Opinions
Nursing or administration: Which is better? It is an age-old question. Is it better for the OR to be under nursing service or administration? We asked several nurses the following question: Is your operating room under nursing service or administration or some other administrative area? What do you believe are the advantages and disadvantages or your administrative structure?
Barbara J Martin, RN
1130
The Evanston (111) Hospital uses a multidisciplinary approach to directing the operating room. The nursing staff reports to the Department of Nursing and is accountable for nursing care delivered to patients. The Department of Surgery, of which anesthesia is a division, is responsible for determining allocation of operative time based on historical data. The Department of Obstetrics and Gynecology is a separate department, but its overall available operative time is determined by the Department of Surgery. Each department is led by a clinically competent chairman. The challenge of this multidisciplinary approach is to bring professionals of different disciplines together to deliver optimal patient care. There are many advantages to this approach. Each chairman is responsible for the professional activities of those who report to him. The chairmen of the Departments of Nursing, Surgery, and Obstetrics and Gynecology are equal colleagues in the decision-making process for the operating room. No one group can set up the rules for the department to its own exclusive benefit without taking into consideration other interest groups. If special needs or problems arise for one group, temporary accommodations are usually made to meet those needs until a permanent solution can be agreed upon by the group. In this system, an advantage to nursing is that we stay in the mainstream of nursing and are
AORN Journal, May 1979,Vol29, No 6
“l would like to see a free to practice the perioperative role of the nurse in more active OR the operating room. One of the potential disadvantages is that if each committee.” chairman does not assume responsibility for the professional activities of those who report to him, the system breaks down and it is difficult to get problems solved or decisions made for the operating room. We are fortunate in having true professionals as chairmen who accept their professional and administrative responsibilitiesand have made themselves accountable for the performances of their staffs and for the function of the operating room. The biggest improvement I would like to see in our system is a more active operating room committee, which would address issues and problems involving the operating room and related departments and would function in an advisory capacity to the three chairmen to assist them in making decisions regulating the function of the department. In this way, no one group could feel it did not have adequate voice or participation in the decision-making processes that control the functioning of the department or that its interests were not being considered when decisions were made.
Barbara J Martin, RN Clinical Coordinator, Operating Room Evanston (111) Hospital
As director of operating rooms, I have worked under both hospital and nursing administration. In my previous position, I was fortunate to have a director and vice-president of nursing who tagged me as “the expert” and let me manage the department, along with my assistants, without interference but with consultation when necessary. The same attitude applies to my present position, which is directly under the hospital administrator. The OR functions independently of nursing administration, but our nursing council brings together the nursing directors for monthly meetings to discuss interdepartmental nursing problems and to plan goals. The hospital administrator and the chairman of surgery, who is a surgeon, are always willing to help with surgical staff, nursing policy, and budgetary and disciplinary questions, including protocol. They appreciate the fact that they are not asked to solve trivial problems. This is not necessary if the OR nursing staff and the surgical staff communicate, and
1132
AORN Journal, May 1979,Vol29, No 6
“Use the channels petty problems are solved on a daily basis before they open to YOU for become difficult and/or acute. The name of the game consultation.” is informing management of any potential problems
that might require intervention, cost containment and reduction, changes in current policy and surgical trends, staffing needs, and possible medical-legal situations. I do not want to give the impression that the OR director does not receive some problems indirectly from the administrator and the chairman of surgery. There are always certain nurses and surgeons who only communicate with the latter. The director is then obliged to backtrack answers concerning situations or events she recalls dimly if at all. Every hospital is working toward a common goal-the best possible care for its patients. To achieve this goal, each employee must prove he is the expert he has trained to be-professional or nonprofessional, worker or boss. This happens only with mutual respect for people and position, reinforced by action and honesty. Few problems are unsurmountable, and with total involvement as to what is right and reasonable, there will be few unilateral decisions. Control the problems if possible, but use the channels open to you for consultation. Be responsible and responsive. The end result will be a feeling of satisfaction that you are indeed the expert and have met and perhaps surpassed the strict standards of your hospital. This will make better health care available to your community because there is an efficient, satisfied, and intelligent staff in your operating rooms. Martha Hoffman, RN Director, OR, RR, CS Greenville (Pa) Hospital
The design and function of our administrative communications is direct line to administration. We have functioned under this mechanism ever since our hospital opened 12 years ago. Having previously worked under a nursing service communication system, I have found the administration line to be a much more efficient method of carrying out the business of the operating room. However, I must “Nursing sen/ice is stress that we have an extremely good liaison with relieved Of problems nursing service and with all other departments. not specific to f/Oor Problems directly related to patient care between nursing. ” nursing service and the operating room are shared
1134
AORN Journal, May 1979, Vol29, No 6
with the director of nursing and/or her assistant in addition to administration when deemed appropriate. This method has many advantages. Nursing service is relieved of numerous problems not specific to floor nursing. For example, staffing, emergencies, and call are all problems general nursing cannot take care of because they must be covered by operating room nurses and cannot be pulled from general nursing. Complaints and/or suggestions that come from the surgeons or anesthesiologists most often should be shared with administration first hand, instead of inserting a chain of command between these two. Since many types of supplies and equipment necessary for efficient function of our operating room are ultimately approved by administration, why add an extra step? I expect operating room supervisors or the directors of these departments to be knowledgeable, efficient, and experienced listening doers and coordinators. I expect them to constantly take advantage of continuing education to upgrade their performance. I expect them to establish good liaison and use basic common sense and good judgment. If these persons use these qualities to their best advantage, they will find any system works. I believe a direct line to administration is best because of expediency of performance, control, and eventual results and because of the weight of problems this apparently removes from the already taxed duties of general nursing.
