Today’s operating room nurses play a much different role than they did in the not-too-distant past. For starters, they have a new name–perioperative nurses–to encompass all three phases of surgery (the pre-, intra-, and post-operative stages). They provide, manage, teach and study the care of patients undergoing surgery or other invasive procedures. Above all, they are enjoying a wide range of exciting career opportunities that extend far beyond the traditional OR. (See “Perioperative Nurses Wear Many Masks.”)
Often, the nurses choose a specialty, such as neurosurgery, open heart surgery, orthopedics, pediatrics or podiatry. But no matter what new levels of responsibility they acquire, perioperative nurses agree that their chosen field is an exciting career where’s there never a dull moment–which is what drew them into this specialty in the first place.
Bernice Gordon, RN, MA, MS, an African-American nurse who is director of performance improvement and staff development for the operating room at New York/Presbyterian Hospital, an affiliate of the Columbia and Cornell University Hospitals, remembers one such dramatic moment. Twelve years ago, back when she was just a “regular” perioperative nurse, she was assisting with the liver surgery of a seriously ill Hispanic girl, only about six years old.
“Before the surgery, I talked to the parents, telling them I’d be the nurse for their daughter and that we’d take good care of her,” Gordon recalls. “I remember that she was so tiny I actually carried her into the operating room. The child was so beautiful. Sadly, in the middle of surgery, she died on the operating table.
“Because I had established a link with the parents, the surgeon asked me to come with him as he went out to explain to them what had happened. The father said, ‘I need to see my daughter.’ But the surgeon was so upset over losing the patient that he couldn’t see the father’s pain, and he answered, ‘We’re sending her to the morgue.’
“I had children of my own,” Gordon continues, “and I knew the father wouldn’t be able to bear seeing his daughter on a slab in the morgue. So I just put my hand on the doctor’s arm and said, ‘No, there’s no reason why he can’t see her. It would be nice if we could let the father spend some time with his daughter now.’ The doctor agreed just like that. It wasn’t like I was usurping his power. It was a team effort.”
Emotionally intense moments like this exemplify what the rewarding profession of perioperative nursing is all above, Gordon believes. “The parents cried and we all cried with them. It’s something you couldn’t understand just from reading about it. You have to experience it.”
Diversifying the Faces Behind the Masks
Gordon’s story about the Hispanic family also illustrates the crucial contributions minority nurses can make in the perioperative nursing arena. Educating patients and their families about what will happen during surgery and what to do in the post-op recovery stage is an important part of the nurse’s responsibilities. And because life-or-death medical decisions and end-of-life issues are so often involved, there is an urgent need for more nurses from a diversity of racial and ethnic backgrounds who can provide culturally and linguistically competent care to an equally diverse patient population.
“Minority nurses are culturally sensitive,” agrees Michelle Burke, RN, MSA, CNOR, administrative director of perioperative services at St. Vincents Hospital and Medical Center in Manhattan and vice president of the Association of periOperative Registered Nurses (AORN). “We have had to struggle to get to where we are, and this makes us more sensitive to the needs of minority patients, as well as minority colleagues, such as physicians and aides. I think patients and families find it easier to relate to and trust a nurse who shares their same cultural background.”
Debora S. Tanner, RN, BSN, CNOR, director of the outpatient surgery facility at Riverside Health Systems in Newport News, Va., points to figures from the U.S. Department of Labor which predict that the population of Hispanics and other ethnic groups in America will increase dramatically in the next 10 years.
“Our country is going to look different,” says Tanner, who is African American. “That means the patients we take care of are going to be different, too. Minority nurses will play a very key role in [providing care to this diverse population]. But I don’t think any one ethnic group brings more to the table than any another,” she adds. “The diversity, collectively, is far more beneficial for the patients than [an increased number of nurses from any one minority group]. We need Hispanic nurses, Middle-Eastern nurses and Caucasian nurses.”
Gordon, too, emphasizes that minority perioperative nurses are in great demand. “The population we’re serving has definitely gotten browner,” she says. “A hospital thrives on being representative of all the patients it serves. When you’re ill, you respond through your culture.”
“We Need More Nurses!”
The need for more ethnically diverse and culturally sensitive perioperative care providers is just one reason why this field is a hot career opportunity for minority nurses. The other reason is that perioperative nursing is one of the specialty areas that have been hit particularly hard by the current nursing shortage. AORN cites a 1999 joint study by the American Nurses Association, HRSA’s Division of Nursing and other organizations which found that the greatest shortage of RN staff is concentrated in three specialties: neonatal, ICU and OR.
