aorn think tank participants develop a preferred future for perioperative nursing

OCTOBER 1996, VOL 64, NO 4

P W E S I I) E N 1 ’ s M E S S A G E

AORN Think Tank participants develop a preferred future for perioperative nursing

ast month’s “President’s Mes- sage” focused on changes in perioperative nursing that are

attributable to technology and eco- nomic imperatives but indepen- dent of mandated efforts to reform health care. In that article, I stated that as AORN members, it is our responsibility to create nursing care options that assist surgical patients along the continuum of the perioperative experience.

THINK TANK This sense of responsibility

motivated the AORN Board of Directors to convene a Think Tank in August. Although the Board members willingly accept responsibility for providing a vision for the Association, we realize that a vision viewed only by the elected leaders and Headquarters staff members can be distorted. For this reason, we invited AORN members with expertise in a variety of areas to share their visions of perioperative nursing practice in the future. The Think Tank participants included specialty assembly leaders, project team leaders, AORN Board members, past Pres- idents, the AORN health policy analyst, and RN staff members from AORN Headquarters; Educa- tion Design, Inc; and the National Certification BoardPerioperative Nursing, Inc.

The theme of this meeting was “Creating a Preferred Future for Perioperative Nursing,” and the participants’ task was to identlfy how AORN can position perioperative nurses to thrive as continuing

providers in the health care arena and to meet the public’s need for cost-effective, quality surgical care. Two facilitators, who are rec- ognized futurists and have assisted other health professionals in simi- lar ventures, led the Think Tank sessions.

professional and national trends that are projected for the twenty- first century (Table l).’ Next, we reviewed siflicant events that have affected surgery and periop erative nursing since 1960-the decade of plenty in the 1970s, cost shifting in the 1980s, cost contain- ment in the 1990s-as well as projected future events.

We predicted that patient care outcomes and efficiencies in achieving those outcomes will be the keys for perioperative nursing’s success in the next millennium. Specific issues that will affect this future are robotics, telesurgery, vir- tual reality, reuse and recycling of health care supplies, computerized patient data linkages, miniaturiza- tion of technology, and specific measures of patient care outcomes.

We analyzed the perioperative nursing specialty and realized that several closely held values (eg, all- RN staffiig, RNs functioning as scrub nurses, geographic defini- tions of where invasive procedures are performed, preoperative visits) have been eliminated or are being reevaluated against emerging or boundary events and trends. These emerging trends include rn reduced demands for periopera-

tive nursing services,

The participants first reviewed

rn changesin professional compensation, new services designed in response to patients’ needs,

rn expansionof unlicensed assistive personnel roles beyond traditional boundaries, and

rn computerized patient data being accessible from remote sites.

LINDA K. GROAH

VISION OF A PREFERRED FUTURE The recognition of advanced

perioperative practice roles (eg, case managers, surgical services brokers, cost-reduction specialists) motivated the Think Tank participants to develop a vision of the preferred future for perioperative nursing. This vision conceptualizes the perioperative nurse as a comprehensive, interventional care coordinator who is responsible for establishing and maintaining syner- gistic partnerships between perioperative providers for the purpose of ensuring quality care for surgical patients and their family members.

After molding and sharing this vision, we identified obstacles to achieving this vision within the next three to five years. We decided that the following elements would be essential to achieve this vision. rn Comprehensive support systems

will be needed to provide models that will assist managers in making decisions about the use of perioperative resources.

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Partnerships must be established with education facilities to create accessible, innovative educational bridges for perioperative nurses. The role of resource optimiza- tion specialists must be devel- oved and imdemented.

With this base of support, perioperative nurses can expand their roles and become comprehensive interventional care coordinators with responsibilities for collaborating and consulting with other perioperative care providers.

SCENARIO Let me use the following sce-

nario to illustrate the expanded perioperative nursing role. Ms J consults with Dr S, and they joint- ly decide that surgery is indicated to treat Ms J's health problem. Dr S refers Ms J to Mr B, RN, MSN, CNOR, a perioperative case coordinator who is a broker of surgical services. Mr B serves as an ombudsman for surgical patients and has the decision-making authority in obtaining cost-effective quality care for his patients. To achieve this result, Mr B uses a database that identifies the health care facilities that have the best patient outcomes for specific surgical procedures, which are achieved by using resources opti- mally and cost-effectively. Mr B informs his patients that they can find perioperative report card information about health care facilities on the Internet and that they can use this information (eg, patient care outcomes, competen- cies of care providers, mixes of direct care providers appropriate for specific surgical procedures) to select surgical facilities.

