Perioperative Nurse Residency Program
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Share PrintFor three years, our Perioperative Nurse Residency program has successfully cross-trained registered nurses (RNs) to the operating room, as fully independent circulating and scrub nurses as planned replacements for outgoing nurses entering retirement. This nine-month clinical program has also raised our hospital nurse retention rate by 1.83%, keeping nurses who were seeking professional growth into a critical care area.
Origin:
February 2018, Sacramento VA Medical Center
Adoptions:
1 successful, 3 in-progress
Awards and Recognition:
AORN Journal, Recognized Author (May 2021)
Partners:
Diffusion of Excellence
Recent Updates
Overview
The problem
The Sacramento Veterans Affairs Medical Center (SVAMC) of the Northern California Health Care System (NCHCS) has four operating rooms (OR) with plans to expand by one additional OR room in 2022. IN 2018, nine of the nineteen OR registered nurses required to keep all four ORs open were eligible for retirement, necessitating a strategy to acquire experienced
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The Sacramento Veterans Affairs Medical Center (SVAMC) of the Northern California Health Care System (NCHCS) has four operating rooms (OR) with plans to expand by one additional OR room in 2022. IN 2018, nine of the nineteen OR registered nurses required to keep all four ORs open were eligible for retirement, necessitating a strategy to acquire experienced nurses to replace them. Compounding the issue, the OR was experiencing a 1.5% increase in operating hours due to increasing case demand. Nationally reported statistics in 2017 indicated that the average age of perioperative nurse leaders was 52 years with 43% planning to retire within the next five years. Historically, OR RN positions have been extremely difficult to recruit. Only one facility in the metropolitan Sacramento area offers an OR cross-training program and when contacted to possibly collaborate with them, they estimated seven years before their own staffing needs would be met.
Facility leadership members had considered attempting an “on-the-job” training program, but it was determined that the process would be too prolonged with a risk of inconsistent instruction and quality.
Exploring options, it was noted that many of the hospital’s medical-surgical nurses had one to three years of experience. Retention of these RNs was decreasing with the number one stated reason – a perceived lack of opportunity to progress, especially into critical care specialty areas, including the OR. See more
Facility leadership members had considered attempting an “on-the-job” training program, but it was determined that the process would be too prolonged with a risk of inconsistent instruction and quality.
Exploring options, it was noted that many of the hospital’s medical-surgical nurses had one to three years of experience. Retention of these RNs was decreasing with the number one stated reason – a perceived lack of opportunity to progress, especially into critical care specialty areas, including the OR. See more
The solution
The Sacramento VA Medical Center (SVAMC) team determined that an ongoing perioperative nurse residency within the hospital would be beneficial in meeting the OR nurse demand. A perioperative nurse educator position was posted internally and externally to spearhead the program. This educator would also be responsible for collaborating with the nurse manager
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The Sacramento VA Medical Center (SVAMC) team determined that an ongoing perioperative nurse residency within the hospital would be beneficial in meeting the OR nurse demand. A perioperative nurse educator position was posted internally and externally to spearhead the program. This educator would also be responsible for collaborating with the nurse managers (of SVAMC and the Ambulatory Surgery Unit in Martinez), to manage ongoing staff education and competency programs, as well as the Perioperative Nurse Residency program. The selected educator had over twenty years of OR experience as well as experience establishing a similar program for training Ambulatory Surgery Unit OR nurses in the community for four years prior to her work with SVAMC. The educator oriented to the OR and explored the preoperative and postoperative care areas, as she assembled the materials to begin a residency program. She interacted with all the staff in the department, including ancillary staff. In networking with contributing services (e.g., Sterile Processing, Anesthesiology, Implant Coordinator) additional experiences were interjected into the AORN Periop 101 course that was delivered. Field trips were added to expose the residents to our sister ambulatory surgery unit and the DOD/VA facility at Travis Air Force Base. The educator became involved with the SVAMC Simulation team and was able to include more simulation experiences, as part of PNR training delivered.
