your day, what are you personally responsible for as a staff nurse?

My day starts with admissions. The recovery room becomes active when the first procedures are completed. Some of my responsibilities include admission assessments; IV starts on both my patients and coworkers’ patients who have challenging IV insertions; patient and family member education; and anything else that arises during the care of our patients.

What skill sets does a nurse need for same day surgery?

It is extremely helpful for same day surgery nurses to have experience in a medical/surgical or similar environment. Our staff nurses have come from the cath lab, education, endoscopy, med/surg floors, emergency room and maternity units. The stellar reputation our unit has as a friendly, healthy work environment where everyone gets the support they need is what attracts nurses from all over the hospital.  Same day surgery’s camaraderie is phenomenal. We are truly a family! Everyone works equally hard. Each of us has many opportunities to use our skills and provide top-notch patient care in a wonderful, team-oriented environment.

Karla Marshall is inspired by the work of her grandmother, who was also a nurse.
A photograph of her grandmother in full nursing uniform hangs in Karla’s home.

You’ve been on this unit for eight years. What’s changed in that time?

We’ve seen more ambulatory care centers being built across our country to serve patients whose surgeries should not require overnight hospital care. Our same day surgery unit differs from ambulatory care centers in that our patients’ surgeries require more complex interventions.  Computer systems and electronic health records have changed medical documentation throughout our hospital.

Our EHR is Cerner, and I’m a superuser, which requires me to be available to my coworkers when questions arise. Due to Cerner, we use very little paper now. Other changes include robotic surgery and lasers. Similar to how computer systems and EHRs have helped us better serve our patients, the use of robotics results in decreased recovery times due to less-invasive techniques.

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With access to Internet information, patients have become much more informed. This keeps us on our toes to be able to answer our patients’ questions. In addition, we are able to research any questions we cannot answer with our prior knowledge. Since medicine is extremely dynamic, we are always watching to see how we can improve our unit.

Do you see any negative sides to people being sent home more quickly?

Everyone reacts differently to surgery. Reactions can include pain levels, post-op bleeding and the inability to void. All these and others can cause issues when the patient leaves the hospital.  With this in mind, we advocate for any patient we feel may need to spend a night in the hospital to recover. We have a 24-hour hold unit for this purpose.

Even with insurance companies encouraging us to send patients home, we can usually make a strong case for holding a patient we feel is not stable enough to leave the hospital. Due to the stress surgery has on a patient and their loved ones, there are also cases where patients do not understand and absorb our discharge instructions even though those instructions are comprehensive and user-friendly. To overcome this possibility, we call every discharged patient the next morning to follow up and ensure they are doing well.

Do you have plans for any next steps in your career?

Even though I recently turned 65 years old, I don’t plan to retire any time soon because I love what I do. I cannot put enough value on the opportunity I have to learn something new every day. An example of these learning opportunities happened recently. I had a patient with a diagnosis I hadn’t heard about in many years, so I spent time at home that night researching the diagnosis. This is something I do quite often. After all, new medications and procedures are frequently developed.

Beyond that, I enjoy nurturing and supporting nurses who have less experience and seeing them grow in their abilities. Being part of a unit that respects me, my experience and my skills means so much to me. I love our patients, doctors, ancillary staff and the other nurses with whom I have the honor of working. I can honestly say I’m totally thrilled with what I do and have no doubt nursing is my calling.

Throughout my career I’ve been inspired, encouraged and mentored by many, from my grandmother to my current manager. My grandmother was a nurse, and I actually have a beautiful picture of her in full nursing uniform hanging in my living room. It’s a constant reminder of how long this career has been a necessity for serving patients throughout the world.


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.

Photographs by Christopher Grisanti.


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