MARCH 1999. VOL 69. NO 3 P R A C T I C A L I N N 0 V A T I 0 N S

Investing in the future- an OR orientation program

for nursing students he average age of nurses today is 44, and the average T age of perioperative nurses is

47.’ Keeping this statistic in mind, look around the surgical suite and see how many 20- to 30-year-olds you see. In 10 years, who will be the nurse who assess- es us in the holding area for our pacemaker insertion or total hip replacement? As a 47-year-old perioperative nurse, this issue concerns me, and it should con- cern all perioperative nurses.

STUDENTS EXPERIENCES IN THE PERIOPERATIVE ARENA

tor, I have gained some insight into two reasons why the OR does not attract younger nurses. The first reason is that associate degree in nursing (ADN) and bachelor of science in nursing (BSN) programs are not giving students enough exposure to the OR as a potential career area. The second reason is that OR staff members do not always use the time they may be given with stu- dents to the best advantage.

When I came to University Community Hospital, Tampa, Fla, I observed nursing students who were dropped off at the OR front desk on the morning of their one- day surgery observation. The stu- dents were turned over to the charge nurse, who was responsi- ble for running the OR scheduling board. It was the charge nurse’s job to find a place for the students to observe. The students’ instruc- tor, who was not an OR nurse,

As a surgical services educa-

would have the students in scrubs, but without hats or masks. The charge nurse eventually would assign each student to an OR. Some circulating nurses and sur- geons were interested in having students in the OR, but some did not want students observing. At times, the students were instructed that their hair must be covered before entering the OR. Other times, they were not told until one of the surgical team members yelled, “Don’t you know this is an OR? Cover your hair!”

DEVELOPING A PERIOPERATIVE ORIENTATION PROGRAM

I called an instructor in one of the ADN programs at a local community college to arrange for a meeting to discuss my concerns

KATHLEEN E. SCHULZ, RN, BSN, CNOR, is manager of sur- gical senices at the Carrolwood Campus of the University Community

Hospital, Tampa, Fla. At the time this article was written. she was the peri- operative educator for surgical senic- es at University Community Hospital.

KATHLEEN DtSANTO, RN, ARNP, CS. is a professor of nursing at Hills- borough Com- munity College, Plant City, Fla.

about students’ surgical experi- ences. I was happy to discover that she had these same concerns, but had no one with whom to share them. We both believed that we were losing potential penoperative RNs because they were not having positive experi- ences in the OR.

We agreed to develop an OR orientation program that all stu- dents would complete before their surgical observations. This orien- tation includes a brief history about perioperative nursing, a description of surgical team members’ roles, and a tour of the OR environment, including restricted, semirestricted, and unrestricted areas. We also include a demonstration of how to don a surgical hat and mask. The orientation takes approxi- mately 45 minutes to present, after which students tour the change rooms and entrance areas. Finally, students are shown where to meet the OR educator on the morning of their observation and are given OR learning objectives with instructions to complete them in writing before their scheduled observation. The objectives ask students to

describe the role of the circulat- ing nurse and the scrub person, define sterile technique and clean technique, list the principles of sterile technique, and summarize their experiences with an emphasis on the role of the RN in perioperative nursing.

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ASSIGNING STUDENTS TO ROOMS At observation time, the OR

educator makes every effort to assign each student to a room that might enhance his or her learning experience. The type of proce- dure, the surgeon, and the OR staff members in the room are considered when deciding which rooms would best meet students’ needs.

The educator assesses each student to determine what type of surgical procedure he or she is interested in observing and what, if any, experience he or she has in the OR. For students who are not interested in the OR, the edu- cator chooses the one-day surgi- cal suite, where students can observe shorter, less complicated procedures (eg, breast biopsies). Other students are extremely interested in the OR and even have particular surgical proce- dures in mind (eg, open heart procedures). For such students, the educator examines the OR schedule and tries to assign the students to the procedures they want to observe. In general, this task is accomplished easily. On rare occasions, the educator makes the best possible decision regarding the assignment based on the available procedures. By allowing students to participate in the decision-making process, the best results are accomplished.

THE IMPORTANCE OF PRECEPTING Rooms in which OR nurses

who express an interest in pre- cepting students are present are used whenever possible. Every effort is made to avoid placing a student in a room where the cir- culating nurse is not interested in precepting students. On rare occa- sions when there is no other choice, the educator speaks with

the circulating nurse before assigning a student and explains the need to place the student in that room. The educator then reviews the student’s objectives with the circulating nurse and dis- cusses the importance of provid-

We invested only one hour of time in

the students and were seeing a

ten-fold return in their altitudes.

ing the student nurse with a good surgical experience. By dis- cussing the national shortage of OR nurses, the need to recruit new RNs into the OR, and the fact that this might be our only opportunity with these students, the educator has gained support from the circulating nurses. As time has gone on, the RNs not only enjoy having the students observe, they also request that students be assigned to their rooms.

