This month, many perioperative nurses make a pilgrimage to the Association of periOperative Registered Nurses (AORN) Congress. I use the term pilgrimage, which denotes a special journey, deliberately. Indeed, those who make the commitment, sometimes using their own finances and vacation time, consider the journey to AORN special. Attendance is generally driven by the educational content and the opportunity to interact with colleagues from around the world. The information participants take back to their respective institutions helps them improve their practice and patient outcomes.
In my experience, perioperative nurses are a dedicated group committed to their practice and their patients. So AORN's theme this year, "Reaching the Peak of Perioperative Practice," is apt and a worthy guiding principle for any year. This theme addresses continuous improvement, and individual and organizational commitment to optimum patient outcomes and to collaboration. The question becomes how do we move forward? What steps do we take to reach the peak of perioperative practice?
One step our organization has recently taken is to make preoperative briefings mandatory. Generally led by the surgeon, these briefings let the surgical team discuss specific patient issues affecting the surgery and provide an opportunity to communicate special requirements such as positioning or special equipment needs. Team members can ask questions related to their roles and the operative case, promoting enhanced collaboration and communication.
The journey to excellence can be long and tedious. Those of us who've been perioperative nurses for any length of time understand the magnitude of implementing required preoperative briefings. The OR culture hasn't always made these types of changes easy-although there were and are surgeons who valued team communication, there were many more who didn't. The lack of interdisciplinary communication and a "captain of the ship" hierarchy set up roadblocks to clear and open communication. But the OR culture is transforming slowly.
Evidence-based practice, education, and physician-nurse leadership collaboration have guided this transformation. Few if any OR staff members aren't aware of the evidence linking poor communication to patient errors. Preoperative briefings and other communication tools or techniques have surfaced to provide effective and efficient communication.
Patient safety and technology has raised the level of education needed to support the perioperative practice. Few facilities continue to have on-the-job training for scrub persons. This wasn't the case when I started as a nurses aide in surgery: I trained on the job to scrub and circulate as needed. At that time, an RN was present in the OR, but not necessarily in a circulating role. Today, the knowledge base needed to perform competently in a complex surgical environment precludes using untrained personnel. Scrub persons generally have 1 to 2 years of education, depending on the program, and RNs entering the OR have previous experience or receive a lengthy orientation. Many facilities require OR nurses to be AORN-certified.
Physician-nursing leadership collaboration is essential to promoting this cultural transformation. Understanding the value of a team approach and continuing to search for methods to enhance communication provide the fuel to continue the journey. Our pilgrimage to reach the peak of perioperative excellence is an ongoing journey, with the focus and destination of optimal patient outcomes.
Elizabeth M. Thompson, MSN, RN, CNOR
Editor-in-Chief Nursing Education Specialist Mayo Clinic, Rochester, Minn. [email protected]