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An administrator returns to practice as a perioperative nurse

AORN Journal, Nov, 2002 by Ruth Waibel

Much attention has been drawn to the shortage of nurses in health care organizations today. Statistics show that the average age of nurses in the current nursing workforce is 45 years, and projections indicate that the number of younger students entering nursing programs will continue to decline. (1) Although the shortage is reported to be nationwide, nurse recruitment and retention issues are not the same throughout the country. (2) Executives have structured human resource plans to address the nursing shortage in their areas and improve staffing patterns in their respective organizations. A Missouri hospital recently asked retired nurses to return to work. (3) Although this may be a short-term strategy, it will increase the number of nursing staff members in departments with shortages. Other strategies have included offering sign-on bonuses, sometimes as high as $10,000. (4)

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In the present health care environment, many nurses in leadership roles return to staff positions for various reasons, including lessening stress from administrative responsibilities, receiving personal fulfillment from a clinical practice role, or because their leadership positions are restructured. Exciting challenges exist for nurses with managerial experience who return to staff nurse roles.

FROM ADMINISTRATOR TO STAFF NURSE

I formerly was employed as an administrator in a children's hospital and became unemployed when the organization realigned managerial positions and implemented numerous cost-reduction strategies. I was going to school part-time and working full-time before the elimination of my job, so I was compelled to find employment that could provide an income to cover family expenses and costs of living.

Circumstances limited my opportunities for finding a new job. I did not plan to relocate, and there were no management positions available in the community. My license to practice nursing was current, however, which made a nursing position an option. Although my resume documented years of management experience and clinical practice, my OR experience was dated. I responded to advertisements for perioperative nurses in local hospitals and ambulatory surgery centers in the area, but no jobs were offered.

Colleagues from the local AORN chapter provided insight into the dilemma that perioperative directors face. They want to hire younger nurses they can train or nurses with recent OR experience to save on orientation costs. Hiring a former nurse manager may be considered a waste of time because the former manager is apt to leave a staff nurse position as soon as another management position becomes available. Nurses with managerial credentials might be perceived as threatening to other staff members and managers. Hiring a former manager into a staff member position, therefore, must be undertaken with care and insight, or the benefit to staffing structures will be short-lived.

A nursing colleague and friend offered me a position as a part-time perioperative staff nurse to supplement staffing and relieve full-time staff members for vacations or other time off. I would start with the easy procedures--those I had plenty of experience with in the past, such as pediatric otorhinolaryngology (ORL), general surgery, and ophthalmology procedures. She also suggested that I would serve the department best by managing procedures that had changed little during the past years. I had found a job, but more challenges lay ahead.

SUCCEEDING AS A STAFF NURSE

My first responsibility was to think as a staff nurse, not an administrator. Although both positions are imperative for organizational success, different foci are unique to each position. For example, the manager has responsibility for understanding and representing global patient and hospital needs and the perioperative nurse dedicates his or her time to specific patient care planning and managing a day's surgical schedule. Relationships in the OR are part of a successful team strategy. Nurses' relationships with colleagues and physicians are patient-focused and more collaborative than are relationships between those in managerial roles.

The process to learn or relearn how to structure time commitments, procedure management, patient priorities, nursing practice patterns, and team dynamics with various surgical professionals became a daily agenda. Basic surgical techniques and standards of nursing care that once had been well-developed routines would be tested. Meeting the challenges of daily schedules might be grueling at best. Practicing perioperative nursing under new standards surely would be a test.

KNOWLEDGE AND MASTERY OF PRACTICE

The anticipation of returning to work as a perioperative nurse when my skills were rusty evoked both feelings of joyful anticipation and tinges of nervous expectation. My experience during the past 25 years included working as a perioperative nurse and supervisor in two large community hospital ORs, two pediatric hospital ORs, and a freestanding ambulatory surgery center. Over time, my responsibilities focused first on surgical and then later on nonsurgical divisions where I developed and implemented health care businesses, such as an urgent care center, neonatal networks, and home health services.

Health Care Industry

An administrator returns to practice as a perioperative nurse

AORN Journal, Nov, 2002 by Ruth Waibel

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