Tennessee RN First Assistant Survey Data—What Types of Perioperative Education are Needed? - registered nurse

AORN Journal, Nov, 1999 by Rod Heckman, Jan Barnhill

Over the years, as nursing education moved from hospital diploma programs to the university setting, many nursing programs removed perioperative education from their curricula. Nursing graduates interested in the OR have had to rely on perioperative nurses and managers to provide on-the-job training or have had to find some type of formal course presented by individual institutions. The perioperative practice area now is experiencing fewer numbers of perioperatively educated graduates, an aging perioperative nurse population, and multiple new career opportunities that attract perioperative nurses away from the OR.

The consequences of this are many. Hospitals in outlying areas have to staff their perioperative areas with traveling nurses and surgical technologists. Many hospitals have been forced to increase the numbers of surgical technologist staff members for scrub roles because RNs with perioperative experience are not available. It is common to hear perioperative nurses relate how they and other managers have to perform staff functions on a daily basis at nursing seminars and meetings across the country. In response to this need for perioperative nurses, a small number of nursing programs are beginning to include perioperative courses; however, it remains difficult for perioperative nurse managers to attract new nursing graduates and RNs with perioperative experience.

BACKGROUND

Data collected from a recent survey in Tennessee suggests that RN first assistants (RNFAs) have the same difficulty finding educational preparation as perioperative nurses because of the lack of formal RNFA education in basic nursing programs or in postgraduate RNFA courses. The postgraduate courses currently being offered by hospitals and other educational institutions rely on applicants who have previous perioperative experience, the ability to take time off work, and the ability to absorb travel expenses and relatively high tuition costs.

The need exists for schools of nursing, hospitals, and other educational institutions to develop formal guidelines, structured programs, and evaluation processes--under the guidance of AORN and the RNFA Specialty Assembly--that are based on national standards. The first steps toward standardizing and accrediting programs are now being taken by the Certification Board Perioperative Nursing (CBPN). The current list of approved RNFA education programs is available from the CBPN, and more programs are being reviewed for accreditation.

SURVEY RESULTS

The authors believe that nurses interested in the perioperative field and RNFA role do not have access to programs with formal standards and uniform qualities, and their specialty education does not occur in a timely manner. More postgraduate programs for perioperative nurses and RNFAs need to be established. If this occurred, it is the authors' belief that increased recruitment and retention of RNs and RNFAs in the perioperative area would result and this, in turn, would increase staff nurse morale, career opportunities, and the marketability of perioperative nurses and RNFAs.

During a seminar offered by a subgroup of the RNFA Specialty Assembly located in Tennessee, 80 seminar participants were asked to complete a survey consisting of approximately 50 questions about the practice patterns of the RNs and RNFAs present. The survey asked standard data-gathering questions about the RN or RNFA and his or her practice.

SURVEY ONE--PRACTICE PATTERNS

The results of this survey supported the authors' belief that RNs are not being exposed to perioperative nursing practice during their basic education. With a small number of today's nursing programs offering perioperative nursing courses, the demand for experienced perioperative RNs and RNFAs is greater than the supply. As seen in Table 1, the majority of RNs who responded (ie, 63.2%) had to rely on their employers to provide their education in perioperative nursing skills and techniques. Nurses wanting to expand their roles to include first assisting faced the same situation.

Table 1

SURVEY ONE-PERIOPERATIVE RN AND RN FIRST ASSISTANT (RNFA) PRACTICE PATTERNS

* 80 participants/38 responses (47.5%).

* 83.3% female/16.7% male.

* Mean age = 40.6.

* Median age = 43.

* Mean number of years in the OR = 14.3.

* 32 respondents (84.2%) were hospital based.

* 11 respondents (29%) worked full time in the OR as RNFAs.

* 21 respondents (56%) had an associate's degree or associate of science degree in nursing.(*)

* 5 respondents (12.2%) were diploma graduates.(*)

* 36 respondents (9.5%) had a bachelor of science degree in nursing.(*)

* 9 respondents (2.4%) had a master of science degree in nursing.(*)

* 19 respondents (4.8%) had a bachelor of science degree in another field.(*)

* 19 respondents (4.8%) had a master of science degree in another field.(*)

* 14 respondents (36.8%) had some type of structured postgraduate perioperative or RNFA course.

* 24 respondents (63.2%) received on-the-job perioperative or first assistant education.

* 24 respondents (63.2%) had CNORs.(*)