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The evolving role of advanced practice nurses in surgery

AORN Journal, May, 1998 by Denise M. Hodson

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The advanced practice CRNFA role in surgical arenas has many similarities to the APN and ACNP designations; however, it as yet has not been fully recognized by educators, surgical directors, or health care administrators. These new roles are not bound by the traditional CNS and NP parameters, nor are they restricted to particular settings.(33) The roles are designed to provide collaborative, comprehensive, and continuous advanced nursing care for clients across the continuum of acute care services.(34) The impetus is to look beyond roles and focus on applying clinical knowledge to streamline cost-effective, quality health care. For the purposes of this article, the term APN will be used exclusively to discuss nurses with advanced clinical practice experience because of inconsistencies in role titling.

More Articles of Interest: National Nursing Stakeholders' Meeting On Advanced Practice Nurses; Can Advanced Practice Nurses Succeed in the Primary Care Market?; acute care nurse practitioner: An evolving role in Kansas, The; Demonstrating APN value in a capitated market; Reimbursement Issues in Advanced Practice Nursing: An Overview

Changes in care delivery are opening doors for perioperative nurses to move beyond circulating and scrub roles into expanded and advanced practices.(35) AORN has recognized this revolutionary mandate for change and is in the process of strategically posturing perioperative nursing practice for the future. In July 1997, AORN formulated a new vision and collaborated to redefine and reconceptualize the perioperative nursing practice. The Association designed a perioperative nursing document to meet the needs of perioperative patients within various practice settings' and allow for flexible boundaries for nurses to move between three roles: perioperative clinician, interventional care coordinator, and advanced practitioner.(36) The primary emphasis for perioperative clinicians is within the intraoperative phase of patient care in either scrub, circulating, or supervising roles. Interventional care coordinators are certified perioperative nurses functioning in expanded clinical and managerial roles. The interventional care coordinator descriptor includes the expanded roles of RNFA, surgical case manager, intraoperative patient care coordinator, patient and family educator, and cost reduction specialist.

The focus for all providers is perioperative patients whose needs are met in a variety of preoperative, intraoperative, and postoperative practice settings. Practice foundations in all roles include the nursing process, leadership, ethics, legal and regulatory issues, research, quality, multicultural considerations, and individual and professional accountability. Nurses develop competence at each level along the novice to expert continuum.(37) Although the framework is in the infancy stage, the paradigm shift of perioperative advanced practice has been recognized and identified in clinical and managerial terms, and the framework now is a working document for AORN.

The APN role has been accepted nationwide as an effective strategy for patient care management. The AORN House of Delegates adopted the ANA definition of advanced practice and applied it to perioperative nursing in 1995. This definition states the advance practice nurse

* possesses a master's degree;

Health Care Industry

The evolving role of advanced practice nurses in surgery

AORN Journal, May, 1998 by Denise M. Hodson

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