Partnerships and New Learning

Models to Create the Future

Perioperative Nursing Workforce
SABRINA GREGORY, MSN, RN, CNML; DEBORAH R. BOLLING, MS, RN, NE-BC, NEA-BC;
NANCY F. LANGSTON, PhD, RN, FAAN, ANEF

ABSTRACT
To create new and sustainable approaches for development of the perioperative
nursing workforce, perioperative nursing leaders at a hospital collaborated with
administrators and faculty at a school of nursing to create an innovative learning
model that reintroduces perioperative experiences to students in a nursing bacca-
laureate program. Key components of the initial approaches included an externship
for nursing students and a revised internship for experienced nurses who wished to
work in perioperative nursing. Project leaders then expanded the nursing student
learning opportunity by adding two additional elective perioperative courses to the
curriculum. Formation of perioperative clinical placement sites within the senior-
level adult acute care course was an additional positive outcome of these initial
initiatives. These initiatives resulted in decreased use of agency nurses at the clinical
site where the externships take place and increased numbers of younger nurses
working in the perioperative areas where they externed, with high levels of satis-
faction reported by nurses involved in the program. Through this innovative
collaboration, the perioperative nurse shortage at the hospital has abated, and the
opportunity to continually recruit new colleagues into the practice of perioperative
nursing has been established. AORN J 99 (January 2014) 96-105. ! AORN, Inc,
2014. http://dx.doi.org/10.1016/j.aorn.2013.10.012

Key words: perioperative nursing shortage, nursing externship, baccalaureate

clinical experiences.

T
he demise of perioperative courses as a part
of nursing education has been identified as
a significant factor in the perioperative
nurse shortage.1 Happell2 asserts that the absence
of perioperative experiences in schools directly
results in a decrease in student interest in pursuing
a career in the specialty after graduation. Partner-
ships between educational institutions and nursing
services, particularly perioperative units, can create
new models that effectively address this issue while
simultaneously addressing the problem of ensuring
sufficient quality clinical experiences to enable
schools to expand enrollment.
Based on mutual goals, organizations like
AORN and the National League for Nursing (NLN)
have indicated that they could benefit their

