Investing in the future—an OR orientation program for nursing students

AORN Journal, March, 1999 by Kathleen E. Schulz, Kathleen Disanto

The average age of nurses today is 44, and the average age of perioperative nurses is 47.(1) Keeping this statistic in mind, look around the surgical suite and see how many 20- to 30-year-olds you see. In 10 years, who will be the nurse who assesses us in the holding area for our pacemaker insertion or total hip replacement? As a 47-year-old perioperative nurse, this issue concerns me, and it should concern all perioperative nurses.

STUDENTS' EXPERIENCES IN THE PERIOPERATIVE ARENA

As a surgical services educator, I have gained some insight into two reasons why the OR does not attract younger nurses. The first reason is that associate degree in nursing (ADN) and bachelor of science in nursing (BSN) programs are not giving students enough exposure to the OR as a potential career area. The second reason is that OR staff members do not always use the time they may be given with students to the best advantage.

When I came to University Community Hospital, Tampa, Fla, I observed nursing students who were dropped off at the OR front desk on the morning of their one-day surgery observation. The students were turned over to the charge nurse, who was responsible for running the OR scheduling board. It was the charge nurse's job to find a place for the students to observe. The students' instructor, who was not an OR nurse, would have the students in scrubs, but without hats or masks. The charge nurse eventually would assign each student to an OR. Some circulating nurses and surgeons were interested in having students in the OR, but some did not want students observing. At times, the students were instructed that their hair must be covered before entering the OR. Other times, they were not told until one of the surgical team members yelled, "Don't you know this is an OR? Cover your hair!"

DEVELOPING A PERIOPERATIVE ORIENTATION PROGRAM

I called an instructor in one of the ADN programs at a local community college to arrange for a meeting to discuss my concerns about students' surgical experiences. I was happy to discover that she had these same concerns, but had no one with whom to share them. We both believed that we were losing potential perioperative RNs because they were not having positive experiences in the OR.

We agreed to develop an OR orientation program that all students would complete before their surgical observations. This orientation includes a brief history about perioperative nursing, a description of surgical team members' roles, and a tour of the OR environment, including restricted, semirestricted, and unrestricted areas. We also include a demonstration of how to don a surgical hat and mask. The orientation takes approximately 45 minutes to present, after which students tour the change rooms and entrance areas. Finally, students are shown where to meet the OR educator on the morning of their observation and are given OR learning objectives with instructions to complete them in writing before their scheduled observation. The objectives ask students to * describe the role of the circulating nurse and the scrub person,

* define sterile technique and clean technique,

* list the principles of sterile technique, and

* summarize their experiences with an emphasis on the role of the RN in perioperative nursing.

ASSIGNING STUDENTS TO ROOMS

At observation time, the OR educator makes every effort to assign each student to a room that might enhance his or her learning experience. The type of procedure, the surgeon, and the OR staff members in the room are considered when deciding which rooms would best meet students' needs.

The educator assesses each student to determine what type of surgical procedure he or she is interested in observing and what, if any, experience he or she has in the OR. For students who are not interested in the OR, the educator chooses the one-day surgical suite, where students can observe shorter, less complicated procedures (eg, breast biopsies). Other students are extremely interested in the OR and even have particular surgical procedures in mind (eg, open heart procedures). For such students, the educator examines the OR schedule and tries to assign the students to the procedures they want to observe. In general, this task is accomplished easily. On rare occasions, the educator makes the best possible decision regarding the assignment based on the available procedures. By allowing students to participate in the decision-making process, the best results are accomplished.

THE IMPORTANCE OF PRECEPTING

Rooms in which OR nurses who express an interest in precepting students are present are used whenever possible. Every effort is made to avoid placing a student in a room where the circulating nurse is not interested in precepting students. On rare occasions when there is no other choice, the educator speaks with the circulating nurse before assigning a student and explains the need to place the student in that room. The educator then reviews the student's objectives with the circulating nurse and discusses the importance of providing the student nurse with a good surgical experience. By discussing the national shortage of OR nurses, the need to recruit new RNs into the OR, and the fact that this might be our only opportunity with these students, the educator has gained support from the circulating nurses. As time has gone on, the RNs not only enjoy having the students observe, they also request that students be assigned to their rooms.