Surgical Safety Does Not Happen By Accident: Learning From Perioperative Near Miss Case Studies.

Adverse surgical events cause negative patient health outcomes and harm that can often overshadow the safe and effective patient care provided daily by nurses as members of interprofessional healthcare teams. Near misses occur far more frequently than adverse events and are less visible to nurse leaders because patient harm is avoided due to chance, prevention, or mitigation. However, near misses have comparable root causes to adverse events and exhibit the same underlying patterns of failure. Reviewing near misses provides nurses with learning opportunities to identify patient care weaknesses and build appropriate solutions to enhance care. As the operating room is one of the most complex work settings in healthcare, identifying potential weaknesses or sources for errors is vital to reduce healthcare-associated risks for patients and staff. The purpose of this manuscript is to educate, inform, and stimulate critical thinking by discussing perioperative near miss case studies and the underlying factors that lead to errors. Our authors discuss 15 near miss case studies occurring across the perioperative patient experience of care and discuss barriers to near miss reporting. Nurse leaders can use our case studies to stimulate discussion among perioperative and perianesthesia nurses in their hospitals to inform comprehensive risk reduction programs.

Periop 101: Improving Perioperative Nursing Knowledge and Competence in Labor and Delivery Nurses Through an Evidence-Based Education and Training Program.

INTRODUCTION: To reach the highest levels of health care quality, all nurses providing intraoperative care to surgical patients should have a firm grasp of the complex knowledge, skills, and guidelines undergirding the perioperative nursing profession. In military treatment facilities, either perioperative registered nurses or labor and delivery (L&D) nurses provide skilled intraoperative nursing care for cesarean deliveries. However, L&D and perioperative nurses occupy vastly different roles in the continuum of care and may possess widely differing levels of surgical training and experience. MATERIALS AND METHODS: The purpose of this project was to improve surgical care quality by standardizing and strengthening L&D nurse perioperative training, knowledge, and competence. Our population, intervention, comparative, and outcome question was, "For labor and delivery nurses of a regional military medical center (P), does implementing an evidence-based training program (I), as compared to current institutional nursing practices (C), increase nursing knowledge and perioperative nursing competence (O)?" We implemented Periop 101: A Core Curriculum-Cesarean Section training for 17 L&D nurses, measured knowledge using product-provided testing, and assessed competence using the Perceived Perioperative Competence Scale-Revised. RESULTS: We found that perioperative nursing knowledge and competence significantly improved and were less varied among the nurses after completing the training program. Nurses demonstrated the greatest knowledge area improvements in scrubbing, gowning, and gloving; wound healing; and sterilization and disinfection, for which median scores improved by more than 100%. Nurses reported significantly greater perceived competence across all six domains of the Perioperative Competence Scale-Revised, with the largest improvements realized in foundational skills and knowledge, leadership, and proficiency. CONCLUSIONS: We recommend that health care leaders develop policies to standardize perioperative education, training, and utilization for nurses providing intraoperative care to reduce clinician role ambiguity, decrease inefficiencies, and enhance care.

Surgical Team Structure: How Familiarity and Team Size Influence Communication Effectiveness in Military Surgical Teams.

INTRODUCTION: Preventable patient harm has persisted in health care despite recent advances to reduce errors. There is increasing recognition that non-technical skills, including communication and relationships, greatly impact interprofessional team performance and health care quality. Team familiarity and size are critical structural components that potentially influence information flow, communication, and efficiency. METHODS: In this exploratory, prospective, cross-sectional study, we investigated the key structural components of surgical teams and identified how surgical team structure shapes communication effectiveness. Using total population sampling, we recruited surgical clinicians who provide direct patient care at a 138-bed military medical center. We used statistical modeling to characterize the relationship between communication effectiveness and five predictors: team familiarity, team size, surgical complexity, and the presence of surgical residents and student anesthesia professionals. RESULTS: We surveyed 137 surgical teams composed of 149 multidisciplinary clinicians for an 82% response rate. The mean communication effectiveness score was 4.61 (SD = 0.30), the average team size was 4.53 (SD = 0.69) persons, and the average surgical complexity was 10.85 relative value units (SD = 6.86). The surgical teams exhibited high variability in familiarity, with teams co-performing 26% (SD = 0.16) of each other's surgeries. We found for every unit increase in team familiarity, communication effectiveness increased by 0.36 (P ≤ .05), whereas adding one additional member to the surgical team decreased communication effectiveness by 0.1 (P ≤ .05). Surgical complexity and the influence of residents and students were not associated with communication effectiveness. CONCLUSIONS: For military surgical teams, greater familiarity and smaller team sizes were associated with small improvements in communication effectiveness. Military leaders can likely enhance team communication by engaging in a thoughtful and concerted program to foster cohesion by building familiarity and optimizing team size to meet task and cognitive demands. We suggest leaders develop bundled approaches to improve communication by integrating team familiarity and team size optimization into current evidence-based initiatives to enhance performance.