Joanne Oliver, RN
Joanne Oliver, RN Director, OR, RR Diagnostic Center Hospital Houston
“The OR cou’d be directed more efficiently W’Xkr the hospital diECtOr. ” 1136
There is no particular advantage to being under nursing administration except that OR nurses fall in this broad category and are subsequently directed by the nursing service department. As a clinical coordinator of Operating Room Services, I believe the operating room could be directed more efficiently and effectively if the hospital director had responsibility for its administration. The operating room is a unique service as it interacts with every other department within the hospital. Interpersonal relationships are developed through close teamwork and daily crisis intervention. Problems often occur within surgical service that require administrative intervention to
AORN Journal, May 1979, Vol29, No 6
“The OR should not be divorced from If
nursing
relieve the pressure. I believe personnel problems within the team occur more frequently in a medical teaching facility where there is frequent turnover of the professional staff. Administration is the policy-making body with final say in policy changes, procedure approval, and implementation of standards. Quick approval is required to cope with everchanging surgical techniques and new equipment used in operating rooms. Operating room supervisors control a substantial budget that needs direct administrative input. Final decisions on procurement of supplies and purchase of equipment are made by the OR supervisor and chief of materials management. No other nursing supervisor has this responsibility and final budget decision. To be under the direction of administration does not, however, divorce the OR from nursing service. Nurses in the operating room take advantage of inservice programs, career development, and career mobility provided by the nursing service department. As a result, the Operating Room Services is a self-sufficient department within the formal structure of a hospital. I feel the operating room supervisor should report directly to administration as a department head. It is his or her responsibility to provide full utilization of the OR and establish the department as cost effective. Operating Room Services traditionally makes money to provide other services within the hospital. Because the operating room provides highly specialized and unique service to the hospital, I would hope hospital directors would give careful consideration to restructuring the formal management lines of this department.
Carolyn J Mackety, RN Clinical Coordinator, OR Services William Middleton Memorial VA Medical Center Madison, Wis
“Under we are supposed to be strictly business.” 1138
In different hospitals, the operating room has been placed either under the nursing service or under administration. Some places have fought over the placement of the operating suite because of the fact we generate the highest revenue. If we are put under administration, we wear a different hat. We are supposed to be strictly business, and we must act like a machine or computer, making no mistakes in time and charges. We find ourselves at
AORN Journal, May 1979,Vol29, No 6
the point of forgetting our professional responsibility to our patients. When major decisions are made, we consult with a person who usually doesn’t know where the operating bed is or how to position it. Yet, as nurses, we act as a patsy and go along with whatever administration tells us because it is the establishment. We have become so involved accepting its answers that it really doesn’t bother us, regardless of how ridiculous the answers may be. If the operating room is under an administration that has some operating room knowledge and is open-minded, it could be to the OR’Sadvantage. Administration is in the position to adhere to our wants and needs in equipment and personnel. I find many disadvantages to a direct administrative setup. We are told the goals we must aim for and often how to achieve them. This leaves a conscientious supervisor frustrated in many areas. As professionals, we have been taught to think for ourselves and work out the problems in our own department. Under the direct supervision of administration, we have a tendency to let someone else manage our department for us. We are professional surgical personnel and need to keep in mind we are still working with real people. We should try to put ourselves in their place.
