Standards, Guidelines and
Position Statements for Perioperative
Registered Nursing Practice
Promoting Excellence
OPERATING ROOM NURSES ASSOCIATION OF CANADA (ORNAC)
10
THEdition
Copyright registration number
1084471
All rights reserved. No part of this document may be reproduced or transmitted in any form or by
any means, electronic or mechanical, including photocopying, recording, or by any information
storage and retrieval system, without the written permission of the ORNAC Executive.
Table of Contents
Page
Foreword ... 7
A Message From the President ... 9
Section 1 ORNAC Beliefs, Professional Standards and Competencies Part A ORNAC's Fundamental Principles and Position Statements ... 12
ORNAC Philosophy ... 13
ORNAC Mission, Values, Vision ... 14
National Standards for Perioperative Registered Nursing Practice ... 15
Conceptual Model for Perioperative Registered Nursing Practice ... 16
ORNAC Scope of Perioperative Registered Nursing Practice ... 17
Scope of Practice for Expanded Perioperative Nursing Practice ... 17
Scope of Practice for Advanced Perioperative Registered Nursing Practice ... 18
ORNAC Position Statements a) Staffing the Surgical Suite... 19
b) Perioperative Certification ... 21
c) Perioperative Nursing Experience in Basic Nursing Education Programs ... 22
d) Environmental Responsibility ... 24
e) Perioperative Registered Nurses are Essential to Quality Care in the Operating Room ... 24
f) The Perioperative Registered Nurses’ Role in Primary Healthcare ... 25
Safe Surgery Saves Lives ... 26
Part B Standards for Perioperative Registered Nursing Practice ... 28
Professional Standards ... 29
Professional Standards for Perioperative Registered Nurses ... 30
Professional Standards for Perioperative Registered Nurse Managers ... 39
Professional Standards for Perioperative Registered Nurse Educators ... 41
Professional Standards for Expanded Practice Perioperative Registered Nurses ... 43
Professional Standards for Perioperative Registered Nurse Researchers ... 45
Professional Standards for Advanced Practice Perioperative Registered Nurses ... 48
Part C Competencies for Perioperative Registered Nursing Practice ... 50
Purpose ... 51
Knowledge and Skills Expected of the Perioperative Registered Nurse Prior to Entering the Specialty of Perioperative Nursing ... 52
Characteristics of Each Competency ... 53
Competencies of the Perioperative Registered Nurse ... 54
Competencies of the Perioperative Registered Nurse Manager ... 59
Competencies of the Perioperative Registered Nurse Educator ... 67
Competencies of the Advanced Practice Perioperative Registered Nurse ... 73
Competencies for Expanded Practice Perioperative Registered Nurses Registered Nurse First Assist (Appendix A) ... 75
Section 2 Infection Prevention and Control
Routine Practices and Additional Precautions ... 89
Routine Practices ... 89
Airborne Precautions ... 91
Droplet Precautions ... 94
Contact Precautions ... .95
Classic Creutzfeldt-Jakob disease (CJD) ... 97
Implementing CJD Precautions ... 97
CJD Perioperative Precautions ... 98
Reference Guide Assessment Tool (Appendix A) ... 102
Environmental Cleaning/Sanitation ... 104
General Practices ... 104
Preliminary Cleaning... 106
Intraoperative Cleaning ... 106
End of Procedure Cleaning (Between Cases) ... 107
Terminal Cleaning ... 108
Weekly and /or Monthly Cleaning ... 108
Traffic Control ... 109
People ... 110
Supplies and Equipment ... 111
Dress Code ... 112
Patients ... 112
Visitors ... 112
Staff ... 113
Scrubbing, Gowning, Gloving ... 116
Scrubbing ... 116
Gowning ... 117
Gloving ... 118
Aseptic Technique ... 121
Establishing an Aseptic Environment ... 121
Establishing the Sterile Field ... 121
Dispensing Sterile Supplies ... 122
Maintaining the Sterile Field ... 123
Storage of Sterile Supplies ... 124
Instrument Management and Reprocessing ... 126
Intraoperative Instrument Care ... 126
Reprocessing Surgical Instruments ... 127
Loaned and Leased Surgical/Medical Equipment ... 129
Packaging for Sterilization ... 129
Rigid Sterilization Containers ... 131
Sterilization ... 132
Emergency (Flash) Sterilization ... 134
High Level Disinfection ... 135
Specialized Instruments and Equipment ... 140
Prosthesis Care and Handling... 140
Power Equipment Management ... 141
Single Use Medical Devices (SUMeDs) ... 142
Selection, care and handling of materials ... 143
Wrappers, Surgical Gowns, and Drapes ... 143
Bundles ... 145
Skin Preparation (Prep) ... 146
Draping ... 149
Dressing(s), Drain(s), Irrigation ... 150
Dressings ... 150
Drains ... 151
Irrigation ... 152
Section 3 Safety/Risk Prevention and Management Introduction to Risk Management ... 155
Risk Avoidance/Minimization ... 156
Patient Safety ... 160
Ambulatory Patient Care Recommendations ... 160
Patient Admission and Identification ... 163
Consent for Surgical Intervention ... 164
Surgical Site Verification ... 165
Surgical Pause/”Time Out” ... 166
Surgical Counts ... 167
Surgical Positions ... 178
Visitors to the Surgical Suite ... 184
Gathering Medicolegal Evidence in the Surgical Suite ... 185
Guidelines for Collection of Evidence: (Appendix E) ... 189
Specimen Management ... 190
Medication Management ... 193
Nursing Documentation ... 196
Electronic Health Records ... 201
Organ and Tissue Procurement Protocol ... 203
Team Safety ... 206
Credentialing ... 206
Occupational Health & Safety ... 207
Students/Preceptors ... 209
Orientation/In-service/Continuing Education ... 211
Environmental/Equipment Safety ... 212
Equipment Selection/Trialing... 221
Preventative Maintenance Programs ... 225
Risk Alerts/Recalls ... 225
Intra-operative Equipment Malfunction ... 226
Specialized Surgical Equipment ... 226
Electrosurgery (ESU) ... 226
Laser Safety and Administration ... 234
Minimally Invasive Surgical Equipment ... 242
Section 4 Environmental Hazards and Responsibilities Physical Hazards ... 250 Environmental Factors ... 250 Light ... 250 Noise ... 251 Ventilation ... 252 Electricity ... 254 Radiation ... 256 Fire/Explosion ... 260 Chemical Hazards ... 263 Anesthetic Agents ... 263
Sterilizing Agents - Ethylene Oxide ... 264
Other Sterilizing Agents/Disinfectants ... 264
Formaldehyde ... 265
Glutaraldehyde ... 265
Methyl Methacrylate ... 265
Drugs: Cytotoxic, Dyes, Pharmaceuticals ... 266
Waste Management ... 266
Infectious Waste ... 266
Latex Sensitivity/Allergy: Staff ... 268
Section 5 Nursing Care of the Anesthetised Patient Preoperative Considerations ... 273 Intraoperative Considerations ... 275 Postoperative Considerations ... 279 Local Anesthesia ... 281 Procedural Sedation/Analgesia ... 283
Intravenous Regional Anesthesia (Bier Block) ... 288
Regional Anesthesia-Spinal, Epidural, Peripheral Nerve Blocks ... 290
Herbal Remedies ... 292
Blood and Blood Products ... 294
Emergency Situations ... 296
Malignant Hyperthermia ... 296
Latex Allergy ... 298
Cardiac Arrest ... 300
Disseminated Intravascular Coagulation ... 302
Death ... 304
Glossary ... 307
Evaluation Form ... 332
FOREWORD
ORNAC was inaugurated in 1983, and by June 1986, the Standards Committee had developed “Standards for
Operating Room Nursing Practice”. Two years later, in 1988 “Recommended Technical Standards” were
published. This was a significant milestone for a young organization. The body of knowledge required in the specialty was defined as required by the Canadian Nurses Association to meet the requirements of a certification process.
