This week, we’re highlighting one of our Intraoperative Neuromonitoring (IONM) clinicians, Toree Baldwin. She discusses what led her to a career in IONM, what a typical day looks like, and how she builds surgeon relationships. She also provides valuable career advice and details a memorable moment from her job.
How long have you been an IONM clinician?
I’ve been working for SpecialtyCare since June 2020, so I’m coming up on two years now. I currently work on the Nashville team. I was a student IONM associate at the University of Michigan for three years before that.
What led you to become interested in IONM, and can you describe the path you took to become a clinician?
Funny story: I went to an engineering high school in Boulder, Colorado, which convinced me to get an undergrad degree in engineering to have a job when I graduated. Long story short, I started on a research team for the School of Kinesiology, which introduced me to the Movement Science major and the Intraoperative Neuromonitoring program at U of M.
One of my Anatomy TAs was in the program and convinced me to take the IONM introduction course the following semester. That’s the initial course you take as a sophomore, where you learn about surgical procedures, neuroanatomy, and some anesthesia/physiology/electrophysics. This course had me hooked. The material was challenging, but I was good at it, and the job offers out of this program were outstanding.
After that semester, I applied, and we moved through the program together. We dove deeper into anatomy, physiology, modalities, and had a lab course alongside classroom lectures the first few semesters. Our professor was animate about us being well-versed in IONM literature, and we were assigned multiple papers a week for group discussions during class time. We were all academically prepared, but nothing competes with stepping into the ORs and getting real-time experience.
We began in the Michigan ORs during the summer before senior year. I continued my research job three days a week and clinicals two days a week. As students working alongside a preceptor, we started our first day hands-on in the OR, placing electrodes, documenting, having conversations with anesthesia, surgeons, and residents. I remember asking many questions and felt very supported in my endeavors to learn more about the surgery and our role on the team.
Each student moved at their own pace, and the grading system allowed that. Personally, I set up goals like “get baselines and document anesthesia before the time out” or “talk to anesthesia before they get their drugs.” These were baby steps that would ultimately become part of my usual routine. This, and the feedback we received from our preceptors for each case, helped progress my skills tremendously. During the fall and winter semesters, I continued my regular major and minor classes in addition to clinicals 2-3 days a week.
The IONM program at Michigan has a career fair each year when multiple companies and hospital systems come to interview, hire, and network with our students. This is where I met with Julie Trott, the director of IONM education at SpecialtyCare, and Cheryl Wiggins, the Vice President of IONM Education and Clinical Performance. This interview stood out because it was the only one where the two interviewers were women. They were intelligent, driven, and working towards a common goal of excellent, data-driven patient care. I knew I wanted to be a part of that mission. Later that month, I visited Nashville. I fell in love with the weather and the people and accepted my offer.
What was your journey from the UofM program to SpecialtyCare like?
My transition was smooth, having graduated two months into a global pandemic. I started in the ORs alongside my manager on day one. He met me by the parking garage, walked me inside, introduced me to everyone, and we rolled the case together. Soon after that, I was assigned to a clinical instructor, Jason Seinfeld. He worked with me as I gained independence in specific case types, and the education department provided refresher materials for brushing up on the didactics. I’d been out of the OR for a few months because COVID-19 hit during my final semester of clinicals at Michigan, but I quickly gained my confidence in the Nashville ORs with Jason’s assistance and was ready to take on independence before long. We joked that I was an “SN1.5 coming in,” SNIs being the newbies, SNIIs being fully board-certified.
After achieving my board eligibility requirements, I was enrolled in SpecialtyCare’s IONM board prep (CNIM prep) and started studying. Although I didn’t go through the full traditional SpecialtyCare training program, this prep was part of my exposure to SpecialtyCare’s SNIs’ fantastic resources. I met with others studying for the CNIM and had access to practice questions, study guides, and anything you needed to succeed on the exam. I passed my exam in October and then completed a capstone project. This was a short presentation I gave via Zoom about intraoperative EEG. Afterward, I got my post-CNIM raise and was officially a board-certified salaried SNII.
How was your move from Michigan to Nashville?
I was fortunate enough to move down here with my partner and a U-Haul, courtesy of SpecialtyCare’s relocation fund. We moved down here when my graduation was supposed to occur, so it was a pretty nostalgic day.
What has it been like to build surgeon relationships?
My favorite part of my job is the relationships with the team. Our job is unique in that my co-workers, the other SNPs, aren’t the people I work with the most. We help each other out and interface a lot at the hospitals. The people I work with the most are our surgical teams and the surgeons.
