Opinions
Do you want to become certified? In October, the American Nurses’ Association (ANA) and the Association of Operating Room Nurses announced that joint certification for professional achievement would be available to operating room nurses in 1978. The first examination for certification of operating room nurses will be offered next fall. Other evidence of professional achievement will be required. How do individual operating room nurses feel about becoming certified? To find out, we asked ten members this question: When certification for professional achievement for operating room nurses is available, will you want to become certified? These are their responses.
Juanita Ponton, RN
There has been a great deal of controversy over the role of the professional nurse in the operating room. Just what is it that a registered nurse does that is important in patient care? Certification is one way to define, in concrete terms, what it means to be a professional nurse who excels in that function. This is as important for the nurse as it is for others on the health care team. Too often, it is not truly clear to registered nurses what they are doing and what they have to offer. The problem reminds me of a story by Roger Mager in his book Preparing lnstructional Objectives. In the story, a sea horse sets out to seek his fortune. On the way he meets other sea creatures who promise him a speedier trip by selling him different methods of transportation and advising him of shortcuts. His last shortcut takes him into the mouth of a shark, where he is devoured. Just as in this story, OR nursing may lose its proper identity if we do not define our goals and function in patient care. For too long nurses have drifted and have allowed nursing to be shaped and molded by others. Knowing where you are going and what you are going to do when you get there is vital to growth-not only professional growth, but also self-actualization. For me,
0 AORN Journal, December 1977, Vol26, No 6
1067
“OR nursing may lose its proper identity if we do not define our goals.
”
certification is a recognition of goal setting and a means to develop a feeling of self-worth. In nursing, the rewards have been in promotions to administrative positions for monetary gain and recognition of good performance of duties. Certification is a means to demonstrate excellence and receive recognition for it while the registered nurse is delivering patient care. This is what is important for our profession-allowing the nurse to develop, grow, and be recognized as the one who is accountable for the patient.
Juanita Ponton, RN Director of nursing Lodi Memorial Hospital Lodi. Calif
“0R nursing requires When the American Nurses’ Association/AORN additional expertise. certification is available, I will want to be certified. ”
Even though I received my degree as a medical-surgical specialist and theoretically should be able to apply my expertise to any medical-surgical area, I believe that OR nursing requires additional expertise and proficiency and that this should be recognized. I believe that care for surgical patients begins with assessment at a preoperative visit and ends with evaluation at a postoperative visit. The nursing process belongs in the operating room as well as other nursing areas. It is my understanding that a certification exam will test for knowledge of the nursing process as it applies to nursing in the operating room. This is good because OR nurses should be as knowledgeable about the nursing process as they are about instruments, sutures, and equipment. With this knowledge and the determination to implement it, the OR nurse will truly be a specialty nurse providing for the needs of his or her patients. Certification for proficiency sponsored by two respected professional organizations will lend credibility to the role of the professional nurse in the operating room. Reservations I have regarding certification are that nonnursing personnel may misinterpret its significance and consider the certified nurse a super technician. Another reservation is that nurses, once certified, may see this as a substitute for advanced education. I would hope that once certified for professional achievement the OR nurse would feel a greater
1070
AORN Journal, December 1977, V o l 2 6 , No 6
responsibility to keep up with trends in nursing and interpret these trends to his or her coworkers. With OR experience disappearing from nursing curricula, with the increase of nonprofessionalsin operating rooms, and with the desire to keep costs down by hiring nonprofessionals to perform nursing duties, the operating room nurse in many hospitals has a hard, uphill fight to explain his or her role to administration. Certification may just be the vehicle needed to carry the message to the world outside the double doors that nursing does take place inside the operating room. Wilhelmina Fernsebner, RN Instructor, medical-surgicalnursing Newton-WellesleyHospital School of Nursing Newton, Mass
"There is too much emphasis placed on diplomas and certificates.
