Nurses are evolving their traditional roles in surgery and creating entirely new ones. Surgeons -- once the final clinical authority -- are now lessening their grip on decisions, especially those related to technology procurement and operating room (OR) design.
"Our minimally invasive surgery [MIS] OR is more of a peer-to-peer environment now," says Donna Marin, RN, a surgical nurse working for a private practice in St. Louis. "The technology has had a leveling effect."
Donna Stanbridge, RN, educational chair of the Association of periOperative Registered Nurses' MIS/Laser Specialty Assembly, agrees. "Obviously, the ‘top-down' style of authority in the physician/nurse relationship has been fading over the years," she says. "Acute-care settings, even office-practice settings, are more egalitarian. But the OR was a last holdout. Now, at least in MIS, there is a clear shift taking place."
Stanbridge says there is now a closer integration around technology than ever before. Nurses, she says, have their hands on the tools as much as or more than surgeons. Nurses load the data and prep, sterilize and even troubleshoot the devices during a procedure.
"The success of every MIS case relies on the efficacy of the devices used," Stanbridge explains. "These surgeons know this and are creating a practice environment that raises nurses into even more essential roles. It's a good time to be in the OR."
Don't Call Us ‘Technologists'
Nurses have clear views on the perception that advanced technology is displacing core nursing skills in the OR.
"There are more machines and more specialists in the OR now," says Kate Moses, RN, CNOR, CPHQ, a nurse working in quality management for the Baptist Hospital of Miami. "But the goal hasn't changed. It's still about better outcomes, which means nurses must absolutely stay current with their skills without leaving the basics behind."
Annette Wasielewski, RN, BSN, CNOR, manager of MIS at Hackensack University Medical Center in New Jersey, says there's a huge misconception about nurses in the OR. "Our role extends far beyond managing technology," she says. "It's multitasking, really, with nurses making patient assessments throughout their OR experience. Nurses are patient advocates. That doesn't change once the team goes to work."
Still, it's a tempting conclusion after one look inside the working MIS unit, with its array of unusual machines and supporting gear, including banks of video monitors. This is not the OR that nurses rotated into during their clinical education. The days of a surgeon, a scalpel and a speak-when-spoken-to nurse at the physician's side are over.
"All surgical procedures have gotten more complex as technology has been developed to assist the surgical team," Wasielewski says. "Yes, nurses' roles are changing, but so are surgeons'. New tools require new approaches, which opens the door for nurses to establish and define their value to patients in interesting new ways."
Procurement Is Power
Surgical technology, including minimally invasive tools, laparoscopic devices and robotic instruments, has a relatively short life cycle. Indeed, the advertising catchphrase of "new and improved" has real meaning to institutions practicing MIS. It's not just a question of outcomes and the evidence used to support the claims. The decisions about what to test, upgrade and buy new have an immediate impact on essential issues to surgical teams, from the initial learning curve to long-term maintenance.
Now, nurses are making a place for themselves in the rooms where these decisions are made.
"There's a right way to go about it and a wrong way," Stanbridge says. "If nurses are very proactive in working with the technology manufacturer to get data or demos, and if nurses develop a body of evidence from other hospitals or from the literature, then surgeons and their procurement teams are much more likely to consider nurses' recommendations when making the call. But if we wait until the contract is on the table and pens are poised to sign before raising objections, no matter how valid, we won't be able to shape these key issues the way we should."
At Stanbridge's institution, The McGill University Health Centre in Montreal, she and her nurse colleagues are active participants in planning the MIS units of a new campus that's being built. "In fact, there are more nurses on the development team than doctors," she reports.
This article originally appeared on Monster.com.
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