The two documents were combined in a single issue in 1993 and also included a chapter on competencies. That issue was used as a primary resource for the development of the Canadian Nurses Association (CNA) Certification exam in Perioperative Nursing Practice.
The document continued to evolve with the 1998 edition, which reflected the movement towards ambulatory surgery.
The 2003 revision incorporated a major format change. This edition was re-designed into modules. The constant rapid change in healthcare requires a design that enables more consistent review/revision. ORNAC is a volunteer organization of committed perioperative Registered Nurses. Revision/review of modules is more easily facilitated on a continuous basis by these volunteers. According to the Canadian Nurses Association (CNA), a standard is a desired and achievable level of performance against which we can measure actual performance. Self regulating professions are characterized by standards of practice, based on the values of the profession. This document is meant to complement not replicate other standards in existence.
The 9th edition, 2009 revision was published in a bound format as a result of feedback and requests from
perioperative nurses across the country. A bound publication provides assurance that each and every copy contains all of the most current revisions. Committee energy was focused on the fourth and fifth sections of the publication. Minor revisions were made to the remaining sections based on questions the committee received through the ORNAC website.
For the current (10th edition) revision, the committee focused on Section 2, with minor revisions to the remaining sections.
It is the mandate of the Standards Committee to develop and review standards on an ongoing basis. Content
expertise has been provided by perioperative Registered Nurses across Canada and reflects current practice, research, and review of medical/surgical literature.
The Standards Committee has endeavoured to develop a “user-friendly” document that will serve as a guide and reference for perioperative Registered Nurses, health care facilities that care for surgical patients, and other professional associations. It is the responsibility of individual perioperative Registered Nurses and health care facilities to ensure that the most recent recommendations are being used.
Those who served as reviewers and validators are to be commended for a job well done. Thank-you to the ORNAC Board and Executive, and perioperative Registered Nurses from across the country for their assistance and to colleagues from other specialty areas who assisted us.
Notes:
1. The intended application of these standards, guidelines, and position statements, is for the perioperative environment. It is the responsibility of the users of this document to apply it in the context of their
individual setting respecting provincial/national and professional regulations and laws within each province and jurisdiction.
2. This document was developed from broad input of perioperative Registered Nurses and the final document represents consensus of the content. Consensus is defined as agreement in collective opinion and belief. Consensus is more than a simple majority, but not necessarily unanimity.
3. ORNAC standards, guidelines, and position statements are subject to periodic review.
4. “Shall” is used to express a requirement, i.e., a provision that the user is obliged to satisfy in order to comply with the standard, “should” is used to express a recommendation or that which is advised but not required, and “may” is used to express an option or that which is permissible within the limits of the standard.
Kathy Radcliffe RN, BSN, CPN(C) – Chair, Standards Committee, Ontario Loraine Best, RN, BSN, CPN(C) – British Columbia
Chris Downey RN, BScN, CPN(C), MSc, RNFA, CMLSO,– Ontario Cathy Ferguson RN, BScN, RNFA, CNOR, CPN(C) – Nova Scotia
Carol Knudson RN, BN – Manitoba
Rupinder Khotar RN, BScN, CPN(C) – British Columbia Kelly Kuz RN, BScN, MN, CPN(C) Alberta
Corenia Price RN, CPN(C), CMDRT – Newfoundland & Labrador Leah Restall RN - Manitoba
Anne Smith RN, – Prince Edward Island Cathy Timmons, RN – Nova Scotia Margot Walsh RN – Newfoundland & Labrador
1
A MESSAGE FROM THE PRESIDENT. . .
Promoting Excellence
Promouvoir l’Excellence
A MESSAGE FROM THE PRESIDENT…
On behalf of the Operating Room Nurses Association of Canada’s Board and Executive, it is my pleasure to preface the tenth edition of the ORNAC “Standards, Guidelines, and Position Statements for Perioperative Registered
Nursing Practice”. During the fall ORNAC strategic planning process, the executive, provincial and affiliate
representatives confirmed that the production and continuous review of the Standards is a strategic priority to support best practices in perioperative patient care. This edition represents the ongoing validation and revision of the
Standards, necessary to keep pace with the health care environment and maintain safe patient care.
As demonstrated by the ORNAC conceptual model, this document is the foundation of registered nursing practice in the perioperative setting and represents our professional practice to our colleagues. While the Standards have evolved since the first publication, ORNAC – Recommended Standards for Operating Room Nursing Practice, June 1986, the intent remains the same – to guide the delivery of safe patient care and perioperative registered nursing practice in Canada. The review and compilation of the Standards document is an enormous task coordinated by the volunteers of the ORNAC Standards committee. Their generous donation of time, knowledge and expertise to develop and inform this document is commendable.
The Operating Room Nurses Association of Canada is a professional organization dedicated to the promotion and advancement of excellence in perioperative practice. The
ORNAC “Standards, Guidelines, and Position Statements for Perioperative Registered Nursing Practice”
provides the vital reference to demonstrate to the public, government and other stakeholders that as a profession, perioperative registered nurses are dedicated to maintaining the public trust and to upholding standards for excellence in professional practice.
Bonnie McLeod, RN, BScN, MN, CPN(C)
Section 1
ORNAC Beliefs, Professional Standards and
Competencies
Section 1 ORNAC Beliefs, Professional Standards and Competencies Part A
ORNAC's Fundamental Principles and Position Statements ... 12
ORNAC Philosophy ... 13
ORNAC Mission, Values, Vision ... 14
National Standards for Perioperative Registered Nursing Practice ... 15
Conceptual Model for Perioperative Registered Nursing Practice ... 16
ORNAC Scope of Perioperative Registered Nursing Practice ... 17
Scope of Practice for Expanded Perioperative Nursing Practice ... 17
Scope of Practice for Advanced Perioperative Registered Nursing Practice ... 18
ORNAC Position Statements a) Staffing the Surgical Suite... 19
b) Perioperative Certification ... 21
c) Perioperative Nursing Experience in Basic Nursing Education Programs ... 22
d) Environmental Responsibility ... 24
e) Perioperative Registered Nurses are Essential to Quality Care in the Operating Room ... 24
f) The Perioperative Registered Nurses’ Role in Primary Healthcare ... 25
Safe Surgery Saves Lives ... 26
Part B Standards for Perioperative Registered Nursing Practice ... 28
Professional Standards ... 29
Professional Standards for Perioperative Registered Nurses ... 30
Professional Standards for Perioperative Registered Nurse Managers ... 39
Professional Standards for Perioperative Registered Nurse Educators ... 41
Professional Standards for Expanded Practice Perioperative Registered Nurses ... 43
Professional Standards for Perioperative Registered Nurse Researchers ... 45
Professional Standards for Advanced Practice Perioperative Registered Nurses ... 48
Part C Competencies for Perioperative Registered Nursing Practice ... 50
Purpose ... 51
Knowledge and Skills Expected of the Perioperative Registered Nurse Prior to Entering the Specialty of Perioperative Nursing ... 52
Characteristics of Each Competency ... 53
Competencies of the Perioperative Registered Nurse ... 53
Competencies of the Perioperative Registered Nurse Manager ... 59
Competencies of the Perioperative Registered Nurse Educator ... 67
Competencies of the Advanced Practice Perioperative Registered Nurse ... 73
Competencies for Expanded Practice Perioperative Registered Nurses Registered Nurse First Assist (Appendix A) ... 75
Part A
ORNAC'S FUNDAMENTAL PRINCIPLES
AND POSITION STATEMENTS
The Operating Room Nurses Association of Canada (ORNAC) is an organization of professional perioperative Registered Nurses dedicated to the promotion of excellence in perioperative nursing.
