One of the top concerns in healthcare today is insufficient nurse staffing. The nursing shortage is predicted to increase over the next several years. “The need for nurses is expected to grow to 26% by the year 2020” (Johnson & Johnson, 2013). This number is faster than the average occupation. “The aging baby boomer population will place a demand on healthcare for more health services as people live longer” Bureau of Labor Statistics, 2012-2013). The national shortage of nurses has also contributed to the increased turnover rates for nurses.
“Accurately predicting staffing needs is a crucial management skill because it enables the manager to avoid staffing crises” (Marquis& Huston, p. 325). “It is expected that by the year 2020 the United States will face a shortage of 800,000 nurses. Registered Nurses account for 2. 6 million jobs in the US and by 2018 that number is expected to swell to 3. 2 million, with the greatest number working in hospitals”. The American Association of Colleges of Nursing (AACN) states that “many individuals seeking to enter the nursing profession cannot be accommodated despite meeting all of the programs entrance requirements.
” The AACN states that “a number of causes are due to an insufficient number of clinical placement sites, faculty and funding” (AACN, 2013). Some nursing programs cease to exist. Research on the development of PCI’s (student nurses) to RN’s began as a method to train PCI’s in the role of a tech in the OR. This method helps staffing numbers, but it also gives the PCI an opportunity to learn what skills are needed to work in the OR setting. The student nurse first applies for a position to the OR as a PCI. The student nurse has to have had at least one semester of clinical, and must be enrolled in a Baccalaureate of Science of Nursing program.
Baccalaureate nursing curriculum provides minimal exposure to the perioperative specialty area despite the fact that students are often very interested in this area of nursing. Usually the baccalaureate learning experience is that of a single passive observation rather than actively participating in care of perioperative patients. Peer interviews are conducted with the student, manager, RN’s technicians and if possible a PCI. By having peer interviews the student can get a better understanding of the interests and needs of the OR. The student nurse will also shadow with an RN and a PCI for a few hours.
Feedback is given to the manager on whether the student will be a good fit for the OR; based on attitude and behavior during the shadowing experience. “Wise leader-managers surround themselves with people of ability, motivation, and promise” (Marquis & Huston, 2012, p. 329). Once the student is hire and has completed hospital orientation then a preceptor is selected by the manager. Preceptors must have completed an educational program geared on training new staff that includes adult learning principals, and developing appropriate feedback.
A preceptor to a student nurse involves many roles, including acting as a role model, facilitating learning, and supervision that is relevant and appropriate to the OR. In researching this project it was decided between the manager and I that we would look at the orientation process and identify if any changes needed to be made. The orientation process includes a competency based model that is effective for evaluating knowledge, skills, and abilities, with more or less time spent as needed on a given skill as needed. The PCI model prepares the PCI to the culture of the OR.
Video and written materials that were created by AORN were reviewed. The AORN program is based on “testing the level of knowledge and confidence in that knowledge” . The program was adapted for the PCI’s in the OR. As the PCI progresses through a module, educational resources are provided to help them understand and to begin to use their critical thinking skills. By using their critical thinking skills this will help them to master their knowledge in the OR. The PCI also has hands on with the surgical instruments in the OR orientation.
Four PCI’s from the OR were interviewed with the questions: What are your thoughts and ideas on the PCI program in the OR? Would you change anything? All four student nurses said that they were learning from the PCI experience. Three of the four interviewed said that they really wanted to work in the OR after graduation. For the changes they would like to have more time in the different areas of perioperative services. At this time the PCI’s only shadow for a few days in the different areas. One PCI was unsure if the OR was the place for her and volunteered to train in the other areas of the perioperative areas.
This particular PCI also shared that she didn’t think that the nurses did enough with patient care that they catered more to the physicians than the patients. All four of the PCI’s graduate in May of 2014. With the information gathered from the PCI’s, a change to the orientation is being developed with a competency based model. Competency based model are most effective in true evaluation of knowledge, skill, ability, and behavior in a clinical setting. Competency based models also allow for individualized progression and higher engagement by orientees and their preceptors.
Besides orientation in the OR, the PCI’s will train in three of the perioperative areas so that they will get the full benefits of the perioperative services The three areas would include the Post Anesthesia Care Unit (PACU), Sterile Processing Department (SPD), and Pre-Operative/Day Surgery area. There are other areas in perioperative services; however these four areas are a good starting point so that the PCI can experience what a patient goes through preoperatively, intra-operatively, and postoperatively.
In the preoperative area the student can follow the process of getting the patient ready for surgery. In the PACU the PCI can learn to understand what it is like to help care for a patient who has just finished a surgical procedure. In SPD, the PCI can assist in cleaning and preparing the surgical instruments with a certified surgical technician. When meeting with the managers in perioperative services, it was decided that this would be an excellent method of training the PCI’s. This way the PCI’s would get a well-rounded orientation and start to develop skills in each of the areas.
The PCI’s are also cross trained and can work in one of the areas that are short staffed. “Transitioning into a new job would result in less role strain if programs were designed to facilitate role modification and role expansion” (Marquis & Huston, 2012, p. 366). The orientation process of the PCI can be tracked with a variety of reports that managers can access at any time and share with the PCI’s and educators. The tool that is used at University Hospital is called the Career Assessment Tool (CAT). This tool is used by the preceptor to help identify what the PCI has accomplished in orientation.
These reports can track individual student progress and can also provide information on how PCI’s respond to specific questions and tasks potentially identifying knowledge gaps. This enables the managers to focus education in a specific area and improve competencies. The PCI will gain exposure to perioperative nursing and recognize that it is a significant specialty area in nursing. The career assessment tool changes will provide students with basic knowledge and skills necessary for a beginning practitioner in the perioperative setting.
As the PCI’s advances and gets closer to graduation they will begin an introduction to patient education, discharge planning, evidence based practice, and the role of the nurse will be their focus. “Understanding the needs and challenges of student nurses and new nursing graduates, and supplying them with the tools and resources are the keys to keeping them in practice” . With changes in health care looming just beyond the horizon, this model can become a superb instrument in training PCI’s to be future RN’s working in perioperative services.