AORN Position Statement on
Allied Health Care Providers and Support Personnel in the Perioperative Practice Setting
PREAMBLE
Today's complex health care environment requires a health care workforce comprised of individuals in a widely diverse and broad mix of roles with varying levels of education. Perioperative registered nurses demonstrate leadership by selecting nursing activities that may be safely and legally delegated to competent allied health care providers and support personnel. The allied health care provider and support personnel provide support for the delivery of safe patient care and are valued members of the perioperative care team.
Concern for patient safety mandates that perioperative registered nurses examine and understand their roles and responsibilities for appropriate delegation and supervision of these individuals and the delegated nursing tasks they perform. Perioperative registered nurses coordinate patient care and direct the activities of the perioperative care team with respect for the individual and recognition of the important contribution each team member makes to the patient's well-being. Effective perioperative care teams consist of multi-skilled care providers working in a collaborative partnership to achieve expected patient outcomes and satisfaction. During a surgical or invasive procedure, the circulating nurse will be a registered professional nurse. Team members must perform patient care activities consistent with the needs of the patient and the team member's education, scope of practice, and skills to ensure patient safety.
AORN recognizes that the key to understanding the roles and responsibilities of the perioperative registered nurse and the allied health care providers and support personnel is the clarification of professional nursing care delivery and the activities that can be delegated within the domain of nursing. Delegation is the transfer of responsibility for the performance of an activity from one person to another while retaining accountability for the outcome.1
Delegation requires the perioperative registered nurse to use professional judgment based on the concept of patient safety; individual needs of the patients; patient acuity; complexity of technology; the education, experience, and skill of the allied health care provider and support personnel; and the extent of supervision required. The National Council on State Boards of Nursing states that "Delegation is the act of transferring to a competent individual the authority to perform a selected nursing task in a selected situation, the process for doing the work."2 Delegation of tasks should be within the defined role functions and documented competency of the individual. Delegation must be consistent with applicable law, regulation, and accrediting agency standards. Any nursing intervention that requires independent, specialized, nursing knowledge, skill or judgment cannot be delegated.3
POSITION STATEMENT
Perioperative registered nurses are accountable for patient outcomes resulting from the nursing care provided during the perioperative experience.4 To ensure that patients receive the highest quality and standard of care, the circulator must always be a perioperative registered nurse.
Perioperative registered nurses plan, direct, and coordinate the care of every patient undergoing operative and other invasive procedures.
The perioperative registered nurse is responsible for supervision of the appropriate performance and completion of delegated nursing tasks. Supervision of allied health care providers and support personnel is a function of the perioperative registered nurse.
Delegation of tasks should be within the defined role functions and documented competency of the individual. Delegation must be consistent with applicable law, regulation, and accrediting agency standards.
Skilled and competent allied health care providers and support personnel are valued members of the perioperative care team, contributing to safe patient care and positive patient outcomes.
Allied health care providers should be graduates of accredited education programs and/or have successfully completed a national specialty certification process. Allied health care providers in the perioperative setting include, but are not limited to,
- anesthesia technologists and technicians,
- biomedical technicians,
- certified medical assistants,
- certified nursing assistants,
- endoscopy technicians,
- materials management personnel,
- sterile processing technicians, and
- surgical technologists.
Support personnel should have the appropriate education and documented competency required to perform the defined role functions. Support personnel include, but are not limited to,
- administrative and clerical staff,
- building service personnel,
- patient transporters, and
- surgery schedulers.
The perioperative registered nurse should participate in the education and utilization of allied health care providers and support personnel who provide direct and indirect patient care.
DEFINITIONS
The following are operational definitions of terms used in the statement.
Anesthesia technician and technologist: Provides assistance to the licensed anesthesia provider in various settings. The anesthesia technician performs duties under the direction of the perioperative registered nurse and/or licensed anesthesia provider. The anesthesia technician provides support of the anesthesia provider by assisting in the preparation and maintenance of patient equipment and anesthesia delivery systems. The technician performs first-level maintenance on anesthesia machines and cleans, sterilizes, and maintains routine anesthesia equipment.5 Anesthesia technicians and technologists can achieve certification.
Biomedical technician or biomedical equipment technician (BMET): One who is knowledgeable in the theory of operation, the underlying physiological principles, and the safe clinical application of biomedical equipment. The BMET applies electrical, electronic, mechanical, chemical, optical, and other engineering principles to perform maintenance, service, repair, and overhaul of medical equipment and medical systems. Examples of equipment may include, but are not limited to, imaging, hemodialysis, physiological monitoring systems, electromedicals, lasers, sterilizers, and dental equipment.
Because of the diversity of the equipment, specialization is sometimes required.6 The international certification for BMETs is a formal recognition by the International Certification Commission for Clinical Engineering and Biomedical Technology that individuals have demonstrated excellence in theoretical as well as practical knowledge of the principles of biomedical equipment technology.7
Building service personnel: Ensures that the OR environment has been cleaned as per policy and procedure. Cleans fixed and movable equipment and the physical environment according to policy and procedures that have been approved by the facility infection control department.