ORNAC serves as a spokesperson for perioperative Registered Nurses on issues affecting Registered Nurses, nursing practice, patient care, and societal needs/ expectations.
We believe:
Perioperative nursing is a dynamic process guided by theoretical knowledge, ethical principles, research, specialized clinical skills, and caring practice.
Perioperative Registered Nurses respond to complex and changing clinical needs during a crucial period of a person’s surgical experience.
The scope of perioperative nursing practice is continually evolving as Registered Nurses respond to societal and technological changes.
Standards of nursing practice, as well as collegial and interdisciplinary collaboration, enhance perioperative nursing practice.
People are unique individuals whose needs change and may be compromised during the
perioperative experience. They have a right to high-quality health care that promotes informed and responsible decision making.
Health encompasses the whole being and is influenced by one's environment. Using a wellness approach, individuals and communities shall be proactive and responsible for achieving optimal health.
Education is an ongoing life-long process and perioperative Registered Nurses are responsible for their learning. ORNAC is committed to enabling perioperative Registered Nurses to meet this responsibility.
The introduction to perioperative nursing should be a component of the basic nursing curriculum. To fully practice the scope of perioperative nursing, the Registered Nurse needs to acquire additional knowledge and clinical skills.
ORNAC’s Motto “Promoting Excellence” demonstrates commitment to meeting the needs of its members and society.
Approved by Board and Executive: April 1994
Revised: May 2003, June 2007, February 2009, March 2011
The Operating Room Nurses Association of Canada (ORNAC) is a professional organization of perioperative Registered Nurses dedicated to:
The promotion and advancement of excellence in the provision of perioperative care to our patients.
The professional growth, competence and personal enhancement of perioperative Registered Nurses.
The ongoing development of Standards, Guidelines and Position Statements for Perioperative Registered Nursing Practice
The promotion and advancement of perioperative nursing practice at a regional, provincial and national level through political activity.
Vision Statement
The Operating Room Nurses Association of Canada (ORNAC) is a strong, unified national association that enhances and advances the practice of perioperative Registered Nurses.
Values reflect the basic beliefs that are most important to the Operating Room Nurses Association of Canada (ORNAC):
KNOWLEDGE We recognize and are committed to education and research which are essential
components guiding our practice.
We promote and demonstrate critical thinking skills in the delivery of perioperative nursing care.
RESPECT We recognize the worth, quality, diversity, and importance of the patients we care for,
and of each other.
PROFESSIONALISM We promote and continually develop our unique specialized body of knowledge.
Weencourage all perioperative Registered Nurses to become certified through the Canadian Nurses Association (CNA).
We collaborate with nurses, organizations /agencies, other disciplines and medical industries that impact our practice.
We are responsible and accountable for our actions and decision-making. We comply with the Canadian Nurses Association (CNA) Code of Ethics.
CONTINUOUS QUALITY We strive to achieve excellence in perioperative practice, and the activities
influencing our Association.
Mission Statement
LEADERSHIP We are role models who communicate a vision andwho empower others to achieve perioperative nursing excellence.
PATIENT ADVOCACY We promote the perioperative patient’s right to be informed and to
make autonomous decisions regarding their care.
We strive to protect the rights, health and safety of the patient throughout the perioperative experience.
STEWARDSHIP We strive to be fiscally and environmentally responsible while optimizing patient
outcomes.
National Standards for Perioperative Registered Nursing Practice
ORNACholds the following beliefs regarding standards:
The implementation of standards contributes to the continued improvement of safe patient care and perioperative registered nursing practice in Canada.
Standards assist the perioperative Registered Nurse in attaining and maintaining competence in the performance of quality patient care.
Standards define safety measures for patients and the health care team.
Standards provide a baseline and tool for measurement when evaluating perioperative registered nursing practice.
Standards are an integral part of a facility's quality assurance and improvement program.
Standards provide a consistent reference base for programs such as orientation, in-service, continuing education, research, and formal perioperative post basic education programs.
Standards are the benchmark from which the perioperative Registered Nurse Manager and Educator provide the structure, resources, and environment for the health care team.
CONCEPTUAL MODEL FOR
PERIOPERATIVE REGISTERED NURSING PRACTICE
The conceptual model provides direction for perioperative registered nursing practice. The surgical patient is the focus of perioperative registered nursing practice, which has as its’ foundation professional and clinical standards, and competencies.
The professional standards provide guidelines for the perioperative Registered Nurse on which to base decisions in
such areas as ethics, legal aspects, and professional conduct. The competency statements reaffirm that perioperative Registered Nurses are responsible and accountable for the
nursing care of the surgical patient during the perioperative phase.
In order to implement the standards and develop competence, the perioperative Registered Nurse shall be cognizant of the qualities necessary to become a Registered Nurse. Competence integrates the characteristics of knowledge, clinical and ethical decision-making, communication skills, psychomotor skills, safety, accountability, responsibility, team organization, continuing education, and leadership skills. The perioperative Registered Nurse is guided in the clinical area by these characteristics in order to function both independently and in collaboration with other members of the health care team.
The clinical standards provide a basis for consistent, uniform, and acceptable outcomes of nursing practice. The perioperative Registered Nurse is systematically guided through the perioperative phase. The clinical standards are the benchmarks for quality improvement.
The standards are implemented during the immediate preoperative, intraoperative, and immediate postoperative phases of the surgical patient's experience. Administration and management provide support, direction, leadership, resources, and commitment to the practice of these standards.
ORNAC Scope of Practice for Perioperative Registered Nurses
The Scope of Perioperative Registered Nursing Practice is a continuum of nursing activities that focuses on identifying and meeting the individual needs of the surgical patient throughout the perioperative experience. This nursing practice occurs in, but is not limited to operating rooms, ambulatory care settings, clinics, and physician’s offices.
The perioperative Registered Nurse provides excellent care to the surgical population using critical thinking skills guided by the ORNAC Standards, Guidelines and Position Statements for Perioperative Registered Nursing Practice and provincial legislation. Basic and expanded nursing knowledge is used to address the physiological, psychological, socio-cultural, and spiritual responses of the patient to the surgical event.