Edna Meadows, RN
Edna Meadows, RN Operating room supervisor Caliaillo Medical Center San Diego
II
T h r e was lack of a single aUthOrity.”
The operating room at Georgetown University Hospital is a separate department from nursing service and has been for the past two years. Until that time, there had been multiple problems associated with the OR, including the lack of a single authority accountable for several fragmented areas of responsibility. Staffing guidelines and budget for personnel came from the nursing department, posting and scheduling were handled by the anesthesia department, and there was a distinct lack of written rules and guidelines to complement the smooth running of the OR schedule on a daily basis. At the time, the nursing staff in the OR was against decentralization. The concept of fragmenting the nursing department into other departments was not thought to be beneficial. It was felt that a dangerous precedent would be set and that the timing was
cfAORN Journal, May 1979,Vol29, No 6
1139
"Having a separate extremely bad. The nursing department was budget was a distinct undergoing reorganization, and compounding these
benefit for the OR.''
"Prob'ems receive I'mXe direct, hmedkfte aflention." 1142
existing problems was the imminent move to a new OR facility in another building. Most of these problems seem far in the past now because the move went smoothly and decentralization worked out to the benefit of the OR department. The concern that nurses would report to administration or a medical director did not materialize. All nursing personnel in the OR are ultimately responsible to a director of nursing, OR, who reports to an executive director. This person is also a registered nurse and is responsible to the physician head of the department, or the medical director. All nursing practice within the department is controlled by the director of nursing who establishes and maintains standards of nursing practice. Having a separate budget has proved to be one of the distinct benefits for the Department of the OR. Since we are a revenue-producing department, the case load is directly related to the amount of staffing available. In the past, when budgetary restrictions prohibited hiring more nursing staff, the staff was overworked and felt that at times their nursing principles were being compromised because of budgetary restrictions. Under a separate budget, this doesn't happen. We are able to hire and replace the maximum number of nursing personnel on our budget and maintain newly created ancillary positions, which are a complement to the department. For example, the large ancillary staff allows the nursing staff to remain with the patient longer, particularly before anesthesia starts, because they assume many of the technical tasks such as assembling supplies and equipment needed for the case. There are also decided benefits in purchasing equipment for the department. Our equipment budget no longer is lumped with funds for other departments, and problems receive more direct, immediate attention. In the past, the OR was 1 of 28 subhospital departments. Now, with a straight chain of command, supervisory personnel are more available and readily accessible on a daily basis. We don't have to compete with other departments for the time and attention of the department head. At times, there is a certain isolated feeling in being separated from the nursing department. Perhaps this is more related to growing pains. Since the OR was the first hospital section to undergo this division from
AORN Journal, May 1979,Vol29, No 6
“There is an isolated feeling in being separated from nursing.”
nursing service, there seems to be some animosity toward this department. The reasons for this include individual personalities as well as a commitment on the part of the OR department to support and maintain this separation in light of the benefits.
Claire T West, RN Director of the operating room Georgetown University Hospital Washington, DC
M W a r e t Leere, RN
1144
As director of Surgical Services, which includes the operating room, postanesthesia recovery, and ambulatory surgery, I report directly to the assistant executive director in patient operations. I believe that the operating room service should function with independent controls as a specialty service, yet demonstrate a patient-centered awareness and open communication between medical staff and other departments. The operating room department head who reports directly to administration has the advantage of a direct line of accountability toward meeting long- and short-term goals; budget planning and accounting; determination of staffing needs; recruitment, training, and continuing education needs; and in analysis of data as they affect the total technology and efficiency of the department. The self-assurgd, independent, action-oriented leader with strong administrative and behavioral skills will probably experience the highest level of satisfaction and achievement when reporting directly to administration, which expects measurable results based on statistical data. A potential disadvantage in reporting directly to administration is the lack of lateral cooperation from the nursing department; however, I have never experienced this and believe it would not be likely to occur as long as there are open lines of communication and mutual respect. An advantage of the operating room reporting to nursing could possibly include a strong nursing support for nursing functions. However, a skilled and knowledgeable nursing leader in the OR/PAR should be able to provide sound rationale and produce positive results, which benefit the patient when delineation of nursing activities are challenged by medical staff and/or administration. Based on my experience, I think that much depends on the size and type of hospital and department,
AORN Journal, May 1979,V o l 2 9 , No 6
Nursing or administration: Which is better? It is an age-old question. Is it better for the OR to be under nursing service or administration? We asked several nurses the following question: Is your operating room under nursing service or administration or some other administrative area? What do you believe are the advantages and disadvantages or your administrative structure?
