he AORN Research Committee, in 1974, conducted a mail survey of 143 AORN members listed as clinical nurse specialists on the AORN membership roster. The purpose of the survey, funded by AORN, was to determine if nurses were functioning in this advanced clinical role in the OR. As defined by the American Nurses’ Association (ANA): Clinical nurse specialists are primarily clinicians with a high degree of knowledge, skill, and competence in a specialized area of nursing. These are made directly available to the public through the provision of nursing care to clients and indirectly available through guidance and planning of care with other nursing personnel. Clinical nurse specialists hold a master’s degree in nursing preferably with an emphasis in clinical nursing.’ Of the 50 members who responded, three were identified as clinical nurse specialists practicing in the OR according to the ANA definition. The committee found the title of clinical nurse specialist lacked a common meaning among members participating in the survey. The term was used more as a job title than as a generic level of preparation for practice. In a search of the literature, the committee found one reference to the potential for a clinical nurse specialist in caring for surgical patients,2 but no reports could be found describing implementation of the clinical nurse specialist role in the OR. Two major questions were considered by the committee. 1. Were the 143 RNs prepared a t the master’s level practicing clinical nursing with surgical patients in the OR? 2. Was t h e t e r m , clinical nurse specialist, being used only as a job title and not as a generic level of preparation for practice?
T
AORN survey of members listed as CNS Mary Gill Nolan, RN
AORN Journal, December 1977, VoI 26, N o 6
1035
Methodology. A mail survey was conducted to obtain information about each of the 143 members listed as clinical nurse specialists on the AORN membership roster. Key variables investigated were those reflecting the nature of advanced professional clinical nursing practice as described in the ANA definition. Other variables describing advanced clinical practice and the practice setting were selected from the literature. These were 1. flexibility in working hours, use of time, activities 2. salary commensurate with education, responsibility 3. direct line access to administrative head, nursing, or a n assistant for clinical practice or education 4. geographic mobility with reference to surgical patients 5. staff relationship to all OR personnel 6. certified nurse specialist in the operating room new position in organization
Mary Gill Nolan, R N , MN, is a clinical nurse specialist for surgical patients at Daniel Freeman Hospital, Inglewood, Calif. She is a graduate of St Vincent’s Hospital Training School, Erie, Pa; California State University, Long Beach, and the University of California at Los Angeles. Nolan was a member of the AORN OR Nursing Research Committee at the time of this study.
1036
___
Table 1 ~-
Variables
Subiects #I
Diploma BSN MSN ANA member Yearslnursing YearsiOR YearslCNS
+ + + + >20 16-20 2-5
#2
#3
+ +
+ + + +
16-20 3-5 2-5
>20 20 > 2
-
+
Educational and professional variables of three OR clinical nurse specialists.
7. certified nurse specialist positions in other clinical areas 8. resource for all line levels of nursing, other health care disciplines, patients, families 9. use of full range of change strategies 10. use of research or research findings in practice. A questionnaire containing 74 forced-choice items and six open-ended questions was designed. Questions were based on all the variables. Responses would provide educational and professional profile employing agency profile placement and methods of function in the system strategies used to effect change restraining and driving forces concerning role development research activities and publications. A cover letter explained the survey to the total population under study. Return was requested within two weeks. Because of the exploratory nature of the survey and the limitations of nominal data the questionnaire would yield, no plan was made to show statistical relationships between variables. Data
AORN Journal, December 1977, V o l 2 6 , No 6
Table 2 Variables
___.
.
~
Subjects
_ _ _ _ _
#1
Salaried Salary Geographic area Overtime comp Hours Plan timelworkiactivities Agency type Beds # ORs Proceduresimonth OR under Reports to Trad org structure Staff position CNS-new position CNS in other areas Job title
#2
#3
+
+
+
11-14,000 Southwest time off flexible self federal 600-699 10-14 400-599 nursing Nsg dir
1 I-14,000
14-20,000 West time off flexible self community 300-399 6-9 400-599 nursing Nsg dir
+ + + +
Midwest time off flexible self university >800
>20 >1,500
nursing Nsg dir -
+ +
+
+
+
+
clinician
clinician
+
CNS
Employment agency profiles of three OR clinicat nurse specialists.