Ms J uses this information to select an appropriate health care facility, after which Mr B schedules

Table 1 FUTURE LIFE, WORK, AND BUSINESS TRENDS'

Cocooning (ie, seeking insulation, avoidance, coziness, control) Fantasy adventure (ie, momentary risk taking that is risk free) Small indulgences (eg, 'I want it, I will have it, I deserve it') Egonomics (ie, drive to make a personal statement) '99 lives' (ie, too much to do in too little time) 'Cashing OW (ie, giving up high-powered careers to have a slower pace of life)

Staying alive (ie, exaggerated quest for health, wellness) 'Downaging' (ie, abandoning rules of how people should behave at certain

Vigilante consumerism (ie, consumers protest against marketing immorality) 'Save our society' (ie, interest in protecting the planet) 'Clanning' (ie, bringing together people with mutual interests) Seeking pleasure revenge (ie, people tired of being told to live healthy lives) 'Anchoring' (ie, looking at spiritual needs) Adopting the 'female think' (ie, men becoming more comfortable with female traits) 'Mancipation" (ie, men become more three-dimensional individuals who do not need to be macho, overly analytical, or emotionally distant from families) Icon toppling (ie, established professions losing power)

ages)

NOTE

Work, and Your Business (New York: Harper Collins, 1996). 1 . F Popcorn, L Marigold, Clicking 16 Trends to Fulure Fit Your Life, Your

her for preoperative assessment and education at a nurse-managed presurgery clinic. Ms J and her family members can choose to visit the clinic, have the clinic personnel visit them, or complete the presurgi- cal assessment and education process by using a computer. On the day of surgery, the perioperative care coordinator greets Ms J and her family members and serves as the case manager to ensure that Ms J's care follows the appropriate critical pathway through her recovery and rehabilitation phases. To help achieve this outcome, Mr B serves as a bridge by collaborating and consulting with perioperative care providers, other staff members,

home health care providers, and community resources.

ager in patients' intraoperative care. In this role, he coordinates the surgical team's activities, mod- ifies patients' critical pathways as indicated, serves as a patient and family educator, consults with the circulating nurse, and provides expert clinical nursing services as he deems appropriate.

Mr B also serves as a case man-

STRATEGIC ACTIONS This scenario depicts roles that

have not been designed but which are part of perioperative nursing's preferred future. The Think Tank participants defined six strategic

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directions or action categories that will position perioperative nurses for this preferred future.

expand the perioperative nursing role, we need to define-in clear, simple terms-our role and how we contribute to the care of the surgical patient. We need to improve the ways in which we tell our story and change our handmaiden stereotype. We must direct this communication at a wide range of audiences, includ- ing the public, private-sector and public policymakers, and other health care professionals.

Preparing nurses. We must develop innovative education programs and products that will prepare perioperative nurses for broader roles in emerging health care systems. Perioperative nurses must be prepared to follow surgical patients as the geographic boundaries of where invasive procedures are performed expand beyond traditional surgical suites. We must retool and retrain our thinking to emphasize lifelong learning and to develop the abili- ty to cope with uncertainty as we participate in the reframing of the health care system.

Developing models. We must identify and test innovative models and develop an inventory of the best practices and bench- marks of perioperative nursing. When we implement these new models, we must do so in the context of multidisciplinary work teams that focus on building part-

N O T E

Expanding the role. TO

Creating a preferred future will have an

impact on our patients and on our future as periopera-

tive nurses.

nerships, and we must share our findings with all the key stakeholders.

lmpiementlng research. Our research agenda must focus on developing a tool to measure patients’ satisfaction with surgical care (ie, a perioperative report card). We then must use this tool to compare patient care outcomes in surgical facilities with varying practice models and different RN:patient ratios.

Building partnerships. Devel- oping “co-opetition” strategies and building partnerships with all health care stakeholders is impera- tive as we design our preferred role for the future. These partnerships and strategies include rou- tinely collaborating with other nursing associations, the American College of Surgeons, the American Society of Anesthesiologists, our industry colleagues, and other nurses.

present when decisions are made about the care provided to patients

Positlonlng nurses. We must be

who undergo invasive procedures. By developing strong grassroots partnerships with third party pay- ers, legislators, consumers, hospital board members, and other health care providers, we can make our voices heard as facilitators of change that will improve surgical patients’ health care outcomes. To build effective partnerships, we must identify opportunities in which we can contribute to the for- mation of policies and regulations before they are made available for public response. It is essential that we create and participate in coali- tions of health care professionals to achieve this level of input.

THINK TANK CONCLUSIONS

leaders gathered to develop this preferred future for penoperative nursing-a future that has an expanded focus on patients and their family members. The energy and excitement generated at the Think Tank will serve as a catalyst to move these ideas from visions into clinical practice as we enter the next millennium.

We owe a debt of gratitude to the AORN leaders who were present at the Think Tank. The participants were willing to take risks and create a preferred future for perioperative nursing-and this will make all the difference to our patients and to our future as perioperative nurses.

Past, current, and future AORN

LINDA K. GROAH RN, MS, CNOR C N M

PRESIDENT

the Twenty-First Century (San Francisco: University of Cal- l . F Popcorn, L Marigold, Clicking 16 Trends to Future

Fit Your Life, Your Work, and Your Business (New York: Harper Collins, 1996); Pew Health Professions Commission, Critical Challenges: Revitalizing the Health Professions for

ifornia at San FranciscoCenter for the Health Professions, 1995); G S Wunderlich, F A Sloan, C K Davis, eds, Nursing Staff in Hospitals and Nursing Homes: Is it Adequate? (Washington, DC: National Academy Press, 1996).

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aorn think tank participants develop a preferred future for perioperative nursing

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