The perioperative Registered Nurse possesses the knowledge, skills and abilities to provide quality care for all perioperative patients.
Working in collaboration with the health care team, the perioperative Registered Nurse performs skills supported by perioperative nursing education and evidence-based research within the boundaries of the health care facility’s policies and procedures.
The perioperative Registered Nurse precepts and mentors colleagues.
BIBLIOGRAPHY
Canadian Nurses Association (2007). CNA joint position statement Promoting Continuing Competence for the Registered Nurse. Ottawa: Author.
International Council of Nurses (R2007). The ICN position statement on Ethical Nurse Recruitment. Geneva: Author.
Watson D. S. (2008). Patient Safety, an Issue of Perioperative Nursing Clinics. Toronto: Elsevier.
Registered Nurse Anesthesia Assistant- RNAA
The experienced perioperative Registered Nurse, with additional education, knowledge and skills in anesthesia assists the anesthesiologist to facilitate quality care of patients undergoing anesthetic procedures. The increasing complexity of patient condition and anesthetic procedures provides the perioperative Registered Nurse who has expanded perioperative nursing education with the opportunity to practice in collaboration with and under the direction of the anesthesiologist. The scope of practice of the Registered Nurse Anesthesia Assistant is part of perioperative nursing practice and encompasses the preoperative, intraoperative, and postoperative phases of the anesthetic experience.
BIBLIOGRAPHY
Nagelhout, J. J. & Plaus, K. (2010). Nurse Anesthesia (4th ed.). Toronto: Elsevier/Mosby.
Registered Nurse First Assistant - RNFA
The experienced perioperative Registered Nurse, with additional education, knowledge and skills in surgery assists the surgeon to facilitate quality care of patients undergoing surgical procedures. The increasing complexity of patient conditions, diagnoses, and surgical procedures provides the perioperative Registered Nurse who has expanded perioperative nursing education with the opportunity to practice in collaboration with and under the direction of the surgeon. The scope of practice of the RNFA is part of perioperative nursing practice and encompasses the
preoperative, intraoperative, and postoperative phases of the surgical experience.
BIBLIOGRAPHY
Schroeder, J. L. (2008). Acute Care Practitioner: An Advanced Practice Role for RN First Assistants. AORN, 87(6), 1205-1215.
The scope of Advanced Nursing Practice focuses on a specialty clinical service (i.e. Perioperative), providing support to clients and the healthcare team, as a consultant, researcher, administrator, educator, and clinical practitioner. Advanced Practice Nurses include Nurses Practitioners (NP) and
Clinical Nurse Specialists (CNS).
BIBLIOGRAPHY
Canadian Nurses Association. (2008). Advanced Nursing Practice: A National Framework. Ottawa: Author. Canadian Nurses Association. (2008). Nursing Leadership: Do We Have a Global Social Responsibility. Ottawa: Author.
Canadian Nurses Association (2008). Advanced Nursing Practice A National Framework. Ottawa: Author. Girard, N. J. (2009). Leadership an Issue of Perioperative Nursing Clinics. Toronto: Elsevier/Mosby. MacDonald, M., Schreiber, R. & Davis, L. (2005). Exploring New Roles for Advanced Nursing Practice, A Discussion Paper. Ottawa: CNA.
ORNAC POSITION STATEMENTS
STAFFING THE SURGICAL SUITE
For the patient undergoing surgical intervention, one of the most critical periods of care occurs in the operating room theatre.
Every patient has a right to an optimal level of nursing care, and each facility has the responsibility to provide appropriate staffing in order to:
Meet individual patient's needs and surgical complexity.
Maintain acceptable levels of safety for patients, personnel and physicians.
Function within legal limitations of the provincial scope of practice.
Facilitate appropriate initial and specialty orientation, and continuing education.
Attain and maintain perioperative Registered Nurse competency.
Each surgical patient care encounter occurs in an environment where each individual theatre is a specific unit of care that shall be staffed independently with the staffing levels as defined.
To promote excellence in perioperative nursing care, the position of the Operating Room Nurses Association of Canada (ORNAC) is:
The surgical patient in each theatre shall be under the direct supervision of an appropriately experienced perioperative Registered Nurse who is physically present in each theatre, and who is immediately available, i.e. Circulating Role to respond to unstable, unpredictable and emergency situations.
That in order to maintain competency in the circulating role, the perioperative Registered Nurse shall be competent in the scrub role.
Each case or surgical procedure shall be staffed by a minimum of two perioperative professional nurses competent within their scope of practice. The circulating role shall be assigned only to a perioperative Registered Nurse. The scrub role may be filled by another healthcare professional. A second perioperative Registered Nurse shall be immediately available within the surgical suite. It may be necessary for additional circulating perioperative Registered Nurses and competent healthcare personnel to be present in the theatre to provide care within their scope of practice or job description. Only a perioperative Registered Nurse may relieve the circulating Registered Nurse for coffee, lunch, or other duties.
Each procedure or case shall be staffed with a minimum of one perioperative Registered Nurse and a second perioperative Registered Nurse immediately available.
Documentation shall include all personnel in attendance and clearly identify who provided direct patient care.
BIBLIOGRAPHY
Bull, R. & FitzGerald, M. (2006). Research Paper, Nursing in a technological environment: Nursing care in the operating room, International Journal of Nursing Practice, 12, 3-7.
Canadian Health Services Research Foundation (CHSRF), (2006). Staffing for Safety: A Synthesis of the Evidence on Nurse Staffing and Patient Safety, CHSRF, Ottawa, ON retrieved March 29, 2009 from www.chsrf.ca
Canadian Health Services Research Foundation (CHSRF), (2006). Evidence Boost Implement nurse staffing plans for better quality of care, The Problem: Current nurse staffing strategies are not adequate to improve patient safety, CHRSF, Ottawa: Author.
Canadian Nurses Association. (2007). C NA Policy Brief # 2, Meeting Future Health-Care Needs Through Innovations to Nursing Education. Ottawa: Author.
Canadian Nurses Association. (2006). CNA joint Position Statement, Practice Environments: Maximizing Client, Nurse and patient Outcomes. Ottawa: Author.
Canadian Nurses Association. (2005). CNA Position Statement Interprofessional Collaboration. Ottawa: Author. Canadian Nurses Association (CNA), (2005). Evaluation Framework to Determine the Impact of Nursing Staff Mix Decisions. Ottawa: Author.
Canadian Nurses Association. (2003). Patient Safety: Developing the Right Staff Mix, Report of the Think Tank. Ottawa: Author.
Craddick, S. (2009). Quality Indicators, An Issue of Perioperative Clinics. Toronto: Elsevier/Mosby Garrett, C. (2008). Effective Nurse Staffing Patterns on Medical Errors and Nurse Burnout. AORN, 87(6), 1191-1204.
International Council of Nurses, (ICN). (2008). Nurse Retention & Migration. Geneva: Author
Springer, P. J., Corbett, C. & Davis, N. (2006). Enhancing Evidence-based Practice through Collaboration, The Journal of Nursing Administration, 36(11), 534-537.
