AORN JOURNAL JANUARY 1987, VOL. 45, NO I

President Ir Message

Preparing for the nursing shortage

s nurses, we are keenly aware of the profound A changes taking place in the American health care system. The impact of those changes affects the everyday workings of hospitals, ambulatory surgery facilities, and alternate health care services. From the patient care viewpoint, however, the impact on nursing may be more serious. The nursing profession is experiencing a shortage of qualified practitioners-specialists and manag- ers-educated to deal with the types of patients cared for in today’s hospitals and ambulatory surgery units.

In the face of this relative twofold shortage, we should not take the survival of our traditional nursing values and roles for granted. Values we have held about patient care may be challenged, and we may find ourselves in conflict with institutional values regarding cost-effectiveness, staffing patterns, appropriate use of support services, and in the case of ambulatory surgery, admitting decisions.

In many ways, I see a certain amount of value conflict as beneficial. It makes us examine our practice carefully and use scarce and expensive resources more efficiently and effectively. As perioperative nurses, though, we must always keep the welfare of the patient as our primary goal. If we do not, the patient will be the loser. We must anticipate some of the conficts and prepare ourselves and future perioperative nurses to deal with them.

We know that inpatient acuity levels are increasing and that many patients are being discharged earlier. We also know that given a relative shortage of experienced perioperative

nurses, the pressure to hire less qualified health care workers is increasing. These facts stir up conflict between administrators and nurses.

One way to prepare for this conflict is to ensure that nurses enter the management arena well- prepared for the challenges they will face. Many of today’s nursing leaders are not prepared to operate successfully in this new environment. They need new skills in finance, personnel relationships, and negotiation to compete with non-nurse managers in the institutional hierarchy. They must learn hard management tactics by attending seminars and formal academic program. To help managers obtain these executive skills, AORN is offering management seminars that focus on marketing, finance, organizational development, and legal issues. Also, the AORN Education Department has prepared the Management Anthology, which is an excellent reference book for the nurse manager.

Contributing to the overall shortage of nurses is the fact that enrollment in basic nursing education programs is declining. This may be due in part to the widening array of career oppor- tunities for women. But when there is a decrease in the number of graduate nurses, a decrease in nurses who specialize in one clinical arena will follow.

We in the perioperative nursing specialty must try to prevent a critical shortage within our ranks. Modem surgical technology has generated a need for perioperative nurses to become even more specialized than in the past. In addressing the potential for a perioperative nursing shortage, AORN has accelerated its Project Alpha activities,

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JANUARY 1987, VOL. 45, NO I AORN JOURNAL

and the National Committee on Education (NCE) has developed an award program to recognize outstanding chapter Project Alpha activity in each region. The first awards will be presented at Congress.

The Board of Directors has appointed an Invitational Conference Planning Committee to present a 6th Invitational Nurse Educator Conference in the fall. At this meeting, college faculty are invited to come and learn about how perioperative nursing courses can be incorporated into their curriculums. At last year’s conference, we learned that more colleges and universities are offering clinical courses in perioperative nursing for their students. (A complete report of the 5th Invitational Nurse Educator Conference will appear in next month’s issue of the Jouml.) Faculty members from two universities reported that they are designing graduate programs with a major in perioperative nursing. We do not want

to lose that momentum, and thus an additional conference is planned for this year. Also, the NCE is in the process of developing a preceptor guide to assist clinical preceptors with their teaching of students.

In its continuing efforts to provide educational materials for members, the AORN Education Department is developing a text to serve as a teaching guide for perioperative nursing in the clinical arena.

AORN is actively involved in addressing the trend toward the future nursing shortage. By planning ahead and not relying on old problem- solving methods, I believe we will not only survive but thrive in today’s health care environment. And by preparing future perioperative clinical nurses and managers, we will solve patient care conflicts so that we all can win.

ALICIA C. ARVIDSON, RN, BSN, CNOR PRESIDENT

Nonnarcotic Drug Has Morphine-Like Effects There is a new nonnarcotic drug that may be as effective as morphine in relieving postoper- ative pain, according to a study performed at Northwestern University, Evanston, Ill.

The drug, ketorolac tromethamine, was used in a double-blind, random test on 155 patients ranging in age from 19 to 74 years. According to the researchers, when the drug was given intra- muscularly, it was as effective as morphine and lasted longer in relieving postoperative pain. In addition, because the drug is a nonnarcotic (keto- rolac tromethamine is in the same drug classifica- tion as indomethacin [Indocin]), it does not have the addictive potential of morphine.

The researchers found that patients receiving ketorolac tromethamine had continued pain relief for as long as five to six hours after intra- muscular injection compared to a maximum of three hours for patients who received morphine. When comparing side effects, researchers found that less than 3% of the patients receiving keto- rolac tromethamine had side effects.

New Spinal Disk Procedure Tested Surgeons have adapted a suction-and-cutting probe used in eye surgery to help patients with herniated disks, according to an article in the Sept 22, 1986, issue of Medical World News.

Known as a percutaneous diskectomy, this procedure was tested on 120 patients participat- ing in clinical trials at 14 centers and showed a 73% success rate. This procedure could be an alternative to laminectomy whenever possible, according to Gary Onik, MD, senior scientist in neurology at the Allegheny General Hospital, Pittsburgh.

anesthesia, and a 2 mm needle-like probe is inserted through the patient’s back and guided toward the spine with the aid of fluoroscopy. Computed tomography is used to map out the course of the probe before the procedure. The patient helps the surgeon guide the probe by tell- ing him or her if the probe touches a nerve.

Percutaneous diskectomy is done under local

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