AUGUST 2002, VOL 76, NO 2 H E A D Q U A R T E R S R E P O R T

AORNs response to the nursing shortage in perioperative seltings

ORN believes that there is a growing shortage of qualified A health care personnel, specifi-

cally professional nurses.’ The current shortage is the result of a confluence of three major factors:

declining nursing school enrollment, an aging workforce, and competition for skilled personnel.

It is expected that during the next two decades, the nursing shortage will increase as many RNs enter their fifties and sixties and eventu- ally retire. This overall shortage has contributed significantly to shortages of personnel in the OR.

According to a recent analysis of 16 major studies examining the nursing shortage, the shortage is real, past solutions are inadequate, and workforce and public health crises loom in the hture. This analysis also indicates that the nursing shortage is present throughout the United States, except in Montana. The intensity is related to the diversity of the population and penetration of managed care independent of edu- cational opportunities.2

Factors causing the current and worsening shortage in the OR include

an aging workforce with many current and imminent retirements,

E a lack of surgical educational content and clinical experi- ences for nursing students, demands for professional nurs- es in ambulatory care surgical settings, and

difficulty attracting and keep- ing perioperative nurses.j

Although these factors exist in numerous clinical areas, their effects seem more dramatic in the OR. Many anecdotal and quanti- tative reports provide evidence of this shortage in perioperative settings.

AORN believes that nurses bring a unique body of knowledge to perioperative settings. Further- more, the Association recognizes that professional RNs contribute significantly to cost-effective, efi- cient, quality, and safe care in the perioperative setting. AORN believes that it plays a critical role in addressing the national nursing shortage and, specifically, the shortage of perioperative RNs. The approach to addressing the nursing shortage must be multidi- mensional and requires highly collaborative efforts of key stake- holders. AORN has committed organizational resources to identi- fy and create solutions to address this growing concern.

AORNS RESPONSE

department at AORN Head- quarters has been involved in efforts and activities to address the nursing shortage. Efforts have been undertaken in various areas, including education, public rela- tions, government affairs and advocacy, membership, and nurs- ing practice and research.

Education. In 1999, AORN developed and implemented a fully integrated curriculum for

In the past five years, every

nurses who do not have any OR experience. This course, titled “Penoperative Nursing Course 101,” is presented in a scripted, modular format and consists of 26 educational topics, PowerPoint slides, posttests, and text reading assignments. The course, which uses the “train the trainer” con- cept, has been implemented in more than 225 clinical settings. More than 800 participants have taken the course in hospitals, free- standing ambulatory surgery set- tings, pediatric specialty hospitals, and academic settings. Contact hours are awarded to participants, and the course is suitable for awarding academic credit.

curriculum and produces numer- ous educational programs on videotape that address the knowl- edge and clinical skills required by perioperative nurses. These serve as introductory or review resources and can be valuable tools for organizations that choose to design their own educational programs.

Additionally, AORN provides a web-based directory of perioper- ative nursing courses for students and nurses interested in a career in perioperative nursing. This direc- tory links to the AOUT Foundation web site for scholar- ship information and to other nursing sites. AORN also has sponsored numerous workshops and education sessions on recruit- ing and retaining staff members. Association members actively work with schools of nursing to

AORN also publishes a core

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support perioperative experiences for students and to increase the emphasis on surgical content. A0R”s National Committee on Education is in the process of developing a tool kit for members to use when promoting the inclu- sion of perioperative content in nursing school curricula.

To help AORN members develop mentoring skills, the Association has provided numer- ous education sessions and Journal articles so staff nurses can support students and new staff members. At AORN’s 2002 Congress, the Association offered free registration to student nurses, and approximately 120 students attended. Students were offered a full-day course on understanding the OR. This course was taught by experts in the field and provid- ed hands-on instruction on such topics as gowning and gloving, skin prep, and electrosurgery.

Also at the 2002 Congress, a number of sessions focused on the nursing shortage and recruitment and retention. These sessions included “Peer Mentoring for Retention”; “Recruitment and Retention: Specialty Teams and Manager Emotional Intelligence”; and “Today’s OR: What Works.” A number of clinical innovation posters were displayed as well. Titles included “A Clinical Immersion Program in Periopera- tive Nursing”; “A Key to Success: Building a Perioperative Nurse Consortium”; “Closing the Circle: Caring about Recruiting, Preparing, and Retaining Future Perioperative Nurses”; and “Collaborating to Address a Perioperative Nursing Shortage.” In July, AORN’s chapter leader- ship meeting focused on perioper- ative nursing opportunities, the image of nursing, attracting young

nurses, recruitment, retention, recognize the contributions of morale, multigenerational issues, and mentoring.

