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Efficacy in Surgical Services Transition-to-Practice: “Critical Thinking” vs. “Standard Work”

By Brandon G. Bennett

Surgical services management is perhaps the most complex nursing leadership specialty. The tasks performed by surgical services nurse leaders and the knowledge needed to perform those tasks have been delineated in job analysis findings. The job analysis findings provide a standardized, scientifically valid foundation for assessments and measurements. These findings are the basis for certification examinations and may also serve as a basis to assess competency; a recognized method of describing levels of performance or practice based on predetermined specific metrics, performance goals or measurements.

Measurement of achievement by competency has been developed against a broad spectrum of expectations. The major areas of knowledge for surgical services nurse leaders provide the framework for preparation and measurement. The seven knowledge and skill domains include: (1) communication and relationship management; (2) financial management; (3) human resource management; (4) leadership; (5) operational management; (6) professionalism; and (7) strategic management.

Successful transition into health care professions is achieved by (a) the academic model by certificate or diploma or (b) self-study or on-the-job training by competency statement or certification. Neither of these methods is standardized for surgical services nurse leaders and there is ongoing opportunity for improvement.

Educational experiences in academia have evolved to more fully support multi-generational learners; however, concerns remain. The overarching problem with academic preparation of surgical services leaders is the lack of specificity of knowledge and skills. A knowledgeable mentor/instructor is also needed to guide and direct the learner. There are few academics who have practice experience in the surgical services space and even fewer who have surgical services leadership expertise.

On-the-job opportunities for learning surgical services leadership are plentiful; however, without structure or support, the experience may not be educational or may not support evidence-based and sustainable leadership development. Although learning opportunities can be readily identified, alignment with a mentor/instructor is a challenge most often attributed to availability of the surgical services expert.

Contemporary models of transition into professional practice incorporate clearly delineated learning experiences. These models are most often created using either the (a) intern-to-residency model or (b) the apprenticeship model associated with a variety of artisans and trades.

Today’s transition-to-practice models are evolving from a traditional critical-thinking format to a more contemporary model using a standard-work format, i.e., there are structured activities from which specific knowledge and unique tasks are learned. The work of surgical services nurse leaders is well delineated with job analysis findings. Thus, surgical services leadership development is poised to reap the benefits of the job analysis work.

Most intern-residency programs for nurses incorporate structured learning activities – standard work – and thereby facilitate entry into the practice of nursing. In internship-residency programs, the student has progressed through formal “academic” educational processes and begins a series of structured experiences. Learning the fundamentals of surgical services management should be structured and should follow the standard work model. It’s not important if the relationship of learner to expert is one of intern, resident or apprentice. What is crucial is identification and alignment with a learned, prepared expert who has surgical services management acumen.

Recommended fundamentals of surgical services management are well defined through job analysis. Program development and affiliation with experts needs to be outcomes driven and should strategically establish learning that will align with the major areas of knowledge substantiated by job analysis methodology. Competency can then be measured by certification examinations, standardized tests of knowledge and assessments of performance. The attainment of certification is an outward demonstration of commitment of the professional to engage in lifelong learning and to seek and validate evidence-based competency in surgical services management.

Brandon G. Bennett, DNP, RN, CNS, CNOR, CNS-CP, CSSM, CEN, NE-BC, has worked extensively with CCI as a presenter and author.



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