Speak out
Study of role of OR nurse, technician raises questions Are nurses expected to do more work because they retain those activities that can be done by technicians as well as those that can be done only by nurses? Do nurses do more cleaning and restocking in the operating room than technicians? Are operating room nurses lagging behind nurses in other clinical areas in the practice of scientific-based nursing? These are some of the questions raised by a study in Seattle, Wash, comparing the role of the operating room nurse and the operating room technician as defined by written job descriptions. The study was done in 1975 by Janice Rose Weatherby, RN, in partial fulfillment for a master’s degree in nursing at the University of Washington. Letters requesting the job descriptions were sent to 23 general hospitals in Seattle. Ten hospitals responded. Of the ten, one had an all-RN staff.
Mary G Nolan, RN, MS, is surgical clinical nurse specialist, Daniel Freeman Memorial Hospital, Inglewood, Calif. She is a graduate of St Vincent’s Hospital Training School, Erie, Pa; California State University, Long Beach, and University of California at Los Angeles. Mrs Nolan is chairman of the AORN Research Committee.
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In content analysis, each job description was broken down into single units or components for classification and coding within the framework of the Standards of Nursing Practice: Operating Room. Job descriptions of OR nurses contained more total components and more components congruent with each standards of practice than job descriptions of the OR technicians. In general, it appears that more activities were expected of nurses than of technicians. Are nurses expected to do more work because they retain those activities that can be done by technicians as well as those that can be done only by nurses? Only the OR nurse job description from the hospital with an all-RN staff had components under the standards for gathering information and making a nursing diagnosis. This job description also provided most of the components for evaluating care. The fewest total components in all the RN job descriptions were found for standards relating to use of the nursing process. This suggests sparse use of this set of nursing activities. If OR nurses in this study are not expected to engage in activities considered to be the essence of professional practice, how are they viewed as nurses by those in formal nursing leadership positions? How do OR nurse job descriptions differ from the job descriptions of other RNs in these ten hospitals? Current literature depicts the OR nurse as a professional who assesses, diagnoses, and evaluates. Yet, this view is not borne out by findings of this study. The OR nurse, as described in the job
AORN Journal, October 1976, Vol24, No 4
645
descriptions, is a coordinator of care and teacher of other personnel. This finding supports other OR nurse role functions described in the literature. The hospital that had no technicians expected the most nursing process activities. One would expect that OR technicians in the other nine hospitals would take over a major portion of the activities suitable for them to perform, making it possible for the OR nurses to engage in nursing process activities. However, job descriptions of the OR technician had fewer components for tasks such as cleaning and restocking rooms than did job descriptions of the OR nurse. The OR nurse job descriptions had fewer components concerned with administration of expressive care than with picking instruments and other motor tasks such as preparations for care, scrubbing, and circulating duties. If actual practice is reflected by these job descriptions, OR nurses in these ten hospitals spend more of their time in activities of a motor nature rather than an expressive nature. Weatherby concludes it appears the OR technician has not relieved the OR nurse of many of the technical tasks the literature reports to be a major function of the OR technician. The Standards of Nursing Practice: Operating Room were not reflected well within the job descriptions evaluated in this study. The job descriptions did not reflect the change from a technical to an expressive type of care by OR nurses as described in the literature except for one hospital in which preoperative visits were expected. Weatherby points out that the study has several limitations. For instance, the sample was small, self-selected, and not random; a large portion of the bibliographic citations were taken from the AORN Journal, the official publication of the Association of Operating Room Nurses, and thus, may be biased by attempting to justify both the role and the organization; the job descriptions may not reflect the role of the nurse and technician as it exists in the operating room setting; and finally, the quality and quantity of information given by the job descriptions varied from hospital to hospital. Among Weatherby’s recommendations is that the study be replicated using a larger
646
population with a broader geographic distribution. Even though the conclusions in this study are limited to ten hospitals in one city, the results stimulate questions. Do these findings represent a universal picture of how nurses currently function in the OR clinical setting? Is the OR nurse role as implemented today more that of a technician than a nurse and if the quality of care is not enhanced by her presence, how can we justify the need for the RN in the OR if the cost of using technicians is less? Are OR nurses lagging behind nurses in other clinical areas in the practice of scientific-based nursing? The lack of role differentiation between OR nurse and OR technician as reflected in the findings needs consideration. Job descriptions that do not require nurses to nurse place severe limitation on professional development and may represent a lack of opportunity for intellectual challenge and stimulation. This could be a factor contributing to the problem of recruitment and retention of professional nurses in the specialty of OR nursing.
Mary G Nolan, RN, MS Inglewood, Calif Notes 1. Association of Operating Room Nurses and American Nurses’ Association Division on Medical-Surgical Nursing Practice, Standards of Nursing Practice: Operating Room (Kansas Citv, Mo: American Nurses’ Association, 1975) 1-9.
Third-party payments increases demand In 1975, third-party payments made up 67.4% of what was spent on health care, according to a report issued in April by the Council on Wage and Price Stability. In third-party payments, costs are paid through health insurance, public insurance, and public health programs. The consumer pays directly little or none of the costs. Third-party payments probably cause demand for more services, says the report.
