Measuring Registered Nurses' Medication Competence in Specialty Settings: An Operating Room Registered Nurse Example.

Nursing professional development practitioners play an active, vital role in shaping, implementing, and evaluating competency models in their organizations. This article describes a process for developing and continuously improving knowledge assessment examinations, one component of a competency model. The article defends the use of specialty-specific medication knowledge assessment examinations. The authors recommend future investigations to link nurses' knowledge assessment results to performance in practice and to analyze costs and benefits of knowledge assessment examinations.

Perioperative pharmacology: a framework for perioperative medication safety.

Learning pharmacology is a critical element of any health care practitioner's education to ensure quality and safety in perioperative care. The medication-use process and safe medication use are two important principles that contribute to the safe use of pharmacological agents in perioperative clinical practice. The medication-use process consists of procuring, prescribing, transcribing, dispensing, administering, and monitoring; however, variations in the medication-use process result from demands unique to the perioperative environment, and these variations can sometimes bypass the safety nets within the system. Understanding these variances will help perioperative practitioners recognize threats to patient safety and help ensure the patient's well-being. Responsibilities of a safe medication-use system include assuring the public that practitioners use medications efficiently, safely, and effectively, and fully document all medications administered.

Best practices for minimally invasive procedures.

Techniques and instrumentation for minimally invasive surgical procedures originated in gynecologic surgery, but the benefits of surgery with small incisions or no incisions at all have prompted the expansion of these techniques into numerous specialties. Technologies such as robotic assistance, single-incision laparoscopic surgery, natural orifice transluminal endoscopic surgery, and video-assisted thoracoscopic surgery have led to the continued expansion of minimally invasive surgery into new specialties. With this expansion, perioperative nurses and other members of the surgical team are required to continue to learn about new technology and instrumentation, as well as the techniques and challenges involved in using new technology, to help ensure the safety of their patients. This article explores the development of minimally invasive procedures and offers suggestions for increasing patient safety.

Preceptorship planning is essential to perioperative nursing retention: matching teaching and learning styles.

Current nursing shortages along with unsuccessful nursing orientation programs have been a major concern for the past decade because they result in poor retention, reduced quality of patient care, decreased job satisfaction and high financial costs to the organization. Specialty areas, such as the Operating Room (OR), are even more vulnerable due to the stressful working environment and critical care skill set. It has been estimated that approximately 35-65% of new graduates will leave their work place within the first year of employment, lending to the 55% nursing turnover rate. The cost of orientating a new nurse to the perioperative role is estimated to cost between $50,000 and $59,000 U.S. Thus, it is imperative to improve the orientation experience for both new and senior perioperative nurses. Matching preceptor/preceptee learning styles is one way to enhance job satisfaction levels. This paper revisits the literature on preceptorship and provides suggestions on how to enhance existing orientation programs.

Perioperative role development: evaluating a fast-track approach to advanced scrub and/or dual role practitioner training.

This report describes the service evaluation of a newly developed fast-track advanced scrub practitioner (ASP)/dual role training programme. The evaluation examines whether the introduction of new policies and training based on risk assessment have strengthened quality assurance measures and controls which aim to ensure that staff work safely within their scope of practice. A further aim is to establish if the fast-track route is adequately meeting the training and development needs of staff within the organisation and supporting service requirements.

How perioperative nurses define, attribute causes of, and react to intraoperative nursing errors.

Errors in nursing practice pose a continuing threat to patient safety. A descriptive, correlational study was conducted to examine the definitions, circumstances, and perceived causes of intraoperative nursing errors; reactions of perioperative nurses to intraoperative nursing errors; and the relationships among coping with intraoperative nursing errors, emotional distress, and changes in practice made as a result of error. The results indicate that strategies of accepting responsibility and using self-control are significant predictors of emotional distress. Seeking social support and planful problem solving emerged as significant predictors of constructive changes in practice. Most predictive of defensive changes was the strategy of escape/avoidance.

Results of the 2009 AORN salary survey.

AORN conducted its seventh annual compensation survey for perioperative nurses in August of 2009. A multiple regression model was used to examine how a variety of variables including job title, education level, certification, experience, and geographic region affect nursing compensation. Comparisons between the 2009 data and previous years' data are presented. The effects of other forms of compensation, such as on-call compensation, overtime, bonuses, and shift differentials on average base compensation rates also are examined. Additional analyses explore the effect of the current economic downturn on the perioperative work environment.

The professional portfolio: an evidence-based assessment method.

Competency assessment is critical for a myriad of disciplines, including medicine, law, education, and nursing. Many nurse managers and educators are responsible for nursing competency assessment, and assessment results are often used for annual reviews, promotions, and satisfying accrediting agencies' requirements. Credentialing bodies continually seek methods to measure and document the continuing competence of licensees or certificants. Many methods and frameworks for continued competency assessment exist. The portfolio process is one method to validate personal and professional accomplishments in an interactive, multidimensional manner. This article illustrates how portfolios can be used to assess competence. One specialty nursing certification board's process of creating an evidence-based portfolio for recertification or reactivation of a credential is used as an example. The theoretical background, development process, implementation, and future implications may serve as a template for other organizations in developing their own portfolio models.