Barbara J Martin, RN
1130
The Evanston (111) Hospital uses a multidisciplinary approach to directing the operating room. The nursing staff reports to the Department of Nursing and is accountable for nursing care delivered to patients. The Department of Surgery, of which anesthesia is a division, is responsible for determining allocation of operative time based on historical data. The Department of Obstetrics and Gynecology is a separate department, but its overall available operative time is determined by the Department of Surgery. Each department is led by a clinically competent chairman. The challenge of this multidisciplinary approach is to bring professionals of different disciplines together to deliver optimal patient care. There are many advantages to this approach. Each chairman is responsible for the professional activities of those who report to him. The chairmen of the Departments of Nursing, Surgery, and Obstetrics and Gynecology are equal colleagues in the decision-making process for the operating room. No one group can set up the rules for the department to its own exclusive benefit without taking into consideration other interest groups. If special needs or problems arise for one group, temporary accommodations are usually made to meet those needs until a permanent solution can be agreed upon by the group. In this system, an advantage to nursing is that we stay in the mainstream of nursing and are
AORN Journal, May 1979,Vol29, No 6
“l would like to see a free to practice the perioperative role of the nurse in more active OR the operating room. One of the potential disadvantages is that if each committee.” chairman does not assume responsibility for the professional activities of those who report to him, the system breaks down and it is difficult to get problems solved or decisions made for the operating room. We are fortunate in having true professionals as chairmen who accept their professional and administrative responsibilitiesand have made themselves accountable for the performances of their staffs and for the function of the operating room. The biggest improvement I would like to see in our system is a more active operating room committee, which would address issues and problems involving the operating room and related departments and would function in an advisory capacity to the three chairmen to assist them in making decisions regulating the function of the department. In this way, no one group could feel it did not have adequate voice or participation in the decision-making processes that control the functioning of the department or that its interests were not being considered when decisions were made.
Barbara J Martin, RN Clinical Coordinator, Operating Room Evanston (111) Hospital
As director of operating rooms, I have worked under both hospital and nursing administration. In my previous position, I was fortunate to have a director and vice-president of nursing who tagged me as “the expert” and let me manage the department, along with my assistants, without interference but with consultation when necessary. The same attitude applies to my present position, which is directly under the hospital administrator. The OR functions independently of nursing administration, but our nursing council brings together the nursing directors for monthly meetings to discuss interdepartmental nursing problems and to plan goals. The hospital administrator and the chairman of surgery, who is a surgeon, are always willing to help with surgical staff, nursing policy, and budgetary and disciplinary questions, including protocol. They appreciate the fact that they are not asked to solve trivial problems. This is not necessary if the OR nursing staff and the surgical staff communicate, and
1132
AORN Journal, May 1979,Vol29, No 6
“Use the channels petty problems are solved on a daily basis before they open to YOU for become difficult and/or acute. The name of the game consultation.” is informing management of any potential problems
that might require intervention, cost containment and reduction, changes in current policy and surgical trends, staffing needs, and possible medical-legal situations. I do not want to give the impression that the OR director does not receive some problems indirectly from the administrator and the chairman of surgery. There are always certain nurses and surgeons who only communicate with the latter. The director is then obliged to backtrack answers concerning situations or events she recalls dimly if at all. Every hospital is working toward a common goal-the best possible care for its patients. To achieve this goal, each employee must prove he is the expert he has trained to be-professional or nonprofessional, worker or boss. This happens only with mutual respect for people and position, reinforced by action and honesty. Few problems are unsurmountable, and with total involvement as to what is right and reasonable, there will be few unilateral decisions. Control the problems if possible, but use the channels open to you for consultation. Be responsible and responsive. The end result will be a feeling of satisfaction that you are indeed the expert and have met and perhaps surpassed the strict standards of your hospital. This will make better health care available to your community because there is an efficient, satisfied, and intelligent staff in your operating rooms. Martha Hoffman, RN Director, OR, RR, CS Greenville (Pa) Hospital
The design and function of our administrative communications is direct line to administration. We have functioned under this mechanism ever since our hospital opened 12 years ago. Having previously worked under a nursing service communication system, I have found the administration line to be a much more efficient method of carrying out the business of the operating room. However, I must “Nursing sen/ice is stress that we have an extremely good liaison with relieved Of problems nursing service and with all other departments. not specific to f/Oor Problems directly related to patient care between nursing. ” nursing service and the operating room are shared
1134
AORN Journal, May 1979, Vol29, No 6
with the director of nursing and/or her assistant in addition to administration when deemed appropriate. This method has many advantages. Nursing service is relieved of numerous problems not specific to floor nursing. For example, staffing, emergencies, and call are all problems general nursing cannot take care of because they must be covered by operating room nurses and cannot be pulled from general nursing. Complaints and/or suggestions that come from the surgeons or anesthesiologists most often should be shared with administration first hand, instead of inserting a chain of command between these two. Since many types of supplies and equipment necessary for efficient function of our operating room are ultimately approved by administration, why add an extra step? I expect operating room supervisors or the directors of these departments to be knowledgeable, efficient, and experienced listening doers and coordinators. I expect them to constantly take advantage of continuing education to upgrade their performance. I expect them to establish good liaison and use basic common sense and good judgment. If these persons use these qualities to their best advantage, they will find any system works. I believe a direct line to administration is best because of expediency of performance, control, and eventual results and because of the weight of problems this apparently removes from the already taxed duties of general nursing.