"The patient wants a nurse to show empathy and reassurance. I'
Certification for professional achievement, at the present time, appears to be of no value or benefit to me or the patients in my care. I believe there is too much emphasis placed on diplomas and certificates and not enough on actual patient care. The patient or physician does not ask or, I believe, care how many certificates are hanging on your walls or tucked away on a shelf gathering dust. They can tell if you are qualified by your actions and the manner in which you respond to them and the situation. The physician wants a nurse who is interested, caring, self-reliant, and flexible and who shows a real desire to learn and perform his or her duties with expertise and confidence. The patient also wants that person to be interested in his welfare and be able to show empathy and reassurance. All the certificates in the world could not give one these traits and skills. When a graduate nurse passes his or her state board exams and becomes a registered nurse, it does not always mean he or she is proficient. Even after years of practical experience, Iam sad to say, there are many registered nurses in whom I would be very hesitant to place the care of my family or myself. Within myself I know if I am proficient at any given task, and I certainly am not hesitant to admit it if I need help. I believe we cannot all be completely proficient in all areas of surgery. In this day of specialization, many of us have limited experience in some types of surgery. This is not to say that we cannot function adequately outside our own area, but
AORN Journal, December 1977,V o l 2 6 , No 6
1071
rather that we do not know all the “ins and outs” of every area of surgery. I don’t believe that is possible unless one is a “super nurse” and there are so few of them left! I can see no monetary value in gaining certification. Hospitals, for the most part, do not pay differentials to surgery personnel. If there is indeed evidence of a real benefit to me and the patients, I will be the first to advocate certification for professional achievement. So far, however, all of the rationale for it seems superficial and unimportant to me. Soundra Smith, RN Staff nurse, operating room University Hospital and Clinics Oklahoma City
Beverly A Peratino,
RN
“The idea of certification could be frightening and threatening. ”
1074
Certification of operating room nurses-what next? I have been an OR nurse for many years, have developed expertise in this specialty area of nursing, and have been doing a good job. Why should I have to take exams to be certified now? What is all this talk about certification anyway? I am sure that most operating room nurses have had these thoughts at some time or another as the discussion of certification of operating room nurses has grown. The idea of certification could be frightening and threatening, especially if one is unclear about what certification is and the benefits it would yield. Certification is the process in which a nongovernmental agency or association grants recognition to an individual who has met predetermined qualifications specified by the agency or association. This certification of an operating room nurse would be the issuance of a statement by AORN attesting that the member has attained proficiency in the area of operating room nursing practice. The question then comes to mind, if AORN offered certification of its members, would I apply for it? Fully realizing that certification would require an examination, some type of demonstration of operating room nursing expertise, endorsement by colleagues, and perhaps proof of continuing education in nursing, I would answer unequivocably, “Yes.” My lack of hesitation here is based on what I feel certification offers the patient, the individual OR nurse, and the profession as a whole.
AORN Journal, December 1977, V o l 2 6 , No 6
”Certification acknowledges superior 0R nursing care.
”
“AORN is taking the initiative to determine the criteria for Certification. ”
What does certification offer the surgical patient? The patient as a consumer of health care services is becoming increasingly aware of his rights, and he expects to receive quality operating room nursing care. The surgical patient entrusts his safety and well-being to the operating room nurse when he enters the operating room suite, especially if he undergoes a procedure that necessitates general anesthesia. The patient expects that while he is anesthetized and not capable of meeting his own needs to survive, the operating room nurse will help coordinate the efforts of the entire surgical team to ensure that he returns to a state of health as normal as possible. Certainly this is a basic function of operating room nursing that we do every day, case after case. Certification provides the patient with a way of knowing that the nurses his care is entrusted to are recognized for their excellent nursing care. What does certification offer operating room nurses personally? I think it would offer a feeling of pride and self-satisfactionto be recognized by our professional organization. As we all know, licensure by the state government agencies to be a registered nurse acknowledges that a nurse has met minimum standards of proficiency. To be certified by our professional association, however, acknowledges superior operating room nursing care given to patients. Certification would also give operating room nurses recognition by their peers for demonstrating superior nursing practice. Certification could improve employment opportunities for operating room nurses and perhaps provide new career opportunities. Lastly, certification would provide operating room nurses with a means to increase our motivation to keep up with current trends of operating room nursing practice and to implement them in practice. What does certification offer the profession as a whole? By establishing a certification process for its members, AORN is recognizing its role in providing quality nursing care to the surgical patient. The Association is taking the initiative and recognizing its responsibilityto determine the criteria for certification of its members rather than having standards imposed by an outside regulatory governing agency. By recognizing its responsibility to certify operating room nurses, AORN will gain status and recognition from other professional organizations. Through the process of certification, AORN will help to increase the quality of operating room nursing practice.