POSITIVE FEEDBACK

halfway through the students’ rotation to say that our new approach had made a difference in students’ experiences. Students consistently were reporting that they had a wonderful experience in the OR. One student comment- ed on how well surgical team members worked together and how much they relied on each other. Another noted how obvious

The ADN instructor called me

it was that the circulating nurse is an integral part of the surgical team. Another student said that she was grateful to be an observer and that the experience gave her an option that she had not consid- ered-the possibility of working in the OR after graduation. This was rewarding for both the ADN instructor and myself. We invest- ed only one hour of time in these students and were seeing a ten- fold return in their attitudes con- cerning perioperative nursing.

ADDITIONAL BENEFITS I began to see an unexpected,

additional benefit to this approach. Before the orientation program, some OR staff members and sur- geons viewed the students as a chore and preferred not to have them in the OR. This attitude began to change when students began sending thank-you cards to their preceptors and bagels to “the wonderful OR staff who made my day in surgery so memorable.” Students now are viewed as a pleasure to have around. In fact, staff members came to me with ideas about how students’ experi- ences could be further enhanced.

As a result, I instructed stu- dents to call the day before their scheduled observations to request the type of surgical procedure they would like to observe. I could offer them an open heart procedure in the cardiovascular OR, a craniotomy in the neuro- surgical OR, or even a one-day stay procedure in the outpatient day surgery center OR.

to the education office and research the procedures they would be observing. AU of these changes were suggestions from staff members who, one year ago, did not enjoy having students in

I also encouraged them to come

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the OR. I even received and posted a card sent to a cardiac surgeon, thanking him for the time he spent explaining a procedure. Needless to say, he now is a real asset for student teaching. The orientation program has been expanded to BSN students because of these positive experiences and, with some modification, to any student who observes in the OR (eg, surgi- cal technologists).

THE OR NURSES OF THE FUTURE We have interviewed several

new graduates during the past year for our perioperative nursing internship program. This six- month program takes RNs with no perioperative experience and educates them in OR nursing. The internship program consists of six weeks of didactic and clinical experience. Three days per week are devoted to the classroom and two days per week to clinical experience. The subject matter that is covered in the classroom is reinforced immediately in the clinical areas. For example, an anesthesiologist or certified regis- tered nurse anesthetist (CRNA) covers information about periop- erative nurses’ responsibilities concerning anesthesia in the class- room. Then a nurse intern is assigned to a CRNA during his or her clinical experience. We encourage the nurse intern to ask questions of the CRNA and learn all he or she can from the expert on anesthesia. This process also

NOTE

builds relationships with the OR team members.

After the first six weeks, the perioperative nurse intern is assigned to an experienced OR nurse, who acts as a preceptor and mentor to the nurse intern. We

Wherever a real joy of

teaching exists, the quality of

patient care w i I I

rotate the intern nurse through all the specialities. Different precep- tors are required for these differ- ent areas. We also give the nurse intern advance OR experience by assigning him or her to work with the charge nurse. This allows the intern nurse to see what is involved in running an OR sched- ule. This rotation concludes at the end of the six-month period and is followed by six months of work- ing independently before being precepted on call. The nurse begins call rotation at the end of the six months of independent work. Usually, three nurses move through the internship program at one time. We do require any nurse

who does not have OR experience to successfully complete the peri- operative nurse internship pro- gram. We interview the candidates and look for traits that we believe are essential to enable a nurse to succeed in the program (eg, how they handle themselves under stress, flexibility, teamwork, maturity, prioritizing, critical thinking skills, people skills). Nurses must have at least one year of nursing experience. Nurses who are accepted into the internship program are required to sign an agreement to work for a set amount of time at our hospital.

During the interview process, we ask nurses why they want to be OR nurses. Several graduates who had their OR observations at our hospital say that it is because of their student observation expe- riences. Although we had not begun our orientation program when these nurses observed, I believe that it was only luck that led to their positive experiences. The ADN instructor and I believe that by presenting the orientation before observation, we will have a much better chance of interest- ing more graduates in the OR. We will conduct research during the next five years to see if we have made a difference in recruit- ment. Regardless of the outcome, I am satisfied with the benefits our surgical areas have experi- enced. Wherever a real joy of teaching exists, the quality of patient care will improve. A

care.” Australian Nursing Journal 3 (June 1996) 35-37. 1. “Who is today’s RN?” The American Nurse

30 (May/June 1998) 10; “AORN membership survey results,” AORN Journal 66 (August 1997) 230. (June 1997) 41-45.

SUGGESTED READING

Warner, S M. “Mentoring nursing students.”

Annand, F. “The mentor commitment.” Insight 22

Cameron-Jones, M; O’Hara, P. “Three decisions

Nursing 27 (February 1997) 73.

about nurse mentoring.” Journal of Nurse Mentoring 4 (July 1996) 225-230. Ross, K. “Follow the leader: Mentoring and health

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improve.