OR nurse shortage and perioperative patient care outcomes

3 Running Head: OR NURSE SHORTAGE AND PERIOPERATIVE CARE

OR Nurse Shortage and Perioperative Care: Impact and Interventions

Name Date

OR Nurse Shortage and Perioperative Care: Impact and Interventions Background and Problem Statement The growing shortage of perioperative nurses has been well documented. As a matter of fact, in the words of Chappy, Madigan, Doyle, Conradt, and Tapio (2016), “perioperative nursing faces a workforce crisis” (104). The future is even bleaker. This is more so the case given that perioperative nurses in their 50s and 60s are retiring and/or nearing retirement. Further, it is important to note that as it has been pointed out elsewhere in this text, in the course of their clinical instruction/education, nurses lack adequate preoperative training. Purpose of the Change Proposal In essence, the relevance of an optimally staffed operating room cannot be overstated in perioperative care. Towards this end, therefore, it would be prudent to not only study how OR nursing shortage impacts the level and standard of care advanced to surgical patients, but also the various interventions that could be embraced in an attempt to ensure that the OR is well-staffed. PICOT In seeking to come up with research questions that are answerable, the PICOT question has been formulated. The said question is, thus: among perioperative patients (P), can addressing the well documented OR nursing shortage (I), in comparison/relation to failure to address OR nursing shortage (C), improve the outcomes of perioperative patients (O), over a 1 year period (T)? Literature Search Strategy Employed The literature search strategy employed in the present paper sought to identify academic resource materials; a) evaluating the issue of perioperative care nurse shortages in most hospitals today, b) assessing how perioperative care is impacted upon by OR nurse shortages, and c) highlighting the most effective interventions that could be embraced to rein in the OR nursing shortage. In addition to largely relying on studies published in recent times about the issue at hand, the present paper also sourced for additional info from reliable academic texts. Mainly, two online databases were utilized for this endeavor – with the main key words used being perioperative care, OR nurse shortage, and perioperative patient outcomes, and OR nurse staffing strategies. Literature Review The shortage of OR nurses is an issue affecting a vast majority of facilities in the United States. In essence, this preoperative nurse shortage is likely to get worse if no measures are put in place to address the key trigger(s) of the said shortage. One of the issues that has significantly contributed to OR nurse shortage, according to Ball, Doyle, and Oocumma (2014), is aging demographics. With perioperative nurses in their 50s and 60s retiring and/or nearing retirement, the situation is further complicated by relatively high perioperative nurse recruitment difficulty index – effectively meaning that replacements may not be made soon enough. The RN recruitment difficulty index has been highlighted in the appendices (appendix 4). The exposure nursing students have to OR content is also very little – both in formal education settings and during clinical rotations (Owens, 2013). Thus in addition to not being privy to info highlighting perioperative nursing as a viable post-graduation employment alternative, novice nurses also lack the necessary experience required to function optimally in the OR setting. The latter concern is a key driver of OR nurse turnover. One of the key philosophies of the nursing profession, as Goodman and Spry (2016) point out, is the enhancement of patient outcomes. As operating room departments attempt to work with an already overstretched OR nurse workforce, errors are largely inevitable. This is more so the case given that personnel may often be distracted from present activities so as to attend to others, become interrupted, or be hurried in an effort to meet tight OR schedules. Stressful conditions in the OR are breeding grounds for errors (Cowen and Moorhead, 2014). This could effectively impact not only the quality of service, but also patient safety – and in some circumstances led to increased mortality rates. It should also be noted that if the OR nurse shortages are not addressed going forward, hospitals are likely to experience significant economic losses. This is more so the case given that preoperative departments have been branded the economic engines of most healthcare institutions today. According to Robinson (as cited in Malley and Young, 2017), surgical undertakings “represent a major source of hospital revenue and profit margins.” Appendix 6 indicates that between 2009 and 2017, there was a general decrease in OR nursing activity reported, i.e. with regard to the volumes of procedures. In addition to limiting the optimal utilization of OR rooms, staffing shortages could cause surgery delays (Goodman, 2012). There are various interventions that could be implemented in an attempt to address the OR nursing shortage concern. Towards this end, the most effective course of action would be the implementation of a preceptor program for perioperative nurses. This would largely entail enrolling those expected to play the role of the preceptor for a AORN 101 certification course where they would be prepared “for their critical role in orienting new registered nurses to the perioperative environment” (Association of Perioperative Registered Nurses - AORN, 2018). According to Condrey (2015), to be effective in their roles, preceptors ought to be equipped with specific skills and capabilities – with the said skills being inclusive of “knowing how to implement the roles of preceptor, such as role model, socialized, educator, and evaluator” (Condrey, 2015). In that regard, therefore, the AORN 101 certification course is made for OR nurses who already poses the relevant experience, but who would nonetheless benefit from enhanced precepting skills. In basic terms, it should be noted that in addition to boosting “evidence-based patient safety” the AORN 101 certification course would improve “staff recruitment and retention” (AORN, 2018). Various studies have indicated that preceptor programs have widespread support amongst OR nurses (Cousley and Martin, 2016). To assess the need as well as viability of a nursing preceptor program, a brief survey of 286 nurses was conducted. 