AORN Journal, December 1977,V a l 26, No 6
1075
Certification may seem threatening, but it need not be if we understand that the certification process only publicly acknowledges what we demonstrate daily in our nursing practice. The process may be time consuming, but with the benefits it offers the surgical patient, the individual nurse in the operating room, and the profession as a whole, wouldn’t it be worth it? Beverly A Peratino, RN Head nurse, operating room University of Colorado Medical Center Denver
Rose Mary Armstrong, RN
Certification is needed because the consumer wants to be assured he is receiving quality nursing care in the operating room. Examination is the only way of proving to others our expertise in our chosen field. My objection is to collaboration with ANA. This will classify OR nurses under the umbrella of medical-surgical nursing. I am not a medical-surgical nurse and do not intend to become involved in that field in the future. I fully expect that the certification examination will require a general background knowledge of nursing and its related sciences, but why should we be tested in medical-surgical nursing. During every surgical intervention, patient assessment demands an integrated wealth of knowledge for appropriate action to be taken, and this is what makes us operating room nurses. The examination ought to be drafted and administered by the Education Department of AORN, which is more qualified to test the expertise of operating room nurses. If collaboration with ANA is inevitable, it should still be entitled Certification of Operating Room Nurses. Nothing less is acceptable. Rose Mary Armstrong, RN OR supervisor Shawnee Mission Medical Center Shawnee Mission, Kan
‘‘Certification would suggest the nurse is only qualified to practice in the OR.”
1078
Certification for operating room nurses is unnecessary, and I will not feel obligated to take the test. When nurses pass their state boards, it is assumed that they are adequately prepared to perform any task in the realm of their jobs. They do not need to take
AORN Journal, December 1977. Vol26, No 6
“Differenthospita/s are another test to reaffirm the fact that they are qualified to different in a certain area. This has already been established
kinds Of surgery‘
”
through the state boards. Certification would also require a number of new tests, which would only repeat state board exams. A certification program for operating room nurses would suggest that the nurse holding this certificate of achievement is only qualified to practice in the operating room suite. This greatly limits the versatility that a registered nurse is supposed to have. I feel it would be more difficult to be hired in another area if the nurse so desired. Thus, certification would narrow his or her scope rather than broaden it. In my opinion, if a certification program is to be started for operating room nurses, then similar programs should be started for other specialties, such as intensive care and emergency room. These specialties also have their areas of proficiency. Last of all, the certification test could be biased and unfair. Different hospitals are geared to different kinds of surgery. A nurse working in an orthopedic hospital could not be expected to answer questions about cardiovascular surgery if she has had no contact with these types of cases. Thus, there would be a need for some type of postgraduate education program if a registered nurse wanted to be certified as an operating room nurse and be able to pass the test.
Andrea Alexander, RN Staff nurse, operating room Robert Packer Hospital Sayre, Pa
“Certification should Although I approve of certification, I feel it should be not be a one-time an option, not a requirement. This option could be effort.” used whenever a nurse feels he or she has enough
experience and wants to become certified. There should be no maximum time limit. The standards for certification should be on a national level rather than a state or local level. In our highly mobile society, certification will be of no value if it means different things in different parts of the country. Certification should include several things. An examination is needed for which a study guide should be available so nurses in small hospitals and those who have been out of training for some time would have equal advantage. There also needs to be an
6* AORN Journal, December 1977, V o l 2 6 , No 6
1079
“Aminimum number of evaluation by the nurse’s supervisor, fellow employee, CE units per year and/or surgeon the nurse may work with regularly. A personal resume including schooling, seminars or be ”
workshops attended, and places of employment should be required. Certification should not be a one-time effort. To remain certified, a nurse should keep abreast of new techniques and procedures in his or her field. The nurse should attend workshops and seminars as well as AORN meetings to further his or her knowledge. A minimum number of continuing education units per year should be required as well as allowing credit for other meetings attended where continuing education units are not granted. If problems exist to prevent attendance at workshops, a means of study should be available so a nurse can maintain his or her status. Perhaps AORN could maintain a lending library or publish lists of books and articles with information on where they could be obtained. In my opinion, certification should be set up on a national level and include an examination, personal history, and statements of competence. Minimum requirements also need to be established for maintenance of that certification.
