By James X. Stobinski, Ph.D., RN, CNOR, CSSM(E), CNAMB(E)
The modern history of perioperative nurses leading and managing operating rooms closely parallels the development of the perioperative nursing profession. Salazar tells us that Florence Nightingale spoke to the role of nurses working in surgery as early as 1860.(1,2) Schools of nursing, based on the Nightingale model, began to be developed in the 1860s, with all nurses in those schools training in the work of surgery. As medical and surgical care became more sophisticated and technologically advanced the work of surgery shifted to hospitals and became more standardized. Specialized staff were needed to support this transition, and the role of operating room nurses emerged. However, these nurses trained in an apprenticeship model and student nurses were a large part of operating room staffing.
Operating room nursing, now more commonly called perioperative nursing, was recognized as the first nursing specialty in the latter part of the 19th century. Caroline Hampstead is documented as a nurse working exclusively in the operating room at Johns Hopkins Hospital in Baltimore in 1889.(3) The tradition of surgical training being embedded in pre-licensure education programs was a key feature of Diploma of Nursing schools in the United States into the mid-20th century. This training centered on experiential learning and there was a notable lack of classroom instruction in these early days. Although nurses have historically had a prominent role in managing the work of operating rooms their orientation to the profession also lacked standardized educational preparation.
The professionalization of perioperative nursing both in terms of practice and leadership preparation experienced a pivotal moment in the mid-20th century as what is now known as the Association of periOperative Registered Nurses (AORN) began operation. AORN is now a preeminent source of standards for perioperative nursing care and over decades the organization has established the role of perioperative nurses and leaders. Early perioperative practice as well as leadership and management methods were dominated by oral tradition and rote memory. That is no longer the case as AORN and other organizations working from the AORN Guidelines for Perioperative Practice have established an evidence base for perioperative nursing care.
This foundational structure of the AORN Guidelines and the work of AORN has been the most influential factor in professionalizing the role of perioperative nursing. The role of perioperative nursing leadership has grown as modern surgery continues to evolve. Managing a modern operating room is a challenging task which requires a specialized skill set, but that work has long operated on tradition-bound assumptions. A long-held belief was that an operating room must be led by a skilled perioperative nursing clinician. That assumption was challenged by new evidence about 12 years ago when the Competency and Credentialing Institute (CCI) initiated the Certified Surgical Services Manager (CSSM) certification. The CSSM Job Analysis findings which studied the work of perioperative nursing leaders affirmed that leading and managing an operating room was a distinct skill set that markedly differed from the clinical practice of perioperative nursing.
The CSSM credential and the education and training courses provided by groups such as AORN inform us that there is a great need for professional development materials specific to the defined work of perioperative nursing leaders. There is no widely accepted curriculum or educational path for contemporary perioperative nursing leaders. The complex work of leading operating rooms requires stakeholders to deliver educational materials for the perioperative nurse leaders of today and for the future. This is a significant challenge, but it is necessary work. While legendary figures such Caroline Hampstead provide historical context the professional development needs of current and future perioperative nurses is the challenge we now face.
– James X Stobinski, Ph.D., RN, CNOR, CSSM(E), CNAMB(E), is a faculty, member at Central Michigan University and director of hospital and ASC surgical education relationships with National Institute of First Assisting (NIFA).
References
- Nightingale F. (1860). Nursing Notes: what it is, and what it is not. New York: Appleton and Company.
- Salazar Maya ÁM. (2022). Nursing care during the perioperative within the Surgical Context. Research and Education in Nursing. 40(2):e02. doi: 10.17533/udea.iee.v40n2e02.
- Hamlin, L. (2020). From theatre to perioperative: A brief history of early surgical nursing. Journal of Perioperative Nursing. 33(4). E19-E24.