would be examined only for similarities and differences. The data collection instrument was designed specifically for this study and was not pilot tested. Face validity was claimed by the fact that questions asked for the desired information. No attempt was made to provide for estimating reliability of response. Subjects were guaranteed anonymity, which tends to enhance reliability of response. Persons not fitting the official ANA definition of clinical nurse specialist might not be able to answer some of the questions; guesswork would negate reliability. Findings and recommendations. Fifty (35%) of the 143 persons identified as clinical nurse specialists on the AORN membership roster consented to participate in the study by returning the questionnaire. Eight of the 50 subjects were prepared a t the master’s level. Seven of these met the ANA criterion of
a master’s degree in nursing. All seven of these subjects belonged to ANA. No other subject in the study reported holding membership in ANA. Of the seven, two subjects with master’s preparation in nursing held top administrative posts in nursing. The other five were practicing as clinical nurse specialists: one in general medical-surgical nursing, one in cardiovascular nursing, and three in the operating room. One of the three OR clinical nurse specialists held a joint appointment on the faculty of a university school of nursing. The complete profiles of the three OR clinical nurse specialists will be compared for similarities and differences. Table 1compares their educational and professional variables. Two subjects held diplomas in nursing; all had earned baccalaureate and master’s degrees in nursing. All three subjects were
AORN Journal, December 1977, Val 26, No 6
1037
members of ANA. Two had been practicing nursing over 20 years; one, 6 to 10 years. Operating room experience of the three varied from over 20 years to 16 to 20 years to 3 to 5 years. Table 2 compares the three OR clinical nurse specialist subjects for employing agency profile. All were salaried and received compensatory time for overtime. Salaries at the time of the survey reflected the differences in nurses’ salaries and wages based on geographic location. All had flexible work schedules and planned their own time and activities. The greatest difference in variables occurred with the employing agency structure. Practice settings included a federal hospital with 600 to 699 beds, 10 to 14 operating rooms, and a case load between 400 and 599 patients per month; a university hospital and school of nursing with over 800 beds, over 20 operating rooms, and more than 1,500 procedures per month; and a community hospital with 300 to 399 beds, six to nine operating rooms, and 400 to 599 cases per month. In each instance, the OR was under nursing service and the clinical nurse specialists reported to the nursing director. Two worked with traditional staff-head nurse-supervisor structures; the university hospital had a fully implemented clinical ladder including unit management. Each clinical nurse specialist in the operating room was filling a new position in a staff relationship to the OR personnel. Each nursing service had clinical nurse specialist positions filled in other clinical areas of the hospital. Two held the job title of clinician; one, clinical nurse specialist. Table 3 compares the three operating room clinical nurse specialist subjects in relation to functional profiles. Functions varied in only two instances. Clinical nurse specialist #3 did not hold patient care conferences; clinical nurse
1038
Table 3 Variables
Su biects #I
Holds nursing care conferences Scrubs, circulates to teach Does preop patient teaching Consultsinursing care of pts Does research Applies research Resource to R N s , MDs, pts, families Acts as change agent through a. teaching b. use of consultants c. increasing problemsolving skillsistaff d. playing politics e. authority of expertise f. manipulation
#2 #3
+ +
-
+ + +
+ + + + + +
- + + + + + + + +
+ + +
+ + + + + + + + + + + + + + + + + +
Functionalprofiles of three OR clinical nurse specialists. specialist #1 did not conduct research projects. All scrubbed and circulated as role models; engaged in direct staff teaching and patient teaching; served as resources and consultants for colleagues, medical staff, patients, and families; applied research findings in practice; and implemented planned change. Change strategies used included teaching, using expert consultants, increasing problem-solving skills of staff, playing politics, and using expert authority (power) and manipulative techniques. Two subjects reported past research projects and publications. Creating and defining the clinical nurse specialist role for the OR setting and gaining understanding and acceptance for the role by physicians and colleagues in the OR were cited as major restraining forces. Perseverance and strong support from the nursing service director were the greatest driving forces in role develop-
AORN Journal, December 1977, Vol26, No 6
~~
-
Table 4
Educational_ level _ _ ~
_ _ _ _ _
Master’s,nursing Master’s,other field Bachelor. nursina Bachelor: other field Associate, nursing Associate, other field Diploma Not stated Total
yo of Subiects total _ _ _ 7 1 11 1 1 1 25 ~3 50
,
2 22 2 2 2 50 6 _ 100
Educational preparation of 50 survey subjects.