Public relations. AORN sup- ports and participates in Nurses for a Healthier Tomorrow, a coali- tion of nursing and health care organizations. This coalition’s efforts focus on creating commu-

perioperative nurses.

cacy. The Government Affairs Department monitors legislation on staffing, funding related to nursing education, and health and safety at both the federal and state level. AORN has joined 45 other

Government affairs and advo-

nication programs targeted to young people to encourage them to consider nursing as a career. The coalition maintains a web site

nursing organizations in endorsing a consensus statement titled “Assuring Quality Health Care for the United States: Supporting

at http:llwww.nursesource.org. Its intended purpose is communicat- ing the tremendous number of Opportunities in the nursing pro- fession and presenting its social importance and career satisfaction.

AORN conducts an active public relations campaign with its members and external stakehold- ers related to the nursing shortage. The Association has placed news

Nurse Education and Training, Building an Adequate Supply of Nurses.” Developed by the Americans for Nursing Shortage Relief (ANSR), an ad hoc group, this statement identifies factors contributing to the nursing crisis as discussed in “Health Policy Issues” in the November 2001 AORN Jouvnal. Through its asso- ciation with other nursing organi-

articles about perioperative nurs- ing in several general newspapers throughout the country. In addi- tion, both the AORN Journal and

zations in the ANSR alliance, AORN has continued to support passage of federal legislation and responsible public policy action to

SSM have published numerous articles regarding the nursing shortage and retention strategies.

Currently, AORN distributes a videotape program titled Nursing. The Ultimate Adventure, Peri- operative Edition. This videotape discusses opportunities in the nursing profession. Career-orient- ed brochures, titled Consider a Career in the OR as a Peviop-

alleviate the nursing shortage.

legislation to be introduced by Rep Carolyn McCarthy (D-NY), one of the three nurses in Congress. The Nurse Retention and Quality of Care Act of 2002 (ie, HR 4654) incorporates many of the features that ANSR sup- ports in S 1864, the senate version of the Nurse Reinvestment Act.

In May 2002, AORN endorsed

erative Nurse, also are available. AORN has a career packet that provides resources for conducting a job search, interviewing, and writing resumds. The Association also sponsors Perioperative Nurse Week each year in November. The purpose of these efforts is to encourage perioperative nurses to share information about their spe- cialty with the general public, support health care facilities, and

This bill is meant to try to jump- start the resolution of the legisla- tive process that seems stalled in the delay of appointments to a conference committee and the lack of conference committee hearings for HR 3487, the House version of the Nurse Reinvest- ment Act, and S 1864.

In April 2002, ANSR drafted a letter to Secretary of Labor Elaine L. Chao asking for a meeting to

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discuss its consensus statement previously mentioned. A similar letter and request for a meeting was sent to Secretary of Health and Human Services Tommy Thompson in October 2001. To date, no meetings have been held with either Chao or Thompson.

a letter to the House and Senate committees that passed HR 3487 and S 1864 requesting the imme- diate appointment of the confer- ence committee and passage of the Nurse Reinvestment Act. Americans for Nursing Shortage Relief supported the Senate ver- sion of the bill, including facilita- tion of the entry of new nurses into the profession; enhancement of the practice environment through implementation of best practices in the nursing environ- ment; promotion of faculty devel- opment; and improvement of the public image of nursing to encourage its selection as a career.

During the past few months, ANSR supported President Bush’s proposed 2003 fiscal year budget that would increase the investment for nursing education to $99 million. Some concern was voiced that although $15 mil- lion was proposed for the Nursing Education Loan Repayment Program, only slight increases would be made for the other edu- cation programs funded through title VlIl of the Public Health Service Act. Americans for Nursing Shortage Relief has requested an additional $2 1 mil- lion to fund these programs.

Patient Access for Responsible Care Alliance based in Washing- ton, DC, a group dedicated to ensuring the passage of a federal patients’ bill of rights. The intent of this legislation is to ensure that

Also in April 2002, ANSR sent

AORN also is a member of the

health plans do not discriminate against providers, such as RN first assistants, solely because they are not physicians.

The Association is involved in initiatives with the Occupational Safety and Health Administration and the National Institute for Occupational Safety and Health on reducing health and safety risks in the perioperative environ- ment. In addition, AORN Pres- ident Donna Watson, RN, MSN, CNOR, ARNP, FNP-C, has com- mitted resources to the Work Place Safety Task Force. Members include Deborah Spratt, RN, MPA, CNAA, CNOR, chair; Vi Farrell, RN, CNOR, Sherron Kurtz, RN, MSA, CNAA, CNOR; Trudy Kenyon, RN; and Lorraine Butler, RN, BSN, MSA, CNOR, board liaison.

The American College of Surgeons (ACS) invited AORN to discuss the nursing shortage at a meeting of the ACS surgical spe- cialty society in November 2001. This invitation was a direct result of conversations that Betty Shultz, RN, CNOR, AORN’s Vice President at the time, had with physicians at the ACS annual meeting in October 200 1. Sheila L. Allen, RN, BSN, CNOR, CRNFA, AORN’s President at the time, Shultz, and Tom Cooper, CAE, AORN’s Executive Director, represented AORN at this meeting. Approximately 40 physicians and staff members from 15 surgical specialty groups were present. After introductory remarks from the AORN repre- sentatives, the group held a wide- ranging discussion about the nurs- ing shortage, its root causes, the impact it is having on the OR, and initiatives to address the shortage. All agreed that the shortage is a serious problem for the OR.