Nelda Chandler, RN Staff nurse, operating room Mercy Hospital Hamilton, Ohio
“Our expertise is gained after educations' preparation.
”
1082
A recent report from the American Nurses’ Association states, “The Interdivisional Council on Certification has approved the following definition of certification: Certification is the documented validation of specific qualifications demonstrated by the individual registered nurse in the provision of professional nursing care in a defined area of practice.” Operating room nurses, just as other nurses in various specialty areas, require expertise unique to their area of responsibility. This expertise is gained in most instances after the educational preparation and is worthy of some form of recognition. When AORN, in collaboration with ANA, offers a certification program for professional achievement for operating room nurses, this will no doubt involve taking an examination as well as submitting other evidence of proficiency in practice. The thought of taking an examination is a little frightening to most of us.
AORN Journal, December 1977, V o l 2 6 , NO 6
However, most operating room nurses have acquired more knowledge than they are probably aware of. The certification process could bring to light this knowledge and encourage the refining of skills that would enhance the practice of nursing in our own specialty area. The certification process is a voluntary one and should impose no threat to any nurse. It does, however, provide a specific goal or standard for nurses who would like to attain a higher level of professional achievement in their chosen specialty. Shirley Phillips, RN instructor Harper College Palatine, 111
“Certification would be of little use to nurses in small communities.”
There are several reasons why I would not want to become certified. First of all, the time involved in preparing for certification would be monumental. As a nurse who has been out of school for nine years, I feel there are many areas of nursing in which I am not proficient. To prepare for the written examination would require many hours of study in areas of nursing not pertinent to the operating room. After relearning and taking the examination, I would quickly forget all that I studied. I don’t feel that my time should be spent in this manner. I also feel that certification would be of little use to nurses in small communities for whom operating room experience is minimal. Nurses working at a large teaching hospital would have more need of certification than nurses working in an operating room in a rural area. A nurse in a small hospital would not receive the recognition or the benefits if he or she was certified for professional achievement in the operating room. Sharon Fiori, RN Staff nurse, operating room St Mary’s Hospital Reno, Nev
“0R nurses should not become complacent in performing everyday tasks.”
The process of certification would be a step toward improving the status of the operating room nurse as an individual capable of providing good patient care, although there may be difficulties in developing guidelines to measure proficiency in practice. Most new graduate registered nurses coming into
AORN Journal, December 1977, Vol26, N o 6
1083
Frances Johnston, RN
the operating room have had little or no experience in this area. It takes weeks of orientation (which is far from adequately planned in many hospitals) for the nurse to feel confident in understanding, planning, and preparing for surgical procedures. Certification would be a means of assuring the quality of their inservice training. To prepare for the necessary tests, there should be some kind of review manual with questions relating to anatomy, physiology, and microbiology. These sciences are easily forgotten unless they are often reviewed. I do not believe operating room nurses should become complacent in performing everyday tasks. The nurse who has worked in the operating room for years would profit from the review and study necessary for certification. lnservice education programs could also be used for review in preparing to become certified. In return, the OR nurse who is motivated to take such an exam should be compensated by an increase in salary by his or her employer. For 25 years, AORN has demonstrated leadership in education, and I am proud to be a member of an organization that has made such tremendous progress in this area.
Frances Johnston, RN Department head of operating room technology Dekalb Community College Clarkston, Ga
Editor’s note. A more detailed questionnaire on certification, prepared by the AORN certification committee, was published in the October Journal to find out about members’ interest in certification. Results of that survey will be published in a later Journal.
