AUGUST 1992, VOL 56, NO 2
preoperatively or postoperatively. Keep in mind these may be the same patients you have had or will have in your operating room with fears and concerns that also need to be addressed. We can promote good patient care by helping the physician have adequate time with these future patients; we can only hope that the surgeon will use this time effectively. In regard to office hours, we have all heard how surgeons must start on time because they have office hours. Stop and think that they are primarily seeing patients, and we may be helping their patients by running an efficient operating room. I believe keeping the operating room running on time promotes quality patient care by decreasing patient anxiety and allowing time for the establishment of a patienthealth care team relationship. CHERYL ALLEN,RN STAFF NURSE ROPERHOSPITAL CHARLESTON, SC Editor’s response. I agree with you. Efficient turnaround time is for the benefit of the patient, the surgeon, and the entire surgical team. My objection lies in the concept that “attending nurses” should be hired to take care of physicians, not patients.
A
s a registered nurse certified in both perioperative nursing and in health care quality, I read the “Editorial” published in the May 1992 AORN Journal with concern. Because I did not have the opportunity to read the study around which Ms Palmer centered her article, I can only interpret it through her comments. I agree with her premise that quality patient care is the core of the nursing profession. I disagree with her strong opinion that physician satisfaction is not a part of assuring quality patient care. Continuous quality improvement (CQI) has become a fact of life in health care and in all of American industry. Those who understand its concepts understand that it is not only a way of doing business, it is the only way to do business successfully. It is the reason Japan ran past
AORN JOURNAL
us in the automotive industry, and its principles are now becoming required, not just suggested, for health care organizations. To successfully implement CQI, nurses must give up their traditional adversarial relationship with physicians, and they have to give up the segregation of nursing from the other areas of the health care facility. They have to look at the whole process the patient moves through; for perioperative nurses, this process begins the moment the physician schedules the surgical procedure. One of the basic requirements of implementing CQI, whether in the health care industry or the automotive industry, is customer focus. This requires us to identify both our internal and our external customers. As our minds expand, we will realize that the patient is not our only customer. As perioperative nurses, our customers are admitting clerks, laboratory technicians, administrators, maintenance people, housekeeping people, and yes, even physicians. The list is long, and we should realize that the customer is anyone who needs something from us to do his or her job. We have one thing in common with all of these people-the job of providing the patient with what is needed to move through the perioperative process. Customer focus begins with customer identification and leads to customer partnership. It is customer partnership that leads to a collaborative approach to patient care. In my opinion, as health care moves in this direction, nursing will hold a powerful position on the collaborative team. It is by this means, not by angrily crying out that “my job is as important as yours,” that nursing will finally gain the recognition that has eluded it for so long. As the editor of the AORN Journal, Ms Palmer speaks as a highly regarded authority in her field. I find it an embarrassment to read her anger in an AORN Journal “Editorial” when, for years, I have counseled my staff to feel differently. I have always felt that a part of my commitment to delivering quality care to my patient is providing the surgeon with all of the tools he or she needs to do the job. This includes a well215
trained staff; all of the necessary equipment. instruments, and supplies; timely information access: and a nice atmosphere. Providing my patient with a surgeon who is not angry. frustrated, or hurrying to make up lost time is a part of delivering quality patient care. Starting a case at the scheduled time is not just an agreement with the surgeon but also a promise to the patient. Moving to total quality management is a painstakingly slow process. It will be a painful process for nursing. We will be forced to look at the very core of our practice and redefine just what quality care is. I was sorry to read that Ms Palmer believes that paying attention to physician satisfaction is a put-down to the nursing profession. Hopefully we will learn that identifying and meeting all of our customer‘s needs, including the physicians‘. is a necessary element in meeting our patients’ needs. MARYELLENCAMM,RN. CNOR. CPHQ DIRECTOR OF SCRGICAL SERVICES HULIANA W o a i ~ u ’ sA N D CHILDREN’S HOSPITAL SANAXTONO.TEX Editor...$ rmpoiisc. 1. too, believe in continuous quality improvement. I, too. see patients, physicians. and other members of the health care team as o u r customers. I d o not agree, however, with the concept of hiring nurses to take care of physicians exclusively.