m e n t for t h e t h r e e clinical n u r s e specialists in the operating room. A distribution of the 50 subjects responding to the questionnaire in relation to educational preparation is shown in Table 4. Forty-three subjects did not meet the ANA criterion of master’s preparation in nursing. Half (50%) of the 50 subjects reported a diploma in nursing as the highest education level achieved. Only 1master’s prepared subject had not received her basic nursing education in a diploma program. All but 3 of the 12 subjects with a baccalaureate as highest education level and both subjects with associate degrees had previously earned diplomas in nursing. The associate degree was reported as highest level of education by 4%; the baccalaureate by 24%. Educational preparation was not identified by 6% of the subjects. Participants in this survey reported functioning in a variety of roles (Table 5 ) . Most subjects did not hold positions as generically prepared clinical nurse specialists. Most, however, did hold the job title of clinical nurse specialist and described their roles and role functions in their own words. No common mean-
ing for this job title was found. When the role was not clearly identified other than by responses to the forced-choice questions, it was impossible to determine the exact position held by subjects not prepared atthe.graduate ievel.”The position was therefore classified as “unable to evaluate.” Many participants expressed bewilderment in relation to the current chaotic proliferation of job titles and terms used to describe and identify nursing positions and roles. _ respondent’s words a r e repreOne sentative of the common concern and confusion: . . . the form to renew my RN license . . . had areas for nurse associate, nurse clinician, and nurse specialist. I graduated from a program producing nurse practitioners. What’s the difference between these? It just combines two of the three terms listed above! “It” refers to the term clinical nurse specialist, which combines the terms “clinician” and “specialist.” The survey identified a lack of common meaning for the term clinical nurse specialist among AORN members participating in the study. Subjects reported use of the term clinical nurse specialist as a job title to be more prevalent than as a generic level of preparation for practice. The job title had no common meaning or set of functions. Understanding of advanced clinical practice and advanced clinical practice roles was not, uniform. Recommendations resulting from the study include, first, education of AORN members as t o the meaning, educational (inservice, continuing education, and formal higher education) and experiential preparation of t h e clinical nurse specialist, and role functions for all levels of professional nursing practice in the OR. Second, the Statement Committee should prepare a position statement on role definitions for nurses
AORN Jozo-nal, December 1977, V o l 2 6 , N o 6
1039
Notes
Table 5
_ _
.-
~
Educational level
-__
.
~
~
Role performed
-_ -~
Master's, nursing
___
CNSiOR (3) CNSiother (2) Administration (2) __
-
.___-
Master's. other field
PractitioneriAmb care (1)
Bachelor, nursing
Management (3) Infection control ( 2 ) Inservice (2) Unable to evaluate (5)
- ~ -
.-
-~
.
-
.
.
--
- -
~
-
Bachelor, other field Unable to evaluate (1) .~
~.
Associate, nursing _ ~ -
-
~.
~
Unable to evaluate ( 1 ) -
~
Associate. other field
Unable to evaluate (1)
Diploma
Management (1) Infection control (1) Inservice (1) OfficelscrubiPA (2) Special procedures (1) C-P bypass pump tech (1) Industrial (1) Unable to evaluate (17)
-
-
-
-~~ -
~
Not stated
Infection control (2) tvlidwtfe,PA (1) -
.
~~_.__
Roles of 50 survey subjects in relation to educational preparation Numbers m parenthesis refer to nlrmber of subjects.
in the specialty of operating room nursing to reflect the official ANA definition and prevent further proliferation of titles and terms adding to the existing state of confusion in nursing. Third, the job classification titles on AORN membership renewal forms should be changed to reflect the many actual roles in which the members function.
1040
1. "ANA clarifies practitioner definition," AORN Journal 20 (November 1974) 878. 2. Mary E Morgan, "Surgical nurse clinical specialist," Aerospace Medicine 45 (February 1974) 182-184.
