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Becoming a Perioperative Nurse: The Historical Context

By James X. Stobinski, Ph.D., RN, CNOR, CSSM (E)

Last month, I spoke to issues with recruiting and retaining staff in the operating room including supply chain management professionals, central processing technicians and perioperative nurses. All these roles are vital for the efficient functioning of an operating room suite. This month, I wish to focus more narrowly on the profession of perioperative nursing. I would like to address how nurses enter the profession of perioperative nursing and the history and evolution of their education and training. A look back at the history of nursing in this country is informative regarding perioperative nursing.

The modern history of nursing in the United States is heavily influenced by the work of Florence Nightingale. The profession of nursing in this country really begins with the Civil War which followed Nightingale’s groundbreaking work with the British military during the Crimean War of 1853-1856. Nursing education in this country, until the early 1900s, was essentially an apprenticeship model where student nurses served as the labor force for early hospitals. Thus, disdain for the term apprenticeship in nursing is long standing and continues yet today.

Curiously enough in these early days of professional nursing there were few employment opportunities in hospitals after graduation and many nurses entered private employment as much care was delivered in the home. To establish nursing as a profession it was necessary to strengthen and standardize the educational preparation for nurses and to base that preparation in science versus just the performance of tasks. The concentration of more sophisticated medical care in the hospital setting eventually brought employment opportunities to the hospital setting versus the earlier private employment model.

The refinement of surgical techniques and the increasing complexity of surgical care was a large factor in the rise to prominence of hospitals in the American health care system. As surgery progressed, the specialty of perioperative nursing developed and became grounded in the hospital operating room. Shannon R. Olwine, in her honors thesis, refers to the writing of Linda Groah in 1990, and tells us that operating room nursing became the first recognized specialty in nursing in 1889. This key development in the late 1800s established operating room nursing as a hospital-based specialty with the employer, the hospital, playing an integral role in the education and training processes of these nurses.

Operating room nurses were oriented in the workplace and the employer had a large influence on the education and training processes. These early methods still influence the profession today. For example, Isabel Hampton Robb, in her seminal 1907 text, recommended that student nurses have two months of clinical experience in the operating room. The perioperative specialty grew rapidly in parallel to advances in surgery and in 1920 the National League of Nursing Education Committee on Curriculum recommended a familiarization to the OR for nursing students, but conceded that the work required extensive training for those wishing to specialize.

Although perioperative nursing has one of the longest orientation periods in nursing there is not yet a widely accepted, core curriculum for the specialty. Even though entry to the profession may require a year of education and training there is no final examination, akin to the NCLEX which facilitates entry to practice, to mark entry to the specialty. There is a paucity of research-based evidence on the efficacy of current orientation methods and the employer still retains a central role in the assessment of perioperative nursing competency. There are ample opportunities for perioperative nursing to address these professional issues. Next month, I will speak more to possible action items in this area for perioperative nurses and revisit the term apprenticeship.

References Editors (2018). Crimean War. Accessed November 1, 2020 at:
National League of Nursing Education (U.S.). Committee on Curriculum. (1920). Standard curriculum for schools of nursing: prepared by the Committee on education of the National league of nursing education (1915 to 1918) M. Adelaide Nutting, Chairman. [3d ed.]. Baltimore: The Waverly Press.
Olwine, S. R. (1992). [Honors Thesis]. The Changing Roles of Perioperative Nursing.
Robb, I.H. (1907). Educational Standards for Nurses: With Other Addresses on Nursing Subjects. E. C. Koeckert.

James X. Stobinski, PhD, RN, CNOR, CSSM(E), is Chief Executive Officer at Competency & Credentialing Institute (CCI).



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