292 - What a Concept: Perioperative Preceptorships for Senior Nursing Students
Description: This poster describes the implementation and outcomes of an eight-week cap-stone preceptorship for senior Bachelor of science (BSN) nursing students interested in the perioperative environment. focus: perioperative, intra-operative nursing care of the surgical patient. Description of teamTeam: 1. Selected senior BSN nursing students with an interest in perioperative nursing 2. Regional clinical perioperative consultant 3. Academic institution 4. Perioperative nursing leaders5. Clinical educator 6. Trained clinical RN preceptors7. Perioperative team: Anesthesia provider, surgeon, physician’s assistant, surgical technologist, circulating RN, Admit and Post anesthesia care RNs8. Central sterile processing (CSP) staff.Preparation and planningA large healthcare system in Northern California and an affiliated academic institution collaborated to provide clinical perioperative experience for senior nursing students. Nursing students were chosen by their academic institution. Selection of the students was based on grade point average and interviews. The onboarding process at the medical center followed that of a new employee. RN preceptors completed an online preceptor training and attended an instructor led four-hour class. Preceptors also reviewed department policies, accessed the health systems clinical library and AORN recommended practices via the facilities web-site. Nursing leadership informed anesthesia and surgeons that nursing students would complete preceptorships in the OR. Classrooms were reserved as needed. Arrangements were also made for the students to spend a day with an anesthesia provider, a day in central sterile processing and to attend an off-site eight-hour electronic charting class focused on intra-operative documentation for circulating RNs. Prior to the start of the program the students attended a two-hour orientation to the perioperative area during which time they completed department specific requirements and obtained badge access to the department. A program calendar was developed and shared with all stake holders. This program calendar identified daily assignments, focus for the week and guideline objectives for each day. The students were encouraged to be active participants in their learning.AssessmentThe healthcare system has a long history of student nurse training and has been affiliated with numerous academic institutions for student placements. Until recently years student nurse placements have been placed in traditional med/surg settings. Other disciplines have been integrated into the perioperative environment as part of their training, schools of nursing need to support the advancement of their programs to include perioperative clinical placements for nursing studentsThe current academic nurse training structure and reluctance of perioperative leadership to support clinical nursing student placements in the OR robs student nurses of their right to experience care of the surgical patient and to hone their assessment skills in recognizing potential or actual surgical complications in their patients. Opportunities to engage interested student nurses in the perioperative environment provides a clinical pathway for student nurses to become perioperative nurses. More importantly, regardless of the area in which the qualified nurse decides to practice, he or she will gain invaluable experience of the pre, intra and postoperative care of the surgical patient. Only in the perioperative arena can this experience be gained. Increasingly surgery is preformed on an out patient basis. At this healthcare system 80% of total joint patients return to their homes and their community same day of surgery. Student nurses in traditional med/surg rotations will not care for post-operative patients undergoing: Laparoscopic cholecystectomy, total joint surgery, thyroidectomy, elective aortic aneurysm repair or cataract surgery, these patients go home after surgery. Studies show that student nurses who provide care to pre, intra and postoperative patients demonstrate greater knowledge, empathy, sympathy and kindness in their interactions with all patients, regardless of location or environment. This greater knowledge and empathy are sustained over time. Exposure to perioperative nursing, in a supportive environment, creates a more knowledgeable and empathetic nurse. ImplementationThe affiliation between the two entities was in place, perioperative leadership, surgeons and anesthesia were on board. Prior to the first day of clinicals a “welcome our nursing students” flyer with student photos and clinical day 1 assignments was sent out via email and posted in the department. Perioperative leadership, the students and preceptors were provided with goals for each week, together with clinical assignments. The focus was on intra-operative care of the surgical patient. The first week students were introduced to perioperative continuum of care and:* Followed surgical patients through the continuum of care, from pre-op, intra-op to post op.* Observed in the OR* Worked alongside a trained preceptor in the admit area* Worked alongside a trained preceptor in the post anesthesia care unitEach student was assigned a patient population, based on surgical specialty. i.e. Sports medicine, bariatric surgery, GYN/GU. Etc. This provided consistency. Stated objectives were shared with the students and the surgical teams. Two-hour classes, once or twice a week, were integrated into the program calendar and were designed to provide opportunities for reflection, discussion of RN roles and responsibilities and to practice skills prior to the upcoming assignments and stated clinical foci for the following week. Identified knowledge and skill acquisition included patient assessment, to include airway, pain and risk assessments. Concept awareness included the role of team communication in patient safety and risk avoidance and the role of the RN as a patient advocate. Simulation labs in an empty operating room allowed the students to practice gowning and gloving in the scrub role as well as handling and passing instruments. In the circulating role the simulation lab was helpful in demonstrating and practicing surgical positioning, assisting anesthesia during intubation and building familiarity with surgical equipment. The classes were facilitated by the perioperative consultant, or clinical educator. When students spent a day with an anesthesia provider objectives and guidelines were provided to the provider and student to provide topics for discussion. Students were encouraged to join AORN and to access “guideline essentials.” Students also received, via email, the AORN study guides with topics timed to coincide with learning objectives for each week. OutcomeSince inception, three years ago, 15 students have completed the eight-week program. Eight, as RNs, have been hired into training positions and four are now staff nurses in the OR. Students thrive in a supportive perioperative environment and embrace the opportunities to learn and grow. They are appreciative of opportunity they have been given. It was helpful that in 2017 a two-week perioperative immersion program for nursing students was established and provided perioperative nursing experience to several of the students. The immersion program (AORN Poster #101, 2017) has provided opportunities for students to be accepted into perioperative preceptorships through-out the San Francisco Bay area. Implications for perioperative nursing There is a global shortage of perioperative nurses. The number of patients requiring surgery, especially baby boomers, is increasing, concurrently perioperative nurses of baby boomer age are retiring from careers spanning the last forty years. Years of expertise and knowledge are walking out of the door. Preceptorships in the perioperative environment provide desired opportunities for student nurses to gain valuable insights and experience in care of surgical patients. Preceptorships also provide opportunities for experienced preceptors to share their expertise and pass the baton. The experienced RN preceptor, in the presence of a nursing student, is challenged to be current in evidence-based care of the surgical patient. This relationship benefits both the student and the nurse, who gains by honing communication skills, while providing clear guidance and constructive feed-back, during the continuum of patient care. Very often the relationship between preceptor and student becomes symbiotic, with the student contributing to the knowledge of the nurse. In addition, this program provides eight weeks of perioperative clinical experience to student nurses. These students, as new grads, are well positioned to be hired into AORN’s periop 101 training programs. They already have eight to ten weeks of perioperative experience, are excited about their chosen career and are familiar with perioperative team dynamics as well as the roles and responsibilities of the perioperative nurse.