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more
The results
Retention of our previously non-OR experienced RNs has been improved by providing an avenue of advancement to a critical care surgical position. Improvements have been noted in job satisfaction as the nurses advance in their career, while they also help meet our hospital’s immediate need for competent surgical nurses to support expanding surgical specialty
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Retention of our previously non-OR experienced RNs has been improved by providing an avenue of advancement to a critical care surgical position. Improvements have been noted in job satisfaction as the nurses advance in their career, while they also help meet our hospital’s immediate need for competent surgical nurses to support expanding surgical specialty services including robotic surgery. With an emphasis on providing the most current and complete best practices, our current perioperative nursing staff review the standards, guidelines, and processes within the OR, and as needed, updated to the most current AORN guidelines. At the completion of the program, the nurse resident is fully trained in both the scrub and circulating RN roles in the OR. The perioperative team has been effectively expanded with the addition of competent RN residents providing the highest level of surgical care for our Veterans.
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more
Metrics
- Retention of residents from all three cohorts (nine RNs) is nearly 100%, with only one RN leaving due to her active-duty spouse transfer. One of our 2018 graduates has also obtained her national Perioperative Nurse (CNOR) certification in 2021. Nine retirees and/or relocating RNs were lost from 2018-2020 and have been replaced by the hiring of four experienced nurses plus the nine residency graduates, enabling our surgical team to maintain our surgical volumes and keep all current ORs open. To date no case has been deferred or cancelled due to OR RN staffing. Nurse recruiting cites the perioperative residency as contributing to the medical-surgical nurse retention rate which increased by 1.83% from April FY20 to March FY21. Validating the competency and proficiency of the OR RN resident, four of our six graduates from the 2018 and 2019 cohorts have undertaken service lead and/or backup lead roles, responsible for all supplies and equipment for that surgical specialty. The quality of the program training has enabled us to support an 8.5% increase in operating hours from 2018 to 2020. Recognizing our ability to perform complex cases, the National Surgery Office granted our facility (as one of only two facilities in the VISN) to perform cochlear implant surgery to provide definitive care for our hearing-impaired Veterans. The number of interested nurses in the Perioperative Nurse Residency remains high with more than fifteen inquiries per year. Nurses request information concerning what continuing education/skills may be required to be considered for the next residency. We have obtained an average of ten to twelve applications for each cohort, many of whom have worked to obtain more skills to increase the possibility of obtaining a resident position. In addition, it has been learned that the residency program is being utilized as a nurse recruitment and retention tool by our academic affiliates.
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Implementation
Timeline
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Month One
•Gain Administrative Executive Approval / Support for 9 Month Education Period of Performance (PoP)•Obtain nursing education funds (for materials)• Executive Budget Approval for additional temporary staff positions (Residents)•Hire Perioperative Educator (our facility converted two half-time OR Nursing positions to obtain one FTE Educator) - (allow two months for recruitment/interview and selection of the Perioperative Educator FTE if not currently on staff.) -
Month Two
•Material Purchase (1 week):•AORN Perioperative 101: A Core Curriculum – one seat for each resident•Textbooks – Alexander’s Care of the Patient in Surgery – one per resident (plus one for perioperative educator - for first residency only)•Cine-Med Video Library•Recruitment / Advertising of Residency Program – Application Deadline (allow 3-4 weeks) -
Month Three
•Perioperative Educator•Reviews/updates materials,•Determines module order, and•Adds appropriate additional resources,•Edits AORN reading list to include review of local standards of practice,•Plans progressive clinical skills schedule and•Begins networking with Subject Matter Experts (SMEs) (e.g., anesthesiologist, surgical process service staff, and the implant coordinator) to develop additional clinical experiences for trainees (ongoing)•Panel Interview of RN candidates including candidate selection (1w)•HR contacts/confirms selected candidate acceptance of residency•HR to obtain signatures for Resident 2-year Commitment Contract (1w)•Expected transfer of residents to OR Nurse Residency program (1m)•Gain Nurse Recruiter support to backfill resident previous RN positions (variable timeframe)•Educator confirms Classroom reservation with computer stations (1w) -