1086
AORN Journal, December 1977,Vol26, No 6
Do you want to become certified? In October, the American Nurses’ Association (ANA) and the Association of Operating Room Nurses announced that joint certification for professional achievement would be available to operating room nurses in 1978. The first examination for certification of operating room nurses will be offered next fall. Other evidence of professional achievement will be required. How do individual operating room nurses feel about becoming certified? To find out, we asked ten members this question: When certification for professional achievement for operating room nurses is available, will you want to become certified? These are their responses.
Juanita Ponton, RN
There has been a great deal of controversy over the role of the professional nurse in the operating room. Just what is it that a registered nurse does that is important in patient care? Certification is one way to define, in concrete terms, what it means to be a professional nurse who excels in that function. This is as important for the nurse as it is for others on the health care team. Too often, it is not truly clear to registered nurses what they are doing and what they have to offer. The problem reminds me of a story by Roger Mager in his book Preparing lnstructional Objectives. In the story, a sea horse sets out to seek his fortune. On the way he meets other sea creatures who promise him a speedier trip by selling him different methods of transportation and advising him of shortcuts. His last shortcut takes him into the mouth of a shark, where he is devoured. Just as in this story, OR nursing may lose its proper identity if we do not define our goals and function in patient care. For too long nurses have drifted and have allowed nursing to be shaped and molded by others. Knowing where you are going and what you are going to do when you get there is vital to growth-not only professional growth, but also self-actualization. For me,
0 AORN Journal, December 1977, Vol26, No 6
1067
“OR nursing may lose its proper identity if we do not define our goals.
”
certification is a recognition of goal setting and a means to develop a feeling of self-worth. In nursing, the rewards have been in promotions to administrative positions for monetary gain and recognition of good performance of duties. Certification is a means to demonstrate excellence and receive recognition for it while the registered nurse is delivering patient care. This is what is important for our profession-allowing the nurse to develop, grow, and be recognized as the one who is accountable for the patient.
Juanita Ponton, RN Director of nursing Lodi Memorial Hospital Lodi. Calif
“0R nursing requires When the American Nurses’ Association/AORN additional expertise. certification is available, I will want to be certified. ”
Even though I received my degree as a medical-surgical specialist and theoretically should be able to apply my expertise to any medical-surgical area, I believe that OR nursing requires additional expertise and proficiency and that this should be recognized. I believe that care for surgical patients begins with assessment at a preoperative visit and ends with evaluation at a postoperative visit. The nursing process belongs in the operating room as well as other nursing areas. It is my understanding that a certification exam will test for knowledge of the nursing process as it applies to nursing in the operating room. This is good because OR nurses should be as knowledgeable about the nursing process as they are about instruments, sutures, and equipment. With this knowledge and the determination to implement it, the OR nurse will truly be a specialty nurse providing for the needs of his or her patients. Certification for proficiency sponsored by two respected professional organizations will lend credibility to the role of the professional nurse in the operating room. Reservations I have regarding certification are that nonnursing personnel may misinterpret its significance and consider the certified nurse a super technician. Another reservation is that nurses, once certified, may see this as a substitute for advanced education. I would hope that once certified for professional achievement the OR nurse would feel a greater
1070
AORN Journal, December 1977, V o l 2 6 , No 6
responsibility to keep up with trends in nursing and interpret these trends to his or her coworkers. With OR experience disappearing from nursing curricula, with the increase of nonprofessionalsin operating rooms, and with the desire to keep costs down by hiring nonprofessionals to perform nursing duties, the operating room nurse in many hospitals has a hard, uphill fight to explain his or her role to administration. Certification may just be the vehicle needed to carry the message to the world outside the double doors that nursing does take place inside the operating room. Wilhelmina Fernsebner, RN Instructor, medical-surgicalnursing Newton-WellesleyHospital School of Nursing Newton, Mass
"There is too much emphasis placed on diplomas and certificates.
