AORN Position Statement on

PREAMBLE

A healthy perioperative work environment can be defined as a practice setting that is safe, healing, humane, and respectful of the rights, responsibilities, needs, and contributions of all members of the perioperative team. ¹  Members of a highly functioning perioperative team communicate, collaborate, and respect each other’s role and skill set. A positive work environment encourages safe patient care practices, promotes optimal patient outcomes, and fosters a desirable employment setting.²
A healthy perioperative work environment contains key components to ensure the delivery of quality surgical patient care. Key components to sustain a healthy perioperative culture are collaborative practice; rich communication; accountability; adequate staffing systems; expert, credible, and visible nursing leadership; shared decision making; encouragement of professional practice; recognition of the value of nursing’s contribution; and peer recognition. ^1,3

POSITION STATEMENT

AORN is committed to supporting the components essential to achieving a healthy perioperative work environment. AORN believes that the healthy perioperative work environment can be exemplified by the following: ^1,3,4

Collaborative Practice Culture
Contributions of all perioperative team members are acknowledged and treated with respect in an environment of trust to achieve optimal outcomes.
The perioperative team is committed to diversity of persons, ideas, and the decision making process.
The health care organization establishes a zero-tolerance policy for addressing
abuse and disrespectful behavior by any member of the perioperative team.^5,6,7,8

Communication Rich Culture
Communication between perioperative team members is clear, respectful, open, and trusting.
Communication skills include self awareness, inquiry, dialogue, conflict management, negotiation, advocacy, and listening.
The health care organization provides perioperative team members with support
for and access to education programs that develop communication skills.

A Culture of Accountability
Role definitions and expectations of the perioperative team are clearly delineated.²
All members of the perioperative team are accountable for their own actions.

The Presence of Adequate Numbers of Qualified Perioperative Registered Nurses 
The health care organization provides adequate staffing for quality care to meet patients’ needs including at least one perioperative registered nurse circulator dedicated to every patient undergoing a surgical or other invasive procedure.⁹
Work and on-call schedules are established to promote work/home life balance.¹⁰

The Presence of Expert, Credible, Visible Nursing Leadership
Perioperative registered nurses demonstrate leadership skills at every level within the health care organization.^3,4,11
All perioperative registered nurses serve as advocates for nursing practice.
All perioperative team members’ support shared decision-making to promote quality patient outcomes and further the mission of the health care organization.⁷
Resources are allocated to support nursing education, research, and professionalism. ^4,7

Shared Decision-Making at All Levels
Perioperative nurses participate in policy development and decision making at the unit, system, and organizational levels. Nurses, who are empowered in the process of developing, maintaining, and implementing professional standards, advance the profession and improve clinical outcomes.⁴
Formal structure exists within the health care organization to support shared decision-making among the perioperative team.
Perioperative registered nurses are responsible and accountable for their professional practice.^4,11

The Encouragement of Professional Practice and Continued Growth/Development
Ongoing education, professional development, and certification are supported, encouraged, and acknowledged for all members of the perioperative team.
Active participation in professional associations is encouraged and promoted.
An information-rich environment is demonstrated by activities such as evidence- based practice and ongoing quality initiatives.^4,11,12

Recognition of the Value of Nursing’s Contribution
Perioperative nurses are recognized by their peers and other members of the perioperative team for their performance and the value they bring to the team.¹⁰
Career mobility and professional growth options are available for perioperative registered nurses.

Recognition by Nurses for Their Meaningful Contribution to Practice
Peers provide perioperative registered nurses with individualized and meaningful recognition at every stage of their professional career.¹¹
The health care organization has a program in place that formally recognizes excellence in perioperative practice.

REFERENCES

1. American Association of Critical-Care Nurses. AACN standards for establishing and sustaining healthy work environments: A journey to excellence. Am J Crit Care. 2005;14(3):187-197.
2. Parsons ML, Newcomb M. Developing a healthy or workplace. AORN J. 2007;85(6):1213-1223
3. Principles and elements of a healthful practice/work environment. Nursing Organization Alliance. http://www.aone.org/aone/pdf/PrinciplesandElementsHealthfulWorkPractice.pdf. Accessed October 16, 2008.
4. Standards of perioperative administrative practice. Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2008:15-17.
5. Joint Commission. Behaviors that undermine a culture of safety. Sentinel Event Alert. July 2008;40. http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_40.htm. Accessed October 16, 2008
6. Standards 2.2(b), disruptive conduct. In: The Joint Commission Code of Conduct. Oakbrook Terrace, IL: The Joint Commission, 2008:7 http://www.jointcommission.org/NR/rdonlyres/5B9CE6DD-FA09-465E-BDA8-C1FBCE03A555/0/Code_of_Conduct_08.pdf. Accessed October 16, 2008.
7. Standard LD.03.01.01. In: The Joint Commission Accreditation Program: Hospital Leadership. Oakbrook Terrace, IL: The Joint Commission, 2008:9. http://www.jointcommission.org/NR/rdonlyres/D53206E8-D42B-416B-B887-491B6D5AA163/0/HAP_LD.pdf. Accessed October 16, 2008.
8. Explications for perioperative nursing. Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2008:633-660.
9. AORN position statement: statement on one perioperative registered nurse circulator dedicated to every patient undergoing a surgical or other invasive procedure. AORN. http://www.aorn.org/PracticeResources/AORNPositionStatements/Position_RegisteredNurseCirculator/. Accessed October 16, 2008.
10. AORN position statement: safe work/on call practices. AORN. http://www.aorn.org/PracticeResources/AORNPositionStatements/Position_SafeWorkOnCallPractices/. Accessed October 16, 2008.
11. Standards of perioperative professional practice. Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2008:23-26.
12. AORN guidance statement: creating a patient safety culture. Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2008:213-218.

 Resources
A position statement on perianesthesia safety. ASPAN. http://www.aspan.org/Portals/6/docs/ClinicalPractice/PositionStatement/14-Perianes_Safety.pdf Accessed October 16, 2008.
Dawes BSG. Focusing on the safe, healthy workplace. AORN J. 2001;73(1):16-18.
Kramer M, Schmalenberg C. Confirmation of a healthy work environment. Crit Care Nurse. 2008;28(2):56-64
Miracle VA. A healthy work environment. Dccn. 2008;27(1):43-42.
Pinkerton S. AACN standards for establishing and sustaining healthy work environments. Nurs Econ. 2005;23(3):138.
Reina ML, Reina DS, Rushton CH. Trust: the foundation for team collaboration and healthy work environments. AACN Adv Crit Care. 2007;18(2):103-108.
Shirey M. Fostering leadership through collaboration. Reflect Nurs Leadersh. 2006;32(3). http://nursingsociety.org/RNL/3Q_2006/features/feature5.html. Accessed October 16, 2008
Ulrich B. Healthy work environment standards: Is your unit up to par? Nephrol Nurs J. 2007;34(1):8.

Footnote
AORN recognizes the link between the work environment and the provision of safe patient care. The American Association of Critical-Care Nurses (AACN) and the Nursing Organizations Alliance (NOA) have both identified components of a healthy work environment.1,3 AORN endorses the AACN “Standards for establishing and sustaining healthy work environments”1 and NOA’s “Principles and elements of a healthy practice/work environment.”3 AORN acknowledges the work of these documents in the preparation of this position statement.


Original approved by House of Delegates, Chicago, IL. March 2009
Sunset date: March 2014