Perioperative RN Anesthesia Orientation Mount Sinai Hospital
Summary
My fellowship project was the creation of an orientation document to supplement the orientation process of a new perioperative Registered Nurse in Mount Sinai Hospital's operating rooms. Mount Sinai Hospital is a teaching hospital that often sees medically complex patients. Novice perioperative nurses encounter a steep learning curve as they adjust to the specific practices of the new setting. During a 14 week period, the orientee alternates between several surgical services learning the responsibilities of a scrub and circulating perioperative nurse.
The aim of this fellowship was to provide best practice guidelines and rationale for the various tasks performed in the role and to assist the novice nurse in decision making and workflow. Originally, the fellowship was to cover several topics to support a novice nurse in their role. After discussing with organizational stakeholders, it became apparent it would be beneficial to focus on one aspect of the role. This focused approach would provide a structure for the document, a body of literature for support, and identify the appropriate personnel to advise on the content. All patients who come to the operating room receive some form of anesthesia, so this area of focus aligns well with the duties of the role. There is also a significant amount of literature and personnel who could support this area of focus. The final outcome is a document detailing the background, rationale and nursing considerations for various anesthesia related practices.
The result is a 55 page document providing details related to the perioperative nurse's role when supporting patients during anesthetic interventions. Some examples of the topics covered include the insertion of airway devices and when they are needed, the placement of nerve blocks (e.g. spinal anesthetic), and invasive monitoring lines (e.g. arterial pressure line).
Mount Sinai Hospital is undergoing a major transition to a new physical space consisting of 19 operating rooms in the spring of 2021. The increase in capacity creates an increased demand for perioperative nurses. The creation of a document to support the orientation process aligns with the organization’s priorities.
Provide a brief description of the overall learning goal (objectives) and share the description of the skills, knowledge, and expertise that you have gained through the fellowship.
During the course of the fellowship I gained knowledge and expertise in the orientation process, the topic of anesthesia, and implementing change in an organization.
First and foremost, I conducted research to increase my understanding of the qualities and structures of the orientation process. The first two weeks of the project involved learning about adult learning principles and research about how other institutions implement orientation programs in the operating room. I compared and contrasted the various aspects of the onboarding process. This included staff retention rates, length of orientation and how the time was allotted, and the education required to enter the role. I also delved into trends of nurses in the workforce and the learning styles for the incoming generations. This help to build foundational knowledge to guide the creation of the orientation document.
After my initial research, I set about to gain a deeper understanding of the rationale to the anesthesia practices and requirements in the perioperative environment. The operating room is a complex environment with several tasks being conducted simultaneously. Knowledge is transferred verbally and creating a document is an opportunity to capture verbal knowledge to further support orientation. The objective of creating this document was to create a broader understanding of the nuances of anesthesia practices. Through this fellowship, I have gained a great deal of knowledge to inform my own practice. The process of researching, verifying my knowledge and constructing the orientation manual helped to advance my own practice and build my confidence in supporting new perioperative nurses.
The final area of learning was professional development related to making change within an organization. Throughout the process, I have learned about stakeholder engagement, gap analysis, research, resourcing, and collaborating to implement a change. Some of these lessons came about as I went to navigate some of the various resources and supports available (e.g. library personnel and resources, hospital branding, hospital policies). By interacting with these resources to create the document, I was able to witness and respect the existing structures of the institution.
Outcomes
My fellowship project involves perioperative nursing considerations associated to anesthetic interventions. The perioperative nurse carries out numerous anesthesia related responsibilities, with the majority of them focused on the most critical aspect of a patient's health: the airway.
Given the anesthetic needs for surgery, all patients’ airways are assessed and a plan of care is made. Most often the perioperative nurse assists to carry out the interventions required, such as placement of an airway device. Given that the patient population is medically complex, the perioperative nurse assists with a variety of low to high risk situations, and must be aware of potential complications and how to respond to accordingly.
