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Stand by for Heavy Seas

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

I recently read an exceptional editorial written by Judy Mathias (2020) about leadership. The editorial was largely a recounting of remarks made by James Mattis in a recent webinar. Although some of you will recognize the name of this retired four star general, it is not often that you find him cited among health care experts. However, Gen. Mattis is a subject matter expert on leadership and during these extraordinary times some wise words on this topic are especially relevant.

The content from Gen. Mattis came under the header, “Rough seas make good sailors.” As a U.S. Navy veteran, this phrase rings familiar. The thought is that challenges and trying conditions, such as the current pandemic, force us to respond and rise to another level of performance. Mattis tells us that the challenges visited upon American health care by the COVID-19 pandemic will exact a toll on those in leadership roles with perioperative nurse leaders not being exempt. He tells us that, “This crisis is applying a very crude and very harsh grading system to our leaders … ” (Mathias, 2020, p. 3). It is disorienting for perioperative nurses accustomed to the security of high demand for surgical care to be displaced to other units, furloughed or lose employment as elective surgical caseload plummets.

Unfortunately, even as some regions of the country return to more normal routines in surgery, there remains considerable uncertainty. Staying with the nautical theme it reminds me of the phrase, “Stand by for heavy seas,” the title of this column. In seafaring, the phrase describes when the water has large waves or breakers in stormy conditions (Mimi Boating, 2020). I have experienced such conditions on a large warship and it is quite disorienting. Under such conditions it is difficult to carry out even the most routine tasks. That description is apt as I predict we will have rough conditions in the OR for the near future. We must address the backload of elective surgeries in the context of severely diminished revenue for one quarter of this year.

At the Competency and Credentialing Institute (CCI), we also have anecdotal reports that many experienced perioperative nurses who were in high-risk groups elected to retire during the pandemic. We have seen unprecedented numbers of our certificants retiring their credentials and applying for emeritus status. Perioperative nurses tend to have long careers and we have many nurses with 30 and 40 years in the specialty. It seems the changes wrought by the pandemic have proven a tipping point for some to leave the profession.

The pandemic has brought a distinct set of challenges for CCI. In-person testing volume has shrunken to record lows with very little testing during April and May. Testing is now slowly resuming, but seat capacity for in-person testing remains limited and spotty with distinct variability by state and by region and city within a state. An example of change for CCI, considering limited seating availability, has been the rapid transition to Remote Secure Proctored Exams (RSPE). That change has not been entirely smooth, and our accreditation bodies have also been forced to pivot quickly to emphasize RSPE.

At CCI, we envision remote testing as having a larger future role. We are working diligently to refine these processes for our nurses. The heavy seas of American health care have forced us to change and adapt and the credentialing specialists at CCI have been instrumental in the startup of remote testing. In our column next month, these frontline staff will relate lessons learned from the CCI transition to RSPE.

1. Mathias, JM (2020). Editorial. OR Manager. 36(7). Pp. 3-5.
2. MiMI Boating. (n.d.) Heavy seas: Definition. Accessed July 2, 2020 at:



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