The RN first assistant as OR concierge

AORN Journal,  July, 2004  by Kathie Robbins,  William J. Mann, Jr.

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The article "The RN first assistant as OR concierge," is the basis for this ORN Journal independent study. The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, BC, education program professional, Center for Perioperative Education. Participants receive feedback on incorrect answers. Each applicant who successfully completes this study will receive a certificate of completion. The deadline for submitting this study is July 31, 2007.

Complete the examination answer sheet and learner evaluation found on pages 99-100 and mail with appropriate fee to

AORN Customer Service

c/o Home Study Program

2170 S Parker Rd, Suite 300

Denver, CO 80231-5711

or fax the information with a credit card number to (303) 750-3212.

You also may access this Home Study via AORN Online at http://www.aorn.org/journal/homestudy/default.htm.

BEHAVIORAL OBJECTIVES

After reading and studying the article on the role of the RN first assistant (RNFA) as OR concierge, nurses will be able to

1. explain problems encountered by the obstetrics and gynecology department at the facility described in this Home Study,

2. discuss options that facility members considered to resolve these problems,

3. identify methods used by the RNFA to solve these problems, and

4. describe skills that an RNFA may possess that would put him or her in an ideal position to act as OR concierge.

Efficiency in health care is a paramount concern as profit margins lessen and budget constraints place harsh demands on surgical services departments. In addition, competition between hospitals for physicians and OR staff members has increased, and unhappy physicians and staff members are quick to move to other facilities. Maintaining adequate OR staffing levels is becoming more difficult because of the nurse shortage, and a projected physician shortage in five to seven years will only aggravate the situation. (1) In this stressful environment, teamwork, which is "the backbone of perioperative patient care," (2 (p 372)) is even more vital to successful functioning.

DIAGNOSING THE PROBLEM

At Jersey Shore University Medical Center, Neptune, NJ, the obstetrics and gynecology (OB/GYN) department found itself plagued by physician complaints about delayed procedures, inadequate or incorrect equipment, and problems with individuals assisting on complex procedures. Perioperative staff members compiled lists of procedures in which problems occurred, and a review of these lists indicated that problems were widespread and not associated with a specific OR team or physician. Some of the ongoing problems reported by perioperative staff members included incorrectly scheduled procedures, physicians requesting instruments that were not on their preference cards, novel patient positioning requirements, and requests for a large variety of unfamiliar instruments.

Frequent lengthy and frustrating discussions were held during the month]y OB/GYN department meetings, but no appreciable improvement was noted. During this time, several physicians decided to perform their procedures in other, smaller facilities where they perceived that fewer problems occurred during surgery. Jersey Shore's volume of gynecology procedures remained stable because of the addition of new surgeons, but individual physicians began to perform fewer procedures as they transferred procedures to other facilities. Additionally, gynecology case volume in the attached same day surgery center (ie, surgicenter) was noted to be very low.

A decision was made to place a nurse in charge of the gynecology service. This individual was instructed to meet with OB/GYN physicians frequently to address their concerns. Unfortunately, because of staffing limitations, this nurse also was responsible for urology and general surgery. In addition, many problems occurred during the evening and on weekends when this nurse was not available; therefore, no improvement occurred, and the nurse overseeing gynecology services became frustrated and transferred to another hospital.

While these problems were occurring in the OR and the surgicenter, a different set of issues began to develop in the obstetrical suite. Jersey Shore University Medical Center serves as a regional referral center for high-risk obstetric procedures. As the complexity of patient conditions increased, more complicated and extended surgical procedures were being performed in the labor and delivery (L&D) department, including hysterectomies, arterial ligations, and extended procedures involving the bladder or ureters. Staff members in the L&D department had considerable expertise in assisting in cesarean sections (C-sections) but were unprepared for more complicated procedures, which usually were emergent and unscheduled.

Significant deficits were noted in instrument trays, particularly because they were not intended to be used for more extensive procedures. Expense prohibited adding needed instruments to every tray, so separate instrument trays were created for more extensive procedures. Identifying these trays and ensuring that they were stocked properly, available, and easy to find and open, however, became a source of concern for L&D staff members and physicians. In addition, physician instrument and supply preferences varied. A staff member was assigned to address these issues, but problems still were encountered in nearly every extensive procedure.