The exmrfs research . . .

Where have all the RNs gone? Q:

Editor’s note: The following question was forwarded to the education department of the National Association of Operating Room Nurses. It was answered with help from members of the American Hospital Association.

Q. It has recently been discussed by mem- bers of our hospital administration to re- move regisfered nurses from the operating room. I am aware that this situation is an ever-occurring one fhroughout the country and, in some aspects, is being advocafed by some educators. / strenuously disagree with this train of thought and feel very defi- nitely that there is a necessary and vifaf need in the operating room for the regis- tered nurse.

What information or list of references do you have available pertaining to’ mainfain- ing or keeping the RN in the operating room?

A. The registered nurse is needed in the operating room; however, the RN’s role i s changing and should be developed into management and supervision rather than technical work. AORN i s taking this into con- sideration by scheduling preoperative visit seminars and management seminars in 1971.

Also, attention should be called to the new proposed Standards of Accreditation of

Hospitals which is being considered by the Joint Commission on Accreditation of Hos- pitals. In the October 1969 issue of Sfand- ards you will note that in Standard 1, Nurs- ing Services, the commission addresses itself to the staffing pattern and utilization of registered nurses and other nursing person- nel for nursing care units, including the surgical suite. The information on pp 30-31 does not address itself specifically to this concern-that is, the removal of registered nurses from the operating room. However, it does mention the utilization of practical and vocational nurses to give nursing care that does not require the skill and judg- ment of a registered nurse as long as they are supervised by a registered nurse.

Each local area experiences various man- power problems not only in the operating room but in the entire hospital. As this oc-

curs, you will see more and more demand

for manpower substitution. This occurs

throughout the health career ladder. For ex-

ample, the registered nurse of today does

some things formerly the exclusive province

of the MD. As the nursing shortage became

March 1971 95

more of a problem, there were substitutions; and licensed practical nurses performed some of the duties normally performed by registered nurses.

Some opinions are that this was not the direction hospital administration has wanted to take but rather has been forced to take due to pressures of the nursing profession itself. For example, rather than creating the opportunity for students to enter the nursing profession earlier and with shorter training, the nursing profession decreed that three- year diploma programs were not sufficient to train the nurse and, therefore, recom- mended baccalaureate programs. Natur- ally, when you increase the length of train- ing, you decrease the supply available. As you decrease the supply available, substi- tutions have to be made.

Even while increasing the educational re- quirements for a baccalaureate nurse, the nursing profession did not specify that the nurse had to take courses or serve in the operating room suite. Therefore, fewer and fewer registered nurses were exposed to this exciting and extremely challenging area of the hospital. When this occurred, additional substitutions had to be made and, therefore, the growth of the operating room technician.

While many people think it would be very nice to take nursing back to the bed- side, it is somewhat practical to believe that this philosophy will never more be thor-

oughly implemented. It i s simply too costly and there are too few nurses to go around.

The registered nurse of the future will be playing a very important rote in patient care in the operating room suite. It will be one of a different nature and will involve a change in the role. This change in role will provide more time for the registered nurse to actually give patient care than has been possible in the past.

For further information, see:

1. "Definition and objective for clinical practice of professional operating room nursing," AORN Journal reprint, November 1969.

2. "The first steps are crucial," AORN Journal reprint, July 1970.

3. "Standards for administrative and clinical practice in the operating room," AORN Journal reprint, March-April 1965.

4. "Nothing i s as far away as one minute ago," Mildred Montag, RN, EdD, AORN Journal, August 1970.

5. "Conclusions: 'I plead with you to- day . . ." Rachel Ayers, RN, MS, AORN Journal, August 1970.

6. "After today-what?" and "Return to yesterday return to love," Evelyn Eng, RN, MS, AORN Journal, August 1970.

7. "The OR nurse in the patient care cir- cuit," Bette Clemons, RN, AORN Journal, August 1970.

Temperature change An error was published in the AORN Journal, December, 1970, in the article "Gas sterilized

x-ray cassettes-their use in the OR." Explained in the arficle was that the cassettes should be

sterilized "for two -hours at 85C." Also mentioned were "a 140C, 48-minute cylcle . . . :" and

' I . . . while using the 140C cycle. . . ." These temperatures should have read 8SF and 140F respectively, since sterilization at fhese

same temperatures on the centigrade scale would not be possible in the described equipment:

and damage would also be caused to the cassettes.

96 AORN Journal