Is Perioperative Nursing Right for You?
Monday August 21, 2000
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Deborah Mason, RN, Barbara E. Mintline, RN, ADN, M. Christine Hogue, RN, Vicki Hickinbotham, RN, Judy Lazor, band together to form a cohesive team at St. Agnes Healthcare, Baltimore, MD. Photo by Keith Weller.
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nurses have to say about it!
Family members sit anxiously in the surgical waiting room awaiting news of their loved one. Normally, this would mean hours of suspense before someone came out to let them know how the patient is doing. But because her surgery is being performed at St. Agnes Hospital, Baltimore, MD, they will be given frequent updates by Barbara Mintline, RN, surgical patient and family advocate.
And if she is having joint replacement surgery, she will have been contacted by Judy Lazor, RN, care coordinator of the orthopedic Joint Connection Program at St. Agnes. "I would have arranged for her to attend a preop class where she would have learned about anesthesia, physical therapy, and other aspects of her impending surgery," says Lazor. "After surgery, I would visit her several times a day and help her prepare to either go home or to rehab." Lazor's devotion to her patients and to the Joint Connection Program at St. Agnes make it easy to understand why she was named St. Agnes' "Nurse of the Year" during this year's Nurses Week (May 6-12).
Continuity of Care in Perioperative Nursing
The current emphasis on continuity of care in nursing is strongly evident in the area of perioperative nursing, as the patient moves from the admitting unit to the OR, post anesthesia care unit, and from there to the surgical unit that receives the patient or where the family takes him or her home. Interviews with four nurses working in the perioperative setting at St. Agnes highlight the role that nurses play in ensuring continuity of care for patients undergoing surgery.
Debbie Mason, RN, subspecialty coordinator in the OR, St. Agnes, talks about the importance of communication between different units to provide that continuity of care, "Communication is the key to everything. If one link is missing, it can mess up the whole system. When the patient comes into the AM Admit unit and a problem is identified, the nurses dig a little deeper for the pertinent information and relay that to the anesthesiologist and [other] nurses. Communication is the key for that continuity."
Joan Fee, RNIII, a nurse in the PACU, St. Agnes, talks about the importance of information obtained from the patient pre-operatively. In both the OR and PACU, the anesthetized patient is dependent upon their chart to speak for them. "We get report from the anesthesiologist, but I like to look through the chart," says Fee. "The nurses in AM Admissions are getting much busier. They are responsible for everything on that chart before the patient goes to the OR."
Communication is the mainstay of Mintline's role as patient and family advocate. Her routine includes meeting with surgical patients when they first come in and explaining her role. After patients have been in surgery for about an hour she starts her rounds. "I go from OR to OR and check with the docs to see how things are going. I always check with anesthesia because that is the biggest fear of anybody going into surgery and their family members. They are coming in and literally turning their lives over to total strangers."
Mintline makes the rounds in the OR hourly, and for the anxious families in the waiting room, she is a lifeline to the surgeon. "They don't necessarily want technical information. They want to know that I was in the OR, I saw mom while she was on the table and the circulating nurse said everything was quiet."
Some of the surgeons will let Mintline tell the family good news - for example if a malignancy was suspected when none was found. When there is bad news, she frequently accompanies the surgeon. "What I find is that I sit there with the family and don't say a word through the whole thing. [The doctor] says to the family, 'Do you have any questions?' Well, they're too upset because all they heard was the word cancer or that their loved one has just died. When the doctor leaves, I just sit there and wait."
Mintline finds that eventually "the questions come - and that's when it's important that we have an RN in that role, to answer those questions and interpret information from the doctor," says Mintline. "Nurses for the most part are attuned to feelings. You try very hard not to get personally involved but sometimes you can't help it and I don't think it's improper."
The Importance of Pain Management
While there are many "hot" issues that impact the practice of perioperative nursing, pain management and the need for ongoing education ranked highest among those interviewed.
The Joint Commission on Accreditation of Healthcare Organizations (JACHO) has elevated the patient's right to effective pain control to a top priority in its survey of hospitals. Once the PACU nurse receives report from the anesthesiologist, he or she becomes the patient's advocate for assessment and management of their pain.
Fee has several theories about the heightened focus on pain management. "Patients are much sicker, the procedures being done now may be more painful, but patients are also more aware of their rights and options. Society is more aware that you don't have to be uncomfortable. And we want our patients to be very comfortable."
Ongoing education and clinical updates are essential in an area with such dramatic changes in equipment, procedures, and medications. At St. Agnes, Wednesday mornings are devoted to staff education and a full-time nurse educator is available. Perioperative nurses also keep current through certification and membership in professional organizations. These include ASPAN (American Society of Post Anesthesia Nurses) and AORN (Association of Operating Room Nurses). Certifications include CPAN (Certified Perianesthesia Nurse) and CNOR (Certified Nurse of the OR).
From the time a patient enters the admissions department at St. Agnes, until they are discharged, strong communication ensures quality of care at every point along the way. Like an air traffic controller expertly passing a plane out of their airspace onto the next, these nurses guide their patients through the surgical experience. Mason describes her vision of that process, "They come in and you fix them up and when they leave, they're all together. That's kind of thrilling to me. You don't get to see the end product in the OR, but you know it's there."
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