trained staff; all of the necessary equipment. instruments, and supplies; timely information access: and a nice atmosphere. Providing my patient with a surgeon who is not angry. frustrated, or hurrying to make up lost time is a part of delivering quality patient care. Starting a case at the scheduled time is not just an agreement with the surgeon but also a promise to the patient. Moving to total quality management is a painstakingly slow process. It will be a painful process for nursing. We will be forced to look at the very core of our practice and redefine just what quality care is. I was sorry to read that Ms Palmer believes that paying attention to physician satisfaction is a put-down to the nursing profession. Hopefully we will learn that identifying and meeting all of our customer‘s needs, including the physicians‘. is a necessary element in meeting our patients’ needs. MARYELLENCAMM,RN. CNOR. CPHQ DIRECTOR OF SCRGICAL SERVICES HULIANA W o a i ~ u ’ sA N D CHILDREN’S HOSPITAL SANAXTONO.TEX Editor...$ rmpoiisc. 1. too, believe in continuous quality improvement. I, too. see patients, physicians. and other members of the health care team as o u r customers. I d o not agree, however, with the concept of hiring nurses to take care of physicians exclusively.


read with great interest your editorial regarding a recent Health Care Advisory Board publication. “Physician Bonding. Volume 111.” Because the role of our company is to get to the heart of controversial subjects, I feel we have done our job when studies spur debates and. as in your case, informed opposition. I am dismayed, however, that our study was construed as denigrating the nursing profession. That was nei’er o u r intention. In our work on clinicit1 quality. we have affirmed the evergrowins role of the nursing profession in ensuring a consistently high standard of care. We believe that fostering a closer working relationship between nurses and physicians can only contribute to the mutual goal of achieving stel-

lar patient service. In that context, we do not believe that placing high priority on the accessibility of nurses for consultation or on nurse understanding of the preferences of their clinical “partners” should be construed as demeaning. Thank you for a thought-provoking editorial and for the opportunity to respond. ELISSA PAGNANI EDITOR-IN-CHIEF HEALTHCAREADVISORY BOARD WASHINGTON, DC

Attitudes Toward Certification


e read the article “Attitudes toward certification: A pilot study,” in the March 1992 issue of the AORN Journal with great interest. While we appreciate the attention to our program, for the benefit of Journal readers, we would like to correct and clarify several points brought out in the article. The assertion that “the general assumption is that performance skills accompany the set knowledge level” is incorrect in reference to the CNOR certification program. Because this has never been tested, we specifically state in our 1992 Certification and Recertification Polic-y Manual that “possession of knowledge does not ensure its proper application.”’ The authors also state, “In one study, CNOR certification is shown as important in improving patient care skills . . . .” This study was conducted by Pamela s. Gibson, BSBA, director of certification, who asked study participants their opinions about whether preparing for certification would improve their patient care skills. The conclusion that it did or did not improve skills cannot be inferred from the study. SUSANPUTERBAUGH, RN, MBA, CNOR EXECUTIVE DIRECTOR PAMELA S. GIBSON, BSBA DIRECTOR OF CERTIFICATION NATIONAL CERTIFICATION BOARD: PERIOPERATIVE NURSING, INC DENVER Note 1 . “Certification process,” in 1992 Certification

AUGUST 1992, VOL 56, NO 2

and Recertification Policy Manual (Denver: National Certification Board: Perioperative Nursing, Inc, 1992) 18. A u t h o r s ’ r e s p o n s e . The 1992 CNOR Certification and Recertification Policy

Manual distributed by the National Certification Board: Perioperative Nursing, Inc (NCB:PNI) to CNOR applicants defines CNOR certification as “The documented validation of the professional achievement of identified standards of practice by an individual registered nurse providing care for patients before, during, and after surgery.”’ The manual describes perioperative nursing performance that “exceeds that which is necessary for competency in practice.”2 The manual goes on to identify the first objective of the CNOR program: “Recognize the individual professional nurse who is proficient in practice.”3 These statements are repeated in the 1992 certification information and application pamphlet distributed by the NCB:PNI to potential applicants. The CNOR examination is a test of knowledge only. We believe that our comments are appropriate. When only knowledge is tested and claims are made regarding practice/performance, the logical assumption is that the performance level accompanies the knowledge level. Pamela S. Gibson’s work was referenced in our article. She was very considerate to have shared it with us. It was rewarding for one of our findings to coincide with one of hers. Eighty-four percent of the respondents in her study agreed that certification would improve their patient care skill^.^ Obviously, a majority felt that a link existed between CNOR certification and perioperative nursing practice. The statement in our article was not intended to imply anything further than a degree of importance being attached to the CNOR credential in relation to practice. This was not a contention of our project, and no other assertions related to the issue were made. We appreciate the interest in our article and hope these misinterpretations have been cleared. One of our intentions was to stimulate


interest in the CNOR certification process. It appears that we have succeeded. During formal and informal presentations of our project’s process and findings, a great deal of interest and comments pertaining to certification are consistently present. DALEE. ALLEN,RN, MSN, CNOR, MAJ, US AIRFORCE AIR TRAINING COMMAND COURSE SUPERVISORDNSTRUCTOR OR NURSING COURSES, LACKLAND AIRFORCEBASE,TEX NANCY J. GIRARD, RN, MSN, CNOR ASSISTANT PROFESSOR UNIVERSITY OF TEXASHEALTH SCIENCE CENTER SCHOOL OF NURSING SANANTONIO. TEX Notes 1. “Certification process,” in 1992 Certification and Recertification Policy Manual (Denver: National Certification Board: Perioperative Nursing, Inc, 1992) 1. 2. Ibid. 3. Ibid. 4. P S Gibson, “The factors motivating perioperative nurses to pursue certification,” (unpublished research project, University of Phoenix, Denver, 1989) 30. The AORN Journal welcomes letters f o r its “Letters to the Editor” column. Letters must refer to Journal articles or columns published within the preceding two months. All letters are subject to editing. Authors of articles or columns referenced in the letter to the editor may be given the opportunity to respond. Letters that are included in the “Letters to the Editor” column must contain the reader’s name, credentials if applicable (eg,RN, BSN, CNOR),position or title, employer, and employer’s address. Submit all correspondence to the AORN Journal, Letters to the Editor, 10170 E Mississippi A w , Denver, CO 80231.


Attitudes toward certification.

trained staff; all of the necessary equipment. instruments, and supplies; timely information access: and a nice atmosphere. Providing my patient with...
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