Perioperative Nursing, Bonita Aceto, Redlands Community Hospital

Please describe the structure and hierarchy within your OR.

We have a patient-focused team approach. RCH believes that the staff closest to the patient know best how care should be delivered. That means our OR nurses have a voice and are actively engaged in projects and initiatives to improve all aspects of their roles.  We’ve adopted a program called TeamSTEPPS [Team Strategies & Tools to Enhance Performance & Patient Safety], developed by the federal Agency for Healthcare Research and Quality (AHRQ) to improve collaboration and communication among care teams.

Nationally, poor communication has been proven to be the greatest obstacle to safe patient care, so TeamSTEPPS is designed to change that.  Nurses are the strongest advocates for the patient under anesthesia. One of the AHRQ safety tools we use is CUS, which is an acronym for “Concerned, Uncomfortable, Safety issue.” When someone broaches a concern in this way, all care providers stop and examine the concern closely.

Tell us a little about the RN first assistant role.

This is a specialized certification that allows a nurse to ligate, clamp tissue and suture, acting as an additional set of hands for the surgeon. These duties used to be performed by a second surgeon, but with the advancement of nursing practice, nurses have stepped into the role.  It takes about two years of surgeon precepting to become an RN first assistant. There is a didactic portion and then experience in the field.

What do you love the most about your specialty?

The new technology! The surgical specialty is changing rapidly, so there is no chance of having a boring day.  As technology advances, surgical procedures will continue to become less invasive. With minimally invasive surgical approaches, patients experience less pain, fewer complications and shorter hospital stays.

Surgery and radiology are increasingly partnering with artificial intelligence (AI). So, you can now look at a three-dimensional image through your surgical console as you remotely direct a robot. I see AI increasing in its use and effectiveness — that’s the future in which we find ourselves.

Do you have any concerns about the rise of technology in healthcare?

There is great risk in losing the human interaction to the world of technology. At RCH, we’ve adopted Jean Watson’s Caring Science to guide our practice and keep nurses grounded in caring. The goal is “creating a healing environment for the physical and spiritual self which respects human dignity,” which means creating a healing environment for both patients and the entire team.

No technology can change the importance of the nurse-patient connection in establishing patient trust. A surgical patient has lost all autonomy and is at their most vulnerable. They need to feel they are in good hands.

How do you keep your nurses healthy, ontrack, satisfied and up to speed?

I try to stay focused on staff well-being. If an RN is stressed, their ability to make good decisions can be jeopardized. Our management team will step into the case to allow the staff member time to refocus and center themselves.  We encourage nurses to come talk to us if they feel the need. Maybe something is going on at home or at work. We will ask, “Are you okay today? Is there some way I can help?”

As a leader, it’s important to have a personal rapport with the nurses and be clued into what’s happening in their lives. Staff deserve engaged leadership and we strive to deliver it.  We also debrief on intense situations, growing team-building and critical thinking skills.

What qualities do you look for in your OR nurses?

High-level clinical skills are necessary, but you must also have passion and motivation. We support the novice new grad in learning the skills needed to excel, so I love hiring a nurse who’s enthusiastic and energetic. Through behavioral interviewing, I also assess an applicant’s ability to handle stressful situations. The OR can be a life-or-death environment and therefore a very stressful place.

OR nurses can’t be complacent — there’s no room for that in surgery. Complacency occurs when we rely on rote learning and always doing things the same way, even where better procedures and approaches are clearly available.  Nurses must enter each surgery mindfully and patient-centered. This sets the stage for successful and safe outcomes.

What are your goals and plans for the future?

Currently, I am focused on increasing our OR suites from eight to 12 rooms, providing additional opportunities for our community to receive state-of-the-art care. We are also providing expanded services such as enhanced vascular, neuro-interventional and minimally invasive surgeries. My nursing team and I are proud to have been a part of this expansion. It has been a challenge and a pleasure for me. Nurses need to be involved in construction projects, as this is where we will practice. Clinically, as a team, we’ve dedicated ourselves to providing the best care, and we succeed. That’s where I thrive.

KEITH CARLSON, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996 and has hosted the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at www.nursekeith.com.

In this Article: Career Advice, Nursing Workforce, Surgery