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Perioperative Nursing – The Apprenticeship Model

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

Last month, I wrote of perioperative nursing as the first recognized nursing specialty. Isabel Robb in 1907 stated that operating room nursing required extensive training for those wishing to specialize. Beginning with the early hospital-based training methods in the late 1800s the employing facility has played a large role in the education and training of perioperative nurses. The influence of the employer continues today. It can be argued that the employer has more authority than professional organizations and/or certification bodies regarding entry into practice.

Logically, it follows that for specialization in nursing practice there should be defined educational criteria for those wishing to practice in that specialty. This is part of the social contract between nursing and those we serve. That is, that perioperative nurses possess competency predicated on specialty-specific education and training. Although perioperative nursing has been a recognized nursing specialty for decades, there is not yet a universally agreed upon educational course for entry to the profession.

In the United States perioperative nurses begin autonomous practice after an extended orientation period which features classroom learning, lab experiences for skills and a lengthy precepted learning experience. This orientation may be guided by supporting materials from an external source or the program may be devised entirely by the employer. Notably, current programs have many of the characteristics of apprenticeship programs which historically were used for skilled trades such as electricians and carpenters.

The Department of Labor defines an apprenticeship as, “ … an industry-driven, high-quality career pathway where employers can develop and prepare their future workforce, and individuals can obtain paid work experience, classroom instruction, and a portable, nationally recognized credential.” Such programs require mentors or preceptors and the awarding of a nationally recognized credential upon completion. This aptly describes the current methods used in perioperative nursing except for one key factor – a nationally recognized credential.

Although the nursing profession has a marked disdain for the terminology, the current processes have many of the elements of an apprenticeship program. Patricia Benner (2013) used a framework she termed the “Three Apprenticeships” to describe how a nurse assimilates into the profession and a specialty of nursing. Benner and co-authors spoke to the need for intellectual training, a skills-based apprenticeship and socialization to the role, all these elements being necessary to attain competency. Crider and McNiesh (2011) describe the use of this framework in psychiatric nursing, but such usage has not been well documented in perioperative nursing.

The time seems ripe for perioperative nursing as a profession to re-examine the theoretical assumptions underpinning current methods used to bring nurses into the profession and to also evaluate the utility of the programs espoused by the Department of Labor. Benner’s work is not inconsistent with the precepts of the Department of Labor programs. Perioperative nursing is experiencing staffing shortages and the demand for surgery is not declining. Now is the time to strengthen the rigor of perioperative nursing orientation programs and to evaluate best practices in apprenticeship programs which are now used in industries such as advanced manufacturing, information technology and the energy sector.

The Competency and Credentialing Institute (CCI) believes that a high quality, rigorous period of education and training provides an essential foundation for the long-term professional growth of a perioperative nurse. We also believe that the principles of apprenticeship programs should be evaluated and adapted if suitable for our complex specialty. As a profession we must address the key deficit in our current methods – the lack of a nationally recognized credential. Next month, I will outline the CCI plans for that shortfall.

References

Crider, M.C. & McNiesh, S.G. (2011). Integrating a professional apprenticeship model with psychiatric clinical simulation. Journal of Psychosocial Nursing and Mental Health Services. 49(5):42-9. doi: 10.3928/02793695-20110329-01. Epub 2011 Apr 13.
Robb, I.H. (1907). Educational Standards for Nurses: With Other Addresses on Nursing Subjects. E. C. Koeckert.
Shulman, L. S., Leonard, V., Benner, P., Sutphen, M., & Day, L. (2013). Educating nurses: A call for radical transformation. San Francisco, Calif: Jossey-Bass.
U.S. Department of Labor (n.d.) Explore apprenticeship. Accessed November 21, 2020 at: https://www.apprenticeship.gov/employers/explore-apprenticeship.

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

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