Nursing master degree program

Educating RNs to work in the OR is an expensive venture. In some regions of the country, nursing students' only exposure to the OR during their clinical rotations is a day of observation. These days often are spent watching surgeons instead of what the circulating nurse and other members of the surgical team are doing.

Louisville, Ky, like many other US cities, has more than a dozen hospitals and ambulatory surgery centers. The need for qualified perioperative nurses is a constant issue, and many hospitals are training their own. Often after a hospital has invested time and money to train perioperative nurses, the hospital loses them to other ORs in the city. Spending thousands of dollars to train nurses only to have them go to work for competitors is not cost effective. This issue gave rise to a new concept of how hospitals in the city of Louisville could pool resources to prepare nurses for the OR without incurring such significant expenses.

A CERTIFICATE IN PERIOPERATIVE NURSING

Perioperative educators in Louisville, along with some of the OR directors, met to discuss offering a certificate in perioperative nursing continuing education class through a local university. The class would prepare RNs, at their own expense, to work in the OR.

None of the colleges or universities in Louisville offered a perioperative nursing class. A certificate program was chosen because it would be less expensive for the students. The least expensive college course for credit in Louisville was twice the cost of the certificate program.

Certificate programs provide nurses with an opportunity to gain experience and knowledge in areas they have never been exposed to and to decide whether these areas of nursing fit their goals. Employers see certificate programs as a way to improve expertise and competency. Colleges and universities see certificate programs as a way to encourage higher learning for nurses. Certificate programs also ease nurses back into studying and give them more confidence to complete a bachelor of science or master's degree in nursing. (1)

THE PLANNING PROCESS

The program coordinator, a perioperative education coordinator at Baptist Hospital East, Louisville, approached the dean of nursing at one of the local universities with the idea of offering a certificate program in perioperative nursing. The dean was willing to add the program to the university's School of Continuing Education and Studies. She and the program coordinator met with the director of the School of Continuing Education and Studies to discuss the process to go forward with the program.

Both clinical OR educators and OR directors were invited to a meeting because it was important to get OR directors' buy-in for the project. Without preceptors to conduct the clinical portion, the class would not be successful. In many ORs, preceptors are overworked and are not compensated for the extra teaching they are asked to do; as a result, finding qualified preceptors can be difficult. The OR directors saw the value of providing a class for motivated nurses and quickly offered support for the program. Each hospital estimated how many students it could accommodate. This helped determine the number of students that could be accepted into the program. The group decided that a 20-student maximum was a good starting point for the first class.

Clinical educators from area hospitals were asked whether they would be interested in teaching the first class. Four perioperative clinical educators from four different health care facilities volunteered to help develop the class curriculum. Another educator served as the program coordinator, an assistant to the four primary educators during class times when laboratories would be taught, and a back-up in case one of the instructors could not attend class. It was important to avoid interrupting the flow of the class. The class was fast paced, lasting only 11 weeks, and it had to move along consistently so students could build their basic skills from week to week.

FINANCING

Cost was a major consideration. If RNs were to pay for the class themselves, costs had to be kept down. The dean suggested obtaining grants to pay the instructors' fees so the university would not have to add that expense to the tuition fee. The perioperative educators volunteered to supply any items needed from their ORs. All ORs have waste, and many have unused, opened items that are collected to send to third-world countries. These were sources for supplies, such as prep trays, drapes, suture, and gowns, that could be used in the classroom.

The program coordinator sent a request for program funding to Ethicon Products Worldwide, Somerville, NJ, a division of Johnson & Johnson, and received grant request forms to fill out and return to the company. The program was awarded a significant grant, which was used to pay the instructors' salaries and other expenses associated with the program. The cost for the class was set at $249, and students were asked to buy their own textbooks. Some of the grant money, however, was used to purchase 20 copies of AORN's Standards, Recommended Practices, and Guidelines for the students.

The local AORN chapter was asked to administer the funds. The chapter treasurer established an education account, and program instructors turned in time sheets and were paid through this account. Reports about the class were given at the chapter's monthly meetings.

The university received the tuition money and provided continuing education units. The course was offered for 11 weeks, with four hours of class time and four hours of clinical lessons per week. Eighty-eight continuing education units were awarded at the completion of the class for a cost of approximately $3 per continuing education unit.

The class was offered through the university's catalog for the School of Continuing and Professional Studies. It also was marketed in various nursing newsletters and magazines throughout Louisville. The class quickly filled to the 20-student limit, and a waiting list was started.

IMPLEMENTATION

One area hospital provided a classroom adjacent to a completely furnished OR for the class. Gowning and gloving, prepping and draping, and instrumentation classes were held in the OR. Students learned about sterile fields and how to maneuver in an OR.

Textbooks used for the class were Berry & Kohn's Operating Room Technique, 10th edition, and the 2003 Standards, Recommended Practices, and Guidelines. Students also were given focus sheets for their clinical lessons each week (Table 1). These included objectives the students were to meet for that week's clinical hours.

When the educators and directors first met, they discussed the possibility of having all hospitals use the same interpretation of standards for their practices. Louisville physicians work at a variety of hospitals; therefore, consistency in interpreting standards would be a benefit when dealing with issues that arise each day. Using AORN's standards to teach the students was a first step in achieving consistency. A few months before the program began, the instructors met to complete the course syllabus (Table 2), using the appropriate standards to supplement each lesson plan.

Students were given a list of local hospitals where they could perform their clinical practice. Students were encouraged to choose a hospital for their clinical experience, and if they did not have a preference, the program coordinator assigned them to a hospital. Some students chose the hospital where they worked. Five students were sent to the class by their respective hospitals. At the time, they were being oriented to their hospitals' ORs but were taking the class to learn theory. Two nurses were working in ambulatory surgery centers and were taking the class because they had never had formal classes on perioperative nursing. One nurse had not worked in nursing for a few years and was taking the class as a refresher course. The remaining nurses were taking the class to see if they would be interested in perioperative nursing.

Students were assigned to the hospitals in a way that prevented smaller hospitals from being overwhelmed with students. There are five nursing schools in the Louisville area that send students to local hospitals for an observation day. In an effort to evenly distribute students and make sure they all had quality preceptors, the program coordinator tried to send more students per week to a hospital with 25 ORs than to a hospital with five ORs.