OR Manager March 2022 - 20

Perioperative Survey
The demographics of perioperative nursing: What we know now
BY COMPETENCY AND CREDENTIALING INSTITUTE
dvances in surgery and the growing
use of technology and equipment
have contributed to the ascendance
of the hospital setting for the
education and training of perioperative
nurses when delivering surgical care.
Education and training programs based
on hospital needs have led to a diversity
of methods among employers and
a decided lack of standardization. The
scarcity of perioperative nursing content
in pre-licensure coursework, combined
with the creation and monitoring
of orientation programs being left with
employers, has contributed to a lack of
visibility for the specialty.
A
In a nutshell, recent nursing graduates
are not exposed to OR training,
jobs, or skills unless they stumble upon
it somehow or are directed to the track
by a mentor. There is no standardized
path to enter the perioperative profession.
The
methods long used in perioperative
nursing orientation, dominated by
on-the-job training in the hospital setting,
have not been extensively studied
for efficacy. By default, responsibility for
workforce planning devolves to the level
of the employer-the health system or
facility-so they can address their local
staffing needs. Ultimately, this leads to
a disjointed, non-systematic approach
that results in local shortages and competition
among employers for the essential
human resource of perioperative
nurses.
The employing healthcare facility
then, as the provider of perioperative
nursing orientation programs, plays a
significant role in determining competency
for the profession. This has been
the case since the early 1900s. Much
of the data on the makeup of the specialty
and the efficacy of training methods
remains isolated at the local or
system level secondary to the nature of
orientation programs.
Role of employers
There are inherent issues with the cen20
OR
Manager | March 2022
tral role of employers controlling entry
to the perioperative nursing specialty.
The seminal work of the 2011 Future
of Nursing Report is instructive for perioperative
nursing. Of interest is Key
Message #4, which states that planning
for the healthcare of the future
requires a clear understanding of " the
numbers and composition of the health
care workforce " and " sufficiently granular
data on the current workforce and
projections of future workforce needs. "
Such data is lacking for the perioperative
nursing specialty.
A first step
to address
perioperative
nursing shortages
is to gather more
consistent data for
workforce planning.
A number of questions arise from
the incomplete data we have at present:
*
Will there be enough perioperative
nurses in the future to do the vital
work of the OR?
* Who should have responsibility for
workforce planning for the perioperative
nursing specialty?
* What is the best strategy to address
these potential shortfalls of perioperative
nurses?
* What are the implications of keeping
the demographic information for perioperative
nursing sequestered at the
local/system level?
Today, the employing facility determines
who will become a perioperative
nurse. As we recently wrote in
OR Today, " the current standard for
entry into perioperative nursing resides
mainly in the documentation that the
employer must provide for accreditation
requirements. " Thus, the employers,
rather than the profession, determine
who will be a perioperative nurse. And,
it is the employer who holds that documentation
and who has much discretion
on the makeup of orientation programs.
The employer also holds much of the
data on the demographics of perioperative
nursing, which makes workforce
planning infinitely more complex.
Current state of data
There are three easily accessible
sources of data for the makeup of the
perioperative nursing workforce. The
Competency and Credentialing Institute
(CCI) has some demographic data
for the perioperative nursing specialty,
gathered from some 42,000 certificants.
This data is reliant on self-reports
and updates from the certificant
to keep personal information, such as
educational degrees, current. The CCI
data is concentrated in certified perioperative
nurses, and it is thus not representative
of the whole of the specialty.
Notably, CCI uses the data for
internal purposes for credentialing and
certification work; does not routinely
publish this data; and seldom receives
requests to share data. CCI and the
CCI Research Foundation have recently
funded research to gain a better picture
of the demographics of perioperative
nursing-this data will not be published
until late 2022.
In our test development work, CCI
periodically conducts job analysis studies
and surveys of the perioperative
nursing community. These surveys have
large numbers of perioperative nurse
respondents but also include a high
ratio of certified nurses. This sample
cannot be deemed representative of all
perioperative nursing, but it is a snapshot
of one portion of the larger overall
community.
The most informative and timely CCI
data comes from the CNOR certification
examination and the CFPN credential
Knowledge-Based Test (KBT) post-test
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OR Manager March 2022

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