65% of those surveyed indicated that they would be interested in exploring the preceptor program, while 95% deemed the implementation of the preceptor program as a timely boost to the education and training efforts, and a logical aid to recruitment and retention efforts (appendix 1). Yet another solution that ought to be explored towards this end is a review of pay and benefits. With regard to a review of pay and benefits, it should be noted that as was pointed out by a 2017 AORN salary survey, “insufficient compensation and benefits was cited by 41% of the respondents” as being one of the issues that contributed to the shortage of OR nurses” (appendix 7). Estimates of average base compensation on the basis of the size of the facility as well as job tile have been highlighted in the appendices section (appendix 5). In seeking to assess nursing retention and turnover perceptions, a survey of 58 OR nurses found that amongst other things, compensation was one of the main factors that influenced the decisions of OR nurses on whether to stay or seek greener pastures (appendix 2). With this data in mind, the facility ought to streamline its compensation package in such a way that it sufficiently motivates staff members to stay. Applicable Nursing Theory/Framework Utilized In this case, Dr. Patricia Benner’s model for clinical competence stages has been utilized. In essence, Benner’s framework advances the viewpoint that nursing expertise is developed over time through experience and instruction (Cousley and Martin, 2016). Towards this end, Benner’s model is deemed to be an important framework for the assessment of the various needs of nurses at various professional growth stages. More specifically, “Benner’s novice-to-expert framework is significant in laying the foundation for the progression of expert nurses in acquiring and improving their knowledge, skills, and methods of clinical coaching” (Cynthia, 2016, p. 42). Proposed Implementation Plan with Outcome Measures 1. Approval and Awareness at the Organizational Level The key stakeholders will be identified and notified. Oversight committee membership will also be taken into consideration. Approval for the implementation plan will be sought from the relevant stakeholders. 2. Assembly of an Oversight Committee The committee will be charged with the successful implementation of the proposed course(s) of action. Ideally, it will comprise of both the top leadership of the facility and departmental heads. For suggested committee membership, see Appendix 3. 3. Development of an Aim Statement To ensure that this particular undertaking has a clear scope and direction, an aim statement will be developed. In addition to limiting resource wastage, the Aim Statement will serve as a compass to guide the proposed course of action. The aim ought to be SMART, i.e. Specific, Measurable, Achievable, Relevant, and Time bound. 4. Rollout of the Proposed Course of Action The rollout of the proposed course of action will be done in 4 phases, with each phase comprising of three months. 5. Measurement Tools i. Short-Term: A pre and post participation questionnaire will be developed so as to measure the impact of the educational intervention amongst those who participate in AORN 101 certification course. ii. Long-Term: Annual turnover rates will be evaluated to assess the effectiveness of the adopted course of action 6. Follow-Up and Evaluation i. Follow-up will be periodic (i.e. after every 6 months). Management rounding (or similar mechanisms of feedback) will be utilized so as to assess staff knowledge and job satisfaction levels ii. Progress to be communicated to the relevant stakeholders iii. Deviations from the desired outcomes will be noted and corrective action taken Potential Barriers to Plan Implementation Financial constraints have been identified as the most critical potential barrier to plan implementation. Implementing the preceptor program will be a resource intensive process in terms of associated course costs, orientation costs, etc. A review of pay and benefits means that the salaries and benefits P&L item will increase, effectively reducing the facility’s profitability. The hospital may not be able to meet the costs associated with the two courses of action. It should, however, be noted that according to Brown, Belgard, Washington, and Grueso (2017), “economically, preceptored clinical experiences require fewer faculty members for supervision than in traditional faculty-supervised settings” (22). This effectively means that over time, present costs could be recovered by way of reduced expenditures on this front. Next, as it has already been pointed out elsewhere in this text, preoperative departments are deemed to be the economic engines of most healthcare institutions. This effectively means that if the staffing concern is solved, then the OR can operate at optimum and rake in more revenues – thus effectively canceling out the costs associated with the implementation of the courses of action highlighted herein.

