OCTOBER 1987, VOL. 46, NO 4 AORN JOURNAL

Results indicated that locus of control, age, and amount of preoperative information supplied by the parent/physician related to the child‘s coping strategy. Children who exhibited more active modes of coping had a greater internal locus of control. As the age of the child and/or the amount of information he or she received increased, the child used more active modes of coping. Also, the study suggested that the type of information given to children preoperatively played an important role in their internal locus of control. A child‘s method of coping is important because previous research indicates that active coping measures result in more positive postoperative outcomes.

Perioperative nursing implications. The results of this study support preoperative instructions for children. By observing children’s behaviors such as actively seeking information or avoiding information, the perioperative nurse can plan preoperative teaching to enhance a child’s internal locus of control and thus enhance positive surgical outcomes.

Information given should focus on the child’s need for information to maintain his or her internal locus of control. Recognizing and fulfilling these needs may help the child achieve more control in what is often perceived as an uncontrollable situation. A review of this study is highly recommended for perioperative nurses working with children undergoing surgical procedures.

ROGER A. STONE, RN, MS, CNOR 1987-1988 NURSING RESEARCH COMMITTEE

A S Hinshaw, C H Smeltzer, J R Atwood, “Innovative retention strategies for nursing staff,” Journal of Nursing Administration 17 (June 1987) 8- 16.

Although recruiting nurses has been the focus of tremendous energy, retention is equally as important. Recruiting and orienting an RN may cost from $3,000 to $5,000. For an intensive care nurse, the cost may be between $7,000 and $8,000. Nurse administrators need innovative strategies to prevent turnover and thus to reduce costs.

This study examined what factors influence nurse retention. According to this study, retention

strategies can be tailored to effectively meet the needs of recruited nurses. A five-stage theoretical model provided the framework. Each stage was predicted to influence the other.

Researchers used a sample of 1,597 nurses from both urban hospitals (68%) and rural hospitals (32%). Of those, 62% were RNs, 19% were licensed practical nurses, and 19% were nursing assistants. The nurses had an average of 11.2 years of experience. Educationally, 37.5% had an associate degree, 29.5% had a diploma in nursing, 25.1% had a bachelor of science degree in nursing, 6.7% had a baccalaureate in some other field, and 1.2%, had a master’s degree or higher. They worked in critical care, general medical/surgical, obstetrics and gynecology, pediatrics, and psychiatry.

The initial data was gathered on-site by using a confidential, self-reporting questionnaire. Each subject was followed for 12 months. By the end of the year, 16% had quit their job.

Results showed that job stress is buffered by job satisfaction. Although job stress had no direct effect on anticipated turnover,job stress was found to be the strongest predictor of professional/ occupational job satisfaction. Group cohesion and autonomy had moderate influence on job satisfaction. Control over practice also had some influence on job satisfaction.

In terms of education, diploma nurses focused on organizational job satisfaction and the ability to control their practice. Baccalaureate nurses focused more on group cohesion as a method to promote job satisfaction.

In terms of their clinical service, critical care nurses were found to focus on organizational job satisfaction factors such as administrative style and professional status. Control of practice was very important to them. For general medical/surgical nurses, stress reduction, increases in job satisfac- tion, being able to deliver quality care, and group cohesion were crucial factors to improving their retention.

Lack of team respect and feelings of incom- petence, according to the study, are major stress factors to be reduced. Primary satisfiers (ie, professional status and general enjoyment in one’s position) correlated significantly with the ability to deliver quality nursing care.

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Perioperative nursing implications. OR man- niittees on nursing practice, policies and proce- agers should contemplate the findings of the study, dures, and quality assurance allow nurses to have compare them to their operating room practices, a say in their practice. Also, attention to and then design individualized retention strategies. professional growth facilitates feelings of high job Based on the results of this study, OR managers satisfaction that, in turn, affects staff turnover. should pay attention to orientation programs and Nurse managers must creatively address the cross-training procedures. These will facilitate perioperative nurse shortage. Two methods they integration into the system quicker and aid in can use are promoting job satisfaction of current acquisition of the necessary job skills. staff members and developing strategies to retain

This study suggests that staff retention can be the staff. accomplished by recognizing professional achieve- SUZANNE F. WARD, RN, MN, CNOR ments, encouraging committee responsibilities, and 1987-1 988 NURSING RESEARCH COMMITTEE developing career mobility opportunities. Com-

Pos tsurger y Interviews Reveal High Infection Rates Researchers at Calgary General Hospital and the University of Calgary, Alberta, Canada, found infection rates in postdischarge surgery patients to be more than three times higher than deter- mined in the hospital standard surgical wound surveillance program. Results indicate that pas- sive reporting systems are unreliable in determin- ing infection rates, and that more intensive train- ing of patients and staff, or an active surveillance system might be more appropriate, according to the researchers.

ing the six-month study period, 521 inpatients and 103 day surgery patients were contacted by telephone four weeks after their surgery. A staff member from the office of infection control asked each patient whether there had been any discharge from the incision, and if so, the color, amount, and duration of the discharge. The patient was also asked if the operative site was red or swollen, if there had been any fever, whether he or she had contacted a physician, and whether treatment had been prescribed. Patients were considered to have a surgical wound infec- tion if their physician told them they did, if they were given antimicrobial therapy for their wound, or if they described a purulent discharge.

Standard surveillance of surgical wound infec- tion continued during the study period, resulting

Of 7,179 patients who underwent surgery dur-

in 8 (1.5%) reports of infection in the 521 patients. When telephoned, an additional 20 patients reported infections, however, producing an infection rate of 5.4%. Of the 103 day surgery patients, eight (7.8%) reported infections. Day surgery patients are not routinely followed through the hospital surveillance program.

The mean hospital stay of the eight patients whose infections were reported in the standard surveillance program was 76 days, compared to 6.6 days for those whose infections were identi- fied after their release from the hospital. Of the total number of patients who reported infections when telephoned, 70% had been hospitalized for less than one week.

The researchers are further examining the occurrence of infection in day surgery patients. They claim that reliable methods of determining surgical wound infection rates are necessary to validate surgeon-specific rates and for early iden- tification of potential outbreaks. The results of their study were reported in the June issue of Infection Control.

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