I’ve learned that it’s all about the little things, whether it’s learning a surgeon’s routine to provide anesthesia with a reasonable timeline for the case, asking a surgeon how a patient is doing, responding to a change, or being able to work through it with the team sensibly. Those little things definitely add up. I’ve been able to onboard a few new surgeons and surgical teams, and that’s one of my favorite things. IONM is done differently at many places, so it’s nice to give the teams a brief overview of my role and ensure they know how to be safe around our equipment, etc.
What are the benefits of a career in IONM?
It’s not your typical 9-5, 6-3, or 7-7. Flexibility, adaptability, integrity, and hustle are built into this career. Those are characteristics that are only developed when they’re tested, and surgery does just that. I’ve grown a lot as a clinician and a teammate from this job.
What is a day in the life of an IONM clinician like?
My day technically starts the evening before when my team gets a case notification at 5 p.m., so that’s when I plan out my next day. I always prepare my breakfast, lunch, and a snack the night before to grab and go in the morning.
If my case is at 7:30 start or later, I hit the gym at 4:50 a.m. to start my day. Then, I either get ready there or swing home to walk the dog with my partner and get ready afterward, depending on my timing. I only live about 15 minutes from most of our hospitals, making my commute easy. Then, I head into whichever hospital I’m assigned to for the day, put my things down, and grab a cart to head to the main OR board.
I’ve been in the market long enough to recognize most support staff, the nurses, scrubs, anesthesiologists, and FAs. When I come in with my cart, I always say good morning and check in with familiar faces. Then, it’s time to set up the bed, my electrodes, tear tape, chat with anesthesia and the team, and meet the patient. We consent to every patient such that we both have a good understanding of what’s to come. I always tell people this is one of the essential pieces of prep that we do before a case, along with tear tape.
After consenting, I type up a patient summary to send to my neurologist so they’re on the same page. Once the patient is put to sleep, it’s game time. It’s my job to safely and effectively place electrodes in specific anatomical locations that we can then use later to assess the functioning of the patient’s somatic nervous system. Depending on the case, our team safely positions the patient and, after a little more work with the electrodes to keep them tidy and out of the way, I collect baselines.
If I have more than one case, this essentially repeats until I head home for dinner, walk the dog again, and go to the climbing gym.
What communication advice would you give when it comes to a team dynamic?
Listen more than you speak and always advocate for the patient. My job uses sharps, which must be handled appropriately for staff and patient safety. When I’m with a new team, I pinpoint where I’m working, and best explain how to handle the electrodes.
What was a surprise to you about the career when you first started?
I love the diversity in the OR. Everyone has such a unique story that led them to their current position, and it makes us more effective teams because of it.
What has been a memorable moment or story you’d like to share from your career?
In December, I remember walking into an OR in downtown Nashville, our busiest surgery season. I was earlier than expected because I hadn’t worked with this particular surgeon in a while and wanted to come prepared. I rolled into the OR, and the scrub said, “Oh Toree, I’m so glad it’s you today. We needed a little ray of sunshine!”
Later saying hi and chatting with the surgeon, we talked about what monitoring was best for our patient. I had the chance to clarify the benefit of one modality, and we were able to communicate more effectively when we did have a change. Days like that reinforce the importance of communication, teamwork, and being personable.
How has SpecialtyCare been helpful for your continued training, board prep, and/or ongoing career development?
As I mentioned before, the board prep was outstanding. SpecialtyCare has many resources to best prepare a student for the CNIM. Additionally, our company provides many opportunities for continuing education like Neurology Grand Rounds via Zoom.
What advice do you have for someone who’s considering a career change or challenge?
Make value-based decisions. Before choosing a company, I laid out three things I needed from an employer that would make them a match for me, regardless of the job. I wanted a transparent, data-driven employer with systems in place for their employees to give and receive feedback.
SpecialtyCare fit all of those values for me, so there was no second-guessing. You can embody any values you want, but sticking to them can be challenging. If that means changing careers, then go for it.
What advice do you have for someone who’s considering relocating for a job opportunity with SpecialtyCare?
Speak with the managers. They know the market better than anyone and have often been in a similar position as you. Each market is different. There are different hospital setups, team dynamics, call schedules, surgeons, and caseloads, so ask questions and get a better idea of what the market is for IONM.
SpecialtyCare is a people company, dedicated to providing an exceptional patient experience, becoming the OR employer of choice, and leading the way in OR innovation.