Addendum Following the report of the survey's findings and recommendations to the AORN Board of Directors in 1975, the Board asked the Statement Committee and Research Committee to collaborate in developing a resolution to define roles in OR nursing practice for presentationto the House of Delegatesat the 1976 Congress. A resolution, "Definition: roles in operating room nursing practice," was placed before the House of Delegates but was not adopted. The AORN definitions of nursing practice in the OR as presented in the resolution were: Registerednurses who specialize in operating room nursing provide direct care to surgical patients with primary emphasis on the intraoperative period, utilizing the nursing process to make decisions. They work as colleagues in collaboration with other health professionals to determine care needs and assume responsibility for nursing care. Their nursing practice includes identification of clinical problems, nursing actions, and evaluation of the results of actions taken, as well as periodic self-evaluation and peer review of their contributions to health care. The minimal preparation for an operating room nurse is a license to practice as a registered nurse. Operating room nurse clinicians have developed competence in utilizing physiological and psychosocial patient behaviors for planning and implementing as well as evaluating both direct and indirect care, coordinating patient care with other disciplines and other nursing units, and teaching individuals, families, or groups in a variety of settings. Nurse clinicians demonstrate expertise in OR nursing practice and insure ongoing development of their expertise through clinical practice and continuing education. Generally the minimal preparation for this role is the baccalaureate degree in nursing. Operating room clinical nurse specialists are advanced clinicians with a greater depth of theoretical knowledge, technical skill, and
AORN Journal. December 1977, Val 26, N o 6
T
AORN survey of members listed as CNS Mary Gill Nolan, RN
AORN Journal, December 1977, VoI 26, N o 6
1035
Methodology. A mail survey was conducted to obtain information about each of the 143 members listed as clinical nurse specialists on the AORN membership roster. Key variables investigated were those reflecting the nature of advanced professional clinical nursing practice as described in the ANA definition. Other variables describing advanced clinical practice and the practice setting were selected from the literature. These were 1. flexibility in working hours, use of time, activities 2. salary commensurate with education, responsibility 3. direct line access to administrative head, nursing, or a n assistant for clinical practice or education 4. geographic mobility with reference to surgical patients 5. staff relationship to all OR personnel 6. certified nurse specialist in the operating room new position in organization
Mary Gill Nolan, R N , MN, is a clinical nurse specialist for surgical patients at Daniel Freeman Hospital, Inglewood, Calif. She is a graduate of St Vincent’s Hospital Training School, Erie, Pa; California State University, Long Beach, and the University of California at Los Angeles. Nolan was a member of the AORN OR Nursing Research Committee at the time of this study.
1036
___
Table 1 ~-
Variables
Subiects #I
Diploma BSN MSN ANA member Yearslnursing YearsiOR YearslCNS
+ + + + >20 16-20 2-5
#2
#3
+ +
+ + + +
16-20 3-5 2-5
>20 20 > 2
-
+
Educational and professional variables of three OR clinical nurse specialists.
7. certified nurse specialist positions in other clinical areas 8. resource for all line levels of nursing, other health care disciplines, patients, families 9. use of full range of change strategies 10. use of research or research findings in practice. A questionnaire containing 74 forced-choice items and six open-ended questions was designed. Questions were based on all the variables. Responses would provide educational and professional profile employing agency profile placement and methods of function in the system strategies used to effect change restraining and driving forces concerning role development research activities and publications. A cover letter explained the survey to the total population under study. Return was requested within two weeks. Because of the exploratory nature of the survey and the limitations of nominal data the questionnaire would yield, no plan was made to show statistical relationships between variables. Data
AORN Journal, December 1977, V o l 2 6 , No 6
Table 2 Variables
___.
.
~
Subjects
_ _ _ _ _
#1
Salaried Salary Geographic area Overtime comp Hours Plan timelworkiactivities Agency type Beds # ORs Proceduresimonth OR under Reports to Trad org structure Staff position CNS-new position CNS in other areas Job title
#2
#3
+
+
+
11-14,000 Southwest time off flexible self federal 600-699 10-14 400-599 nursing Nsg dir
1 I-14,000
14-20,000 West time off flexible self community 300-399 6-9 400-599 nursing Nsg dir
+ + + +
Midwest time off flexible self university >800
>20 >1,500
nursing Nsg dir -
+ +
+
+
+
+
clinician
clinician
+
CNS
Employment agency profiles of three OR clinicat nurse specialists.