PERIOPERATIVE CERTIFICATION
The certification program for perioperative Registered Nurses was established in 1995 by Canadian Nurses
Association (CNA) in collaboration with Operating Room Nurses Association of Canada (ORNAC), whose motto is “Promoting Excellence”.
The certification exam measures the knowledge, skills, abilities, attitudes, and judgments in specific competency areas required of perioperative Registered Nurses in Canada.
The mission of ORNAC includes the promotion and advancement of excellence in perioperative patient care, and the professional and personal enhancement of perioperative Registered Nurses. One of the objectives of the Canadian Nurses Association is to promote high standards of registered nursing practice in specialty areas in order to promote quality nursing care in Canada. Certification confirms this pursuit for quality and excellence.
ORNAC supports the CNA certification/ recertification program and recommends that perioperative Registered Nurses in perioperative nursing practice write the certification exam and earn the national credential of Certified Perioperative Nurse (Canada) CPN(C), in order to:
promote high standards of perioperative nursing practice for optimal patient care;
validate competency in perioperative nursing;
meet national standards in perioperative nursing;
confirm commitment to nursing excellence and personal achievement;
confirm professional accountability for continuing education;
promote risk management principles; (CNA, 2006, p. 108)
enhance qualifications;
maintain accountability to the public; and
provide a nationally recognizable level of competency to the employer.
REFERENCES
PERIOPERATIVE NURSING EXPERIENCE IN BASIC REGISTERED
NURSING EDUCATION PROGRAMS
The Operating Room Nurses Association of Canada (ORNAC) believes that perioperative clinical experience is the primary means by which student nurses attain knowledge and skills in the management of care for the surgical patient.
Whereas the Canadian Nurses Association (CNA) has an ideal opportunity to influence future changes in basic nursing education, and whereas consistency in the basic preparation of nurses is desirable, ORNAC recommends CNA endorse the perioperative experience as an integral component of basic nursing education.
Perioperative registered nursing practice encompasses professional and clinical nursing activities, which focus on identifying and meeting the needs of the surgical patient while applying the nursing process. The perioperative Registered Nurse performs in a collaborative role with other members of the health care team.
Learning Assumptions
The student nurse gains experience in the perioperative setting as a member of the multidisciplinary team through the use of a conceptual model, the nursing process, and standards of perioperative nursing practice.
The surgical suite provides the best environment for learning perioperative registered nursing practice.
The theory and clinical experiences are best retained when the student can immediately apply what has been taught. Active participation is the most effective method of teaching and learning.
Advantages of Perioperative Experience
1. For the Student
Students gain knowledge and skills through their perioperative experience. Advantages include, but are not limited to:
1.1 Participating in the active management of surgical patients during the preoperative, intraoperative and immediate postoperative phases;
1.2 Developing confidence and assertiveness in the ability to make decisions regarding the care of the surgical patient;
1.3 Improving observational and organizational skills by practicing in an environment where activities shall be performed quickly and accurately;
1.4 Developing critical-thinking skills through the identification of priorities and the organization of patient care;
1.5 Developing collaborative working relationships within the perioperative environment; 1.6 Communicating effectively with patients and members of the health care team; 1.7 Developing and enhancing leadership skills;
1.8 Developing specialized clinical skills;
1.10 Increasing knowledge of anatomy and pathophysiology by observing the surgical intervention;
1.11 Recognizing how the surgical intervention impacts postoperative care and recovery;
1.12 Recognizing the legal and ethical responsibilities and accountability of the perioperative Registered Nurse and other health care team members; and
1.13 Developing the role of patient advocate.
2. For the Patient
Patients benefit from the knowledge and skills that the student nurse gains from experience in the surgical suite. Advantages include but are not limited to:
2.1 Higher quality of care;
2.2 Decreased preoperative and postoperative apprehension, discomfort, and stress due to the Registered Nurse's understanding, empathetic approach, and confidence;
2.3 Improved education for the surgical patient and family due to the Registered Nurse’s increased knowledge base; and
2.4 Reduced risk of infection through improved aseptic technique.
3. For the Employing Agency
The employing agency will benefit from the student’s perioperative nursing experience due to their increased understanding of effects of surgical intervention. Advantages include but are not limited to:
3.1 Increased interest in perioperative nursing after graduation, thereby enhancing recruitment and retention strategies;
3.2 Increased knowledge and ability to provide comprehensive care to a wider range of patients; 3.3 Increased understanding of legal issues related to surgical interventions e.g., informed
consent, surgical counts;
3.4 Experience functioning as members of the surgical multidisciplinary team;
3.5 Improved communication between departments, health care facilities and schools of
nursing; and
ENVIRONMENTAL RESPONSIBILITY
The Operating Room Nurses Association of Canada (ORNAC) supports the environmental responsibility principles
of Reduce, Reuse, Recycle, Recover, and Re-educate.
Perioperative Registered Nurses should participate in and support waste management programs and waste reduction initiatives. We must be influential in setting standards and effecting change through environmental awareness within surgical suites, health care facilities, with medical suppliers, and on a professional level. In addition, ORNAC supports compliance with applicable federal, provincial, and municipal government regulations regarding environmental protection issues.
BIBLIOGRAPHY
Canadian Council of Ministers of the Environment (CCME). (1992). Guidelines for the Management of Biomedical Waste in Canada. www.ccme.ca
Canadian Nurses Association. (2008). Role of Nurse in Addressing Climate Changes. Ottawa: Author. Canadian Standards Association (CSA) Standard, CAN/CSA-Z317.10-01 (R2006). Handling of Waste Materials in Health Care Facilities & Veterinary Health Care Facilities. Toronto: Author. www.csa.ca
Joint Canadian Nurses Association (CNA)/Canadian Medical Association (CMA) (2000). Position Statement – Environmentally Responsible Activity in theHealth Sector.
PERIOPERATIVE REGISTERED NURSES ARE ESSENTIAL TO
QUALITY PATIENT CARE IN THE OPERATING ROOM
The scope of Perioperative Registered Nursing practice is a continuum ranging from a novice to an expert level of professional nursing that focuses on identifying and meeting the individual needs of the surgical patient,
preoperatively, intraoperatively, and immediately postoperatively. Perioperative Registered Nurses are:
professionally responsible and accountable for their practice
coordinators of patient care
leaders and educators in the health care field
cost effective (multi-skilled and cross trained)
patient and family advocates
risk managers (protect the patient, personnel, and the environment)
health promoters
Perioperative Registered Nurses have:
critical-thinking skills
a broad knowledge of human and natural sciences
specialized surgical nursing knowledge including anatomy, physiology/ pathophysiology, pharmacology, aseptic technique and assessment skills
a certification process (examination established by the Canadian Nurses Association)
a Code of Ethics through the Canadian Nurses Association which guides nursing practice Perioperative Registered Nurses:
establish respectful, trusting, therapeutic relationships with patients and their families
use the nursing process to direct care
use evidence based practice in the provision of nursing care
assume new responsibilities in response to the changing needs of patients
work independently and collaboratively to provide focused care
recognize that all surgery is a major life event for each patient
define and direct their practice (Scope of Practice)
articulate their roles and expectations as defined by the standards for perioperative Registered Nursing practice
develop and implement policies and protocols to provide safe patient care
establish professional working relationships with members of the multidisciplinary team
coordinate multidisciplinary team activities
care for patients with both predictable and unpredictable outcomes. Perioperative Registered Nurses will:
develop professionally in response to the changing needs of patients, the health care systems and society.