Month Four
•Perioperative Nurse Residency Program begins – PoP 9 months
Departments
- Administration
- Nursing services
- Human resources
- Surgery
Core Resources
| Resource type | Resource description |
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PROCESSES |
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Links
- Periop 101 Education Solutions for Healthcare Facilities - Periop Education Solutions - Periop 101: A Core Curriculum - Association of periOperative Registered Nurses (aorn.org) AORN - Periop 101: A Core Curriculum
- Evolve Resources for Alexander's Care of the Patient in Surgery, 16th Edition - 9780323547031 (elsevier.com) Evolve Resources is a free resource, available for purchasers of Alexander’s Care of the Patient in Surgery textbook with added illustrations and education adjuncts
- AORN Perioperative Nursing Video Library (cine-med.com) Cine-Med Video Library – discounted with AORN Periop 101 purchase
Optional Resources
Links
- Developing a Perioperative Nurse Residency Program to Address Planned Nurse Retirements - Nissen - 2020 - AORN Journal - Wiley Online Library AORN Journal Article: “Developing a Perioperative Nurse Residency Program to Address Planned Nurse Retirements” author: Nancy A Nissen, BHS, RN, CNOR
Support Resources
| Resource type | Resource description |
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PROCESSES |
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Risks and mitigations
| Risk | Mitigation |
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| One of the main difficulties may be obtaining administrative and financial support. |
This can be mitigated by assembling data that demonstrates: 1) the number of expected retiring operating room (OR) nurses over the next two to five years 2) the difficulty in recruiting experienced OR nurses supported by numbers of applications, selectees and onboarded nurses and 3) costs associated with overtime costs, cancelled, or delayed surgery due to staff shortages and staff turnover due to decreased staff morale. The operating room staff must be supportive of the perioperative nurse residency program. Open communication concerning the added responsibility of the whole team in welcoming the residents and patience while precepting is imperative. Any staff questions and/or concerns need to be addressed quickly to successfully enfold the residents into the team. The residents need to be included in the morning huddles, education and simulation events and partnered with an experienced preceptor. Daily debriefs with the educator and fellow residents to share their experiences and questions, was a feature that past residents stated was very beneficial to their learning experience and assimilation into the OR team. There is always a risk that a resident will seek a position in the community, after training. Our hospital has been fortunate to retain all our residents post-graduation, with only one exception to date, due to an active-duty spouse transfer. This is greatly assisted by having a written contract between the resident and the hospital. The Perioperative Resident Contract is beneficial for both the facility and the resident, guaranteeing that the successful resident will have a position in the OR post-graduation as well as the assurance that the resident will stay for the required two years. |
Contact
Comment
Comments and replies are disabled for retired innovations and non-VA users.
Email Karen.Putnam@va.gov with questions about this innovation.
About
Original team
Karen Putnam
Nurse Manager, Preop/OR/PACU - Program Champion
Nancy Nissen
Retired Program Champion
I would like to learn more about starting a Operating room nurse residency program
I would like to learn more about this process
The VACT had the same issue when 5 of our experts retired on the same month. We
started conceptualizing a residency program (in 2008) based on the AORN Periop 101 framework (a 6-month didactic and clinical application). The acuity of our OR (Level 1 Complex Facility) called for recruitment of experienced OR nurses and during those times Nurse Educator was not a position. In order to fully implement Periop 101, you needed 2 administrators and a consistent preceptor. So, we had to internally recruit but competing with the cases scheduled, the leadership team needed to fill the gap by recruiting experience nurses. Depending on the budget provided to us, we were able to successfully hire eight (8) of the Periop residents, the last one is going to take the test at the end of this month. We have an on-going contract with AORN for the required seats and preceptors, but we are dependent upon the fiscal allocation. Right now, we are meeting the required staffing methodology. We have seven OR servicing our Veteran patients from General to CT including OH/complex PV cases and venturing on TVAR.
This residency program is a testament and a great recruitment and retention initiative and can be sustained with fiscal collaboration and a successful mentorship program