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The Times They are a Changin’ – with Apologies to Bob Dylan

By James X. Stobinski

The Competency and Credentialing Institute (CCI), the organization that administers the CNOR and CSSM credentials, is amid a strategic planning process. Part of that process is an environmental scan to determine the current place of CCI within the larger world of perioperative nursing practice. As the CEO of CCI, I have been actively engaged in that process and have gained a few insights. First, the profession of perioperative nursing and the nature of surgery within the context of American health care is in a period of disruptive and turbulent change. Even the sites where surgery is performed are changing.

The total number of surgeries continues to increase as does the amount of surgery performed in ambulatory settings but the amount of surgery requiring admission to a hospital is not rising in tandem. (Munnich & Parente, 2014). And, the number of hospitals is slowly declining (Statista, n.d.). Advances in technology and procedures underlie these changes but another causative factor is the transition to value-based care. The sum of these changes culminates in things like same day surgery for total joint procedures, a process difficult to even imagine when I entered the OR 30-plus years ago.

These changes have enhanced the role of perioperative nursing and created new opportunities. However, these new opportunities bring heightened expectations and increasing demands for our profession. CCI has observed that continuous professional development (CPD) is now a necessity throughout a career. And … familiar methods long used in the profession will no longer suffice to meet the learning needs of perioperative nurses. American nurses have long used continuing education (CE) courses to remain current in their practice. At CCI, we believe the use of CE (as currently configured) will no longer suffice to maintain the clinical competency of perioperative nurses going forward.

A review of the evidence regarding our current system of CE reveals that the link between the use of CE and improvements in nurse competency is at best – weak. (IOM, 2010). The question for perioperative nurses then becomes – if the use of evidence-based practice in our clinical work is now commonplace should we also apply that perspective to the educational and administrative segments of our practice? CCI believes that based on the evidence we need to strengthen and refine our professional development efforts to give optimal patient care.

As CCI changes relative to the implementation of our strategic plan we hope to align our work with the professional development needs of our perioperative nurses to deliver the highest quality care within a rapidly evolving American health care system. CCI believes that the complexity and pace of change in modern perioperative nursing requires a robust system supporting lifelong learning and CPD which will lessen the dependence on CE. We see the current CE-based system replaced in some measure by structured, systematic lifelong learning consistent with the recommendations from the Institute of Medicine report on the future of nursing. (2011, p. 13).

CCI continues to invest in technology such as the freestone Learning Management System (LMS) to develop an optimal learning environment for certified perioperative nurses. CCI, in the very near future, will have a perioperative centric LMS with a repository of meaningful learning activities for its certificants. We hope, in working with our partners such as OR Today Live, to establish a dynamic and sustainable system that perioperative nurses can utilize throughout their career. For our current certified nurses and those who aspire to certification, stay tuned. CCI and our partners and stakeholders have some exciting changes coming. We look forward to working with you to deliver excellent perioperative nursing care in these rapidly changing times.

James X. Stobinski, Ph.D., RN, CNOR, CSSM (E), is the CEO of the Competency and Credentialing Institute. He may be reached at

1. Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, D.C.: The National Academies Press. Accessed October 5, 2018 at:
2. Institute of Medicine. (2010). Redesigning continuing education in the health professions.



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