Joanne Oliver, RN
Joanne Oliver, RN Director, OR, RR Diagnostic Center Hospital Houston
“The OR cou’d be directed more efficiently W’Xkr the hospital diECtOr. ” 1136
There is no particular advantage to being under nursing administration except that OR nurses fall in this broad category and are subsequently directed by the nursing service department. As a clinical coordinator of Operating Room Services, I believe the operating room could be directed more efficiently and effectively if the hospital director had responsibility for its administration. The operating room is a unique service as it interacts with every other department within the hospital. Interpersonal relationships are developed through close teamwork and daily crisis intervention. Problems often occur within surgical service that require administrative intervention to
AORN Journal, May 1979, Vol29, No 6
“The OR should not be divorced from If
nursing
relieve the pressure. I believe personnel problems within the team occur more frequently in a medical teaching facility where there is frequent turnover of the professional staff. Administration is the policy-making body with final say in policy changes, procedure approval, and implementation of standards. Quick approval is required to cope with everchanging surgical techniques and new equipment used in operating rooms. Operating room supervisors control a substantial budget that needs direct administrative input. Final decisions on procurement of supplies and purchase of equipment are made by the OR supervisor and chief of materials management. No other nursing supervisor has this responsibility and final budget decision. To be under the direction of administration does not, however, divorce the OR from nursing service. Nurses in the operating room take advantage of inservice programs, career development, and career mobility provided by the nursing service department. As a result, the Operating Room Services is a self-sufficient department within the formal structure of a hospital. I feel the operating room supervisor should report directly to administration as a department head. It is his or her responsibility to provide full utilization of the OR and establish the department as cost effective. Operating Room Services traditionally makes money to provide other services within the hospital. Because the operating room provides highly specialized and unique service to the hospital, I would hope hospital directors would give careful consideration to restructuring the formal management lines of this department.
Carolyn J Mackety, RN Clinical Coordinator, OR Services William Middleton Memorial VA Medical Center Madison, Wis
“Under we are supposed to be strictly business.” 1138
In different hospitals, the operating room has been placed either under the nursing service or under administration. Some places have fought over the placement of the operating suite because of the fact we generate the highest revenue. If we are put under administration, we wear a different hat. We are supposed to be strictly business, and we must act like a machine or computer, making no mistakes in time and charges. We find ourselves at
AORN Journal, May 1979,Vol29, No 6
the point of forgetting our professional responsibility to our patients. When major decisions are made, we consult with a person who usually doesn’t know where the operating bed is or how to position it. Yet, as nurses, we act as a patsy and go along with whatever administration tells us because it is the establishment. We have become so involved accepting its answers that it really doesn’t bother us, regardless of how ridiculous the answers may be. If the operating room is under an administration that has some operating room knowledge and is open-minded, it could be to the OR’Sadvantage. Administration is in the position to adhere to our wants and needs in equipment and personnel. I find many disadvantages to a direct administrative setup. We are told the goals we must aim for and often how to achieve them. This leaves a conscientious supervisor frustrated in many areas. As professionals, we have been taught to think for ourselves and work out the problems in our own department. Under the direct supervision of administration, we have a tendency to let someone else manage our department for us. We are professional surgical personnel and need to keep in mind we are still working with real people. We should try to put ourselves in their place.
