AORN JOURNAL JULY 1993, VOL 58, NO 1

President’s Message

AORN members must help define perioperative nursing

at is a perioperative nurse, and why is w this question so important? So important, in fact, that AORN has invested heavily in time and money to study a question that any active member of the Association could answer by looking in the mirror.

The Project Team to Redefine/Reconcep- tualize Perioperative Nursing, an outgrowth of Project 2000, continues its search for a new definition-one that will recognize the changes in our practice settings and our roles and yet leave intact the core identity that will allow nurses practicing in hospital operating room suites, nurses researching perioperative nurs- ing, and nurses assisting surgeons in office- based procedures to call themselves periopera- tive nurses. I will not take on the Project Team’s work here; rather, I would like to encourage all of us to view this task as critical to the future of AORN and its very survival and to expand our thinking.

At this year’s Congress, I heard delegates repeatedly allude to the impression that AORN was attempting to rede- fine perioperative nursing because the Board of Directors believed there was a need to increase the size of the membership. While it is true that our current 48,400 membership number suggests a powerful body of nurses, redefinition is not intend- ed to increase membership. Mem- bership growth will strengthen AORN only if members have a

goals for the Association. Membership growth, pursued as an end in itself, can weaken the Association.

Redefinition is not about increasing member- ship. It is about not losing members or restrict- ing AORN membership, because perioperative nurses may not practice in the traditional setting or perform the traditional tasks of scrubbing or circulating. In 1978, we expanded our definition of perioperative nursing to include the preopera- tive and postoperative phases of surgical care, because the exclusivity of the intraoperative phase was too restrictive. As our practice extended beyond the actual surgical procedure, our role expanded. It is changing again. Surgeries or procedures once performed in the operating room now are performed in dedicated suites, clinics, physicians’ offices, and other locations far removed from the OR. Some of us have moved along with these procedures and patients. Are we still perioperative nurses?

Can the nurse who works only in the endoscopy or bronchoscopy suite be considered a perioperative nurse? Can the cardiac catheterization nurse, who may never have prac- ticed in the OR but who practices aseptic technique according to AORN’s recommended practices, who circulates in much the same way as an OR nurse, who acts as an advocate for the patient during an invasive procedure, and who pro- vides preprocedure and postproce-

common identity and common Cynthia C. Spry dure instructions, be considered a

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AORN JOURNAL JULY 1993, VOL 58, NO 1

perioperative nurse? Can a nurse who formerly headed an OR’S orthopedic specialty team still be considered a perioperative nurse if he or she is hired by the same institution to be the surgical orthopedic case manager? Can the nurse in the preadmission testing area who prepares the patient for surgery be considered a perioperative nurse?

I believe that all of these individuals, if they are grounded in perioperative nursing theory and have a hands-on familiarity with the world of intraoperative nursing, can be labeled peri- operative nurses. How does one measure “grounded in perioperative theory” and “hands- on familiarity with the world of intraoperative nursing”? Does a clinical rotation suffice? Does learning from a surgeon how to scrub or circu- late to assist in office-based surgical procedures suffice? There is no perfect way to measure these terms. Certainly, if we are liberal in our definition of perioperative nursing, some nurs- es-who previously were not eligible for active membership status and who may not have much in common with the Association’s issues-may join AORN. Most of these nurses, however, will be unable to identify with our issues and initiatives. They will not be suffi- ciently interested to join or will prefer not to part with the money to pay membership dues.

Most of us agree that we do not want the tra- ditional “floor nurse” to represent perioperative nursing. We also do not wish to exclude from membership nurses who care for patients under- going surgical or invasive procedures just because the procedures no longer are performed in the traditional operating room or because pro- cedures that once required major incisions now are accomplished using minimally invasive techniques. I would hope that we do not restrict our membership to the extent that today’s mem- bers will not be eligible tomorrow because of changes in practice (eg, new technology, the financial drive to do less invasive surgery, the movement of surgery to external sites).

I vote for a less-restrictive definition-ne that doesn’t sacrifice the good for the perfect. I am concerned that we will err on the conservative side and find our membership and power base

shrinking because fewer of us will qualify for membership. If this happens, AORN will become exclusive, and members will look to other organi- zations to address their professional needs. AORN can address the needs of the “new” peri- operative nurses, but only if they are members.

My vote does not matter; it is your vote in the House of Delegates that will decide this crucial question. You will define the essential ingredi- ents in the ultimate formula that is labeled “peri- operative nurse.” Communicate with the Project Team members. They listened to the members who attended Congress. Those of you who could not attend also can be heard. Send your ideas and opinions to the Project Team to Refinel Reconceptualize Perioperative Nursing, c/o AORN Headquarters, 2170 S Parker Road, Suite 300, Denver, CO 80231-5711. These could be the most important letters you ever write.

CYNTHIA C. SPRY, RN, MA, MSN, CNOR PRESIDENT

Understanding of Cancer Increased by Kids’ Game Eight children with cancer invented a game to help them deal with the disease. The game, called “Road to Remission,” now is being mar- keted to children’s hospitals across the coun- try, according to an article in the March 8, 1993, American Medical News.

The game helps children understand and expect things that might happen to them. The object of the game is to reach “remission.” Players move based on cards they draw, which include instructions such as, “You just finished your last cycle of chemo! Advance three spaces,” and, “Treatment extended. Move back four spaces.”

All proceeds from game sales will be used to purchase computer and recreational items for patients at Children’s Hospital Medical Center of Akron, Ohio. For information about obtain- ing the game, call the Children’s Hospital at (216) 379-8760.

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