Certified nursing assistant: Performs delegated nursing tasks and functions within the range of functions authorized in the state Nurse Practice Act and rules governing nursing. Nursing assistive personnel work under the supervision of a perioperative registered nurse.8
Competency: The knowledge, skills, and abilities required to fulfill patient care activities in the perioperative setting.
Delegation: Transferring to a competent individual the authority to perform a selected nursing task in a selected situation. The nurse retains accountability for the delegation.9
Endoscopy technician: Provides delegated patient care activities after demonstrating competency and within the following limits:
• assists in collecting data (eg, vital signs);
• assists the perioperative registered nurse with the implementation of the plan of care;
• assists the physician and the perioperative registered nurse during diagnostic and therapeutic procedures; and
• cleans and maintains equipment according to standards and infection control policy and procedures.10
Materials management personnel: Responsible for inventory management, to include both stock and non-stock supplies. Procures stock, non-stock, and specialty supplies and equipment as needed. Effectively and efficiently manages inventory to prevent stock overload and out-of-stock situations. Monitors utilization for contribution to the budget process.
Medical assistant: Unlicensed person who provides administrative, clerical, and technical support to the physician. Most medical assistants are found in physicians' offices.11
Sterile processing technician: Provides practical knowledge in sterile processing and the distribution of manufactured supplies and equipment. They have seven technical responsibilities: reprocessing, decontamination, disinfection, preparation, packaging, sterilization, and distribution. Sterile processing technicians can achieve certification.12
Supervision: The active process of directing, guiding, and influencing the outcome of an individual's performance of an activity.
Surgery scheduler: Member of the perioperative team whose primary responsibility is to schedule procedures and perform data entry of required information. The surgery scheduler ensures that the procedure is scheduled in an appropriate block of time and ensures that special needs are communicated to the appropriate staff members.
Surgical technologist: Possesses expertise in the theory and application of sterile and aseptic technique and combines the knowledge of human anatomy, surgical procedures, and implementation tools and technologies to facilitate a physician's performance of invasive, therapeutic, and diagnostic procedures.13 Surgical technologists can achieve certification.
Transporter: The OR transporter is responsible for ensuring the safe transportation of the patient to and from the operating rooms. Transport personnel also ensure that the transport vehicle is safe, in good repair, and clean, and that the transport vehicle is appropriate for the specified mode of transport.
References
1. American Nurses Association, "Registered nurse utilization of unlicensed assistive personnel," in Compendium of American Nurses Association Position Statements (Washington, DC: American Nurses Association, 1996) 213-215.
4. "Working with others: A position paper," National Council of State Boards of Nursing, http://www.ncsbn.org/pdfs/Working_with_Others.pdf (accessed 6 June 2006).
3. State Operations Manual, "Appendix A-Survey protocol, regulations and interpretive guidelines for hospitals," (Rev 1, 05-21-04) §482.51, Centers for Medicare and Medicaid Services, http://www.cms.hhs.gov/manuals/Downloads/som107ap_a_hospitals.pdf (accessed 6 June 2006).
4. "Standards of nursing practice," in Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2006) 387-428.
5. The American Society of Anesthesia Technologists and Technicians Standards of Practice (Glenrock, NJ: American Society of Anesthesia Technologists and Technicians, 1997).
6. "What is a BMET?" Association for the Advancement of Medical Instrumentation, http://www.aami.org/resources/BMET/whatis.html (accessed 6 June 2006).
7. "What is certification?" Association for the Advancement of Medical Instrumentation, http://www.aami.org/certification/about.html (accessed 6 June 2006).
8. "Draft model language: Nursing assistive personnel," National Council of State Boards of Nursing, http://www.ncsbn.org/pdfs/Model_Language_NAP.pdf (accessed 6 June 2006).
9. "Delegation concepts and decision-making process: National Council position paper, 1995," National Council of State Boards of Nursing, https://www.ncsbn.org/323.htm (accessed 6 June 2006)
10. "Role delineation of assistive personnel," Society of Gastroenterology Nurses and Associates, http://www.sgna.org/Resources/statements/statement8.cfm (accessed 6 June 2006).
11. American Medical Association, Health Professions Career and Education Directory, 2005-2006 (Chicago: American Medical Association, 2005) 237.
12. J Ninemeirer, Central Service Technical Manual, fifth ed (Chicago: International Association of Health Care Central Service Material Management, 1998) 4.
13. "Surgical technology," Commission on Accreditation of Allied Health Education Programs, http://www.caahep.org/Documents/ST%20Standards%20and%20Guidelines%20May%202004.2.pdf (accessed 6 June 2006).
Original approved by the House of Delegates, Washington, DC, March 2006
Sunset review: March 2011