Implementing a perioperative nursing: elective in a Baccalaureate Curriculum

AORN Journal, Nov, 2004 by Susan P. Holmes

The United States is experiencing a nursing shortage that is expected to worsen significantly during the next two decades. Specialty units that require additional and unique training for nurses, including perioperative nursing units, already are reporting critical shortages. (1,2) The current perioperative nursing shortage is the result of several trends:

* an aging nursing workforce,

* an aging population that requires more health care services,

* technological innovations that create a constantly changing work environment, and

* the lack of exposure of nursing students to perioperative clinical experiences. (3)

The majority of future specialty nurses are new graduates from nursing programs; however, if new graduates have had little or no experience in perioperative clinical areas, it is unlikely that they will choose to work in these units. (4 )After graduation, nurses generally choose to work in areas in which they had the most clinical experience as students. (1)

The most aggressively recruited specialists today are perioperative nurses, clinical nurse specialists, medical/surgical specialists, critical care nurses, emergency services nurses, and obstetric nurses. (5) Insufficient numbers of trained perioperative nurses may lead to the hiring of staff members who are not nurses but who can be trained in technical tasks. Patients are most vulnerable when they are sedated or anesthetized, however, and one of a perioperative nurse's major responsibilities is to be the patient's advocate in the OR. (6) If there is no professional nurse to speak for the patient, patient care may suffer.

THE CURRENT STATE OF NURSING EDUCATION

Nursing education must take on the responsibility of preparing future practitioners to meet the needs of surgical patients in efficient and cost-effective ways without neglecting the need for increased patient advocacy in today's health care environment. Most undergraduate nursing programs offer few, if any, courses or experiences specific to the specialty of perioperative nursing. (7) During the past 40 years, rotations in perioperative areas have been eliminated from most baccalaureate nursing curricula, even as the demand for nurses in this specialty has increased. (8) There also has been a move away from the medical model to a more generalist preparation for nursing students. (6) Focused content and even brief clinical experiences in specialty areas within nursing have been reduced drastically in most baccalaureate nursing programs. (6)

The nursing shortage is not restricted to staff nurses but extends to nursing faculty members as well. There are fewer qualified faculty members available to teach an already full curriculum. It is difficult to develop experiences in perioperative nursing within the curriculum when faculty positions are vacant and faculty members are overwhelmed with existing coursework. The impetus to add new content to the classroom and clinical area simply does not exist in this environment. Faculty members also are not willing to give up hours dedicated to already developed content to facilitate new and different experiences.

SHORTCOMINGS OF TRADITIONAL NURSING SCHOOL CURRICULA

In many traditional nursing school curricula, several factors may limit or prohibit students' observation of surgical procedures. A patient who is assigned to a student for a clinical rotation may not undergo surgery during that clinical rotation. Surgery also may be scheduled on an emergency basis, and the short notice may not allow time for necessary permissions to be obtained so that the student can observe in the OR. Furthermore, students should have the time to review surgical asepsis and principles of care of an anesthetized patient before observing procedures so that they can think critically about what occurs from preoperative preparation through postanesthesia care.

Other factors that may prevent students from observing in perioperative areas include short staffing, a heavy surgical case load, restrictions on the number of individuals allowed in the OR for certain procedures, lack of extra scrub clothing for student use, and the number of new employees being oriented in the unit on a given day. As a result, many nursing students receive minimal exposure to perioperative nursing, and this limited exposure does not allow them to develop an understanding of or appreciation for the specialty. (2)

Some educators report that they encounter resistance to placing students in the OR for clinical rotations. (9) Issues include nurses and physicians who are not interested in having students in the OR and OR staff members who feel that working with students is an intrusion on their work time rather than an opportunity to foster an appreciation for the specialty. (9)

Some nursing programs, however, report having developed unique and individualized perioperative nursing electives. (2,4,6,8-11) Credit for these electives vary from one to four credit hours. The amount of didactic and clinical time allotted also varies. All electives were developed in collaboration with clinical agencies with whom the schools of nursing held clinical affiliation agreements.