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AORN Position Statement
Orientation of the Registered Professional Nurse to the Perioperative Setting
PREAMBLE
AORN has been approached many times during the past few years to provide guidelines for orientation of both novice and experienced perioperative registered nurses. We recognize that facilities come in every size and configuration, and one orientation program will not adequately address every need. We believe, however, that there are certain basic components of orientation that must be met consistently to ensure optimal patient outcomes.
AORN defines a novice perioperative registered nurse as any nurse who has not worked in an OR environment before. This would include a new graduate or an experienced nurse from another area of nursing. It also would include a nurse with previous OR experience who has been away from the OR for an extended period of time.
AORN defines an experienced perioperative registered nurse as a nurse with recent OR experience. This nurse should have at least two years of experience in a facility of similar size and patient acuity as the hiring facility. A skills assessment form should be completed to accurately assess competency levels in all specialties.
POSITION STATEMENT
AORN believes that orientation programs need to be customized to meet the individual needs of the orientee as well as the facility. Before a new nurse begins work, the nurse educator, orientation facilitator, clinical nurse specialist, and/or the nurse manager need to assess both the ability of the system to accommodate the learning experience and the orientee's baseline knowledge and preferred learning method. Orientation timelines, and therefore the impact on the budget, will vary depending on the capacity of the facility.
Scope of orientation. AORN believes that the following topics should be developed by the organization and incorporated into the orientation of perioperative registered nurses.
AORN believes that perioperative registered nurses must be oriented to both the scrub and circulating roles during the orientation period. The orientation process should include orientation to off shifts, weekends, and call situations. This should be accomplished using the preceptor system (ie, having an experienced nurse serve as an immediate resource for the orientee).
AORN supports the use of an outcomes-focused orientation process that incorporates the outcomes defined in the Perioperative Nursing Data Set.1
Domain 1: Safety. The patient will be free of signs and symptoms of acquired physical injury. (Patient-specific outcomes are in parentheses.)
Domain 2: Physiologic response. The patient's physiologic responses to surgery are as expected. (Patient-specific outcomes are in parentheses.)
Domain 3A: Behavioral response. The patient and family are knowledgeable regarding the perioperative process.
Domain 3B: Behavioral response. The patient and his or her family member's rights and ethics are supported. (O26)
Domain 4: Health system concerns. The perioperative nurse has knowledge regarding the health system environment.
AORN believes that a basic orientation for a novice perioperative registered nurse should include every clinical specialty within the nurse's defined practice area and should be measured by successful competency assessment. The recommended exposure to a clinical specialty is at least 40 hours.
AORN believes that novice orientation should include a didactic and clinical component.
AORN believes that completion of an individualized orientation for both the novice and experienced nurse should be measured by successful competency assessment. The recommended orientation of a novice perioperative registered nurse should require at least six months and no longer than nine months. The recommended timeframe for orientation of an experienced nurse should take a minimum of at least three months.
Reference
1. S Beyea, ed, Perioperative Nursing Data Set: The Perioperative Vocabulary, second ed (Denver: AORN, Inc, 2002).
Original statement adopted by the AORN Board of Directors in November 2004; ratified by the House of Delegates, New Orleans, in April 2005. Revised; approved by the House of Delegates in December 2005. Sunset review: March 2010
AORN has been approached many times during the past few years to provide guidelines for orientation of both novice and experienced perioperative registered nurses. We recognize that facilities come in every size and configuration, and one orientation program will not adequately address every need. We believe, however, that there are certain basic components of orientation that must be met consistently to ensure optimal patient outcomes.
AORN defines a novice perioperative registered nurse as any nurse who has not worked in an OR environment before. This would include a new graduate or an experienced nurse from another area of nursing. It also would include a nurse with previous OR experience who has been away from the OR for an extended period of time.
AORN defines an experienced perioperative registered nurse as a nurse with recent OR experience. This nurse should have at least two years of experience in a facility of similar size and patient acuity as the hiring facility. A skills assessment form should be completed to accurately assess competency levels in all specialties.