I
read with great interest your editorial regarding a recent Health Care Advisory Board publication. “Physician Bonding. Volume 111.” Because the role of our company is to get to the heart of controversial subjects, I feel we have done our job when studies spur debates and. as in your case, informed opposition. I am dismayed, however, that our study was construed as denigrating the nursing profession. That was nei’er o u r intention. In our work on clinicit1 quality. we have affirmed the evergrowins role of the nursing profession in ensuring a consistently high standard of care. We believe that fostering a closer working relationship between nurses and physicians can only contribute to the mutual goal of achieving stel-
lar patient service. In that context, we do not believe that placing high priority on the accessibility of nurses for consultation or on nurse understanding of the preferences of their clinical “partners” should be construed as demeaning. Thank you for a thought-provoking editorial and for the opportunity to respond. ELISSA PAGNANI EDITOR-IN-CHIEF HEALTHCAREADVISORY BOARD WASHINGTON, DC
Attitudes Toward Certification
vv
e read the article “Attitudes toward certification: A pilot study,” in the March 1992 issue of the AORN Journal with great interest. While we appreciate the attention to our program, for the benefit of Journal readers, we would like to correct and clarify several points brought out in the article. The assertion that “the general assumption is that performance skills accompany the set knowledge level” is incorrect in reference to the CNOR certification program. Because this has never been tested, we specifically state in our 1992 Certification and Recertification Polic-y Manual that “possession of knowledge does not ensure its proper application.”’ The authors also state, “In one study, CNOR certification is shown as important in improving patient care skills . . . .” This study was conducted by Pamela s. Gibson, BSBA, director of certification, who asked study participants their opinions about whether preparing for certification would improve their patient care skills. The conclusion that it did or did not improve skills cannot be inferred from the study. SUSANPUTERBAUGH, RN, MBA, CNOR EXECUTIVE DIRECTOR PAMELA S. GIBSON, BSBA DIRECTOR OF CERTIFICATION NATIONAL CERTIFICATION BOARD: PERIOPERATIVE NURSING, INC DENVER Note 1 . “Certification process,” in 1992 Certification
preoperatively or postoperatively. Keep in mind these may be the same patients you have had or will have in your operating room with fears and concerns that also need to be addressed. We can promote good patient care by helping the physician have adequate time with these future patients; we can only hope that the surgeon will use this time effectively. In regard to office hours, we have all heard how surgeons must start on time because they have office hours. Stop and think that they are primarily seeing patients, and we may be helping their patients by running an efficient operating room. I believe keeping the operating room running on time promotes quality patient care by decreasing patient anxiety and allowing time for the establishment of a patienthealth care team relationship. CHERYL ALLEN,RN STAFF NURSE ROPERHOSPITAL CHARLESTON, SC Editor’s response. I agree with you. Efficient turnaround time is for the benefit of the patient, the surgeon, and the entire surgical team. My objection lies in the concept that “attending nurses” should be hired to take care of physicians, not patients.
