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With Periop 101, Hospitals Groom Own Nurses for OR

Monday December 3, 2007
<B>(From left) James Demetriades, administrative director of surgical services; Patty Lum, RN, operating room educator; and Allison Rovillos, RN, a member of the Periop 101 class at University Medical Center at Princeton. </B>
(From left) James Demetriades, administrative director of surgical services; Patty Lum, RN, operating room educator; and Allison Rovillos, RN, a member of the Periop 101 class at University Medical Center at Princeton.
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When University Medical Center at Princeton (N.J.) recently found itself in need of perioperative nurses, it filled the positions using a novel source — Periop 101, a core-curriculum course created by the Association of periOperative Registered Nurses (AORN).

In fact, an increasing number of facilities are relying on the comprehensive curriculum to generate perioperative nurses in house as the specialty faces a growing national shortage.

"We found that perioperative RNs are just not out there," says Ann King, RN, MSN, CNOR, director of surgical services at University Medical Center. "They're either happy where they are, or they just don't want to come back into the field. So we decided that to meet our need, we needed to home-grow our own."

Ann King, RN, MSN, CNOR
According to the 2004 National Sample Survey of Registered Nurses, an estimated 163,000 perioperative nurses are currently practicing in the United States — 116,927 in hospital settings and 46,212 in ambulatory care. That might sound like a lot, but three trends — the aging nursing population, fewer graduate nurses choosing the perioperative field, and more and larger operating theaters — are creating a demand for perioperative nurses.

Designed for RNs outside the OR

AORN's Periop 101 course was introduced eight years ago and has been used by about 750 facilities nationwide, says Laurie Clark, program manager for Periop 101 at AORN's Center for Perioperative Education. An estimated 5,500 students have taken the course. That number is expected to increase significantly as a result of the September launch of the curriculum's online version (see "Periop 101 Goes Online"). The traditional course uses a CD-ROM with PowerPoint presentations supplemented by lectures, videos and hands-on practice.

"The goal of Periop 101 is to provide basic didactic education for nurses who have no perioperative experience," says Susan Root, RN, MSN, CNOR, manager of education products for AORN's periop education center.

Initially, most of the nurses selected by their employers to enroll in the Periop 101 program were experienced staff nurses from other units in the hospital, Root says. "But now we are seeing more and more facilities taking new graduates and putting them through the program, and a lot of that has to do with the nursing shortage," she says.

Allison Rovillos, RN
Allison Rovillos, RN, is a graduate nurse who is taking the Periop 101 course at University Medical Center at Princeton. She says becoming a perioperative nurse was a childhood dream.

"I had an experience where I was in the OR and everything was so exciting," she recalls. "The nurses and the staff made me feel so comfortable, and I had a good outcome and a good experience. That's how it started."

Before accepting the position at University Medical Center, Rovillos shadowed an OR nurse for a day. "They gave me a tour, showed me where everything is, and I got to observe a procedure," she says. "That was good, especially for someone like me who hasn't had a lot of exposure to the OR. It gave me the opportunity to see how the day runs and how the schedule flows. I knew this was what I wanted to do, but [shadowing an OR nurse] was an important factor in my decision to come work here. I really felt comfortable with the staff."

Course requirements

In exchange for receiving the Periop 101 course, Rovillos and all other nurses in her class will be required to fulfill a two-year work commitment.

"This helps meet our staffing needs," King says. "The nurses who graduate know the policies and procedures of the organization, and we know that they are getting the correct foundation on which to build their careers."

The Periop 101 course requires two textbooks: "AORN's Standards, Recommended Practices and Guidelines" and "Alexander's Care of Patients in Surgery" and recommends supplemental videos. It features 25 modules that cover all aspects of perioperative nursing, with mock setups to reinforce what the students learn in the classroom. Upon graduation, students receive a certificate of completion and 60 continuing education credits.

"At the end of the nine weeks in the classroom, we do a six-month orientation with a preceptor in both the scrub and circulating positions through all the different services," King says. "At the end of the eight months the students are ready to be counted in the staff numbers and function as a perioperative staff nurse."

Adaptable curriculum

Martha Kavanagh, RN, MA, CNOR, nurse educator for perioperative services at Memorial Sloan-Kettering Cancer Center in New York City, has been teaching the Periop 101 course for five years. "It provides good standardized content for new nurses who are interested in pursuing a career in the OR," she says. "There are so many things that new nurses coming to the OR have to know. The curriculum allows me to focus on planning appropriate, unit-based activities to complement the content already developed by AORN. It also allows for the incorporation of specific institutional policies and procedures. I also like that the AORN updates the curriculum content as necessary."

Memorial Sloan-Kettering Cancer Center opened 21 new operating theaters a year ago, Kavanagh says, and the Periop 101 program has been instrumental in filling the new perioperative nursing positions. Some of the nurses who have taken the course were internal transfers and others were external hires.

Difficult, but exciting

"The course can be a bit overwhelming," Kavanagh says. "Some of the concepts in the beginning can be more than some students are ready for, but I try not to overwhelm them too much. I tell them to stop if what they're reading just isn't clicking because we will discuss it in class, and there will be ample time for questions and concerns."

But despite that initial trepidation, most nurses — especially recent graduates — find the course to be an exciting opportunity, instructors note.

"For many, this is their first real professional position, and it's very exciting to be part of that development, of [helping to mold] their work ethic and their career as a perioperative nurse," says King. "I find that new nurses come in with a lot of good ideas and no preconceived attitudes. They are just so eager to be working in the OR, and as a nurse that it brings a lot of new energy."

Don Vaughan is a freelance writer and frequent contributor to "Nursing Spectrum." To comment, e-mail editorPA@nursingspectrum.com

Periop 101 Goes Online

Next year, AORN's Periop 101: A Core Curriculum course will be available online only for new licensees. Currently, it is available in written format accompanied by CD-ROMs filled with PowerPoint presentations. The CD-ROM/paper course license agreement version will no longer be available for purchase from AORN, effective Dec. 31.

"What we've done is taken the earlier PowerPoint presentations and instructor scripts and evolved them into an interactive online program," says Susan Root, RN, MSN, CNOR, manager of education products at AORN's Center for Perioperative Education. "This will free the educator from having to arrange classroom space and overhead projectors, as well as having to present the same information each time she has a new class of students."

To access the course, students log on to the AORN learning management system through the AORN website. From there, they go through the curriculum's 25 modules on their own. Instructors are able to monitor their students' progress, assign due dates for each module and assign students other tasks. Students may go through modules as many times as needed.

"The instructor still meets with students for presentations, hands-on skill labs and to share facility policies and procedures," Root says. But the online version relieves the instructor from the 80 hours of classroom presentations. "This frees the instructor to do things that may be more valuable to the facility than teaching the course over and over again," she says.

The online version of Periop 101 was beta tested at six sites and has been well received since launch.

"As with any new program, there has been some initial hesitation. Some of the facilitators were worried that we were taking their jobs away from them," Root says. "But after they went through the course, most of them thought it was wonderful."