"The patient wants a nurse to show empathy and reassurance. I'
Certification for professional achievement, at the present time, appears to be of no value or benefit to me or the patients in my care. I believe there is too much emphasis placed on diplomas and certificates and not enough on actual patient care. The patient or physician does not ask or, I believe, care how many certificates are hanging on your walls or tucked away on a shelf gathering dust. They can tell if you are qualified by your actions and the manner in which you respond to them and the situation. The physician wants a nurse who is interested, caring, self-reliant, and flexible and who shows a real desire to learn and perform his or her duties with expertise and confidence. The patient also wants that person to be interested in his welfare and be able to show empathy and reassurance. All the certificates in the world could not give one these traits and skills. When a graduate nurse passes his or her state board exams and becomes a registered nurse, it does not always mean he or she is proficient. Even after years of practical experience, Iam sad to say, there are many registered nurses in whom I would be very hesitant to place the care of my family or myself. Within myself I know if I am proficient at any given task, and I certainly am not hesitant to admit it if I need help. I believe we cannot all be completely proficient in all areas of surgery. In this day of specialization, many of us have limited experience in some types of surgery. This is not to say that we cannot function adequately outside our own area, but
AORN Journal, December 1977,V o l 2 6 , No 6
1071
rather that we do not know all the “ins and outs” of every area of surgery. I don’t believe that is possible unless one is a “super nurse” and there are so few of them left! I can see no monetary value in gaining certification. Hospitals, for the most part, do not pay differentials to surgery personnel. If there is indeed evidence of a real benefit to me and the patients, I will be the first to advocate certification for professional achievement. So far, however, all of the rationale for it seems superficial and unimportant to me. Soundra Smith, RN Staff nurse, operating room University Hospital and Clinics Oklahoma City
Beverly A Peratino,
RN
“The idea of certification could be frightening and threatening. ”
1074
Certification of operating room nurses-what next? I have been an OR nurse for many years, have developed expertise in this specialty area of nursing, and have been doing a good job. Why should I have to take exams to be certified now? What is all this talk about certification anyway? I am sure that most operating room nurses have had these thoughts at some time or another as the discussion of certification of operating room nurses has grown. The idea of certification could be frightening and threatening, especially if one is unclear about what certification is and the benefits it would yield. Certification is the process in which a nongovernmental agency or association grants recognition to an individual who has met predetermined qualifications specified by the agency or association. This certification of an operating room nurse would be the issuance of a statement by AORN attesting that the member has attained proficiency in the area of operating room nursing practice. The question then comes to mind, if AORN offered certification of its members, would I apply for it? Fully realizing that certification would require an examination, some type of demonstration of operating room nursing expertise, endorsement by colleagues, and perhaps proof of continuing education in nursing, I would answer unequivocably, “Yes.” My lack of hesitation here is based on what I feel certification offers the patient, the individual OR nurse, and the profession as a whole.
AORN Journal, December 1977, V o l 2 6 , No 6
”Certification acknowledges superior 0R nursing care.
”
“AORN is taking the initiative to determine the criteria for Certification. ”
What does certification offer the surgical patient? The patient as a consumer of health care services is becoming increasingly aware of his rights, and he expects to receive quality operating room nursing care. The surgical patient entrusts his safety and well-being to the operating room nurse when he enters the operating room suite, especially if he undergoes a procedure that necessitates general anesthesia. The patient expects that while he is anesthetized and not capable of meeting his own needs to survive, the operating room nurse will help coordinate the efforts of the entire surgical team to ensure that he returns to a state of health as normal as possible. Certainly this is a basic function of operating room nursing that we do every day, case after case. Certification provides the patient with a way of knowing that the nurses his care is entrusted to are recognized for their excellent nursing care. What does certification offer operating room nurses personally? I think it would offer a feeling of pride and self-satisfactionto be recognized by our professional organization. As we all know, licensure by the state government agencies to be a registered nurse acknowledges that a nurse has met minimum standards of proficiency. To be certified by our professional association, however, acknowledges superior operating room nursing care given to patients. Certification would also give operating room nurses recognition by their peers for demonstrating superior nursing practice. Certification could improve employment opportunities for operating room nurses and perhaps provide new career opportunities. Lastly, certification would provide operating room nurses with a means to increase our motivation to keep up with current trends of operating room nursing practice and to implement them in practice. What does certification offer the profession as a whole? By establishing a certification process for its members, AORN is recognizing its role in providing quality nursing care to the surgical patient. The Association is taking the initiative and recognizing its responsibilityto determine the criteria for certification of its members rather than having standards imposed by an outside regulatory governing agency. By recognizing its responsibility to certify operating room nurses, AORN will gain status and recognition from other professional organizations. Through the process of certification, AORN will help to increase the quality of operating room nursing practice.
