Stop, look, listen. And act.

Jacqueline Willingham Cordner, RN

I am not of the age group which portant that position is in the total grabs protest signs, stating, for ex- patient care plan.

You and I know how important that position is. You and I know the

tributing to this total patient care

ample, “Remember the OR nurse.” If I were a protest sign maker, how-

the patient.’’ ever, mine “Remember Elf satisfaction that comes from con-

Instead of protest I seek reexami- plan.

I find there is no need to inflate the ORN’s ego by pointing out how im-

defense of my personal choice of spe- cializing in operating room nursing.

Jacqueline Willingham Cordner, RN, i s director, operating room and postanesthesia room nursing, Hackensack Hospital, Hackensack, NJ. She was edu- cated in nursing a t the Roosevelt Hospital School of Nursing, New York City, and received a bache- lor’s degree in health education a t Jersey C i t y College, NJ.

A past president of AORN of New Jersey, Mrs. Cordner i s author of the book Logic of Operating Room Nursing, Springer Publishing Co., New York, 1967, and serves on the editorial board of RN magazine. She i s a past member of the National AORN-AORT Advisory Board.

Defense denotes attack, and I in- tend to follow the revered military dictum, “The best defense is a good offense.” I feel it is time to consoli- date forces, to gather our resources and direct this force toward the goal of optimum patient care.

I direct my remarks, therefore, to you-members of the Association of Operating Room Nurses-in the de- sire to direct and unite you in the task of defending the patient’s in-

April 1971 141

terests. And I direct my remarks to the educators and professionals who are interested in patient care, and who are willing to listen. I don’t ask that they agree with everything I have to say-I ask that we communi- cate.

The bucket-kicking surgeon of yes- terday has been replaced today by R

specialist who pleads with nursing to keep up with him. He sits on panels with nurses and hears nursing educa- tion’s pros and cons-and the educa- tors’ aim for total patient care.

He takes the side of today’s oper- ating room nurse-he says operating room nursing is nursing, and he re- sents educators’ seeming failure to view this phase of the patient’s hos- pital experience as an important link in total patient care.

Accepting the technician as a nurs- ing assistant and team member, the surgeon expects the nurse to be present to guide, teach and direct this assistant. He respects the concerned professional nurse who is able to assess patients’ needs in advance, whose discipline creates the correct aseptic and professional atmosphere where he, too, may render quality pa- tient care.

Today, the OR nurse is not the slave of the surgeon, but she is his assistant and coworker. As such, she must attempt to match his back- ground in liberal arts, but must equally attempt to keep pace with his increasing knowledge and increasing skills in the application of this knowl- edge. She must do this in order to effectively communicate with him and assist in his care of the patient.

It is most evident that elevation of the nurse’s education is the worthy

goal of today’s educators and pro- fessional directors of the nursing field. The motivation for this is the necessity of keeping pace with far- reaching developments and the in- creasing fund of knowledge which is now available for application. Since it is an undisputed fact that surgical skills, knowledge and application have made their advances, how can the idea be entertained that pace can be kept by nonprofessional, non-nursing personnel whose education by defini- tion, will be inferior to nursing edu- cation ?

May I quote from the June 1967 issue of the American Journal of Nursing in an article entitled “Transi- tion in Nursing Education.” “A well accepted premise in education is that the quality of the faculty directly af- fects the quality of the program, and the quality of the program, in turn, affects quality performance of its graduates.” So the big change in modern education is that the OR nurse must assure herself of being well qualified in teaching skills to complement her knowledge.

Let’s look at comparative factors: Inservice programs: Formal hos-

pital programs are given to the new graduate “nursing unit” nurse. These augment the “why’’ of her student nursing education by familiarizing her with the “how to” which is learned only on the ward. This, by the way, increases hospital costs, and affects the patient’s pocketbook.

Inservice programs: The “how to” as well as the “why” in operating room nursing are generally not even thought of by specialized instructors. Why? Because a need has already been recognized and dealt with. Yes- terday, today and immediate tomor-

142 AORN Journal

row, inservice programs have been given in the OR setting by the OR nurses, surgeons, or even self-taught.

Do you know why? Because OR experience for t h e student was mishandled in the past, and the scars of this needed plastic surgery. Needed was integration of this experience with the surgical care of the patient. In addition, the objectives of OR nursing in relation to objectives of patient unit nursing needed an anas- tomosis. The OR nurse’s role? A teacher.

Team nursing: This is a big factor today and is given attention and re- search. With all the attention I have heard comments that it is most ef- fective when there is sufficient staf- fing.

Team nursing: It is a “fait ac- compli” in the OR-yesterday, today and tomorrow. The OR nurse knew all about it. She incorporated all serv- ices-not just nursing. She used all personnel as instructors-the porter, the secretary, the technician, the sur- geon, the anesthesiologist, the path- ologist, now the pump technician, and perhaps soon the electronic expert. The OR nurse’s role? A leader, a co- ordinator, a communicator.

Cardiopulmonary resuscitation: Much emphasis is on this factor for nursing units.

Cardiopulmonary resuscitation: It has always been familiar to the OR nurse, and she even has taught the technician his part in this. Her role? An innovator, responder, the initiator of the original “crash cart.” Briefly, her role is the physician’s counter- part.

I see the role of the operating room nurse described in image and function in the various definitions of nursing, as well as the 10 topics of the Ameri- can Nurses’ Association Code for Nurses.

If ever a group was concerned with patient care, quality standards, i t is the operating room nurse. If ever a group exercised the role of a nurse as a leader, a teacher, a coordinator, if ever a group daily applied humanities, social, biological and physical sci- ences, it is the ORN. And if ever a group identified needs based upon ob- servation, assessment, giving and re- ceiving information with constant evaluation, again it is the operating room nurse.

But in addition, today, she com- municates in scientific terms with her medical professional counterparts.

Tomorrow-the OR nurse-could well be known as a “nurse clinician.” A job description was listed in the August, 1969 edition of RN Mugwme:

“She is a registered nurse who is knowledgeable in general nursing theory and practice, and skilled in the clinical specialty in which she works. She is capable of functioning inde- pendently, analytical in her thinking, and able to suggest practical solutions to patient care problems. She is also to lead, teach and work successfully with others.”

I read that a clinician should spend at least more than half of her time in patient contact, this includes tasks and activities indirectly or directly for the patient.

A nurse-clinician is a specialist, recognized for her knowledge, and is inwardly rewarded by the fact that

April 1971 143

she can function or participate in pa- tient care. (She might even get to scrub without being accused of be- coming task-oriented. How about that?)

By the way, a nurse-clinician is outwardly rewarded by salary com- mensurate with her knowledge and effectiveness. It is many times on the level of a supervisor. How about that?

I have asked you to think, now 1 ask you to act. If we raised our image in others' minds as well as our own, if we took time to educationally ad-

vance ourselves we would be able to influence the role of the nurse today and tomorrow.

A step in the right direction would be to seek communication with the educators and directors of the nursing profession. To explain total patient care-not so much what we are doing, but why we are doing it-this would be communicating on the same chan- nel with educators.

The same channel for nurses and educators is PATIENT. As you real- ize, our purposes are, indeed similar.

Petite protests Unique to the suggestion-box field i s this opinion tool, found in the "know your department" exhibit at a California hospital.

Tacked on a bulletin b a r d , the "complaint form" measures approximately two inches square:

COMPLAINT FORM

Please w r i t e your

Complaint in space

below-write legibly

144 AORN Journal