by Don Sadler
“The challenge of OR nurse training is significant and growing each year with the number of retiring nurses,” says ChrysMarie Suby, the President and CEO of the Labor Management Institute.
Hope L. Johnson, DNP, RN, CNOR, NEA-BC, the Director of Perioperative and Endoscopy Services for the Lehigh Valley Health Network in Allentown, Pennsylvania, puts it this way: “I think anyone in our field would be foolish to say that OR nurse training is anything but challenging.”
“The field is specialized and is not well publicized as an option for nurses during their training,” Johnson adds. “There is an increasing complexity to the field that only seems to gain acuity as years go by.”
Dawn Whiteside MSN, RN, CNOR, RNFA, Nurse Manager, Credentialing and Education Development for the Competency & Credentialing Institute, agrees with Suby and Johnson.
“Today there is an enormous challenge in training perioperative nurses,” says Whiteside. “Most nursing programs offer only one or two days of observation in the perioperative environment.”
For example, a nursing student might follow a patient from the floor throughout the perioperative experience.
“Depending on the type of surgery being observed, students may receive explanations of the perioperative nurse’s role, or they might simply be an observer off to the side of the room,” says Whiteside.
Also, training for perioperative nurses tends to not be specific.
“Each facility determines what its training will look like,” adds Whiteside. “If the facility is using a formal program like the one from AORN, educators still must develop a curriculum or plan for how the content will be grouped together and delivered.”
According to Susan Root, MSN, RN, CNOR, the Manager of Perioperative Education for the Association of periOperative Registered Nurses (AORN), AORN has developed a special course for integration into existing nursing curriculum to try to address this lack of perioperative exposure.
“The Fundamentals of Perioperative Practice provides a well-defined foundation of perioperative nursing concepts,” says Root. “It gives students basic information about aseptic technique and teamwork that can be translated into clinical experiences.”
Typically, the novice perioperative nurse undergoes an orientation period, Root explains. “This orientation should contain didactic content, opportunities to practice new skills in a sheltered environment, and a clinical preceptorship that encompasses all the specialty areas he or she will be expected to practice in,” she says.
Periop 101: Standardized Training
In addition, AORN also offers Periop 101, which is a standardized blended training curriculum for OR nurses. Root says this program, which is built on evidence-based guidelines, is currently being used by more than 2,500 hospitals and ambulatory surgery centers nationwide.
“I think a best practice is any one that involves the AORN Periop 101 course,” says Johnson. “A strong foundation, rooted in providing rationales and recognizing standards and recommended practices, is essential to training a nurse who truly understands the OR at its core.”
Regardless of whether a facility uses a training program they develop in-house or a standardized program like Periop 101, Root says it’s important to blend the didactic content with skills labs and a clinical preceptorship.
“Many facilities don’t include all three components, each of which is important in its own way,” she says.
“We allow the intern to build upon the foundations taught in Periop 101 through repetition and partner them with the same preceptor when in the initial phases of clinical experience,” says Jeanne Luke, MSN, RN, CNOR, the Director of Perioperative Internship and Clinical Program Development at the Lehigh Valley Health Network.
“This will allow for a consistent learning atmosphere and enables the learner to gain ‘wins’ day to day,” Luke adds.
Preceptors and Mentors
According to Suby, OR orientation is usually based on rotations through the functional areas of responsibility within the OR for scrub and circulating positions, from general to specialty surgery.
“Newly hired OR nurses should be paired with preceptors or mentors to help them throughout the training period,” Suby says. “Preceptor selection is an enormous part of being successful. One big mistake is assuming the person with the most experience is the best preceptor.”
Suby recommends that hospitals develop clearly defined competency and skills check-lists for newly hired OR nurses to work their way through to completion.
“Proctors and managers should meet monthly to review the orientee’s progress toward measurable expectations,” she says. “And unit managers should conduct ‘stay reviews’ at periodic intervals thereafter.”
AORNs position statement on “Orientation of the Registered Nurse to the Perioperative Setting” provides guidelines for an orientation program.
“It should be between six and 12 months long and include both didactic and clinical components,” says Root. “In addition, completion of the program should be measured by successful competency assessment that is both role-specific and scope-specific.”
The Institution’s Responsibility
Johnson says that without a strong foundation in perioperative training in academia, “the burden for education and training falls on the institution where the nurse will work. In some institutions, this means on-the-job training while in others, it involves a robust OR/perioperative internship program.”
The internship program where Johnson works is offered in conjunction with the AORN Periop 101 course. “This allows the nurse to be informed and become knowledgeable about the basic tenets of OR nursing, such as positioning, prepping, aseptic technique, gowning and gloving, etc.,” she says.
Anyone without prior OR experience is put through the OR internship, says Johnson.
“This serves as their orientation,” she says. “Recently we have added team specific orientation to the internship program to decrease the overall length of training time.”
All of this is then followed up with OR simulation, Johnson adds. “We are fortunate to have an OR simulation lab where all of these skills can be practiced.”
The use of simulations is becoming more prevalent in the perioperative specialty.
“Previously, the high-priced simulation labs were reserved for medical training, but the importance of interdisciplinary training has emerged recently,” Root says. “With the advent of more complex training manikins, specialized perioperative scenarios are now possible.”
Perioperative simulation allows students and experienced staff to experience high-risk, low-volume patient scenarios more frequently and develop effective responses to ensure patient safety, Root says.
“Even the use of low-fidelity simulations can have a significant impact on the quality of perioperative team training,” she adds.
The Role of HR
Luke stresses the importance of making sure perioperative nursing candidates who apply to work in the OR know what they’re getting into.
“Many applicants don’t know what working in the OR entails,” she says. “They think it’s like one of the shows they watch on TV, but quickly learn that it’s not.”
This is where the human resources department enters the picture.
“It’s important for HR to understand the workflow of perioperative services and the different aspects of patient care in the OR so they can clearly communicate this with applicants who want to work in the OR,” Luke says.