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Perioperative Nursing – The Apprenticeship Model

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

For the last 3 months I have written about the challenges of perioperative nursing in recruiting nurses into our profession. Even with the disruption of the pandemic, surgery continues and the need for skilled perioperative nurses remains. It is possible that some of our most experienced clinicians have left perioperative nursing during the pandemic and when surgical volume does return our staffing shortfalls may be exacerbated. However, as I described last month, we are still faced with some fundamental issues that include the lack of a nationally recognized credential for entry into our profession.

The current standard for entry into perioperative nursing resides mainly in the documentation that the employer must provide for accreditation requirements. Ultimately, the leadership of the facility must document that the nurse possesses competency to practice in their perioperative role. There is no prescribed educational course or a standardized curriculum required by accreditation standards. There is no standardized assessment of knowledge or competency akin to the NCLEX for entry into perioperative nursing. Secondary to variability in roles and work settings accreditation bodies use general language regarding knowledge, skills, abilities and personal attributes when speaking to nursing competency and defer to the employer for specific information.

The research-based evidence on our current orientation methods is not extensive. Tilley (2008) delineates an issue regarding competency assessment in nursing when she states, “Currently, in most states, a nurse is determined to be competent when initially licensed. Continued competency is assumed thereafter unless otherwise demonstrated.” In a very practical sense, a registered nurse with a valid license is assumed to possess competency in the highly specialized field of perioperative if the employer documents that competency.

All of these are big issues, but as Lee Iacocca once said, “We are continually faced by great opportunities brilliantly disguised as insoluble problems.” The Competency and Credentialing Institute (CCI) believes there also opportunities analogous to what Iacocca described.

At CCI, we propose to address the need for a credential upon entry to the profession and to document the knowledge, skills and abilities of perioperative nurses early in their career. In mid-2021 we will operationalize a credential which will precede the CNOR and CNAMB certifications. This new credential will be designed to meet the professional development needs of nurses early in their careers. We propose a bridge credential that spans the period from the end of a nurse’s orientation to perioperative nursing and the two-year mark when they become eligible for other CCI certifications.

We intend a rigorous path of assessment and self-reflection which will be consistently documented and provide a digital resume of the education and training for perioperative nurses. The certification will be documented with digital badges which will allow a previously unattainable level of documentation and portability. Innovations such as these are possible with the resources of our new testing partner, PSI Services, a world leader in testing and assessment with over 70 years of experience in the field.

Our aspiration as a non-profit supporting the career development of perioperative nurses is that this new credential will provide a widely accepted, nationally recognized benchmark for perioperative nursing education and training. This will be a new and innovative approach and it does entail some risk. As Niccolò Machiavelli said, “ … there is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things.” At CCI, we believe it is an approach worth exploring. Stay tuned. There are some exciting new things coming to perioperative nursing certification in the coming year.

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

Good Reads (2020). Niccolò Machiavelli > Quotes > Quotable Quote. Accessed November 27, 2020 at:
Inspirational Stories (2020). Lee Iacocca Quotes. Accessed November 27, 2020 at:
PSI Services LLC. (2020). Where people meet potential. Accessed November 27, 2020 at:
Tilley S. (2008). Competency in nursing: A concept analysis. J Contin Educ Nurs. 39(2): 58-64.



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