would be examined only for similarities and differences. The data collection instrument was designed specifically for this study and was not pilot tested. Face validity was claimed by the fact that questions asked for the desired information. No attempt was made to provide for estimating reliability of response. Subjects were guaranteed anonymity, which tends to enhance reliability of response. Persons not fitting the official ANA definition of clinical nurse specialist might not be able to answer some of the questions; guesswork would negate reliability. Findings and recommendations. Fifty (35%) of the 143 persons identified as clinical nurse specialists on the AORN membership roster consented to participate in the study by returning the questionnaire. Eight of the 50 subjects were prepared a t the master’s level. Seven of these met the ANA criterion of
a master’s degree in nursing. All seven of these subjects belonged to ANA. No other subject in the study reported holding membership in ANA. Of the seven, two subjects with master’s preparation in nursing held top administrative posts in nursing. The other five were practicing as clinical nurse specialists: one in general medical-surgical nursing, one in cardiovascular nursing, and three in the operating room. One of the three OR clinical nurse specialists held a joint appointment on the faculty of a university school of nursing. The complete profiles of the three OR clinical nurse specialists will be compared for similarities and differences. Table 1compares their educational and professional variables. Two subjects held diplomas in nursing; all had earned baccalaureate and master’s degrees in nursing. All three subjects were
AORN Journal, December 1977, Val 26, No 6
1037
members of ANA. Two had been practicing nursing over 20 years; one, 6 to 10 years. Operating room experience of the three varied from over 20 years to 16 to 20 years to 3 to 5 years. Table 2 compares the three OR clinical nurse specialist subjects for employing agency profile. All were salaried and received compensatory time for overtime. Salaries at the time of the survey reflected the differences in nurses’ salaries and wages based on geographic location. All had flexible work schedules and planned their own time and activities. The greatest difference in variables occurred with the employing agency structure. Practice settings included a federal hospital with 600 to 699 beds, 10 to 14 operating rooms, and a case load between 400 and 599 patients per month; a university hospital and school of nursing with over 800 beds, over 20 operating rooms, and more than 1,500 procedures per month; and a community hospital with 300 to 399 beds, six to nine operating rooms, and 400 to 599 cases per month. In each instance, the OR was under nursing service and the clinical nurse specialists reported to the nursing director. Two worked with traditional staff-head nurse-supervisor structures; the university hospital had a fully implemented clinical ladder including unit management. Each clinical nurse specialist in the operating room was filling a new position in a staff relationship to the OR personnel. Each nursing service had clinical nurse specialist positions filled in other clinical areas of the hospital. Two held the job title of clinician; one, clinical nurse specialist. Table 3 compares the three operating room clinical nurse specialist subjects in relation to functional profiles. Functions varied in only two instances. Clinical nurse specialist #3 did not hold patient care conferences; clinical nurse
1038
Table 3 Variables
Su biects #I
Holds nursing care conferences Scrubs, circulates to teach Does preop patient teaching Consultsinursing care of pts Does research Applies research Resource to R N s , MDs, pts, families Acts as change agent through a. teaching b. use of consultants c. increasing problemsolving skillsistaff d. playing politics e. authority of expertise f. manipulation
#2 #3
+ +
-
+ + +
+ + + + + +
- + + + + + + + +
+ + +
+ + + + + + + + + + + + + + + + + +
Functionalprofiles of three OR clinical nurse specialists. specialist #1 did not conduct research projects. All scrubbed and circulated as role models; engaged in direct staff teaching and patient teaching; served as resources and consultants for colleagues, medical staff, patients, and families; applied research findings in practice; and implemented planned change. Change strategies used included teaching, using expert consultants, increasing problem-solving skills of staff, playing politics, and using expert authority (power) and manipulative techniques. Two subjects reported past research projects and publications. Creating and defining the clinical nurse specialist role for the OR setting and gaining understanding and acceptance for the role by physicians and colleagues in the OR were cited as major restraining forces. Perseverance and strong support from the nursing service director were the greatest driving forces in role develop-
AORN Journal, December 1977, Vol26, No 6
~~
-
Table 4
Educational_ level _ _ ~
_ _ _ _ _
Master’s,nursing Master’s,other field Bachelor. nursina Bachelor: other field Associate, nursing Associate, other field Diploma Not stated Total
yo of Subiects total _ _ _ 7 1 11 1 1 1 25 ~3 50
,
2 22 2 2 2 50 6 _ 100
Educational preparation of 50 survey subjects.