AORN Journal, October 1976, V o l 2 4 , No 4
Study of role of OR nurse, technician raises questions Are nurses expected to do more work because they retain those activities that can be done by technicians as well as those that can be done only by nurses? Do nurses do more cleaning and restocking in the operating room than technicians? Are operating room nurses lagging behind nurses in other clinical areas in the practice of scientific-based nursing? These are some of the questions raised by a study in Seattle, Wash, comparing the role of the operating room nurse and the operating room technician as defined by written job descriptions. The study was done in 1975 by Janice Rose Weatherby, RN, in partial fulfillment for a master’s degree in nursing at the University of Washington. Letters requesting the job descriptions were sent to 23 general hospitals in Seattle. Ten hospitals responded. Of the ten, one had an all-RN staff.
Mary G Nolan, RN, MS, is surgical clinical nurse specialist, Daniel Freeman Memorial Hospital, Inglewood, Calif. She is a graduate of St Vincent’s Hospital Training School, Erie, Pa; California State University, Long Beach, and University of California at Los Angeles. Mrs Nolan is chairman of the AORN Research Committee.
&)
In content analysis, each job description was broken down into single units or components for classification and coding within the framework of the Standards of Nursing Practice: Operating Room. Job descriptions of OR nurses contained more total components and more components congruent with each standards of practice than job descriptions of the OR technicians. In general, it appears that more activities were expected of nurses than of technicians. Are nurses expected to do more work because they retain those activities that can be done by technicians as well as those that can be done only by nurses? Only the OR nurse job description from the hospital with an all-RN staff had components under the standards for gathering information and making a nursing diagnosis. This job description also provided most of the components for evaluating care. The fewest total components in all the RN job descriptions were found for standards relating to use of the nursing process. This suggests sparse use of this set of nursing activities. If OR nurses in this study are not expected to engage in activities considered to be the essence of professional practice, how are they viewed as nurses by those in formal nursing leadership positions? How do OR nurse job descriptions differ from the job descriptions of other RNs in these ten hospitals? Current literature depicts the OR nurse as a professional who assesses, diagnoses, and evaluates. Yet, this view is not borne out by findings of this study. The OR nurse, as described in the job
AORN Journal, October 1976, Vol24, No 4
645
descriptions, is a coordinator of care and teacher of other personnel. This finding supports other OR nurse role functions described in the literature. The hospital that had no technicians expected the most nursing process activities. One would expect that OR technicians in the other nine hospitals would take over a major portion of the activities suitable for them to perform, making it possible for the OR nurses to engage in nursing process activities. However, job descriptions of the OR technician had fewer components for tasks such as cleaning and restocking rooms than did job descriptions of the OR nurse. The OR nurse job descriptions had fewer components concerned with administration of expressive care than with picking instruments and other motor tasks such as preparations for care, scrubbing, and circulating duties. If actual practice is reflected by these job descriptions, OR nurses in these ten hospitals spend more of their time in activities of a motor nature rather than an expressive nature. Weatherby concludes it appears the OR technician has not relieved the OR nurse of many of the technical tasks the literature reports to be a major function of the OR technician. The Standards of Nursing Practice: Operating Room were not reflected well within the job descriptions evaluated in this study. The job descriptions did not reflect the change from a technical to an expressive type of care by OR nurses as described in the literature except for one hospital in which preoperative visits were expected. Weatherby points out that the study has several limitations. For instance, the sample was small, self-selected, and not random; a large portion of the bibliographic citations were taken from the AORN Journal, the official publication of the Association of Operating Room Nurses, and thus, may be biased by attempting to justify both the role and the organization; the job descriptions may not reflect the role of the nurse and technician as it exists in the operating room setting; and finally, the quality and quantity of information given by the job descriptions varied from hospital to hospital. Among Weatherby’s recommendations is that the study be replicated using a larger
646
population with a broader geographic distribution. Even though the conclusions in this study are limited to ten hospitals in one city, the results stimulate questions. Do these findings represent a universal picture of how nurses currently function in the OR clinical setting? Is the OR nurse role as implemented today more that of a technician than a nurse and if the quality of care is not enhanced by her presence, how can we justify the need for the RN in the OR if the cost of using technicians is less? Are OR nurses lagging behind nurses in other clinical areas in the practice of scientific-based nursing? The lack of role differentiation between OR nurse and OR technician as reflected in the findings needs consideration. Job descriptions that do not require nurses to nurse place severe limitation on professional development and may represent a lack of opportunity for intellectual challenge and stimulation. This could be a factor contributing to the problem of recruitment and retention of professional nurses in the specialty of OR nursing.
Mary G Nolan, RN, MS Inglewood, Calif Notes 1. Association of Operating Room Nurses and American Nurses’ Association Division on Medical-Surgical Nursing Practice, Standards of Nursing Practice: Operating Room (Kansas Citv, Mo: American Nurses’ Association, 1975) 1-9.
Third-party payments increases demand In 1975, third-party payments made up 67.4% of what was spent on health care, according to a report issued in April by the Council on Wage and Price Stability. In third-party payments, costs are paid through health insurance, public insurance, and public health programs. The consumer pays directly little or none of the costs. Third-party payments probably cause demand for more services, says the report.
AORN Journal, October 1976, V o l 2 4 , No 4