A
s a registered nurse certified in both perioperative nursing and in health care quality, I read the “Editorial” published in the May 1992 AORN Journal with concern. Because I did not have the opportunity to read the study around which Ms Palmer centered her article, I can only interpret it through her comments. I agree with her premise that quality patient care is the core of the nursing profession. I disagree with her strong opinion that physician satisfaction is not a part of assuring quality patient care. Continuous quality improvement (CQI) has become a fact of life in health care and in all of American industry. Those who understand its concepts understand that it is not only a way of doing business, it is the only way to do business successfully. It is the reason Japan ran past
AORN JOURNAL
us in the automotive industry, and its principles are now becoming required, not just suggested, for health care organizations. To successfully implement CQI, nurses must give up their traditional adversarial relationship with physicians, and they have to give up the segregation of nursing from the other areas of the health care facility. They have to look at the whole process the patient moves through; for perioperative nurses, this process begins the moment the physician schedules the surgical procedure. One of the basic requirements of implementing CQI, whether in the health care industry or the automotive industry, is customer focus. This requires us to identify both our internal and our external customers. As our minds expand, we will realize that the patient is not our only customer. As perioperative nurses, our customers are admitting clerks, laboratory technicians, administrators, maintenance people, housekeeping people, and yes, even physicians. The list is long, and we should realize that the customer is anyone who needs something from us to do his or her job. We have one thing in common with all of these people-the job of providing the patient with what is needed to move through the perioperative process. Customer focus begins with customer identification and leads to customer partnership. It is customer partnership that leads to a collaborative approach to patient care. In my opinion, as health care moves in this direction, nursing will hold a powerful position on the collaborative team. It is by this means, not by angrily crying out that “my job is as important as yours,” that nursing will finally gain the recognition that has eluded it for so long. As the editor of the AORN Journal, Ms Palmer speaks as a highly regarded authority in her field. I find it an embarrassment to read her anger in an AORN Journal “Editorial” when, for years, I have counseled my staff to feel differently. I have always felt that a part of my commitment to delivering quality care to my patient is providing the surgeon with all of the tools he or she needs to do the job. This includes a well215
trained staff; all of the necessary equipment. instruments, and supplies; timely information access: and a nice atmosphere. Providing my patient with a surgeon who is not angry. frustrated, or hurrying to make up lost time is a part of delivering quality patient care. Starting a case at the scheduled time is not just an agreement with the surgeon but also a promise to the patient. Moving to total quality management is a painstakingly slow process. It will be a painful process for nursing. We will be forced to look at the very core of our practice and redefine just what quality care is. I was sorry to read that Ms Palmer believes that paying attention to physician satisfaction is a put-down to the nursing profession. Hopefully we will learn that identifying and meeting all of our customer‘s needs, including the physicians‘. is a necessary element in meeting our patients’ needs. MARYELLENCAMM,RN. CNOR. CPHQ DIRECTOR OF SCRGICAL SERVICES HULIANA W o a i ~ u ’ sA N D CHILDREN’S HOSPITAL SANAXTONO.TEX Editor...$ rmpoiisc. 1. too, believe in continuous quality improvement. I, too. see patients, physicians. and other members of the health care team as o u r customers. I d o not agree, however, with the concept of hiring nurses to take care of physicians exclusively.
I
read with great interest your editorial regarding a recent Health Care Advisory Board publication. “Physician Bonding. Volume 111.” Because the role of our company is to get to the heart of controversial subjects, I feel we have done our job when studies spur debates and. as in your case, informed opposition. I am dismayed, however, that our study was construed as denigrating the nursing profession. That was nei’er o u r intention. In our work on clinicit1 quality. we have affirmed the evergrowins role of the nursing profession in ensuring a consistently high standard of care. We believe that fostering a closer working relationship between nurses and physicians can only contribute to the mutual goal of achieving stel-
lar patient service. In that context, we do not believe that placing high priority on the accessibility of nurses for consultation or on nurse understanding of the preferences of their clinical “partners” should be construed as demeaning. Thank you for a thought-provoking editorial and for the opportunity to respond. ELISSA PAGNANI EDITOR-IN-CHIEF HEALTHCAREADVISORY BOARD WASHINGTON, DC
Attitudes Toward Certification
vv
e read the article “Attitudes toward certification: A pilot study,” in the March 1992 issue of the AORN Journal with great interest. While we appreciate the attention to our program, for the benefit of Journal readers, we would like to correct and clarify several points brought out in the article. The assertion that “the general assumption is that performance skills accompany the set knowledge level” is incorrect in reference to the CNOR certification program. Because this has never been tested, we specifically state in our 1992 Certification and Recertification Polic-y Manual that “possession of knowledge does not ensure its proper application.”’ The authors also state, “In one study, CNOR certification is shown as important in improving patient care skills . . . .” This study was conducted by Pamela s. Gibson, BSBA, director of certification, who asked study participants their opinions about whether preparing for certification would improve their patient care skills. The conclusion that it did or did not improve skills cannot be inferred from the study. SUSANPUTERBAUGH, RN, MBA, CNOR EXECUTIVE DIRECTOR PAMELA S. GIBSON, BSBA DIRECTOR OF CERTIFICATION NATIONAL CERTIFICATION BOARD: PERIOPERATIVE NURSING, INC DENVER Note 1 . “Certification process,” in 1992 Certification