m e n t for t h e t h r e e clinical n u r s e specialists in the operating room. A distribution of the 50 subjects responding to the questionnaire in relation to educational preparation is shown in Table 4. Forty-three subjects did not meet the ANA criterion of master’s preparation in nursing. Half (50%) of the 50 subjects reported a diploma in nursing as the highest education level achieved. Only 1master’s prepared subject had not received her basic nursing education in a diploma program. All but 3 of the 12 subjects with a baccalaureate as highest education level and both subjects with associate degrees had previously earned diplomas in nursing. The associate degree was reported as highest level of education by 4%; the baccalaureate by 24%. Educational preparation was not identified by 6% of the subjects. Participants in this survey reported functioning in a variety of roles (Table 5 ) . Most subjects did not hold positions as generically prepared clinical nurse specialists. Most, however, did hold the job title of clinical nurse specialist and described their roles and role functions in their own words. No common mean-
ing for this job title was found. When the role was not clearly identified other than by responses to the forced-choice questions, it was impossible to determine the exact position held by subjects not prepared atthe.graduate ievel.”The position was therefore classified as “unable to evaluate.” Many participants expressed bewilderment in relation to the current chaotic proliferation of job titles and terms used to describe and identify nursing positions and roles. _ respondent’s words a r e repreOne sentative of the common concern and confusion: . . . the form to renew my RN license . . . had areas for nurse associate, nurse clinician, and nurse specialist. I graduated from a program producing nurse practitioners. What’s the difference between these? It just combines two of the three terms listed above! “It” refers to the term clinical nurse specialist, which combines the terms “clinician” and “specialist.” The survey identified a lack of common meaning for the term clinical nurse specialist among AORN members participating in the study. Subjects reported use of the term clinical nurse specialist as a job title to be more prevalent than as a generic level of preparation for practice. The job title had no common meaning or set of functions. Understanding of advanced clinical practice and advanced clinical practice roles was not, uniform. Recommendations resulting from the study include, first, education of AORN members as t o the meaning, educational (inservice, continuing education, and formal higher education) and experiential preparation of t h e clinical nurse specialist, and role functions for all levels of professional nursing practice in the OR. Second, the Statement Committee should prepare a position statement on role definitions for nurses
AORN Jozo-nal, December 1977, V o l 2 6 , N o 6
1039
Notes
Table 5
_ _
.-
~
Educational level
-__
.
~
~
Role performed
-_ -~
Master's, nursing
___
CNSiOR (3) CNSiother (2) Administration (2) __
-
.___-
Master's. other field
PractitioneriAmb care (1)
Bachelor, nursing
Management (3) Infection control ( 2 ) Inservice (2) Unable to evaluate (5)
- ~ -
.-
-~
.
-
.
.
--
- -
~
-
Bachelor, other field Unable to evaluate (1) .~
~.
Associate, nursing _ ~ -
-
~.
~
Unable to evaluate ( 1 ) -
~
Associate. other field
Unable to evaluate (1)
Diploma
Management (1) Infection control (1) Inservice (1) OfficelscrubiPA (2) Special procedures (1) C-P bypass pump tech (1) Industrial (1) Unable to evaluate (17)
-
-
-
-~~ -
~
Not stated
Infection control (2) tvlidwtfe,PA (1) -
.
~~_.__
Roles of 50 survey subjects in relation to educational preparation Numbers m parenthesis refer to nlrmber of subjects.
in the specialty of operating room nursing to reflect the official ANA definition and prevent further proliferation of titles and terms adding to the existing state of confusion in nursing. Third, the job classification titles on AORN membership renewal forms should be changed to reflect the many actual roles in which the members function.
1040
1. "ANA clarifies practitioner definition," AORN Journal 20 (November 1974) 878. 2. Mary E Morgan, "Surgical nurse clinical specialist," Aerospace Medicine 45 (February 1974) 182-184.
Addendum Following the report of the survey's findings and recommendations to the AORN Board of Directors in 1975, the Board asked the Statement Committee and Research Committee to collaborate in developing a resolution to define roles in OR nursing practice for presentationto the House of Delegatesat the 1976 Congress. A resolution, "Definition: roles in operating room nursing practice," was placed before the House of Delegates but was not adopted. The AORN definitions of nursing practice in the OR as presented in the resolution were: Registerednurses who specialize in operating room nursing provide direct care to surgical patients with primary emphasis on the intraoperative period, utilizing the nursing process to make decisions. They work as colleagues in collaboration with other health professionals to determine care needs and assume responsibility for nursing care. Their nursing practice includes identification of clinical problems, nursing actions, and evaluation of the results of actions taken, as well as periodic self-evaluation and peer review of their contributions to health care. The minimal preparation for an operating room nurse is a license to practice as a registered nurse. Operating room nurse clinicians have developed competence in utilizing physiological and psychosocial patient behaviors for planning and implementing as well as evaluating both direct and indirect care, coordinating patient care with other disciplines and other nursing units, and teaching individuals, families, or groups in a variety of settings. Nurse clinicians demonstrate expertise in OR nursing practice and insure ongoing development of their expertise through clinical practice and continuing education. Generally the minimal preparation for this role is the baccalaureate degree in nursing. Operating room clinical nurse specialists are advanced clinicians with a greater depth of theoretical knowledge, technical skill, and
AORN Journal. December 1977, Val 26, N o 6
