Recruitment, Retention and Respect: The Perioperative Nurse Communitys Challenge

ICT sat down with Mary Jo Steiert, RN, BSN, CNOR, outgoing president of the Association of periOperative Registered Nurses (AORN), to discuss the challenges and rewards of working in perioperative nursing.

Q: What have you enjoyed about serving as AORN president?

A: Its been a very positive, rewarding experience. I was pleased to see the amount of respect that our association has among other healthcare organizations and with the physician groups. I always thought that we had some power and influence, but serving as president and attending numerous events and meeting people, it has been outstanding. And our position in the healthcare community is very noticeable.

Q: Theres always a tremendous amount of pride and energy at annual Congress, isnt there?

A: There is! Its a gathering of kindred spirits. Its like being part of a big extended family.

Q: Perioperative nursing is not an easy job, so how do you keep AORN members so fired up and enthusiastic?

A: When we are all together at Congress, there is a charge of energy that passes back and forth between us. No matter how tired I might be from work and from traveling, I am continually energized by our members, and that has been one of the most rewarding parts of being president being out there, working with our members, sharing ideas and listening to what their issues are, and seeing how we can help them as an association. I have had the opportunity to attend several international meetings and its the same kind of experience even though you dont speak the same language and you have to go through interpreters, theres a spark and a passion there. The common goal of caring for our patients supercedes the restrictions we may be encountering.

Q: Perioperative nurses have to be multitaskers in a room where there is a fine line between life and death are they conscious of the critical role they play?

A: Sometimes its something we all take for granted and it just becomes part of our make-up. What we do every day is ensure that our surgical patients are well cared for. It becomes so much a part of us we might not truly recognize the roles we play in peoples lives.

Q: What are some of the biggest issues facing perioperative nursing today?

A: The big issues have been with us for a while and they will be with us for years to come, I think, and thats recruitment, retention, and respect in the workplace.

We will always have to deal with that agenda, especially in context of an aging workforce. There are challenges with all of nursing in that so much of our care is moving to an ambulatory setting; many of our younger nurses are attracted to those outpatient settings because they dont have to be on call or work weekends or holidays.

Patients who require inpatient care are sicker, and there are so many more restrictions placed on the nurses who care for them. A good example of this are the new Centers for Medicare and Medicaid Services (CMS) regulations taking effect in October regarding surgical site infections AORN must advance its ongoing partnerships to thoroughly examine how we can achieve zero infections if at all possible, in the context of payment based on performance. You hate to think about it that way, but its becoming a reality.

Another continual challenge our nurses face is emerging technology. Research is being conducted on how we can be less invasive to our patients and get the same surgical results, and a more satisfactory and quicker recovery. Robotics is another area of technology with which perioperative nurses must keep up. AORN is also continuing to push for appropriate RN-as-circulator language in every state; right now there are 28 states with strong language. Thats going to be an important issue and our primary legislative initiative until we meet our goal or until we are able to convince CMS that it must make it a federal regulation. We are working hard on both avenues. Another thing that has come up in the last year and we are going to have a position statement regarding this issue at Congress is criminal charges for medical errors. There was a situation in Wisconsin last year where a nurse was charged criminally for a mistake that had been made. Its unfortunate we have become such a litigious society. Overall, healthcare providers are very conscientious.

Q: You mentioned zero tolerance of infections how are perioperative nurses working toward this goal of HAI and SSI prevention?

A: The Surgical Care Improvement Project (SCIP) continues to be a benchmark we all strive to achieve but there are some facilities that struggle with that measurement. AORN continues to work with our physician partners in meeting those standards. Heres an example: One of our perioperative patient care attendants who was cleaning an OR bed said he didnt know how to make up a surgical bed.

One of the nurses was talking to him about it and explained the importance of making sure you have clean linen because you dont want to send the patient with a new post-op wound back to the floor on a dirty bed. He said he hadnt made that connection, so that tells me we must continually educate all staff to help them put those puzzle pieces together. Yes, they know its important for patients not to get infections, but sometimes people forget to connect the dots.

Q: Are you still seeing a shortage of perioperative nurses?

A: It is still a critical issue. There are a lot of facilities that have openings. Filling them with traveling nurses helps but is not a permanent solution. Hospitals believe time is money; there is a lot of pressure to turn over the ORs quickly; the faster we move, the more cases we can do. However, we must never forget the importance of having a perioperative nurse present in the OR as the patients advocate, saying, It may take only a few more minutes but we really need to do a time-out and make certain everything is as it should be before we proceed with the surgery. 

Q: Do perioperative nurses still encounter respect issues in the OR?

A: They do, and I wish they didnt. Thats why being able to empower people in the room to speak up when they see something thats not quite right is so important. I attended an executive symposium held by the Council on Surgical Patient Safety last summer where members of AORN met with members of the American College of Surgeons (ACS) and other groups. The physician in charge of education for the ACS showed us some vignettes they are showing to surgical residents to teach the importance of respect in the perioperative setting to facilitate better patient care and reduce errors. I also attended a safe surgical summit meeting at the World Health Organization in Geneva.

The meeting was attended by about 120 people, eight of whom were nurses. We were discussing the importance of teamwork and respect when a surgeon from India said it is all about changing the current culture of the OR. He said that change must be physician-driven, and I thought, what a statement this man comes from a country where there is a class system; women in the nursing role are not always seen favorably or listened to. Its going to take time, but we will get there.

Q: Perioperative Nurse Week is a way to focus regional, state and national attention on perioperative nursing issues and contributions is it helping to raise awareness of the specialty?

A: Perioperative Nurse Week helps highlight the many different methodologies nurses are using to get the word out in the community and with young people. For example, some facilities hold a Teddy Bear Clinic at local schools to help reduce the fear of surgery among young people and also to introduce them to the field of perioperative nursing. We held such a clinic at my facility, where we also tried to tried to emphasize the importance of handwashing with little ones, with all the concern about community-acquired methicillin- resistant Staphylococcus aureus (CA-MRSA). I think we must always make advances in getting the word out, raising the profile of perioperative nurses and championing the contributions these nurses make.

Q: What can the individual perioperative nurse do to help?

A: Recognizing the value of being part of a professional association like AORN would be a good start. Our membership is almost 43,000 yet from information weve gathered, thats only about one-quarter of our population we think there are about 160,000 perioperative nurses in the country. We must continue to demonstrate our relevance and our value to the members, as well as to the broader nursing and medical communities.

Mary Jo Steiert, RN, BSN, CNOR, is currently a perioperative educator at the Medical Center of Aurora/Centennial Medical Plaza in Aurora, Colo. During her career in perioperative nursing she has been a staff nurse, educator, manager and director, working in a variety of settings from a small community hospital to a large metropolitan facility. A CNOR since 1980, she has served as a member and secretary on the AORN board of directors before serving as president from 2007 to 2008.