Edna Meadows, RN
Edna Meadows, RN Operating room supervisor Caliaillo Medical Center San Diego
II
T h r e was lack of a single aUthOrity.”
The operating room at Georgetown University Hospital is a separate department from nursing service and has been for the past two years. Until that time, there had been multiple problems associated with the OR, including the lack of a single authority accountable for several fragmented areas of responsibility. Staffing guidelines and budget for personnel came from the nursing department, posting and scheduling were handled by the anesthesia department, and there was a distinct lack of written rules and guidelines to complement the smooth running of the OR schedule on a daily basis. At the time, the nursing staff in the OR was against decentralization. The concept of fragmenting the nursing department into other departments was not thought to be beneficial. It was felt that a dangerous precedent would be set and that the timing was
cfAORN Journal, May 1979,Vol29, No 6
1139
"Having a separate extremely bad. The nursing department was budget was a distinct undergoing reorganization, and compounding these
benefit for the OR.''
"Prob'ems receive I'mXe direct, hmedkfte aflention." 1142
existing problems was the imminent move to a new OR facility in another building. Most of these problems seem far in the past now because the move went smoothly and decentralization worked out to the benefit of the OR department. The concern that nurses would report to administration or a medical director did not materialize. All nursing personnel in the OR are ultimately responsible to a director of nursing, OR, who reports to an executive director. This person is also a registered nurse and is responsible to the physician head of the department, or the medical director. All nursing practice within the department is controlled by the director of nursing who establishes and maintains standards of nursing practice. Having a separate budget has proved to be one of the distinct benefits for the Department of the OR. Since we are a revenue-producing department, the case load is directly related to the amount of staffing available. In the past, when budgetary restrictions prohibited hiring more nursing staff, the staff was overworked and felt that at times their nursing principles were being compromised because of budgetary restrictions. Under a separate budget, this doesn't happen. We are able to hire and replace the maximum number of nursing personnel on our budget and maintain newly created ancillary positions, which are a complement to the department. For example, the large ancillary staff allows the nursing staff to remain with the patient longer, particularly before anesthesia starts, because they assume many of the technical tasks such as assembling supplies and equipment needed for the case. There are also decided benefits in purchasing equipment for the department. Our equipment budget no longer is lumped with funds for other departments, and problems receive more direct, immediate attention. In the past, the OR was 1 of 28 subhospital departments. Now, with a straight chain of command, supervisory personnel are more available and readily accessible on a daily basis. We don't have to compete with other departments for the time and attention of the department head. At times, there is a certain isolated feeling in being separated from the nursing department. Perhaps this is more related to growing pains. Since the OR was the first hospital section to undergo this division from
AORN Journal, May 1979,Vol29, No 6
“There is an isolated feeling in being separated from nursing.”
nursing service, there seems to be some animosity toward this department. The reasons for this include individual personalities as well as a commitment on the part of the OR department to support and maintain this separation in light of the benefits.
Claire T West, RN Director of the operating room Georgetown University Hospital Washington, DC
M W a r e t Leere, RN
1144
As director of Surgical Services, which includes the operating room, postanesthesia recovery, and ambulatory surgery, I report directly to the assistant executive director in patient operations. I believe that the operating room service should function with independent controls as a specialty service, yet demonstrate a patient-centered awareness and open communication between medical staff and other departments. The operating room department head who reports directly to administration has the advantage of a direct line of accountability toward meeting long- and short-term goals; budget planning and accounting; determination of staffing needs; recruitment, training, and continuing education needs; and in analysis of data as they affect the total technology and efficiency of the department. The self-assurgd, independent, action-oriented leader with strong administrative and behavioral skills will probably experience the highest level of satisfaction and achievement when reporting directly to administration, which expects measurable results based on statistical data. A potential disadvantage in reporting directly to administration is the lack of lateral cooperation from the nursing department; however, I have never experienced this and believe it would not be likely to occur as long as there are open lines of communication and mutual respect. An advantage of the operating room reporting to nursing could possibly include a strong nursing support for nursing functions. However, a skilled and knowledgeable nursing leader in the OR/PAR should be able to provide sound rationale and produce positive results, which benefit the patient when delineation of nursing activities are challenged by medical staff and/or administration. Based on my experience, I think that much depends on the size and type of hospital and department,
AORN Journal, May 1979,V o l 2 9 , No 6
