A successful nursing student practicum in an ambulatory surgery center

AORN Journal, August, 2006 by Linda M. Sigsby, Jolene Selzer, Terry Keenan Wilson

Perioperative nurses are retiring in greater numbers than ever, and the relative lack of perioperative experiences for students in nursing programs may limit the number of new graduates who will choose to pursue a career in this specialty. (1) Perioperative nursing staff members and academic nurse educators have been experimenting with a variety of learning opportunities to expose nursing students to perioperative patient care.

The Think Tank on Perioperative Learning Experiences in the Nursing Curriculum, which took place in February 2004 and was cosponsored by the AORN Foundation and the National League for Nursing, proposed new and creative ways of thinking about nursing education in general and perioperarive nursing specifically. (1,2) One of the goals of the think tank was to encourage partnerships between schools of nursing and clinical facilities to develop a full range of clinical learning opportunities. One such partnership, between the University of Florida College of Nursing, Gainesville, Fla, and the Florida Surgical Center (FSC), Gainesville, Fla, allows undergraduate nursing students to explore the specialty of perioperative nursing in an ambulatory surgery center (ASC), a setting that has been underutilized for perioperative student learning.

Hospital-based surgical suites have been the primary setting for successful nursing student exposures to the perioperative specialty, which generally occur through semester rotations, (3) single-day observational experiences, and elective courses. (4,5) Ambulatory surgery centers also have been used as sites for nursing students' perioperative experiences, but a perceived limited acuity of patients and repetition of mundane procedures sometimes has resulted in less student satisfaction with learning experiences in the ambulatory settings. (6,7)

Patient selection criteria for ASCs includes consideration of a patient's American Society of Anesthesiologists physical status classification, (8) age, and level of obesity or frailty, as well as the surgical procedure to be performed. These considerations are critical in determining viable candidates for ambulatory surgical interventions, but they also limit the types of surgical procedures performed at ASCs. Today, however, staff members at ASCs perform procedures such as knee arthroscopies, rotator cuff repairs, and laparoscopic cholecystectomies that only a few years ago were limited to the inpatient setting. Now ASCs offer nursing students a wide variety of learning experiences.

The exponential growth in the number of ambulatory surgical care settings makes them excellent venues for teaching and learning experiences and means that they may offer employment opportunities for new nursing school graduates." Without information about these settings, however, nursing students often are not aware that ASCs exist as free-standing facilities associated with hospitals or independent clinics specializing in orthopedic; eye; ear, nose, and throat; and plastic surgery procedures.

Historically, seasoned perioperative nurses have been given priority for employment in these settings because working at ASCs was perceived to be less strenuous as a result of the Monday-through-Friday schedules and no requirements for nurses to be on call. As surgical interventions in ASCs be come more complex and demanding, however, a more energetic, vigorous, and flexible new graduate may be the better staff member resource for ambulatory facilities.

A PRACTICUM FOR NURSING STUDENTS

Each year at the University of Florida, approximately 150 undergraduate students who have a grade point average of at least 3.6 on a 4.0 scale are admitted into the junior class in the College of Nursing, with an attrition rate of less than 10% by the conclusion of their senior year. By graduation, students will have completed didactic courses in adult, pediatric, maternal/ child, psychiatric/mental health, and community nursing, as well as courses in research, leadership and management, law and ethics, and professional socialization. They also will have completed a total of 880 contact hours of clinical experience in related courses.

In their final semester, senior baccalaureate students participate in a practicum, the purpose of which is to synthesize didactic learning into a clinical experience that allows students to gain confidence in their abilities and make the transition into a professional working role. Students are required to work a total of 240 contact hours in eight weeks (ie, approximately 36 hours per week) in a clinical setting of their choice. For the experience, they work with a nurse preceptor who has a baccalaureate or graduate degree. An academic faculty member also supervises the students, though the faculty member is not on site constantly.

Students select a site for their practicum experience using a lottery system. Students obtain a ticket as they enter the classroom, and a matching ticket is placed in a bowl. Tickets in the bowl are constantly stirred, and one ticket is selected at a time. The student holding the matching ticket goes to the front of the room and selects his or her clinical site from a wide array of choices. Sites vary by clinical emphasis; city; or type of hospital, clinic, or health department. Students may select a site because they liked the type of nursing care they experienced in an earlier course, or they may want a brief, intense exposure to a new site to help them determine if the particular type of nursing care they can experience at that site is right for them. A student who selects a perioperative setting makes the selection for the same reasons, and therefore may not necessarily have decided to become a perioperative nurse. Perioperative practicum sites include a Veteran's Administration Hospital with 10 ORs, a research hospital with a level one trauma center that has 23 OR suites, a community hospital with eight ORs, and an ASC with four ORs.