AORN Journal, December 1977,V a l 26, No 6
1075
Certification may seem threatening, but it need not be if we understand that the certification process only publicly acknowledges what we demonstrate daily in our nursing practice. The process may be time consuming, but with the benefits it offers the surgical patient, the individual nurse in the operating room, and the profession as a whole, wouldn’t it be worth it? Beverly A Peratino, RN Head nurse, operating room University of Colorado Medical Center Denver
Rose Mary Armstrong, RN
Certification is needed because the consumer wants to be assured he is receiving quality nursing care in the operating room. Examination is the only way of proving to others our expertise in our chosen field. My objection is to collaboration with ANA. This will classify OR nurses under the umbrella of medical-surgical nursing. I am not a medical-surgical nurse and do not intend to become involved in that field in the future. I fully expect that the certification examination will require a general background knowledge of nursing and its related sciences, but why should we be tested in medical-surgical nursing. During every surgical intervention, patient assessment demands an integrated wealth of knowledge for appropriate action to be taken, and this is what makes us operating room nurses. The examination ought to be drafted and administered by the Education Department of AORN, which is more qualified to test the expertise of operating room nurses. If collaboration with ANA is inevitable, it should still be entitled Certification of Operating Room Nurses. Nothing less is acceptable. Rose Mary Armstrong, RN OR supervisor Shawnee Mission Medical Center Shawnee Mission, Kan
‘‘Certification would suggest the nurse is only qualified to practice in the OR.”
1078
Certification for operating room nurses is unnecessary, and I will not feel obligated to take the test. When nurses pass their state boards, it is assumed that they are adequately prepared to perform any task in the realm of their jobs. They do not need to take
AORN Journal, December 1977. Vol26, No 6
“Differenthospita/s are another test to reaffirm the fact that they are qualified to different in a certain area. This has already been established
kinds Of surgery‘
”
through the state boards. Certification would also require a number of new tests, which would only repeat state board exams. A certification program for operating room nurses would suggest that the nurse holding this certificate of achievement is only qualified to practice in the operating room suite. This greatly limits the versatility that a registered nurse is supposed to have. I feel it would be more difficult to be hired in another area if the nurse so desired. Thus, certification would narrow his or her scope rather than broaden it. In my opinion, if a certification program is to be started for operating room nurses, then similar programs should be started for other specialties, such as intensive care and emergency room. These specialties also have their areas of proficiency. Last of all, the certification test could be biased and unfair. Different hospitals are geared to different kinds of surgery. A nurse working in an orthopedic hospital could not be expected to answer questions about cardiovascular surgery if she has had no contact with these types of cases. Thus, there would be a need for some type of postgraduate education program if a registered nurse wanted to be certified as an operating room nurse and be able to pass the test.
Andrea Alexander, RN Staff nurse, operating room Robert Packer Hospital Sayre, Pa
“Certification should Although I approve of certification, I feel it should be not be a one-time an option, not a requirement. This option could be effort.” used whenever a nurse feels he or she has enough
experience and wants to become certified. There should be no maximum time limit. The standards for certification should be on a national level rather than a state or local level. In our highly mobile society, certification will be of no value if it means different things in different parts of the country. Certification should include several things. An examination is needed for which a study guide should be available so nurses in small hospitals and those who have been out of training for some time would have equal advantage. There also needs to be an
6* AORN Journal, December 1977, V o l 2 6 , No 6
1079
“Aminimum number of evaluation by the nurse’s supervisor, fellow employee, CE units per year and/or surgeon the nurse may work with regularly. A personal resume including schooling, seminars or be ”
workshops attended, and places of employment should be required. Certification should not be a one-time effort. To remain certified, a nurse should keep abreast of new techniques and procedures in his or her field. The nurse should attend workshops and seminars as well as AORN meetings to further his or her knowledge. A minimum number of continuing education units per year should be required as well as allowing credit for other meetings attended where continuing education units are not granted. If problems exist to prevent attendance at workshops, a means of study should be available so a nurse can maintain his or her status. Perhaps AORN could maintain a lending library or publish lists of books and articles with information on where they could be obtained. In my opinion, certification should be set up on a national level and include an examination, personal history, and statements of competence. Minimum requirements also need to be established for maintenance of that certification.
