SEPTEMBER 1996, VOL 64, NO 3 P R E S I I) E N T’ S M E S S A <; E

Do the changes in health care and perioperative nursing practice represent a revolution or an evolution?

R apid changes in health care are challenging, restructuring, and reengineering staff members’

roles and responsibilities in many surgical settings where AORN members practice. Do these changes represent a revolution or an evolution in health care and perioperative nursing practice? Our perception of these changes determines the way we respond to them as employees, professionals, and citizens.

Revolutionary change occurs when an existing system is tom apart and replaced with something that bears little resemblance to the original system. Evolutionary change happens when a new sys- tem, which can be considered complete at a given point in time, develops from an existing model.

If we interpret the current changes in health care as being evolutionary, we may think, “This is just a phase that health care is going through. I’ll sit back and wait it out. If I resist long enough, the administrators will move on to the next ‘flavor of the month’ just like in the past.” Peri- operative nurse managers who choose this interpretation may tweak their resource management just enough to pacify upper-eche- lon administrators while trying to preserve the status quo.

the midst of a revolution, we may think, “Health care is changing. Clinicians are being pressured to provide quality care at an afford- able cost. Health care will never return to the way it used to be.”

If we believe health care is in

Perioperative nurse clinicians and nurse managers who choose this interpretation desire to be part- ners in designing the changes in health care.

CHANGES IN SURGICAL CARE During the past five years, we

have witnessed a rapid growth in both ambulatory surgery and min- imally invasive surgical proce- dures. These trends will continue. Outpatient surgical procedures will continue to increase, inpatient hospital stays will decrease, total hospital revenue will be divided equally between inpatient and outpatient services, and regional integrated health care delivery networks will account for 80% of all health care delivered.’ Surgical procedures will be less invasive, and surgical patients will be hos- pitalized for shorter periods as we approach the end of this decade.

Perioperative nursing care is being delivered in many nontradi- tional settings. Surgical facilities with “pickup and tuck-in ser- vices” are offering expanded ser- vices to surgical patients; mobile ORs soon will be parking in patients’ driveways; and periop- erative nurses will provide post- operative monitoring using telecommunication technology in the near future.

THE FUTURE OF PERIOPERA TIVE NURSING

If we are to assume a leader- ship role in the health care system of the future, we must step outside the current boundaries of our roles

and move into surgical patients’ con- tinua of care. To maintain our relevance in the scope of this

anticipate and meet the con- stantly changing challenges that surgical patients present to us. To imagine and plan for our future, we need to study health care economists’ predictions and inter- pret them for surgical patients and perioperative nursing. Although predictions do not always become realities, we can recognize trends if we understand the changes occurring in the current health care environment.

cal experiences for nursing stu- dents is one way in which we can prepare for the future. In planning these clinical experiences, we must remember that today’s nurs- ing students participate in school- based clinics, work-site health programs, and clinics for home- less individuals, all of which are nontraditional settings in which the majority of nursing care will be delivered in the future. We need to expose students to nontra- ditional perioperative roles and settings (eg, advanced practition- ers, pickup and tuck-in services) as well as provide them with intraoperative patient care experi- ences. Providing this balanced view of perioperative nursing is the only way we can recruit

care, we must LINDA K. GROAH

Providing perioperative clini-

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young nurses to join our specialty and our organization.

THE FUTURE OF AORN For nearly half a century,

AORN has provided the frame- work for OR nurses to advocate for quality care for surgical patients. Our members have con- tributed to the development of knowledge about the intraopera- tive phase of surgical care. Many AORN members can remember the angst experienced when we first added the words preoperative and postoperative to our vocabu- lary. Indeed, the perioperative nursing role endured a difficult birthing process, and it still is not embraced by many OR nurses or practiced in many facilities.

We now stand at another threshold and face a new oppor- tunity. Working together, we can create an advanced perioperative nursing practice role that will complement-not replace-the traditional scrubbing and circulat-

ing nursing roles. To create this new role, we must rn stretch our minds, rn proactively participate in trans-

forming our workplaces, rn search for new practice options

that will complement our cur- rent practice models, and

rn maintain our accountability to quality patient care. By participating proactively in

the changes that are occurring, we can position perioperative nurses strategically in making decisions that will reform surgical patients’ care. This position of power will allow us to rn have some control over future

changes, rn provide input into the change

process, and rn form partnerships and strategic

alliances that will enhance our future politically and profes- sionally. We owe it to ourselves and to

future perioperative nurses to cre- ate this preferred future. As

AORN members, it is our respon- sibility to create nursing care options that assist surgical patients throughout the continuum of peri- operative care and to provide these services cost effectively while enhancing patients’ outcomes. We must articulate our worth, value, and competence to achieve recog- nition for the care that only profes- sional perioperative nurses can give to surgical patients.

CONCLUSION We are experiencing a revolu-

tion in health care and perioperative nursing practice. It is our responsi- bility to be part of this revolution by rekindling our passion for peri- operative nursing and by working to create a preferred future.

LINDA K. GROAH RN, MS, CNOR, CNAA

PRESIDENT NOTE

accelerates,” Medfro Month 5 (August 1995) 140.

1. “Transition to outpatient care

Legislative Coordinator, Professional Nurse Educator Hired AORN recently hired a Legislative Coordinator and a new Professional Nurse Educator. Both individu- als joined Headquarters staff in August 1996.

Candace Romig, the Legislative Coordinator, will be responsible for analyzing, formulating, and monitoring federal, state, and local legislative and regulatory issues related to perioperative care and assessing the impact of proposed and existing health policy on the delivery of perioperative care. Romig comes to AORN with 15 years of experi- ence with state-based legislative policy and 13 years with the National Conference of State Legis- latures (NCSL). At NCSL, Romig was the group director of the health and human services depart- ment. In this role, she provided talking points, ref- erence material, and analyses of health-related leg- islative issues for state legislators. Romig has a master’s degree in political science from the Uni- versity of Colorado, Boulder, and is well-versed in

media relations. She can be reached at Headquar- ters at extension 263.

Nurse Educator in the Center for Perioperative Education. Beachy will design, develop, coordi- nate, and implement perioperative education prod- ucts and services and will serve as a staff consultant to volunteer groups of the Association. Beachy comes to AORN with experience as manager of education for the Association of Women’s Health, Obstetric and Neonatal Nurses, Washington, DC; program manager for the University of Colorado Health Sciences Center, Denver; and research nurse and manager of perinatal services at The Children’s Hospital, Denver. She also has extensive publishing and public speaking experience. Beachy has a mas- ter’s of science degree in parent/child nursing from the University of Colorado, Denver. She can be reached at Headquarters at extension 256.

Trish Beachy, RN, MS, is the new Professional

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