Mentoring new nurses in stressful times.

Meeting benchmarks of Ontario's Wait Time Strategy and the expansion of The Ottawa Hospital are key issues driving the recruitment of perioperative nurses in Ottawa and Eastern Ontario. Added pressures resulting from Canada's aging population and a nationwide nursing shortage mean perioperative nurses are overworked and understaffed. Preceptoring new members of staff raises valid concerns as many of the new recruits have little or no operating room experience. The Dreyfus Model of Skill Acquisition demonstrates the importance of time and patience in supporting the learning process. Mentoring is a valuable strategy in an effort to teach and guide new nurses, to increase nursing retention, and to promote professional growth and recognition. Building successful mentorship programs, through the creation of healthy organizational cultures, transformational leadership and staff development programs, will strengthen support for nurses in stressful times. The stress of meeting the province-wide benchmarks outlined in Ontario's Wait Time Strategy and the expansion of perioperative services at The Ottawa Hospital in Ontario are two key issues driving the need for the recruitment of nurses into the specialty of perioperative nursing. As a result of Canada's aging population and a nationwide nursing shortage, perioperative nurses are over-worked and under-staffed while being faced with the pressure to preceptor new staff members while struggling to meet the daily demands of the wait list strategy. This article discusses current trends in healthcare and the career path changes being made by many nurses in response to the demand for specialty trained nurses. It is followed by a brief explanation of the Dreyfus Model of Skill Acquisition. Mentoring is presented as an effective strategy in the guidance and teaching of new nurses with a discussion of the benefits and suggestions on how to build a successful mentorship program to support nurses in these stressful times.

Global interprofessional perioperative education: discussing the reality.

Many countries of the world have outlined clearly defined and distinct roles, for the perioperative environment, that are played by various individuals from a range of professions. Each of these professions tends to educate its practitioners in an environment that is almost completely isolated from the other perioperative professions and from its peers in other countries. One can only, currently, imagine the potential benefits to be gained from the sharing of educational and clinical experience between countries and between nursing and non-nursing perioperative team members, for both patient and the entire perioperative team. If such a level of sharing existed then the entire global perioperative community would benefit. The transfer of education and clinical practice, however, between countries needs careful thought. Many educational and professional disciplines have conducted research into ways of transferring/borrowing good practice between established systems and those just commencing similar practices. Perioperative practice needs a similar research base that has explored the dilemmas of transfer and borrowing between countries. It is important to determine what information should be shared, in the best interest of the patients, what sharing is affordable, and what method of sharing will fit in to an overall, global, strategy for perioperative practice. This paper seeks to use a recent example of multi-professional perioperative learning undertaken by Advanced Scrub Practitioners to provide a possible first glance in to the "crystal ball" of future practice. The aim of the discussion is to stimulate further discussion and effective research that, if carried out correctly, will seek to encourage interprofessional and international co-operation between perioperative professionals worldwide.

International networking: extending the perioperative potential.

The theme of last year's Congress was Realising Potential. The road to success is always under construction, and there are many choices that we make along the way, such as our partner in life, career, or how we spend spare time. A fortuitous choice of mine was to get involved with the Education Committee of NATN in 1994, as many of my lasting friendships have come as a result of my involvement with this organisation. Much of the richness and variety of life comes from the people we engage with and the networks which we develop.

Registered nurse circulator legislation in Connecticut.

Developing regulations or legislation in every state to mandate an RN as the circulator in operating and invasive procedure rooms is critical to patient safety. Current regulatory language is ambiguous and may lead health care facility administrators to consider using licensed practical nurses, licensed vocational nurses, or surgical technologists in the circulator role. The State of Connecticut currently has no legislative or regulatory language regarding the RN as circulator, but some nurses are trying to change this. Communication with state legislators, has made it clear that legislators are in need of education about perioperative nursing and the circulator role.

Hypnosis to alleviate perioperative anxiety and stress: a journey to challenge ideas.

Mention the possibility of surgery to a patient and most will react with a feeling of apprehension at best. Some will be horrified at the mere thought of being 'cut open'. For others, it will be the suggestion of entering a hospital for anything longer than an out patient appointment. Newspaper reports of healthcare-acquired infections (HAIs) may spring to mind: 'Will I leave with more than I came in for?'; 'What if it goes wrong?'; 'Who will look after the family?'. All this worrying leads to increased anxiety and stress, and the patient has not even been put on the waiting list yet, let alone been admitted.

The impact of multi-skilled staff availability on day surgery cancellations.

This paper outlines a study undertaken by Helen Lloyd to assess the impact of multi-skilled theatre practitioners on reducing cancellations in stand alone day surgery units in England and Wales. The author provides the background to the study together with an overview of the results. The literature review undertaken before the study is published in full. It identifies what factors influence the efficiency of day surgery and operating theatre facilities, traditional staffing of operating theatres and day surgery facilities, together with other influencing factors for theatre utilisation. The author recieved partial funding from ERFF to complete her MBA in Health Service Management at Greenwich School of Management (accredited to University of Hull) in 2007.