Struggling to find experienced operating room RNs? One healthcare system started its own pipeline with an OR fellowship program.
This article appears in the November/December 2018 edition of HealthLeaders magazine.
When nurse leaders discuss the nursing workforce, they often say that there's more to be concerned about than whether there are enough nurses to fill open positions. They understand that nurses' professional knowledge is of prime importance in delivering quality patient care and finding RNs with specialty nursing experience is becoming more difficult.
"Around the country, and here at Hartford Hospital, it's challenging to keep up with the demand for operating room nurses," says Maria Tackett, RN, EdD, CEN, TCRN, CCRN-K, nurse director, professional practice at Hartford Hospital in Connecticut.
To help address this issue, Hartford HealthCare launched a system-wide operating room nursing fellowship for student nurses last year. The goal of the program is to drive interest in the perioperative specialty and foster professional development of future operating room RNs.
Here Tackett shares the three steps used to create a fellowship program for a perioperative nursing pipeline at the healthcare organization.
1) Establish Fellowship Program Fundamentals
Hartford HealthCare has experience offering fellowships, including the Susan D. Flynn oncology nursing development program, and a homegrown orthopedics fellowship. Hartford Hospital Vice President of Patient Services, Cheryl Ficara, RN, MS, NEA-BC, was an advocate for starting an OR fellowship to cultivate the next generation of perioperative nurses.
"It was really a directive from Cheryl, who was realizing OR nursing was difficult to [recruit for] and we needed to contribute to its ongoing interest," Tackett says. "We were also finding—and I think this is happening around the country—that the undergraduate curriculum, because of the demands that [nursing schools] have, they can't offer a lot of OR nursing experience."
Tackett and nurse leaders in the perioperative department at Hartford Hospital worked together to develop the program for nursing students entering their senior year of nursing school.
The program was designed to give the fellows an understanding of the role of the OR nurse through didactic and practical learning experiences, including direct observation of patient care and exposure to intraoperative nursing responsibilities.
The fundamentals of OR nursing were covered through a formalized, instructor-facilitated course of study. By working with the nurse educator and perioperative services and OR nurse preceptors, students learned about:
- The foundations of perioperative nursing practice
- The professional role of perioperative nurse practice
- Assessment in the perioperative setting
- Ethics related to nursing practice and patient care in the perioperative setting
- Certification, professional association memberships, and continuing education
- Patient education
- Quality, safety and risk management
- Methods and practices to control and prevent infection in the perioperative setting.
The leadership team wanted to ensure the fellows had an experience that showed them OR nursing is more than technical skills.
Tackett gives the example of a patient going to a well-pregnancy check at an obstetrics office and finding out there are pregnancy complications.
"She is emergently brought here. She has safety issues and the course has changed for this family. We need someone who can provide oversight not only for safety, but to support the family, and understand the physical and emotional complexities they're going through," she says. "We look to our OR nursing professional to do that. So that was another piece of this fellowship: we want these highly knowledgeable and skilled people to be the frontline of safety for us in caring for patients."
Additionally, the fellows completed research projects during their experience. One group focused on fires in the OR while another tackled recycling measures in the OR.
2) Pick the Cream of the Crop
In fall 2017, the team at Hartford Healthcare sent a request for applicants to its partner nursing schools. Junior students who would be entering their senior year, who were in good academic standing, and had at least a 3.2 GPA were able to apply.
After a round of interviews, the applicants were notified of their acceptance into the program before spring break 2018. Ten fellows were placed at five of Hartford Healthcare's various campuses. Hartford Hospital had six fellows; it had 23 applicants for those six spots.
What set candidates apart from the rest of the pack?
"A sincere interest in operating room nursing. Some of the people we interviewed came and said, 'I worked with somebody, or I had somebody in my family who was an operating room nurse, and she was inspiring,'" Tackett says. "We were also impressed by people who had some idea that this was way more than tasks and skills—that it was about advocating for the patient, applying nursing knowledge to maintain safety, keeping the patient safe from infection, and being able to respond to emergencies. There were students who could speak to that. So those [groups of] people were of greater interest to us."
3) Create Cost Effective Mentoring
The fellows worked 40 hours a week for eight weeks and were paid about $7,500 each during that time. The cost of purchasing a curriculum was about $200 per person.
Tackett says, "This was not expensive for us to run. The expense, if you will, is making sure that the nurse educator has the time dedicated for the coordination," she says. "We really do have to free up or balance the educators' time or staff time to make it work. So, there is that cost, but overall it didn't break us."
Through the experience the nurse educator was the fellows' mentor. She worked collaboratively across the healthcare system to have a similar curriculum.
"Another way to look at it is almost as if you had a group of orientees. It's kind of determining what the department can handle," Tackett says. "You have to balance what the service can bear and how many staff you have. But we didn't get complaints of people feeling overburdened because they had this young person with them."
The biggest challenge, says Tackett, was identifying what the fellows could do in the OR. For example, they could assist with positioning under direction but could not push IV meds.
"It was just going through a big list of [responsibilities] to make sure everybody was comfortable," she says.
Tackett says the fellowship was successful on many fronts.
"It was energizing for the team. You have these wonderful young people [and the team was] inspired by their energy and interest," she says. "They're very bright, they can navigate information well, and we were impressed with their research projects, so it was a positive thing. We didn't get any feedback from them or the staff that this was a burden, but we did prepare the staff that we're all in this to develop and support our future."
As for the fellows, they are now back at school completing their senior year. Tackett says there have been discussions about them returning for their capstone experience.
"We're certainly keeping in touch with them," she says. "We're maintaining that relationship with the hope that they will come back in May when they graduate."
Another OR fellowship cohort is planned for the summer of 2019.
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.
Finding experienced OR nurses to replace those who are retiring can be a challenge for nurse leaders
Dedicating resources to a fellowship is one way to improve the OR nurse pipeline.
Student nurse fellows can help energize OR staff.