Statistics from AORN itself show that the number of perioperative nurses seeking employment is down by an alarming 80%, while the number of employers looking for OR nurses is up proportionately. As a result, the association says, hospitals will often report that their operating rooms are fully staffed, even though 80% of their OR nurses are agency nurses. The Midwest is currently experiencing the most acute shortage of perioperative nurses, AORN adds.
Not only are skilled, experienced perioperative nurses urgently in demand, but employers are willing to pay top dollar to hire them. In New York, salaries for perioperative nurses can average $50,000 a year, with some earning as much as $90,000, according to nurses interviewed in that state. On a national level, AORN reports that the median annual wage for perioperative RNs in 1997 was $41,400. However, 30% of these nurses earned between $40,040 and $50,000, and 16% earned between $50,000 and $89,000.
Why are so few new nurses entering the perioperative field to replace the current ones who are retiring? AORN Board Member Debra Fawcett, RN, MS, acting assistant professor of nursing at Indiana University, Kokomo, and one the nation’s few doctoral candidates in perioperative nursing, has studied the shortage for years, and has categorized at least four reasons:
- Perioperative nursing is not offered in most nursing school curricula. When nursing education moved out of the hospital setting into the university domain, the curricula focused less on clinical skills. With standardization of nursing education, all students learn a standard set of nursing skills, but very few receive clinical training in the operating room.
- The OR can seem scary to entry-level nurses. Many graduates are frightened by all the technology in a surgical setting, particularly because they haven’t been exposed to the operating room during their nursing studies. They think that what they don’t know can hurt them.
- Mentoring is virtually unavailable. Many of today’s perioperative nurses are in their late 40s, and Fawcett’s anecdotal research suggests that perhaps younger nurses aren’t choosing this field because they had no role models to take them under their wings. Most of the experienced nurses received their nursing education in a hospital setting, and at this point, they may be too stressed out to take the time or have the patience to mentor fresh university graduates with little clinical experience.
- Very few nurses from the perioperative arena have gone into teaching careers. There is no PhD available in perioperative nursing, and since most universities require their tenured professors to hold doctorates, there are not enough professors who can pass on this specialized knowledge. Fawcett happens to be one of the few nurse educations in the country who is teaching perioperative nursing. Compounding the problem is the fact that OR nursing is very expensive to teach in a university setting because it requires many surgical supplies in order to be taught properly.
No Experience Necessary
What all this means for minority nurses is that the field of perioperative nursing is wide open and eager to hire new talent. As little as five years ago, most hospitals required one year of OR experience, but today that prerequisite has fallen by the wayside. To make up for the lack of OR training among today’s nursing students, many hospitals now offer a six- to eight-month orientation in perioperative nursing for recent graduates.
“Because of the severe shortage, hospitals are willing to hire new graduates with no perioperative experience and then take the time to teach them the basic principles of OR,” Fawcett explains. “For most hospitals, this is working, although retention is still a problem.”
Because it’s so rarely taught in nursing schools, new graduates usually have only a hazy understanding of what perioperative nursing is all about. In the orientation programs, hospitals provide both classroom education and clinical experience with a preceptor. The new nurses get a taste of what it’s like to work in a fast-paced, sometimes stressful, environment and they participate in life-saving decisions that make a difference.
Peggy Garcia, RNC, remembers her six-month orientation at St. Vincents’ Hospital. It was a gradual learning process in which she gained experience with the surgical instruments, procedures, sterile techniques and infection control. “It took about a year to feel comfortable doing all that,” she says. Garcia, a Hispanic nurse of Cuban descent, eventually became the head nurse in the operating room, and is now the nurse manager at St. Vincents’ Cancer Center.
As the administrative director of perioperative services at St. Vincents’, Burke is in charge of 17 operating rooms, each one averaging five surgeries a day. She likes to see a certain type of personality in a nurse applying for a perioperative position.
“You have to be an RN with dexterity, be a risk-taker and be independent,” she asserts. “You must be able to think on your feet, critically and creatively, and show initiative that you want to learn. It’s a highly specialized field, so you need to be mentored.”
