 Newsroom > Media Coverage > Opening Doors Return to Main Media Page
By Sandy Keefe, MSN, RN Advance for Nurses magazine
At a time when the demand for knowledgeable perioperative nurses is rapidly increasing, most undergraduate nursing programs have virtually eliminated theoretical content and clinical experience in perioperative nursing from their curriculum, according to Laurie Hillson, MSN, RN, coordinator of the Lawrence Memorial/Regis College Nursing Program in Medford, MA.
With a sustained increase in surgical procedures in inpatient, outpatient and short-stay settings and the growing complexity of those procedures skilled perioperative nurses are in high demand. Unable to fill vacancies in the perioperative nursing staff in light of the nursing shortage, many healthcare facilities have had to employ agency or travel nurses at a premium in order to schedule both emergent and elective procedures.
Instead of relying on similar measures, Hillson helped develop a perioperative nursing program that adequately prepares nurses for the rigors of the specialty. "Our perioperative nursing certificate program opens this door to perioperative nursing for nurses from various backgrounds, as well as new graduate nurses," she said.
Meeting the Demand
Nurses new to the perioperative setting need a strong theoretical base and essential competencies for practice to reduce frustration and promote retention. The perioperative setting is a challenging environment for nurses. Patient acuity in this setting is increasing and the technology is ever more sophisticated, calling for nurses with critical thinking skills.
Cognizant of these issues, Hillson developed the Introduction to Perioperative Nursing Certificate Program through the Lawrence Memorial/Regis College Nursing Program and in collaboration with Hallmark Health's Center for Professional Development. The perioperative course uses the novice-to-expert framework developed by Patricia Benner, PhD, RN, FAAN.
"I really understand the realities of working in a perioperative setting because I've been there myself as a perioperative nurse," Hillson said, acknowledging that new graduates and nurses placed in the unfamiliar clinical setting of the OR are indeed novices in that area.
The course is designed to provide the theoretical classroom content, laboratory practice and supervised clinical experience needed to guide these novices. As they master new information, gain skills needed for perioperative practice and develop self-confidence, students learn to function within the OR setting. Classroom, laboratory and supervised clinical experiences under the guidance of experienced preceptors provide a trial period for practitioners to decide if they can adapt to the OR environment.
Program Curriculum
During the 14-week perioperative program, students participate in 42 hours of classroom, 16 hours of skill lab and 240 hours of mentored clinical experience in a hospital perioperative setting.
The perioperative course incorporates a number of teaching strategies, including assigned reading, lecture, discussion, gaming, case studies, critical thinking exercises, role-playing, student presentations, demonstrations and return demonstrations, laboratory practice and clinical experience. At the end of the program, the students earn a certificate in perioperative nursing.
The course utilizes experiential learning theory to encourage students to be active participants in their own learning. It also structures students' experiences to accommodate and support different learning styles. As a result, many hospitals have found it more beneficial and cost-effective to send new nurses to this program rather than running their own perioperative nursing course.
"Although money is tight for everyone, this is an opportunity for us to provide for and support new graduate nurses, as well as nurses from other specialties who want to get into the OR," said Donna Sinclair, MHA, RN, nursing director of perioperative services, cardiovascular and critical care at Mount Auburn Hospital in Cambridge.
Classroom Content
The perioperative course content is based on the Association of Operating Room Nurses' standards and recommended practices and guidelines. It includes sections on infection control, patient and environment safety, equipment, patient positioning, modalities used in surgery, anesthesia, postop patient care and pain management, wound healing and patient education and discharge.
The class meets for 3 hours one evening a week during the 14-week course. Issues relevant to perioperative nursing, including legal/ethical concerns, professionalism, trends and research-based practice, are presented by specialists in those areas.
Susan Gallagher, JD, RN, lectures to students about legal and ethical concerns particular to the perioperative setting. She is both a lawyer and director of surgical services at a hospital on the Northshore.
"Many of our faculty have 10 or more years of OR experience," Hillson said. "This level of faculty sets our program apart in a very positive way."
Laboratory Practice
The laboratory setting at the college allows students to practice the technical skills needed for perioperative nursing in a safe, non-threatening environment. Through demonstration, students learn how to don proper attire for different perioperative areas, scrub and gown, identify environmental controls and use the operating table correctly.
As they practice in the lab setting, students become competent in sequencing activities such as opening sterile packages and supplies, creating a sterile field, positioning and prepping patients, and handling sharps and instruments. The laboratory setting also is useful for helping students identify and deal with situations such as inappropriate traffic patterns in the OR and incorrect counts of sponges, sharps and instruments.
Clinical Sites
Beginning in the fifth week, students spend three 8-hour sessions in the clinical setting each week, correlating the knowledge and skills gained in the classroom and laboratory setting into the perioperative environment. They learn to integrate nursing process components into the care of the patient before, during and after surgery. This clinical practice also allows them to apply the principles of perioperative nursing based on AORN standards, and to demonstrate their understanding of the roles and responsibilities of a perioperative nurse.
Hillson has made arrangements with 12 perioperative settings for clinical practice and students who are paying for their own course can choose among them. Students who are sponsored by area hospitals, including Boston Medical Center, Lawrence Memorial Hospital, Melrose-Wakefield Hospital, Mount Auburn Hospital and Southern New Hampshire Medical Center, spend their clinical hours at their hiring facility. During their clinical rotations, students work under the guidance of experienced RNs and scrub-tech preceptors as they gain experience and competency.
Program Outcomes
The perioperative nursing course has been well-received by hospitals in the area. Many healthcare facilities have made course attendance a prerequisite for hiring perioperative nurses without previous OR experience. Interest in the classes has been high, and the course fills rapidly each semester.
Jeanne Bovinett, MEd, RN, CNOR, of Boston Medical Center, praised the quality of the program. "It is a pleasure to work with a clinically and educationally based coordinator and such high-quality faculty to assure our nurses from BMC are prepared for today's technological operating rooms," she said.
Feedback from the students themselves has been overwhelmingly positive. "It is a measure of the program's success that several of the students have recommended our program to other nurses who are either their friends or co-workers," Hillson said.
Many of the students have been told by their seasoned preceptors that they are fortunate to be able to attend such a program, learning the why's of perioperative nursing as well as the how's. Hillson agreed that new nurses who know the theory behind the perioperative equipment and processes are in a much better position to understand new technology and techniques, and to safely integrate them into their clinical practice.
"You have a safer OR when staff are trained and know the processes," she said.
Editor's Note: For more information about the Introduction to Perioperative Nursing Program, call Laurie A. Hillson, MSN, RN, at 781-306-6684.
Sandy Keefe is a regular contributor to ADVANCE.
Return to Main Media Page
|