BIBLIOGRAPHY
Canadian Nurses Association. (2006). Nursing Information and Knowledge Management. Ottawa: Author.
Canadian Nurses Association. (2004). Nurses and Patient Safety: A Discussion Paper CNA & Univ. of Toronto Nrsg. Ottawa: Author.
Keegan-Doody, M. (2007, June). Walk or be driven? Canadian Operating Room Nursing Journal, 25 (2), 30, 31, 33-35.
THE PERIOPERATIVE REGISTERED NURSES’ ROLE IN PRIMARY
HEALTH CARE
The Operating Room Nurses Association of Canada (ORNAC) supports the Canadian Nurses Association’s beliefs that Registered Nurses have a key role in making primary health care a reality in our country.
While perioperative Registered Nurses have traditionally not been involved in the provision of initial health care services, a clinical aspect of perioperative nursing practice is broadening in scope within the preoperative,
intraoperative and immediate postoperative patient care. This provides the opportunity for more patient and family contact. Within this scope, perioperative Registered Nurses are able to perform direct patient care, teach and educate patients, family, health care personnel and as well the community. Perioperative Registered Nurses support and/or perform research and supervise/manage health care services.
Examples of the perioperative Registered Nurse as a primary health care provider are evident in the promotion of:
Healthy lifestyle choices that may prevent possible surgical intervention
Participation in health and wellness-related organizations so that activities can be proactive instead of reactive.
Surveillance of disease conditions, recurrent operative procedures and patients requiring infection control follow-up.
Health education to patients, students and the public:
- Perioperative assessment clinics and/or admission to the operating room suite - Nurse educators and staff to teach students and/other health care team members - Promotion of events such as “National Perioperative Nurses Day”
Collaboration with other primary health care personnel in providing patient care.
Effectiveness of services through Quality Improvement Programs with particular emphasis on the effect of such services on primary health care.
BIBLIOGRAPHY
Canadian Nurses Association. (2005). Unregulated Health Workers A Canadian and Global Perspective, A Discussion Paper. Ottawa: Author.
Canadian Nurses Association. (2005). National Planning for Human Health Resources in the Health Sector. Ottawa: Author.
Canadian Nurses Association. (2005). Nursing Now Issues and Trends in Canadian Nursing, Nursing Staff Mix: A Key Link to Patient Safety. CNA, 19,Ottawa: Author.
SAFE SURGERY SAVES LIVES:
SURGICAL SAFETY CHECKLIST
The Operating Room Nurses Association of Canada (ORNAC) endorses the global efforts to enhance the safety of surgical procedures, to protect patients from harm and ultimately, to save lives. ORNAC is committed to assisting perioperative Registered Nurses in providing the safest care for each surgical patient.
ORNAC is aware of the World Health Organization’s (WHO) work to assist in the provision of safe surgery for all patients. The second Global Patient Safety Challenge: “Safe Surgery Saves Lives” is a campaign established by the WHO ‘World Alliance for Patient Safety’ to improve the safety of all surgeries. The goal established was to define global safety standards, which could be applied in all perioperative settings. An International team met in Geneva, January 2008 and created the WHO Surgical Safety Checklist. The WHO Surgical Safety Checklist was launched in North America in June 2008, with prior endorsement of many organizations including the Canadian Anesthesiology Society, Canadian Medical Association, Canadian Nurses Association, International Federation of Perioperative Nurses, Royal College of Physicians and Surgeons of Canada, and the Operating Room Nurses Association of Canada.
Toronto General Hospital, University Health Network, was one of the eight global pilot sites for the implementation of the Checklist. There was a significant reduction in deaths and complications for lower income sites using the checklist, and also a reduction in deaths and complications in higher income sites. When surgeons were asked if they would want the checklist used if they were having surgery, nearly 100% of them reported that they would. The research results can be reviewed in the issue of the New England Journal of Medicine identified below.
The WHO Surgical Safety Checklist was designed as a template for facility adaption. The Canadian Patient Safety Institute facilitated a working group that adapted the WHO Surgical Safety Checklist to meet the Canadian healthcare context. The Canadian adaption was formally launched at a national meeting in Toronto on March 4, 2009. ORNAC has been represented at each of these activities.
ORNAC strongly encourages all perioperative Registered Nurses to use a Surgical Safety Checklist for every patient with every surgical procedure.
BIBLIOGRAPHY
Haynes AB, Weiser TG, Berry, WR, et al (2009). A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. New England Journal of Medicine, 360 (5), 491-497.
http://content.nejm.org/cgi/content/full/NEJMsa0810119
RESOURCES
www.patientsafetyinstitute.ca www.ornac.ca www.safesurgerysaveslives.ca www.who.int/safesurgeryPart B
STANDARDS
FOR
STAND
PROFESSIONAL STANDARDS
STANDARD 1: Perioperative Registered Nursing Practice Requires Knowledge From Nursing, The Sciences, And The Humanities.
STANDARD 2: Perioperative Registered Nursing Practice Requires The Effective Use Of The Nursing Process For Clinical Decision-Making.
STANDARD 3: Perioperative Registered Nursing Practice Requires Perioperative Registered Nurses To Be Professionally Responsible And Accountable.
STANDARD 4: Perioperative Registered Nursing Practice Requires That A Specific Perioperative
Registered Nurses(s) (Specialty Service Team Leader) Shall Be Assigned and Accountable For A Specific Service Or Service Areas, Theatre(s), And/or Coordination Of
Multidisciplinary Team Members In The Provision Of Patient Care.
STANDARD 5: Perioperative Registered Nursing Practice Requires That The Perioperative Registered Nurse Manager Coordinates The Direction And Availability Of Resources At A Departmental Level.
STANDARD 6: Perioperative Registered Nursing Practice Requires That The Perioperative Registered Nurse Educator Facilitates And Supports The Role Of The Perioperative Team. STANDARD 7: Perioperative Registered Nursing Practice Requires That The Expanded Practice
Perioperative Registered Nurse Facilitates And Supports The Role Of The Perioperative Team and the Perioperative Client.
STANDARD 8: Perioperative Registered Nursing Practice Requires That Perioperative Registered Nurses Facilitate, Conduct and Support Research.
STANDARD 9: Perioperative Registered Nursing Practice Requires that the Advanced Practice Nurse (Perioperative) Facilitates and Supports the Perioperative Health Needs of Client and the Healthcare Team.
PROFESSIONAL STANDARDS FOR PERIOPERATIVE
REGISTERED NURSES
STANDARD 1: Perioperative Registered Nursing Practice Requires Knowledge From Nursing, The Sciences, And The Humanities.
KNOWLEDGE
1.1
Perioperative registered nursing practice requires the use of a conceptual model to
give direction for nursing practice.