“Not the Same Old Same-Old”
A typical day for perioperative nurses starts the day before surgery, when they check their case load for the next day, determine which surgeon they’ll be working with and what instructions the patient needs to hear again. On the day of the operation, a pre-op nurse may see the patients in the morning, take their vital signs, assess how much they know about the procedure they’re about to undergo and quell any fears they may have.
Inside the operating room, there are a variety of different roles perioperative nurses can play. For example, the intra-operative nurse may be a scrub nurse, a circulating nurse or an RN First Assistant. A scrub nurse selects and handles instruments and supplies used for the operation and works directly with the surgeon within the sterile field, passing instruments, sponges and other items needed during the procedure.
The circulating nurse manages the overall nursing care in the OR, helping to maintain a safe, comfortable environment for both the patient and the members of the surgical team. This nurse is also responsible for getting the consent forms from the patient, making sure the patient is free from injury and infection, ensuring that all the instruments are in place and anticipating the surgeon’s need for a procedure.
Higher up on the career ladder is the RN First Assistant. This advanced practice nurse delivers direct surgical care by assisting the surgeon in controlling bleeding, providing wound exposure and suturing during the actual procedure. Finally, when the surgery is completed, post-op nurses are there to care for and educate the patients when they wake up.
This combination of variety, empowerment and opportunities for advancement is what makes perioperative nursing an ideal career for nurses of color, nurses interviewed for this article agree. “It’s an ever-changing environment,” says Burke. “Every day is new. If you’re not interested in the same old same-old, if you truly want to be a fully independent practitioner, this field is for you.”
Perioperative nurses especially like the feeling of being in a partnership with the surgical team, adds Lorraine J. Butler, RN, MSA, CNOR, assistant vice president for surgical services at Brookwood Medical Center in Birmingham, Ala., and an AORN board member. Butler, who is African American, should know: She was the director of surgical services and infection control for the 325th air transportable hospital in Saudi Arabia during Operation Desert Storm from August 1990 to March 1991.
“It’s very hectic, and the nurses need to be very astute,” says Butler, who has been a perioperative nurse for more than 30 years. “It’s a wonderful field, and I encourage all minority nurses to pursue that avenue. You won’t regret it.”
Renee Garnes Spence, RN, MSN, an African-American nurse who works as a clinical specialist in the post-operative units at Washington Hospital Center in Washington, D.C., agrees with that assessment. “I think [minority nurses] bring a better understanding of the culture of some of the patients they are taking care of,” she notes. “Minority nurses need to prepare themselves educationally and take advantage of the opportunities that present themselves.”
While such a fast-paced career may not be a good fit for some nurses, those who thrive in a high-energy environment will love every minute of it. As Garcia puts it, “It’s unpredictable. It’s always ‘let’s go, let’s go.’ But it’s exciting rather than stressful. I love the rush of it all! Even after 12 years as a perioperative nurse, I can still hear the passion in my own voice.”
Perioperative Nurses Wear Many Masks
If you think the term “perioperative nurse” is just a fancy name for an operating room nurse, you’re in for a surprise–many surprises, in fact. As surgical technology continues to advance while the number of in-patient surgeries declines, careers for perioperative nurses are evolving into a wide variety of new, nontraditional settings–from outpatient clinics and community ambulatory care units to the offices of doctors who perform same-day surgeries, and even their own consulting businesses.
“It used to be we were the handmaidens to the surgeon, just passing instruments without any real nursing involved,” says Peggy Garcia, RNC, who was previously the head OR nurse at St. Vincents’ Hospital and Medical Center in New York City before she became the nurse manager of the hospital’s Cancer Center. “Today, perioperative nursing has come a long way from that. We have so many more [career] options available to us than we ever did before.”
Here’s a sampling of some of the new roles perioperative nurses are assuming today:
- Materials manager: Purchases supplies for the operating room. Many hospital networks are hiring perioperative nurses into their materials management positions.
- Cost-reduction specialist: Identifies surgical supplies needed and helps control the costs of purchasing supplies.
- Informatics: Contributes knowledge of surgical nursing to the computer data elements that are necessary in computer-automated programs.
- Perioperative care coordinator: Coordinates care in all phases of surgery. This is a management-level nurse.
- Patient educator: Works with patients and their families to provide them with appropriate information for making informed decisions about care and treatment.
- Operating room director: Manages the business aspect of the facility’s OR.
- Oversees and is responsible for budgets, staffing and other areas that keep the OR running effectively.