Australia degree in nursing

A recent review of literature suggests that nursing specialty areas are being threatened by the nursing shortage. (1) A major issue contributing to this situation is the difficulty of attracting a sufficient number of people into all aspects of nursing. Recruiting sufficient numbers of nurses appears to be a widespread problem that affects not only the United States but Australia and the United Kingdom as well. (2)

The shortage of perioperative nurses can be attributed in part to a decrease in the amount of perioperative content or its complete removal from the curricula of baccalaureate, diploma, and associate degree programs. As a result, many nursing students receive minimal exposure to perioperative nursing, and this limited exposure does not allow them to develop a true appreciation for the field.

THE NURSING SHORTAGE

Health care journals and other media continue to report on the national nursing shortage. Although nursing professionals from the Baby Boom generation have witnessed four or more shortages during their careers, the current shortage affects all institutions, including major medical centers and small-town community hospitals. The American Organization of Nurse Executives reports that the most sought after specialists include

* perioperative nurses,

* clinical nurse specialists,

* medical-surgical specialists,

* critical care nurses,

* emergency services nurses, and

* obstetric nurses. (3)

Reasons for the nursing shortage have been well documented in health care literature during the past few years. These reasons include

* a rapidly aging workforce,

* other options for professional employment, and

* decreased enrollment in schools of nursing.

The current shortage should be a wake-up call to the health care community. The Texas Nurses Association has reported vacancy rates as high as 18% and projects that by 2007, schools of nursing will need to double the number of graduates from nursing education programs to meet the demand. (4) Additionally, across the nation, nursing education programs are suffering from a shortage of budgeted faculty positions. (5)

Legislative acts, such as the Nursing Shortage Reduction Act of 2001, are being put into place to help address this problem. (6) For their part, health care institutions and colleges of nursing must continue to evaluate new paradigms in nursing education and also should consider initiating programs that will help them "grow their own" nurses to provide quality care to their communities.

ESTABLISHING A RELATIONSHIP

Although most hospital-based nursing schools have closed, nursing programs continue to need hospitals to provide the clinical component of nursing academic programs. Nursing schools usually have affiliation agreements with hospitals to provide clinical experiences for students, so opportunities exist to form other types of collaborative relationships. One such collaborative relationship in perioperative nursing was established between Prairie View A&M University's College of Nursing, Houston, and St Luke's Episcopal Hospital, Houston. The vice president of perioperative services at St Luke's wanted to establish a collaborative relationship with a college of nursing to recruit and increase the number of perioperative nurses available for hire. The dean of the College of Nursing at Prairie View A&M University was approached with the idea of offering a perioperative elective for which the hospital would provide qualified instructors, students would receive college credit, and the university would receive revenue. The idea was readily embraced.

Prairie View A&M University already had an established affiliation contract with St Luke's that allowed nursing students to rotate through selected services and departments for clinical experiences. Students usually have a two-day observational rotation in the perioperative services department. There was a need to increase student exposure to perioperative nursing and strengthen the content in the curriculum. Two perioperative educators from St Luke's surgical services department already were teaching the perioperative content in the "Adult Health I" nursing course. These OR staff members functioned as guest lecturers and worked closely with course faculty members to ensure that course objectives were met. St Luke's perioperative services department has a long history of providing quality experiences to nursing students, and staff members were committed to extending that experience to a comprehensive perioperative elective.

DEVELOPING THE COURSE

An elective course in perioperative nursing was developed by the St Luke's perioperative education specialist in collaboration with the College of Nursing's adult health course faculty members. Course content was developed using Berry & Kohn's Operating Room Technique and AORN's Standards, Recommended Practices, and Guidelines to build the foundation. (7) Following college protocols, the course was approved by the curriculum committee as a three-credit-hour elective.

The main focus of the course is acquisition of the knowledge and skills necessary for the delivery of quality perioperative care. The course is offered for six weeks during the summer and provides both didactic and clinical experiences for students. Eligibility requirements include completion of the course "Adult Health I." Established course objectives include

* assessing the patient's physiological and psychological status before, during, and after surgery;

* identifying priorities and implementing perioperative care based on sound judgment and individual patient needs;

* demonstrating thorough knowledge of aseptic principles and techniques to maintain a safe and therapeutic surgical environment;

* explaining the importance of the physical layout of the surgical suite;

* using the nursing process in planning care for the intraoperative patient;

* demonstrating a thorough knowledge of AORN's Standards, Recommended Practices, and Guidelines;

* demonstrating gowning and gloving; and

* explaining the role of each surgical team member.

IMPLEMENTING THE COURSE

Five students enrolled in the first perioperative elective course. The first two weeks consisted of didactic classes at the College of Nursing. Classes consisted of lectures on patients' rights, design of the surgical suite, environmental safety, traffic patterns, asepsis, surgical hand scrubs, gowning and gloving, surgical counts, instrumentation, sutures, anesthesia, and various roles in the OR. During the didactic portion, students also attended practice laboratories where they were able to practice gowning, gloving, draping, and setting up a back table (Figures 1, 2, and 3).

[FIGURES 1-3 OMITTED]

After the first two weeks of content, students progressed to a six-hour clinical session, with one hour of lecture each week on a surgical specialty. During the clinical component, students were paired with OR staff members in the scrub role. Students had a specific objective to meet for each week of scrubbing. For example, during week one, students were expected to scrub in and set up the back table. During week two, they were expected to scrub in, set up the back table, and drape. During week three, they were expected to second scrub, and during week four, they were expected to first scrub. A conference for students to discuss the procedure on which they scrubbed was held at the end of each clinical session. This conference time also provided the instructor with an opportunity to help students understand how to incorporate the nursing process into the patient's care plan.

Methods of evaluation included presentation of a case study by each student to the class. This case study includes

* patient assessment,

* diagnosis,

* surgical procedure (eg, explanation of procedure, positioning of patient, area prep, drains and dressings, wound classification, when the count was performed, if the count was correct), and

* patient outcomes.

Additional information comprises implications of caring for a patient on a medical-surgical unit and completion of a care plan with two nursing diagnoses. Students also were evaluated based on their clinical performance and their scores on three unit examinations. In addition, they were required to attend at least one meeting of the local AORN chapter.

FINANCIAL CONSIDERATIONS