The perioperative Registered Nurse shall practice in a manner that:
1.1.1 demonstrates knowledge, adheres to and promotes the mission, vision, values, philosophy, objectives, goals, policies and procedures of the organization, while providing patient care;
1.1.2 accomplishes goals consistent with professional perioperative registered nursing standards. Thesegoals shallcontribute to the overall goals of the health care team;
1.1.3 demonstrates knowledge of the health care facilities and surgical suite's organizational charts;
1.1.4 demonstrates knowledge of position description, scope of practice and limitations for surgical suite personnel;
1.1.5 participates in the formulation and revision of surgical suite goals, objectives, policies and procedures; 1.1.6 ensures a caring, compassionate, and respectful approach is used in meeting the needs and concerns of the
patient and family/significant others;
1.1.7 provides specific care relatingto the probable origin of the patient's actual or potential health problem; 1.1.8 improves or maintainsthe well-being of the patient applying consistency throughout the surgical intervention;
1.1.9 promotes and supports the role of the perioperative Registered Nurse; 1.1.10 helps create a respectful environment that minimizes stress and anxiety;
1.1.11 identifies priority nursing diagnoses through a complete perioperative nursing assessment of the patient;
1.1.12 identifies appropriate nursing interventions specific to individual patients requiring surgical intervention;
1.1.13 evaluates and supports the expected outcomes for the perioperative patient;
1.1.14 promotesthe concept of self-care for the perioperative patient; 1.1.15 is based on knowledge of perioperative policies and procedures;
1.1.16 promotes and participates in orientation of staff, continuing education and maintenance of competence;
1.1.17 promotes and facilitates communication among all members of the health care team;
1.1.18 communicates and collaborates with management to promote and facilitate a progressive surgical suite consistent with professional nursing standards, ORNAC standards and delivery of quality patient services; and
1.1.19 exhibits clinical, operational, organizational and leadership skills to facilitate achievement of the surgical suite’s mission, vision, values, philosophy, objectives, and goals in the delivery of safe patient care.
1.2
Perioperative registered nursing practice requires a base of knowledge, skills, and
competencies that are current and practical for meeting the needs of the surgical
patient.
The perioperative Registered Nurse shall practice in a manner that:
1.2.1 uses current and accepted rationale when implementing nursing actions designed to meet the individual needs of the surgical patient;
1.2.2 consistently applies the principles of Standard Precautions and additional precautions in reducing the risk of infection to patients and the health care team;
1.2.3 consistently applies the principles of aseptic technique to reduce the potential risk of infection to the patient and health care team;
1.2.4 consistently applies safety measures and risk management strategies for all patients and the health care team;
1.2.5 implements, promotes, and facilitates the scrub, circulating, education, research, leadership roles, as well as Registered Nurse First Assist (RNFA) and other expanded roles of the perioperative Registered Nurse; 1.2.6 complies with legal and professional requirements toparticipate in, implement, and maintain a safety and
risk management program that protects the patient and health care team from adverse consequences; 1.2.7 uses and manages human, material, and financial resources effectively;
1.2.8 values, initiates, promotes and participates in ethically approved research projects that are designed to improve and/or evaluate patient care;
1.2.9 promotes change in nursing practice to strive for the best patient outcome based on the results of such research;
1.2.10 consistently demonstrates competency in perioperative Registered Nursing practice progressing toward expert levels;
1.2.11 exemplifies the perioperative Registered Nurse as a role model, preceptor and mentor;
1.2.13 actively pursues, contributes to, plans, and organizes educational activities that maintain current
perioperative nursing practice levels consistent with professional nursing standards and ORNAC Standards, Guidelines, and Position Statements For Perioperative Registered Nursing Practice;
1.2.14 incorporates reflective practice;
1.2.15 strives to advance the image of the perioperative Registered Nurse with competent and progressive clinical, educational, research, leadership and administrative skills;
1.2.16 uses appropriate and professional communication skills (i.e., written, electronic, verbal, and non-verbal) for the benefit of the patient, health care team, and health care facility; and
1.2.17 actively participates in collaborative practice utilizing positive reinforcement and constructive feedback among the health care team and self-evaluation.
STANDARD 2: Perioperative Registered Nursing Practice Requires The Effective Use Of The
Nursing Process For Clinical Decision-Making
CLINICAL DECISION-MAKING
2.1
Perioperative Registered Nurses are required to collect data during the
perioperative period.
The perioperative Registered Nurse shall practice in a manner that:
2.1.1 includes a preoperative assessment prior to surgery through a systematic collection of data using appropriate sources, including patient, family, significant others, physicians, unit nurses, and other health care team members;
2.1.2 uses appropriate techniques for data collection including interview, consultation, observation, and relevant health record review;
2.1.3 encourages the patient to confirm the assessment, allowing time toidentify and discuss concerns and expectations relative to the impending surgery and care;
2.1.4 provides information, resources, and/or other personnel to assist the patient/ legal designate in making informed decisions and addressing concerns;
2.1.5 uses detailed assessment, intuitive, and observation skills to obtain information when the patient is unable to participate and family/legal designate are not available;
2.1.6 encourages the expression of individual diversity regarding culture, race, age, sexual orientation, gender, beliefs and values; and
2.1.7 respects patient’s and/or family's/significant others, or legal designate’s wishes i.e., a living will, power of attorney, and personal care directives.
2.2
Perioperative Registered Nurses are required to analyze data collected in
accordance with the goals of perioperative registered nursing practice and
knowledge from related fields.
The perioperative Registered Nurse shall practice in a manner that:
2.2.1 effectively integrates and utilizes all data collected by the health care team to reduce redundant and
repetitive practices of questioning and review;
2.2.2 validates the assessment with the patient, and/or others as required to facilitate interpretation of the data collected;
2.2.3 reassures the patient that the surgical team will analyze data and determine/identify actual and potential problems;
2.2.4 communicates relevant data to the patient and appropriate others regarding identified actual and/or potential problems; and
2.2.5 identifies and records specific nursing diagnoses and observations that define individual needs of the patient.
2.3
Perioperative Registered Nurses are required to plan their nursing actions based
upon the identified actual and/or potential problems.
The perioperative Registered Nurse shall practice in a manner that:
2.3.1 identifies and establishes priorities of patient care based on the preoperative assessment and nursing diagnosis related to actual and/or potential health problems recognizing the patient’s individual diversities; 2.3.2 selects appropriate nursing actions based on the identified needs of the patient;
2.3.3 assists in identifying and reducing risk factors, actual or potential, that may compromise the patient, the health care team, and the health care facility;
2.3.4 affirms the patient's readiness and willingness for the surgical intervention;
2.3.5 strives to provide environmental conditions that are conducive to positive patient outcomes; 2.3.6 strives to provide the required staffing and material resources for the specific patient needs;
2.3.7 communicates the plan of care to the patient, specified family members/designate, and the health care team; and
2.3.8 provides a mechanism for, and actively participates in communication and problem solving with the patient, family/legal designate, and the health care team.
2.4
Perioperative Registered Nurses are required to perform nursing actions, which
implement
the nursing care plan.