Differences in Perioperative Nurse Job Satisfaction by Specialty Certification Status.

PURPOSE: To describe differences in perioperative RN job satisfaction by specialty certification status. DESIGN: A retrospective, exploratory, cross-sectional design. METHODS: We conducted a secondary analysis of annual data from the National Database of Nursing Quality Indicators (NDNQI) RN Survey with 12 Job Satisfaction Scales. The sample consisted of 776 perioperative units in 206 hospitals with 13,061 study participants. We used multilevel mixed modeling to examine differences in job satisfaction for nurses holding CAPA (Certified Ambulatory Perianesthesia Nurse), CPAN (Certified Post Anesthesia Nurse), CNOR (certification for perioperative registered nurses), CRNFA (Certified RN First Assistant), other specialty certification, and not specialty certified. FINDINGS: Twelve percent of RN participants held a perioperative nursing certification (CAPA, CPAN, CNOR, CRNFA), 15% held other nursing specialty certifications, and 73% were not certified. Regardless of certification status, nurses were the most satisfied with nurse-nurse interactions and task. They were the least satisfied with nursing administration, decision-making, and pay. CNOR certified nurses reported the lowest levels of job satisfaction in the study. CAPA and CPAN certified nurses reported higher job satisfaction than their noncertified colleagues on multiple job satisfaction scales (ie, CAPA 10 of 12; CPAN 5 of 12). CNOR certified nurses did not report meaningful differences in job satisfaction from non-certified nurses. CONCLUSIONS: As job satisfaction impacts retention, productivity, and patient care quality, our findings have important implications for hospital leaders, nurses, and health care consumers. Based on our findings, we identified nursing professional development as a potential gap in job satisfaction that leaders can target for improvement. Our findings suggest that higher specialty nursing certification rates in perianesthesia nurses may potentially improve job satisfaction and retention of nurses.

Trust and Nursing: Delivering Effective Change Management and Driving a Culture of Innovation.

Trust is foundational for all interpersonal communication and activities in an increasingly networked and interdependent world. Trust is also essential to the effective delivery of health care and for building collegial environments rich in innovation and readily adaptable to change. As the world's most trusted profession and vested peer collaborators across interprofessional health care teams, nurses are uniquely qualified to shepherd change and foster an innovation mindset across organizations and systems. Innovation requires creative teams that are appropriately resourced and supported, and team-based innovation requires time, space, and safety for groups to realize their full potential and maximize contributions. Appropriate staffing, resourcing, internal engagement, and external partnerships are essential to successfully conceive, launch, sustain, and deliver change initiatives that successfully challenge the status quo. Diverse teams are vital to enhancing the performance, effectiveness, and delivery of change and innovation. Effective change management and innovation practices require courage and imagination, skills that nurses have long possessed. Nurses are uniquely equipped to champion human-centered design through all phases of innovation while bringing knowledge of patients and communities to bear in ways that deliver innovation, are respectful of challenges, and mindful of opportunities to strengthen individuals and communities.

Nursing Leadership and COVID-19:: Defining the Shadows and Leading Ahead of the Data.

The COVID-19 pandemic overwhelmed health care systems and exposed major gaps in preparedness and response plans. The crisis challenged nurse leaders to develop and implement novel care delivery plans while preventing disease transmission to patients and staff. COVID-19 required nurse leaders to make decisions in an environment of conflicting data and directives. The authors share essential nurse leader competencies vital to the development and support of thriving nurse leaders. As crises persist and future challenges arise, nurse leaders can leverage these essential competencies to successfully drive engagement, lead ahead of consensus, and define the shadows of limited, incomplete, and conflicting data.

Certified Surgical Services Manager (CSSM): The New Gold Standard for Perioperative Nurse Leaders.

Specialty certification promotes improved surgical outcomes, enhances health care quality, and is an important external benchmark of overall clinician competence. Given the growing technological, financial, and administrative demands of the modern health care system, the roles of perianesthesia and perioperative nurse managers are increasingly complex. The Certified Surgical Services Manager (CSSM) certification establishes a standard of excellence for perioperative managers, demonstrating that they possess the capacity to adapt and lead in the continually evolving roles of perioperative leadership and surgical services management. In this article, we comprehensively review CSSM certification and offer insights into the importance of lifelong learning and continuous professional development. The topics discussed include the advantages of holding the CSSM credential, the importance of specialty certification, and a general examination overview. In addition, we emphasize the value of the CSSM credential and adopting it as the national standard for surgical service managers.

Progressing toward specialty certification as the National Standard for Nursing.

Nursing specialty certification is an objective measure that assures the public that nurses demonstrate the highest level of professional knowledge in their field. Many nurses do not seek specialty certification, as evidenced by low certification rates. In this creative controversy article, we build a case that progressing toward nursing specialty certification as a national standard will increase overall nursing professionalism while better preparing nurses to meet the needs of their specialty patient populations and the changing health care system.