Portal de Periódicos da CAPES

Making Your Mark Through Supporting the Nursing Pipeline

2023; Wiley; Volume: 119; Issue: 1 Linguagem: Inglês

10.1002/aorn.14060

1878-0369

Elizabeth Pincus,

Global Health Workforce Issues

The nursing shortage has been a topic of discussion for decades. As Baby Boomers retire and many nurses choose to leave the bedside or the profession entirely, we are not bringing in new nurses as quickly as we are losing experienced ones. In addition, there are challenges in faculty and clinical instructor recruitment in academia. As a result, the pipeline of new nurses is less robust than we would like. In addition, because many schools still encourage new nurses to begin their careers in inpatient medical-surgical units rather than explore specialty nursing opportunities, leaders in specialties must work even harder to acquire new nurses. I was lucky as a nursing student to have the opportunity to explore perioperative nursing for a semester during our medical-surgical rotation. We rotated through preadmission testing, the preoperative area, the OR (ambulatory and main hospital), the postanesthesia care unit (ambulatory and main hospital), and the endoscopy and lithotripsy units. After this rotation, I completed my senior capstone hours in the OR. These practicum hours were essentially an extended job interview—I knew exactly what the role entailed, and they knew that the OR was a good fit for me. As students, we were allowed to see and participate in the full spectrum of surgical care, and this program is why I became an OR nurse immediately upon graduation. In all my years as an educator, I have welcomed students into my ORs and had a great time introducing them to the world behind the double doors. I have never understood why nurses tell students to “stand against the wall and don't move.” I have also been told that directive is given in labor and delivery units during cesarean births. If students have been adequately prepared for their day in the OR, this approach is not appropriate as it offers a weak learning experience. Actively engaging the students and allowing them to participate within their scope (and according to the hospital's policy) is what preceptors should seek to achieve. There are many ways that perioperative nursing can be incorporated into prelicensure curriculums; what works in an academic medical center may not work in a community or rural hospital. However, the crux of the program and the targeted outcomes will be the same regardless of the setting. I am excited to share some perspectives from one program that has had great success since its inception. Using AORN's Introduction to Perioperative Nursing (IPN) for didactic coursework, hospitals can collaborate with their local colleges and universities to create a program that best suits the needs of the students and hospital staff members. Growing our own pool of talent is critical to having enough perioperative nurses to care for patients in the decades to come. The nursing workforce took a massive hit during the COVID-19 pandemic as many nurses left the profession. In 2021, Chamberlain University and AORN created the “Practice Ready. Specialty Focused.” program, which used both AORN's IPN and partnerships at clinical sites across the country to offer their prelicensure students a chance to explore the world of perioperative nursing.1 The greatest reward for this program is easily the trajectory of one student. If we encourage even one student to explore perioperative nursing who otherwise would not have known about the specialty, and that one student becomes a perioperative nurse, then the program is a success. We discovered a resounding interest from nursing students curious in exploring this specialty. Our expectations for the first year of program implementation included a goal of 100 students completing IPN. Over 300 students completed the program during its first year; today, the total number is over 1,000. I get excited for the students who have a future in this incredible field as they have perhaps found their fit in nursing. I am just as excited for all perioperative nurses who will see the benefit of years of hard work, dedication, and sacrifice be rewarded by knowing their legacy will continue in the next generation of nurses. global issue of resources – securing clinical sites, finding staffing that supports preceptors, and supporting nursing schools through encouraging educators with the expertise to develop and help facilitate clinical experiences. I connected with two of their clinical site coordinators to get some insight into their role in the success of these students. David Reinhart, DNP, MBA, RN, CNOR, director of Nursing Education at Emory Healthcare, Atlanta, Georgia, oversees the Chamberlain students at his facility. Dr Reinhart's interest in the program stemmed from his days in nursing school. “Perioperative services exposure was not offered in the nursing school curriculum in my nursing program, and I knew there was an entire specialty behind the OR doors that I wanted to explore.” As Ochsner Health's perioperative educator, I was in the perfect position to undertake this project. I know and collaborate regularly with the surgery leadership at each of Ochsner's 46 hospitals, and