The orientation document focuses on workflow and decision making related to anesthesia practices in the perioperative setting. The objective was to provide the novice perioperative nurse with a concrete reference for the different airway options and interventions, detailing how and when to respond along with professional expectations. By having a tool to use to support gaining a deeper understanding of the intervention, the nurse is able to recognize each part of the task being conducted. The tool provides information to support decision making in complicated or emergency situations. When knowledge is translated into practice, patients are able to experience better outcomes.
Secondary to airway interventions, the perioperative nurse will assist with other anesthesia related responsibilities. The information in the document is a compilation including materials and techniques used during anesthetic interventions. This allows the perioperative nurse to follow along and have the resource that directs how to appropriately respond in frequent and less frequent situations. This includes which resources are needed to support the patient and anesthesia care provider before or during an intervention.
The main outcome for the patient population is a stronger and more informed perioperative nursing team. Having a strong foundation will allow staff to make build their knowledge base, leading to safer practice and better patient outcomes. The addition of this document as a resource to both novice and experienced perioperative nurses will help to support consistency with information and requirements for anesthesia interventions.
The basis of my fellowship project is to support newly hired perioperative nurses during their orientation to the operating room. Although the document is intended for incoming staff, this resource will also support education and engagement of existing staff.
The orientation document will be distributed to my perioperative nursing colleagues at my organization. Additionally, I will be able to talk about my fellowship journey at a staff education session. I will be able to share the components of the document and the specific ways in which it can be helpful to them. Aside from sharing the direct product of my fellowship, I will be demonstrating the fellowship as an opportunity for personal and professional growth. I feel the support that I received highlights the organization’s core value of discovery which includes asking questions, professional development, and creating opportunities.
Throughout the fellowship I have received the expertise and support of several individuals. The staff I engaged includes nurses, resource nurses, the nursing unit administrator, clinical nurse specialist, anesthesiologists, and anesthesia assistants. Their support made my fellowship possible. I have collaborated and engaged with my colleagues which created recognition of the document as a resource for the unit. My colleagues were happy to support my process and could see the value of their contributions and the impact it will have for our new perioperative nurses.
In terms of outcomes experienced by the organization, the operating room leadership team spoke positively about the fellowship experience. Before deciding on the area of focus, we worked together for several weeks to look at our organization’s current orientation process as a whole. We looked at the trends experienced on our unit over the last few years, and considered the future of the unit and organization. This is important since there are significant upcoming changes as our unit migrates to a new physical space. I had the opportunity to do a thorough literature review to create a plan that aligns with organizational and unit objectives. This comprehensive review informed how to move forward with orientation materials and plans.
Overall experience
My fellowship has been an amazing learning opportunity. I am incredibly grateful for the knowledge I have gained during the various stages. It has been enriching to go through the process of creating a plan, implementing it, encountering and overcoming challenges, and reaching completion.
Working on my fellowship project provided me with a more academic focus to my day to day experience. This provided some contrast to the clinical environment, bringing about a change in pace. I had the opportunity to work on my fellowship on some days, while in the operating room on other days. I felt that these two settings were complimentary in being able to inform how I practice, as well as informing the creation of my fellowship project. The research I have done during my fellowship has increased my knowledge and skillset which will serve me as I continue in my nursing practice.
One unique aspect of my fellowship experience was that it took place during the Covid-19 pandemic. Due to the uncertainty of the impact of the pandemic, flexibility was required. Although the pandemic brought challenges and required some considerations, I was fortunate to complete my fellowship as planned.
In concluding my fellowship journey, I cannot express enough gratitude for the experience. I am grateful that nursing educational opportunities are supported by my organization, Sinai Health System, and the RNAO. It can be easy to overlook the significance of creating space, time, and money to run a program that encourages professional growth and development. However, it is these opportunities that help augment practice and bring about positive change and ownership to the nursing profession