References Association of Perioperative Registered Nurses – AORN (2018). Preceptor Certificate Program. Retrieved from https://www.aorn.org/education/facility-solutions/periop-101/preceptors Brown, L., Belgard, D., Washington, N. & Grueso, S. (2017). Operating Room Nurse Residency and Specialty Educators: Paramount in the Success of Novice Nurse Retention. Journal of Nursing Education and Practice, 8(5), 20-25. Ball, K., Doyle, D. & Oocumma, N.I. (2014). Nursing Shortages in the OR: Solutions for New Models of Education. AORN Journal, 101(1), 115-136. Bacon, D., Kim, S. (2018). Results of the 2017 AORN Salary and Compensation Survey. AORN Journal, 106(6), 476-493. Chappy, S., Madigan, P.D., Doyle, D.S., Conradt, L.A. & Tapio, N.C. (2016). Preparing the Next Generation of Perioperative Nurses. AORN J, 103(1), 104-112. Cousley, A. & Martin, D. (2016). A Perioperative Model and Framework for Practice. Philadelphia, PA: M&K Publishing. Condrey, T. (2015). Implementation of a Preceptor Training Program. J Contin Educ Nurs, 46(10), 462-9. Cynthia, A. (2016). Clinical Coaching: The Means to Achieving a Legacy of Leadership and Professional Development in Nursing Practice. Journal of Nursing Education and Practice, 6(6), 41-47. Goodman, T. & Spry, C. (2016). Essentials of Perioperative Nursing (6th ed.). Burlington, MA: Jones & Bartlett Publishers Goodman, T. (2012) (Ed.). Advocacy: An Issue of Perioperative Nursing Clinics. New York, NY: Elsevier Health Sciences. Malley, A. & Young, G.J. (2017). A Qualitative Study of Patient and Provider Experiences During Preoperative Care Transitions. J Clin Nurs, 26(13), 2016-2024. Owens, N.G. (2013). New Graduate Nurse Preceptor Program: A Collaborative Approach with Academia. Journal of Nursing Education and Practice, 3(12), 11-19.

Appendices Appendix 1 Preceptor Program: Needs and Viability Assessment Survey Questions This survey, which you are about to complete, has a total of 7 questions. The information gleaned from this survey will enable the facility to assess as well as evaluate the relevance of a preceptor program so as to inform efforts towards the elimination of staff shortages in the OR. Participation is voluntary – effectively meaning that your participation, or lack of it thereof, will have no impact whatsoever on your employment standing or professional engagements within the facility. Please circle or cross choice letters as appropriate. 1. What is your job title? …………………………………. 2. Please identify your typical shift: A: 7:00AM B: 11:00AM C: 3:00PM D: 7:00PM (If not listed above, please specify) …………………………………………………. 3. In your opinion, what is the main driver of staff shortages in the OR? A: Insufficient compensation and benefits B: Diminishing number of new nurses joining the OR C: Perceived minimal opportunities for career growth D: Lack of job satisfaction leading to a high turnover Other (please specify): ………………………………………………. 4. Do you think a preceptor program would help address the issue of preceptor nurse shortages? A: Yes B: No 5. If your answer was yes to 4 above, what is the exact contribution do you think the preceptor program would make towards addressing the issue of nursing shortage in the OR? …………………………………………………………………………………………………………………………………………………………………………………………….. 6. Would you participate in a preceptor education program (PEP) for professionals to prepare your for a preceptor role? A: Yes B: No 7. How would you prefer to receive education? Please make impression on the appropriate choice Instruction Avenue 1st choice 2nd choice 3rd choice