Nelda Chandler, RN Staff nurse, operating room Mercy Hospital Hamilton, Ohio
“Our expertise is gained after educations' preparation.
”
1082
A recent report from the American Nurses’ Association states, “The Interdivisional Council on Certification has approved the following definition of certification: Certification is the documented validation of specific qualifications demonstrated by the individual registered nurse in the provision of professional nursing care in a defined area of practice.” Operating room nurses, just as other nurses in various specialty areas, require expertise unique to their area of responsibility. This expertise is gained in most instances after the educational preparation and is worthy of some form of recognition. When AORN, in collaboration with ANA, offers a certification program for professional achievement for operating room nurses, this will no doubt involve taking an examination as well as submitting other evidence of proficiency in practice. The thought of taking an examination is a little frightening to most of us.
AORN Journal, December 1977, V o l 2 6 , NO 6
However, most operating room nurses have acquired more knowledge than they are probably aware of. The certification process could bring to light this knowledge and encourage the refining of skills that would enhance the practice of nursing in our own specialty area. The certification process is a voluntary one and should impose no threat to any nurse. It does, however, provide a specific goal or standard for nurses who would like to attain a higher level of professional achievement in their chosen specialty. Shirley Phillips, RN instructor Harper College Palatine, 111
“Certification would be of little use to nurses in small communities.”
There are several reasons why I would not want to become certified. First of all, the time involved in preparing for certification would be monumental. As a nurse who has been out of school for nine years, I feel there are many areas of nursing in which I am not proficient. To prepare for the written examination would require many hours of study in areas of nursing not pertinent to the operating room. After relearning and taking the examination, I would quickly forget all that I studied. I don’t feel that my time should be spent in this manner. I also feel that certification would be of little use to nurses in small communities for whom operating room experience is minimal. Nurses working at a large teaching hospital would have more need of certification than nurses working in an operating room in a rural area. A nurse in a small hospital would not receive the recognition or the benefits if he or she was certified for professional achievement in the operating room. Sharon Fiori, RN Staff nurse, operating room St Mary’s Hospital Reno, Nev
“0R nurses should not become complacent in performing everyday tasks.”
The process of certification would be a step toward improving the status of the operating room nurse as an individual capable of providing good patient care, although there may be difficulties in developing guidelines to measure proficiency in practice. Most new graduate registered nurses coming into
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the operating room have had little or no experience in this area. It takes weeks of orientation (which is far from adequately planned in many hospitals) for the nurse to feel confident in understanding, planning, and preparing for surgical procedures. Certification would be a means of assuring the quality of their inservice training. To prepare for the necessary tests, there should be some kind of review manual with questions relating to anatomy, physiology, and microbiology. These sciences are easily forgotten unless they are often reviewed. I do not believe operating room nurses should become complacent in performing everyday tasks. The nurse who has worked in the operating room for years would profit from the review and study necessary for certification. lnservice education programs could also be used for review in preparing to become certified. In return, the OR nurse who is motivated to take such an exam should be compensated by an increase in salary by his or her employer. For 25 years, AORN has demonstrated leadership in education, and I am proud to be a member of an organization that has made such tremendous progress in this area.
Frances Johnston, RN Department head of operating room technology Dekalb Community College Clarkston, Ga
Editor’s note. A more detailed questionnaire on certification, prepared by the AORN certification committee, was published in the October Journal to find out about members’ interest in certification. Results of that survey will be published in a later Journal.
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