As director of surgical education at Bon Secours Richmond Health System in Richmond, VA, Patrick L. Beatty, MSN Ed, RN, CNOR, is part of a 10-person team that establishes and follows through on priorities for operating room nurse competencies within the hospital system.
"We stay attuned to new regulations, standards of care, changes within our own organization, statements from professional organizations, regional influences, directives from the Joint Commission and public agencies, and new techniques or equipment," he explained. "There's so much information from so many directions that we have to continually keep up."
Competency by Objectives
Beatty and his colleagues have developed a comprehensive approach to ensure Bon Secours OR nurses maintain their clinical competencies.
"As part of their mandated orientation, new employees receive a Competency Based Orientation (CBO) book they keep at hand for the first 3-4 months on the job, enabling educators and preceptors to validate competencies," he said. "The objectives range from everyday ones like, 'I can scrub, put on a gown, and gloves' to specific procedures in specialties such as orthopedics or neurosurgery."
Once the books are completed, they're filed in the education office for future reference.
"When we get a new piece of equipment or are teaching a new skill, we make up a new CBO form for everyone to get checked off before we file it," Beatty said. "This gives us written documentation that's easily available for the Joint Commission or anyone else who asks."
Jackie Baker, RN, CNOR, perioperative educator at Shands at the University of Florida, Gainesville, described a similar approach that makes good use of the validated education and testing available through the Competency & Credentialing Institute (www.cc-institute.org) that oversees certification of OR nurses and RN first assistants.
"They cover six areas of OR nurse competency: patient safety, patient positioning, sterilization, aseptic technique, age-specific care and electrosurgery," she said. "We've also developed three competency programs of our own on medication safety, skin in the perioperative setting and SCIP [Surgical Care Improvement Project] measures. Each nurse is required to pass these programs, and we place a copy of the completed exam for each one in the nurse's file."
Every year, OR nurses at Shands must pass tests on topics covered in the hospital's online Mandatory Gazette.
"We include updated content about issues such as patient safety, infection control, fire safety, legal issues and risk management topics pertinent to the perioperative setting," Baker said. "We also require demonstrated competency each year in low-volume, high-risk procedures such as RFLs [radiofrequency lesions] that only a handful of nurses do on a regular basis. The safety officer for the hospital meets with us periodically to cover topics like biomedical waste and fire safety, and there are always new topics being introduced by various hospital committees."
To maintain competencies for current OR nurses, Bon Secours Health System also uses an online education system. "We load mandatory education and competency topics for everyone each year, including some repeat topics like fire safety," Beatty said. "I attend the directors' meeting and get information about the need for new competency skills or educational programs, and all that is managed through the online program. We also receive directives from our own risk management staff or the health system office near Baltimore, and we'll include those topics in the electronic recordkeeping program."
While Bon Secours employees can log on to the online system to complete a good number of their required educational programs, hands-on training sessions are conducted in the OR itself.
"If it's a relatively minor change like a piece of new equipment, we'll set up rolling inservices in an alcove with a vendor representative there for a 3-4 hour period," Beatty said. "Staff signs the attendance sheet indicating they've completed the demonstration and return demo."
For more major changes or the introduction of complex technology, Beatty and his colleague schedule formal classes aimed at targeted groups of perioperative nurses and surgical techs. "If the topic or equipment is specific to a specialty like orthopedics, for example, only the ortho nurses are targeted for the inservice program if that is appropriate," he explained.