I was thrilled to be getting nursing students back in the OR. This program offers a unique experience to a nursing student—to be immersed in an operating room, working side by side with nurses, physicians, and other surgical team professionals. I have enjoyed liaising between clinical instructors and the OR, assisting in bringing students to the OR during clinical [rotations]. I want students to be able to step behind the red line. wanted to ensure we were not overextending staff with this new program. However, these nursing students came into the OR with knowledge that helped them understand sterile technique, counting, positioning, and safety. That made their supervision a bit easier for the OR staff. Identifying preceptors, particularly for students in the OR, is always challenging. Ochsner personnel had a unique approach to addressing this. According to Toledano, One preceptor challenge that we did encounter was the high volume of agency nurses in our ORs. Each location had its way of adapting to and handling the shortage of OR nurses. One facility trained the agency nurses to be preceptors for their new OR nurses, and some agency nurses took on the responsibility of precepting the Chamberlain nursing students. Both Dr Reinhart's and Toledano's hospitals have seen the success of this partnership. According to Dr Reinhart, Emory has hired at least six students. His students have commented that they knew the expectations of the OR nurse, but they didn't know about all the nursing roles in perioperative services. They were well prepared and ahead of others in their class when they began their formal Periop 101 training. Dr Reinhart has also trained students to go directly onto the cardiac team. The program at Toledano's facilities has also been successful; two of the program participants have been hired into the postanesthesia care unit and two into the OR. Her feedback is also positive: “The new OR nurses catch on fast, are ‘practice-ready,’ and their orientation can be shortened because they are ready before six months.” It is costly to onboard new nurses, so the opportunity to shorten that orientation time helps to achieve a positive return on investment. Kylie King, BSN, RN, graduated from Chamberlain University and completed the OR rotation in fall 2022 as a prelicensure student. She is now working as an OR nurse in Illinois. King chose to participate in the IPN program because “every previous clinical had shown me all the different specialties, and I still didn't know what kind of nurse I wanted to be. It was almost time for capstone, and I hadn't yet found an area I had loved.” Although she initially thought she wanted to be an RN anesthetist, the COVID-19 pandemic made her realize that the intensive care unit wasn't for her. Being a student in the OR isn't easy, but King was hired into the hospital where she completed her clinical placement, and that has been a great start to her career. She is pursuing a master's degree in nursing with a focus on education and is planning to complete her master's project on proper preparation of students before they begin an OR clinical rotation. Understand the needs of your students and the health care community that supports them. Decide if you can support approaching the program as an elective, if you have experienced perioperative nurses to serve as subject-matter experts, if you have the staff to implement and manage the nonacademic aspects of the course, and if you have buy-in from your potential clinical sites. When critical pieces are in place before adding students, success of the program will follow. Once those elements are in place, take the time to socialize the program internally to your student population and externally to your potential clinical sites. Both are equally important, as the success of one is predicated on the success of the other. This is where your local AORN chapter can be a huge asset, as the most experienced and passionate advocates for this program are AORN members. As every member of AORN can attest, nursing requires lifelong learning, perioperative nursing included. It is also important to keep the overarching objective of this program in perspective: build and sustain the perioperative pipeline. Perioperative nursing is a fantastic specialty that involves caring, compassion, advocacy, and technical excellence. I have met many students over the years who were eager to become OR nurses but didn't know how to proceed and didn't have perioperative faculty at their nursing school. Opening the doors to prelicensure students will help us grow the nursing pipeline and support surgery for years. If you have a successful OR program for nursing students, whether through your university or hospital, please consider sharing the program details with me by e-mailing [email protected]. It may be featured in a future “President's Message” column. Editor's notes: Practice Ready. Specialty Focused. is a trademark of Adtalem Global Education, Inc, Chicago, IL. Periop 101: A Core Curriculum is a trademark of AORN, Inc, Denver, CO. Elizabeth S. Pincus, MSN, MBA, RN, ACNS-BC, CNS-CP, CNOR, is the AORN President and a clinical nurse specialist at Stanford Health Care, Palo Alto, CA. Ms Pincus has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.