By Don Sadler
With the holidays right around the corner, you might be thinking about what items are on your wish list or the wish lists of your family members and friends.
But what if you had a wish list for the operating room or ASC? What items would be on your OR or ASC wish list this year?
We decided to ask a number of different perioperative professionals this question. Following is a summary of their responses.
Staffing Tops the List
The most common wish list items had to do with OR and ASC staffing.
“I wish I had a magic wand and the nursing shortage would end,” said Bev Kirchner, president of the Texas Collaboration of periOperative Registered Nurses (TCORN). “More specifically, I wish we could figure out how to educate the students who want to be nurses in more significant numbers.”
According to Kirchner, nursing schools have no shortage of applications. “What they have is a faculty shortage,” she said, “followed by restrictive training requirements for hands-on experience. Perioperative nursing is in a crisis mode of operation and the shortage is only going to get worse due to the number of baby boomer nurses retiring daily.”
Adequate OR staffing was also high on the wish list of David Taylor, MSN, RN, CNOR, the president of Resolute Advisory Group LLC.
“ORs across the country are struggling with finding enough qualified, highly trained employees to cover their basic clinical needs,” he says.
“Having enough employees to staff the clinical needs and be able to provide education, training and mentorship – as well as allow for paid time off without interrupting operations – is an OR leader’s dream,” Taylor adds.
It’s not just perioperative employees either. Taylor says that health care organizations rarely staff their leadership roles appropriately.
“The OR may need a director, manager, assistant manager, charge nurse, educator and business manager just to name a few,” he says. “Instead, all the leadership roles are lumped together, making it nearly impossible for leaders to be highly functional.”
Vangie Dennis, MSN, RN, CNOR, CMLSO, assistant vice president, perioperative services at Anmed Health, offered a quick two-word reply to her wish list: “More staff!” she said.
“Even though positions are approved, recruitment is difficult. Creative staffing models, such as hiring staff to just take call, might help,” she added.
“The biggest barrier to my organization in the coming years is human resources, or the lack thereof,” said Julie Brinegar, MBA, BSN, CNOR, CASC, the executive director of Surgery Center Cedar Rapids in Cedar Rapids, Iowa.
“My wish list would include providing a national advocacy campaign for the nursing profession to colleges and the public to assist in the staffing challenges we are facing and provide for a positive awareness of this great need,” adds Brinegar.
Hospital management has historically sought out experienced nurses for OR positions, Brinegar notes. “However, creating awareness of the benefits of hiring more inexperienced nurses or new graduates could turn the tide and encourage them to seek out ASCs for employment.”
“The first item on my wish list would be to have all the staff I need whenever I need them without worrying about a nursing shortage, scheduling conflicts or competition from down the street or across town,” adds Julie Lewis, BSN, MBA, vice president of surgical services for GastroMD in Tampa, Florida.
“My wish is for experienced and available OR nurses so staff are not taxed and without capable persons to promote and provide exceptional and consistent patient care,” adds Deb Yoder, MHA, BSN, RN, CNOR, the director of clinical operations at Surgical Management Professionals in Sioux Falls, South Dakota.
Kyle Dorshorst, RN, the clinical director at Ambulatory Surgical Center of Stevens Point in Stevens Point, Wisconsin, says he’s concerned about the culture and emotional health of the staff at his facility.
“I wish I could grant them all one day off every other week with pay through the end of the year,” he says. “This would give everyone time to refresh and revive.”
Eliminating Surgical Smoke and Improving Patient Safety
Kay Ball, Ph.D., RN, CNOR, CMLSO, FAAN, a perioperative consultant and adjunct professor at Otterbein University in Westerville, Ohio, has been active in efforts to get surgical smoke legislation passed. So, it’s not surprising that having smoke evacuators in all operating rooms that use energy devices is at the top of her wish list.
“The hazards of surgical smoke continue to plague our perioperative environments so we must evacuate plume,” says Ball. “Smoke evacuation should be a standard practice since evidence-based research documents the hazards of the contents of the plume.”
“If I could have one Christmas wish for the operating room, it would be that all surgical smoke is routinely evacuated and filtered,” adds Brenda C. Ulmer, RN, MN, CNOR. “I believe, and fervently wish, that one day we will look back and wonder why it took us so long to routinely opt for clean air while working to save lives in the operating room.”
“At the top of my wish list is for all perioperative services practitioners to work in an organization that puts patient safety and quality first,” says Sharon McNamara BSN, MS, RN, CNOR. “An organization where administrators provide support, resources and education on true teamwork principles, communication skills and transparency without retribution for errors.”
McNamara continues: “I wish for empowered health care practitioners to step forward, be brave and make sure that these changes are not flavor of the month but sustainable quality improvement initiatives that will improve care and keep patients and staff safe. And I wish for an environment of respect, valuing of diversity and patient-centered, physician-led, team-based care.”
Continuing Education and Use of Technology
Ball would also like to see continuing education budgeted for all perioperative team members – both nurses and techs. “The skill level of surgical team members must be kept current as new advancements and technology continue to be introduced to advance surgical procedures,” she says.
“One of the first budget items to be cut is usually funds for staff education,” adds Ball. “This is unsafe as nurses and techs need to continually learn in order to stay abreast of advancements and keep our patients safe.”
Dorshorst would also like to be able to identify and purchase technology that would make the role of the perioperative staff more efficient and patient-centered. “The goal would be for staff to spend less time on charts, computers and non-productive tasks, thus creating more time for staff to spend with patients,” he says.
Nik Unterkircher, the manager of digital learning strategy and design for the Association of periOperative Registered Nurses (AORN), echoes Dorshorst’s technology wishes. “My hope is that nurses will become excited about the use of new technology in their education,” she says.
“We are tech-forward in the OR and that gives us an important foundation to embrace emergent learning platforms that can identify our knowledge gaps and customize our individual education,” Unterkircher adds. “Let’s take advantage of technology that can support our professional development and advance our practice.”
Thinking big, Taylor would like to see a redesign of the standard operating room. “Today’s ORs are too small to accommodate additional personnel and equipment needed for complex procedures,” he says. “Smaller ORs require a great deal of planning and manipulation of the schedule to keep the flow of procedures moving.
“In addition, the shape of all ORs should be the same to avoid having to adjust to new positions or equipment and supply locations,” Taylor adds. “There should be adequate wiring to allow equipment needing electrical supplies to be positioned as needed for a procedure.”
Taylor would also like to see more storage space in the OR. “There is never enough storage to adequately meet the daily needs of an OR,” he says. “Appropriate storage cabinets and rooms designed for equipment should be available in the correct numbers and size to store and protect the supplies and equipment intended for those areas.”
Taylor also believes that the preference card system at hospitals could be improved. “Early in my career, preference cards were written on five-by-nine cards and kept in a file near the OR,” he says. “A hospital might have 100 or so cards for all of the surgeons and could easily add or remove items in real time.”
“Today a hospital could have thousands of electronic preference cards, making it nearly impossible to keep them updated,” Taylor adds. “This does not help staff prepare properly, adds touch points to every procedure and is costly.”
Taking Pride in Perioperative Nursing
Renae Battié, MN, RN, CNOR, AORN’s vice president of nursing, emphasizes the career satisfaction that most perioperative nurses experience. “We are incredibly proud of our direct influence on the quality of care that surgical patients receive and contribution to the health of our community by providing needed access to life-changing procedures,” she says.
“My wish is for all perioperative nurses to finish every day with pride in the value they bring to the surgical team and patients’ safe outcomes,” says Battié. “And that the stories of their impact attract many more future nurses to the perioperative profession.”