program takes into consideration that our nurses need to wear a lot of hats.” Cross-training also is a significant component of the Ambulatory Surgery Center of Niagara’s training program, Zimdahl says. “The more roles an RN can fill, the more valuable they become, so all of our RNs are cross- trained to our different roles.” Harris says her ASCs’ nurses

learn about everything on the outside of the OR before they begin train- ing inside it. “The nurses here need to be aware of their environment and patient care, and know everything we have to monitor in the OR. Infection control and apparel in the OR are two of my biggest areas of focus.” Both ASCs use mentors to provide

training. At Florida Medical Clinic, when it is time for nurses to receive their training in the OR, a preceptor circulator is assigned to them. Train- ees at Zimdahl’s center have a mentor throughout the process.

Not all nurses at Florida Medical

Clinic’s ASCs will be trained in recov- ery, but it is a component of the train- ing program, says Harris. “Normally I do not have any trouble hiring recov- ery room nurses, but we will occasion- ally train a non-recovery nurse to learn how to transport patients out of the OR, how to use the crash and malig- nant hyperthermia carts and other ele- ments of the post-anesthesia care unit.” Both training programs have

proven successful. Harris says her program has developed three periop- erative RNs. Zimdahl says that her program has helped develop skilled staff who are now able to do many dif- ferent things in the ASC, something she considers extremely important.

Keeping Current If an ASC wants to provide perioper- ative RN training, it is imperative that the training is always up to date, Alli- son says.


It seems like OR nurses are turning into dinosaurs. They are very hard to come by, especially in rural areas like our Zephyrhills location.”

—Sandra F. Harris, RN, Florida Medical Clinic ASCs

“ASCs should review and moni- tor changes to published best practice guidelines that come from organizations such as AORN, the Association for Pro- fessionals in Infection Control and Epi- demiology, and the Association for the Advancement of Medical Instrumenta- tion,” she says. “Nurses need to know the most current accreditation stan- dards and Medicare regulations. Those are components ASCs must incorporate into their training instead of only rely- ing on their own policies.” Harris adds, “You have to make ongoing adjustments to your program. There are new rules and regulations to monitor, and they should become part of the program.” It is worthwhile for nurses to

receive education from sources out- side of the ASC to help stay current with perioperative best practices, Allison advises. “There are many conference sessions and webinars on the most current perioperative top- ics delivered by experts in the field. Many state associations provide regu- lar education, especially for infection control. Even vendors can be valuable sources of information. They provide education and training, not just on the

appropriate use of their products but on best practices as well.”

Commitment Required ASCs that want to provide their own perioperative training must be fully committed to developing a complete program, Harris says. “It took me a long time to pull everything together for our program,” she says. “I worked on it for probably eight months before I could get it was necessary as we are investing a lot of time and money into these nurses and trusting them with ensuring the well- being of our patients.” Allison notes, “A poor train-

ing program, regardless of where it is provided, can put patients at risk. Persons creating and implementing training programs must be commit- ted to maintaining a robust program that will support competency.” Anything short of this is unaccept-

able, Zimdahl says. “An organization has to make that commitment. Our patients need to feel confident that their RNs are prepared to give them personal, high-quality care in our facility and make sure they return home safely.”

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