AORN educafion

Begin today to prepare tomorrow’s OR supervisor

Who will be the future leaders in the operating room? How will he or she be prepared? These are vital questions em- ployers ask in selecting an operating room supervisor.

Should the OR supervisor be a profes- sional nurse or a fay person skilled in management? Should she have worked a designated number of years as an operating room staff nurse? Should she have a de- gree? Should she be an efficient scrub nurse? Should seniority be a basis for selection?

Today’s operating rooms are complex arenas of people and things. From al l indi- cations, future operating rooms will become increasingly complex. Few people are born leaders, but with careful guidance and planned experiences, whether on-the-job or in a formal course of study, the nurse who i s interested in becoming a leader can improve her leadership skills.

To be a leader requires an additional set of skills and knowledge seldom used by the average staff worker in her day-to- day activities. These skills concern functions

of management, such as planning, organiz- ing, staffing, directing and controlling; plus the connecting processes of decision making, coordination and communication.

I would like to describe a formal man- agement course for OR supervisors a t the USAF Medical Center Keesler Air Force Base, Biloxi, Miss that I had the privilege of planning and directing for four years. The objective of the course was to provide selected nurses with advanced training in operating room nursing and technology, modern management practices and personnel administration. The course was 22 weeks long, and the nurse attendees were full-time students. Instruction was di- vided into four major blocks: principles and methods of technical instruction, four weeks; operating room technology, two weeks; op- erating room nursing, seven weeks; and management of operating room nursing service, nine weeks.

Principles and methods of technical in- struction. Inclusion of this block on how to teach was based on the rationale that every OR nurse i s a teacher, and as such she

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should learn the principles and varied meth- ods of how to teach. Inasmuch as it was presented at the beginning of the course, i t also served to teach the students how to study and organize their subject material.

This was beneficial because it had been five to ten years since many of the students had had formal classroom work.

Three methods of instruction were taught: performance-demonstration, lecture and guided discussion. Each student participated in practice teaching sessions in each method.

Operating room technology. Described in

this block were the "hardware" and the surgical environment-the "things" part of

the operating room. Among the topics in- cluded were the following: environmental sanitation, principles of asepsis and steriliza- tion, principles of care and preparation of supplies, care and handling of surgical instruments, principles of chemical disinfec- tion and basic equipment.

For a few students, this part of the course seemed elementary, but for the majority i t was the first time they had re- ceived formal instruction in these topics. Not only was the "what" and "how" taught, but perhaps more importantly the "why." Students were taught the underlying princi- ples which govern methods of asepsis, steril- ization, and chemical disinfection. It should not be assumed that because an individual

has worked in an operating room for a number of years that her practices are based on scientific principles. Tradition and "I have always done i t this way" st i l l are dominant forces in OR nursing practice.

Operating room nursing. This portion of the course emphasized the patient and his needs. Philosophy of nursing was discussed.

What i s nursing? What i s OR nursing? What i s i t that the nurse does in the operating room that the technician i s not qualified to

do? Each student had to answer these questions for herself. The nursing care proc- ess in the operating room was investigated

and pre and postoperative visits were made and coordinated. Scrub and circulating du- ties were practiced and analyzed. Work simplification principles, as well as aseptic technique, were stressed. Anesthesia, path- ology and the various surgical specialties were discussed by physicians.

Management of operating room nursing service. In this, the core of the course, the following were discussed: the nature of management; leadership philosophy, styles, patterns and their effect on personnel; work groups; problem solving; decision making;

delegation and authority; communication; interviewing; guidance and counseling; and

eva I uation.

In addition, each student was required to develop an administration project-a hy- pothetical operating room nursing service in writing. Certain broad guidelines such as size of the hospital, services offered, and average daily census were given, but each student was free to develop "her" own op- erating room nursing service.

Over a period of nine weeks, various management tools, such as philosophy and objectives, organizational charts, job de- scriptions, staffing patterns, policies and pro- cedures, evaluation, and inservice were discussed in class. Then each student was required to submit a written paper answer-

ing specific guided questions regarding the various management tools, and to develop a tool for "her" surgical suite. Students were required to write eight papers in de- veloping their operating room nursing serv- ice. Each project soon became a real entity in the mind of the student and instructor. The completed projects serve as a reference for the nurse in her future work.

After the first week of classroom work in OR nursing, management of OR nursing service and OR nursing ran simultaneously for the remainder of the course. The reason for this was to facilitate scheduling and to allow the student time to study in depth

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the various management tools. A typical day for the student was as follows: observed by an instructor, she spent five hours in the

morning scrubbing or circulating on selected cases. Following lunch, she had two hours of classroom discussion, and one hour for patient visiting or library work. In addition,

many off duty hours were spent in study.

During the last month of the course the student spent one week in a preceptorship with the OR supervisor. This experience al- lowed the student to synthesize theoretical with practical concepts of the role and functions of the supervisor. During this time, the instructor did not enter the operating room but was available in her office for consultation if needed.

While in the preceptorship phase, each student undertook a problem-solving re- search project. The student was required to use the scientific method of study-that is, identify a problem, investigate it, estab- lish criteria for the solution, develop solu- tions, test the solutions and finally select

the best solution. Each study was later written in a report. At the end of the course, each student gave an oral report of her research project to a group of invited guests which included the chief of professional education, chairman of the department of nursing, chairman of the department of surgery, OR supervisor and OR nursing staff. Over the four-year period, several of these solutions were implemented by the OR su- pervisor in the participating hospital. Follow-

up evaluation has shown that the course’s

graduates have a deeper understanding of the nursing care process in the operating room, are more self-confident and more effective in organizing people and things.

The course described above was based on the premise that before a nurse studies management she should know herself, be knowledgeable in the technology of her specialty, and be familiar with the teaching- learning process to be a better communi- cator. Self-knowledge enables her to be more aware of her philosophy of nursing and why she chose OR nursing over other

specialties, and what it is that she hopes to accomplish in her field.

Tomorrow’s OR supervisors will be se- lected from today‘s OR staff nurses. It i s the responsibility of each OR supervisor to identify the young staff nurse who shows an interest in and has a potential for leadership. Once identified, this individual

must be nurtured, challenged, and given selected assignments to develop her leader- ship skills. As a tutor, OR supervisors should give related reading assignments along with new work assignments; encourage and make provisions for her attendance at workshops, institutes, and seminars. If she continues to demonstrate leadership ability, suggest that she study a course in operating room nurs- ing service management.

Helen Wells A ssisf ant direct or of edu caf ion

Cu+aruc+s Cataract surgery involves highly refined instruments, sterile technique, and a skilled team of workers. Today, cataract surgery i s successful in 95% of the cases.

The procedure was not quite so sophisticated when it first was tried. The operation apparently originated in India; an unknown writer described the procedure in detail about 1,000 BC. The method spread to the eastern Mediterranean some six centuries later.

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