Apr 01, 2013
Think you know perioperative nursing?
It is one of the largest nursing specialties in Canada, but perioperative nursing remains poorly understood by nurses who don’t venture behind the closed doors of the operating room. Canadian Nurse asked the Operating Room Nurses Association of Canada (ORNAC) to put to rest some common misperceptions about this challenging area of practice.
Perioperative registered nurses don’t do nursing, don’t provide nursing care and don’t use basic nursing knowledge and skills.
FACT: The care perioperative RNs provide has evolved dramatically over the past few decades. But even today, nursing students will tell us that their interest in perioperative nursing was politely questioned by an instructor who said they would lose their nursing skills and decision-making abilities if they worked in the operating room. In fact, we could not deliver quality patient care without a thorough understanding of nursing knowledge and the ability to integrate this knowledge into our practice. In perioperative settings, which include private non-hospital surgical suites, interventional radiology rooms and ambulatory care clinics, we focus on identifying and meeting the physiological, psychological and spiritual needs of patients and their families throughout the surgical experience. Like RNs in other nursing specialties, we are involved in education, leadership, research and advanced practice activities.
Perioperative RNs just follow the surgeon’s orders — there’s no clinical decision-making or independent practice involved.
FACT: Several decades ago, this may have been true. The surgeon, anesthesiologist and nursing personnel worked in silos. Today, we contribute to clinical decision-making as collaborative members of the perioperative team. The surgical safety checklist now used in all operating rooms across Canada has further strengthened the team approach in ensuring patient safety. The patient journeying through the surgical experience is highly vulnerable, and we are the patient’s advocates on this journey. In an instant, perhaps as the result of a reaction to a drug or because of an unplanned surgical event, the patient’s condition can change from stable to critical. We anticipate the needs of the patient and those of the surgical team members and react quickly to meet these needs. We always expect the unexpected and plan patient care accordingly.
Perioperative RNs don’t use the nursing process, because they don’t spend quality time with the patient.
FACT: Although the amount of time we have for patient assessment and relationship building is limited, we are highly skilled in developing a rapport with the patient. It is imperative we meet the patient and the family prior to the surgical intervention so we can review the documentation, identify any special considerations, answer any questions and provide reassurance. We incorporate the information we obtain during this meeting into the plan of care.
Perioperative RNs lack communication skills and personality.
FACT: We advocate for the surgical patient. It is essential that during our admittedly brief encounter with the patient, we are able to establish a comfortable, respectful and confidential environment that instils confidence. On the surgical team, we facilitate negotiation, collaboration and conflict resolution. We are there to ensure that the work of the entire team is directed toward positive outcomes.
The perioperative clinical setting doesn’t provide experiences that meet the objectives of the core curriculum of basic nursing education.
FACT: The perioperative setting provides rich clinical experiences for nursing students. Infection control, anatomy and physiology, the nursing process, teamwork and organizational skills are but a few that students will address. New nurses in the operating room will develop confidence in their ability to make decisions regarding the care of the surgical patient. Through the experience of identifying priorities and organizing patient care, their critical thinking skills are fine-tuned.