POSITION STATEMENT
AORN believes that orientation programs need to be customized to meet the individual needs of the orientee as well as the facility. Before a new nurse begins work, the nurse educator, orientation facilitator, clinical nurse specialist, and/or the nurse manager need to assess both the ability of the system to accommodate the learning experience and the orientee's baseline knowledge and preferred learning method. Orientation timelines, and therefore the impact on the budget, will vary depending on the capacity of the facility.
Scope of orientation. AORN believes that the following topics should be developed by the organization and incorporated into the orientation of perioperative registered nurses.
AORN believes that perioperative registered nurses must be oriented to both the scrub and circulating roles during the orientation period. The orientation process should include orientation to off shifts, weekends, and call situations. This should be accomplished using the preceptor system (ie, having an experienced nurse serve as an immediate resource for the orientee).
AORN supports the use of an outcomes-focused orientation process that incorporates the outcomes defined in the Perioperative Nursing Data Set.1
Domain 1: Safety. The patient will be free of signs and symptoms of acquired physical injury. (Patient-specific outcomes are in parentheses.)
- Count policy (O2)
- Culture of safety (O2 - O9)
- Electrosurgical safety (O4)
- Laser safety (O6)
- Medication safety (O9)
- Positioning (O5)
- Radiation safety (07)
- Smoke evacuation (O6)
- Specimen handling (O2)
- Time out procedure (O2)
- Tourniquets (O2)
Domain 2: Physiologic response. The patient's physiologic responses to surgery are as expected. (Patient-specific outcomes are in parentheses.)
- Assessment of patients (O24)
- Basic life support/code response (O14, O15)
- Latex allergy (O3)
- Equipment/instrumentation/supplies
- Minimally invasive (ie, endoscopic) equipment (O2)
- Powered equipment (O10)
- Basic instrumentation (O10)
- Basic OR equipment (eg, tables, lights, electrosurgical unit, suction) (O5, O2)
- Malignant hyperthermia (O12)
- Monitoring and sedation (O14, O15, O29)
- Prevention of infection
- Infection control (O10)
- Surgical attire (O10)
- Wound management (O10)
- Instrument processing (ie, care and handling) (O10)
- Sterilization/disinfection (O10)
- Skin preps (O10)
- Scrubbing, gowning, and gloving (O10)
- Respiratory status (O14) (eg, airway maintenance, assisting with intubation/extubation)
- Tissue banking (O10)
Domain 3A: Behavioral response. The patient and family are knowledgeable regarding the perioperative process.
- Advance directives (O31)
- Informed consent (O31)
- Preoperative teaching (includes postoperative self-care) (O18 - O23)
Domain 3B: Behavioral response. The patient and his or her family member's rights and ethics are supported. (O26)
- Advocacy (O23, O24, O26)
- Age-specific policies (O21, O24)
- Cultural/population-specific policies (O28)
- Documentation (O24)
- Health Insurance Portability and Accountability Act compliance (O25).
- Patient privacy policies (O25)
- Patient self-determination act (O23)
Domain 4: Health system concerns. The perioperative nurse has knowledge regarding the health system environment.
- Career advancement
- Certification
- Code of conduct
- Committee participation
- Communication
- Critical thinking
- Disaster planning
- Employee rights
- Employee safety
- Environmental responsibility (eg, hazardous waste, recycling)
- Fire safety
- Legal issues
- Organizational structure
- Performance improvement projects
- Professional associations
- Regulatory issues
- Scope of practice
- Team roles
- Terminology
- Vendor policies
AORN believes that a basic orientation for a novice perioperative registered nurse should include every clinical specialty within the nurse's defined practice area and should be measured by successful competency assessment. The recommended exposure to a clinical specialty is at least 40 hours.
AORN believes that novice orientation should include a didactic and clinical component.
AORN believes that completion of an individualized orientation for both the novice and experienced nurse should be measured by successful competency assessment. The recommended orientation of a novice perioperative registered nurse should require at least six months and no longer than nine months. The recommended timeframe for orientation of an experienced nurse should take a minimum of at least three months.
Reference
1. S Beyea, ed, Perioperative Nursing Data Set: The Perioperative Vocabulary, second ed (Denver: AORN, Inc, 2002).
Original statement adopted by the AORN Board of Directors in November 2004; ratified by the House of Delegates, New Orleans, in April 2005. Revised; approved by the House of Delegates in December 2005. Sunset review: March 2010