The perioperative Registered Nurse shall practice in a manner that:
2.4.1 encourages patient and family/significant other’s participation in implementation of nursing actions, recognizing their individual diversities;
2.4.2 presentsa competent, professional and caring approach, which includes identifying themselves, their role and responsibilities throughoutthe perioperative experience;
2.4.3 assists the patient to anticipate and understand steps in the care provided;
2.4.4 demonstrates responsibility, and accountability in implementing the nursing plan of care;
2.4.5 appropriately communicates nursing assessments, care activities, and interventions to the health care team; 2.4.6 appropriately delegates patient care activities to thehealth care team within their scope of practice and job
description;
2.4.7 effectively uses the appropriate human and material resources for patient care;
2.4.8 provides optimal care by adjustingthe surgical theatre environment to meet the specific patient needs; 2.4.9 effectively communicates nursing interventions to the patient and/or family/legal designate;
2.4.10 consistently applies knowledge, and uses skills, competencies, and safety measures;
2.4.11 assists the anesthesiologist in providing patient care consistent with the knowledge, competencies, and skills of the perioperative Registered Nurse;
2.4.12 provides psychological and physical support to the patient during local anesthesia and conscious sedation; 2.4.13 monitors and accurately documents patient parameters during local anesthesia and in procedures when an
anesthesiologist is not present;
2.4.14 assists, facilitates, and supports the surgical team's activities throughout the perioperative experience; 2.4.15 provides appropriate response to emergency situations;
2.4.16 maintains accurate, legible, timely and complete documentation, using only accepted abbreviations of the
health care facility; and
2.4.17 contributes to and maintains a communication network that facilitates a progressive, integrated, successful, positive, and safe work environment.
2.5
Perioperative Registered Nurses are required to evaluate all steps of the nursing
process.
The perioperative Registered Nurse shall practice in a manner that: 2.5.1 evaluates and communicates the outcomes of patient care; and
2.5.2 respects the individual diversity of the patient while recommending, supporting and implementing modifications to the nursing care plan.
STANDARD 3 Perioperative Registered Nursing Practice Requires Perioperative Registered Nurses To Be Professionally Responsible And Accountable.
PROFESSIONAL RESPONSIBILITY AND ACCOUNTABILITY
3.1
Perioperative Registered Nurses are required to comply with legislation and policies
relevant to the profession and the Surgical Suite.
The perioperative Registered Nurse shall practice in a manner that:
3.1.1 adheres to the professional and legally recognized scope of practice for the protection of the patient, self, employer, and the health care team;
3.1.2 complies with organizational and regulatory body policies and legalities pertaining to perioperative registered nursing practice;
3.1.3 reports and documents errors, near misses, unsafe practice, incapacity, incompetence, or professional misconduct to the appropriate person(s);
3.1.4 is based on knowledge, and practice requirements related to registration, competence, credibility and licensure of the perioperative Registered Nurse; and
3.1.5 demonstrates the responsibility to notify their employer that they are unable to give appropriate care if they do not have the necessary physical, mental or emotional health.
3.2
Perioperative Registered Nurses are required to be professionally responsible and
accountable.
The perioperative Registered Nurse shall practice in a manner that: 3.2.1 values, and meets the needs of, patients and the health care team;
3.2.2 provides appropriate documentation and effective reporting of sentinel events, crisis situations and near misses;
3.2.3 provides appropriate and safe patient care regardless of personal limitations or prejudices;
3.2.4 exercises prudent and reasonable judgment in completing perioperative nursing activities in a timely fashion;
3.2.5 delivers clinical practice that reflects current evidence-based knowledge;
3.2.6 consistently demonstrates responsibility and accountability for own actions;
3.2.7 monitors actions of the health care team that constitute non-compliance and reports/documents appropriately;
3.2.8 promotes patient advocacy and practices patient safety;
3.2.10 encourages, participates in, and supports programs that provide professional development;
3.2.11 encourages, participates in, and supports preceptorship and mentoring of students, novices, and newly hired perioperative Registered Nurses, colleagues and auxiliary personnel;
3.2.12 uses knowledge, skills, and competencies consistent with the standards for perioperative registered nursing care and other related standards;
3.2.13 confirms that emergency equipment and supplies are available at all times and has knowledge of their use; 3.2.14 exhibits knowledge of, and participation in, safety programs that protect the patient, self, and the health care
team; and
3.2.15 demonstrates awareness of the evacuation routes out of the surgical suite and is familiar with disaster plans.
3.3
Perioperative Registered Nurses are required to comply with the Code of Ethics for
Registered Nurses.
The perioperative Registered Nurse shall practice in a manner that:
3.3.1 complies with the Canadian Nurses Association Code of Ethics for Registered Nurses.
3.4
Perioperative Registered Nurses are required to function as an integral member of
the health care team.
The perioperative Registered Nurse shall practice in a manner that:
3.4.1 maintains a collaborative and professional working relationship with the health care team, including but not limited to, surgeons, anesthesiologists, nursing units, administration, interdisciplinary teams, auxiliary staff and colleagues, to achieve and maintain an efficient, effective safe working environment;
3.4.2 actively promotes and collaborates with administration to facilitate empowerment and job satisfaction; 3.4.3 promotes and exhibits skills in conflict resolution, interpersonal relationships, and leadership; 3.4.4 demonstrates respect, a caring attitude, and professional conduct;
3.4.5 encourages and provides collaboration with the health care team to complete the nursing process; 3.4.6 facilitates coordination of patient care within a multidisciplinary team;
3.4.7 demonstrates efficient management of human, material, and financial resources;
3.4.8 assigns and evaluates the use of resources in collaboration with the surgical suite team to determine staffing, equipment and resources necessary to comply with safety standards and guidelines; and
STANDARD 4: Perioperative Registered Nursing Practice Requires That A Specific Perioperative
Registered Nurse(s) (Specialty Service Team Leader) Shall Be Assigned And Accountable For A Specific Service Or Service Areas, Theatre(s), And/or Coordination Of Multidisciplinary Team Members In The Provision Of Patient Care.
4.1
Perioperative registered nursing practice requires a complex level of coordination of
multidisciplinary team members to provide surgical intervention, which
encompasses a significant number of risk potentials. A theatre, surgical suite or
service area(s) require an assigned perioperative Registered Nurse to coordinate
activities.
The perioperative Registered Nurse assigned a service, theatre, or group of theatres shall practice in a manner that: 4.1.1 confirms that an identified, qualified, perioperative Registered Nurse is assigned to and accountable for the
care of patients in that service;
4.1.2 maintains and expands specialty knowledge, implements and communicates changes in the specialty service;
4.1.3 demonstrates leadership skills to support and advance the practice of the health care team;
4.1.4 coordinates preoperative communication with the health care team i.e., changes in the scheduled surgery time;
4.1.5 builds and promotes a collegial relationship between other units and the surgical suite for continuing education, service delivery, and continuous quality improvement that will benefit and enhance patient care; 4.1.6 collaborates with administration to maintain and acquire appropriate instrumentation, equipment and new
technology; and
4.1.7 maintains a relationship with vendor representation in accordance with corporate policies and that assists in the provision of education for the health care team.
4.2
Perioperative Registered Nurses assigned a service, theatre, or group of theatres
shall establish a collaborative relationship and environment that facilitates the role
of the surgeon.
The perioperative Registered Nurse shall practice in a manner that:
4.2.1 verifies accurate scheduling information for each patient and resolves discrepancies;
4.2.2 identifies and monitors staff identification of problems related to resource limitations or equipment deficiencies in order to facilitate alternate plans;
4.2.3 organizes surgery times in consultation with staff and physicians, to meet the needs of the patient and the health care team;