Surgeon comments tended to focus on legislative action and reimbursement, and AORN’s comments focused more on work environment issues. Both groups mentioned the importance of edu- cation and training at all levels to address the shortage. Patient safe- ty also was a common theme and concern.

Membership. AORN actively has been recruiting students to join the Association. In June 2001, the Board of Directors approved a student dues rate of $20 annually. More than 200 stu- dents have joined AORN to date as a result. The Association main- tains an active presence at nation- al and local National Student Nurse Association events. At these events, AORN staffs an exhibit booth and provides perioperative nursing information to students. In addition, AORN leaders present sessions on perioperative topics.

research. Cooper and staff mern- bers from the Center for Nursing Practice and the Research Department have been involved actively in the Call to the Nursing Profession efforts related to the nursing shortage. More than 60 nursing organizations participated in the three-day meeting during which discus- sions revolved around 10 domains identified as key issues of concern for nurses, the profes- sion, and the public. AORN serves on the steering committee for this national effort and as a co-champion for the domain of recruitment and retention. The Association has contributed work plans to three domains-public relations, public policy, and recruitment and retention-and participates in regular conference calls with representatives from

Nursing practice and

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various nursing organizations to implement work plans.

has compiled an extensive refer- ence list related to the nursing shortage as well as research arti- cles related to nurse staffing and patient outcomes. The department also has collected various state- specific reports and monographs about the nursing shortage with the help of AORN’s library staff members who routinely monitor a variety of reference resources and have conducted numerous search- es. Information about these mate- rials is available by calling the Research Department at (800) 755-2676 x 248 or by sending an e-mail to research@aorn.org.

AORN’s director of research pub- lished an article titled “The nurs- ing shortage in the operating room

AORN’s Research Department

Past President Allen and

and other surgical settings” in the June 2002 issue of the Bulletin of the American College of Suygeons.‘ It addresses research related to the nursing shortage as well as its etiology and AORN’s activities to address this looming crisis.

CONCLUSION Other shortage-related activi-

ties AORN supports include ft entry-level student nurse schol-

arships given by the AORN Foundation;

R research support for projects related to recruitment and retention;

B position statements related to staffing ratios, the responsibili- ty of mentonng, and student learning activities;

a scholarships for nurses interest- ed in perioperative nursing; and

n conference grants. AORN members have voiced grave concerns about the worsen- ing shortage of qualified nurses. The ever-increasing number of adverse events, such as wrong site surgery, has made the need for qualified, experienced nurses more acute. The Association sup- ports ongoing efforts to address this issue and collaborates in new initiatives with other professional organizations and industry part- ners. AORN remains committed to the belief that every periopera- tive patient deserves a well-quali- fied, competent RN.

SUZANNE C. BEYEA RN, PHD

AORN DIRECTOR OF RESEARCH

Editor‘s note: PowerPoint is a registered trademark of Microsoit Corp, Redmond, Wash.

N O T E S

future.” AHA Trend Watch 3 (June 2001) 1-8.

Nursing in America,” Policx Politics, & Nursing Practice 2 no 3 (2001) 180-186.

3. P Buerhaus. D Staiger, D Auerbach, “Why are shortages of hospital RNs concentrated in specialty care units?’’ Nursing Economics 18 no 3 (2002) 1 1 1 - 1 16.

4. S L Allen. S C Beyea, “The nursing shortage in the operating room and other surgical settings,” Bulletin ofthe American College ofsuvgeons 87 (June 2002) 8-12.

1. “The hospital workforce shortage: Immediate and

2. B Kimball, E O’Neil, “The evolution of a crisis:

Award Established for Patient Education Ideas The California Pacific Medical Center has estab- lished a $2,500 national award for the health care professional or team judged to have developed the best new idea in patient education. The new California Pacific Award for Excellence in Patient Education will be awarded to an individual or team who has developed an outstanding patient education program at an acute care hospital.

The award is funded by a donation from the Mr and Mrs Arthur A. Ciocca Foundation, and Cali- fornia Pacific is inviting nurses, physical therapists, hospital administrators, medical librarians, trans- plant coordinators, radiology technologists, diabetes educators, alternative therapy professionals, and

other health care providers throughout the United States to apply for the award. A team of California Pacific physicians, nurses, and voluntary community advisors will judge submissions.

Applications are due by Nov 20, 2002. For more information, contact Bruce Smith, education coordinator, or Jan Binger, RN, EdD, staff associate to the president, California Pacific Medical Center, at cpheia@sutterhealth.org, or go to http:llwww .cpmc.org/learning/initiative. html.

California Pacific Award Gives Overdue Recognition to Patient Educators (news release, Sun Fruncisco: Cu/iforniu Pucific Medical Center, June 25, 2002).

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