http://dx.doi.org/10.1016/j.aorn.2013.10.012
96 j AORN Journal ! January 2014 Vol 99 No 1 ! AORN, Inc, 2014
CREATING THE FUTURE PERIOPERATIVE WORKFORCE
respective members, and hence nursing globally,
by collaborating to study the issue of little or no
perioperative education in bachelor of science in
nursing (BSN) programs and the effect on the
overall shortage of nurses as well as the shortage
of nurses entering the perioperative profession.
Hence, the AORN Foundation sponsored a think
tank3 composed of nurse educators and perioper-
ative nurse leaders to identify whether the mutual
interests of AORN and NLN could be used as a
platform to transform thinking about the appro-
priateness of perioperative units as units in which
to provide clinical education for undergraduate
nursing students. This think tank released a white
paper, which was published in AORN Journal,3
that demonstrated the majority of skills expected of
a new graduate could be gained through clinical
experiences in perioperative settings. In fact, skills
expected of new graduatesdsuch as teamwork and
safety, including handwashing and sterile tech-
nique and continual assessment of patients who are
in unstable conditionsdare an inherent part of the
perioperative practice environment and therefore
provide quality experiences for students.3 Articles
appearing in AORN Journal subsequent to the
release of the white paper4-6 extended the under-
standing of the competencies of perioperative
practice in a way that affirms the appropriateness
of the perioperative setting for acquisition of skills
expected of a new generalist entry-level nurse.
This understanding is important because under-
graduate nursing programs are designed to prepare
a generalist nurse and not a specialist nurse.
SETTING
At the Medical College of Virginia Hospitals of the
VCU Health System of Virginia Commonwealth
University, Richmond, Virginia, which is a part of
a comprehensive health science campus of the uni-
versity, nursing leaders of the School of Nursing
and Nursing Services of the hospital recognized the
emerging national trend toward developing orga-
nizational partnerships between nursing schools
and nursing services7,8 and specific collaborative
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efforts to support perioperative nursing (eg, the
think tank sponsored by the AORN Foundation3).
Beginning in early 2003, leaders of the school (ie,
dean, associate dean for academic programs, asso-
ciate dean for research) and of nursing services (ie,
chief nursing officer [CNO], director of medicine
and pediatric nursing, director of professional
development) began meeting to discuss how nurs-
ings relationship within the academic health sci-
ence center should or could be transformed. The
relationship between the medical school and the
hospital was clear to the nursing services leaders
and the school leaders, including the CNO of the
hospital and the dean of the School of Nursing, who
believed nursing would benefit from such clarity.
An 18-month dialogue by the formal leadership
team resulted in creation of a proposal for the top-
level university and hospital administrators that
identified the purpose and goals of nursings formal
partnership between the school and nursing ser-
vices and developed titled administrative positions
(eg, the CNO would hold the title of associate dean
for clinical operations of the School of Nursing,
and the dean would hold the title of executive di-
rector of academic nursing of the VCU Health
System) between the two entities. In 2003, the
board members of the health system and the pres-
ident of the university formally endorsed the part-
nership and administrative structure.
Simultaneously, the dean and associate dean of
academic programs of the school and leaders of
perioperative nursing (eg, director, clinical nurse
manager) initiated discussions regarding concerns
about an adequate current and future supply of
perioperative nurses. Medical College of Virginia
Hospitals staffing model of practice was similar
to most perioperative areas and was based on re-
cruitment of experienced RNs only. These experi-
enced RNs are transformed into perioperative nurses
after receiving didactic and clinical education in a
perioperative RN internship program. However, the
yearly attrition rate of these new nurses was 45%,
and the hospitals staffing model routinely resulted
in a shortage of perioperative nurses and inadequate
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staffing ratios for the level one trauma center. As a not new. Gillespie et al4 identified domains of
result, the hospital was increasingly reliant on perioperative competency, the vast majority of
agency nurses, which resulted in an additional which (ie, teamwork, communication, coordina-
personnel expense of approximately $1.2 to $2 tion, clinical leadership) are also expectations for
million each year. In addition, during this time, new generalist nurses as developed by the Amer-
turnover and vacancy rates were skyrocketing, ican Association of Colleges of Nursing.10 Critical
which negatively affected staff morale and nurse thinking is known to be an essential characteristic
satisfaction and caused nurse and patient satisfac- of a competent nurse, regardless of his or her
tion scores to plunge lower than national bench- practice area, and is a relevant experience for pre-
marks every quarter. paring entry-level nurses. Jones5 discussed the
The hospitals reliance on recruitment of expe- significance of instructional strategies designed to
rienced nurses resulted in the average staff peri- develop and enhance critical thinking by nursing
operative nurse being 56 years of age, which was students when in clinical placements in the peri-
significantly older than the national average age of operative environment, and Taber et al6 described
9
46.8 years. Perioperative nursing leaders identified the use of the perioperative setting for a precepted
an initiative to develop research experience
nurses for periopera- for senior-level honors
tive surgical services, Critical thinking is known to be an essential nursing students en-
whereby concerns characteristic of a competent nurse, regardless rolled in an introduc-
related to the current of his or her practice area, and is a relevant tory research course.
and future supply experience for preparing entry-level nurses. Although not all
of perioperative nursing programs
nurses also would require a practicum in
be addressed. One prong of the initiative was to research, BSN programs require a quality assurance
strengthen the hospitals internship program for or quality improvement project that relates to re-
experienced RNs, and the second was to partner search to meet the American Association of Col-
with the university in creating an externship course leges of Nursing characteristics of a baccalaureate
for prelicensure baccalaureate nursing students. As graduate.10
a result of the established organizational partner- Several articles11-14 have described various
ship with the university, creation of a nursing stu- educational models that reintroduce perioperative
dent extern course was seen as a viable venture. coursework to the BSN curriculum, such as
From that initial vision emerged an expansive learning activities designed to enhance periopera-
collaboration that embedded perioperative nursing tive observation experiences already within cour-
within the structure of the prelicensure program of ses, development of elective courses, and clinical
the school. experience options within existing courses. For
those learning activities focused on enhancing the
LITERATURE REVIEW ON PERIOPERATIVE quality of perioperative observation, authors
NURSING IN THE CURRICULUM describe the development of structured orientation
As the perioperative staff nurses and the associate experiences before the students observation
dean of academic programs began the work of day.11,12 In addition to the structured orientation,
developing a perioperative experience, they un- Castelluccio12 expanded the observation experi-
dertook a review of the existing literature. From ence from one to two days. Mott13 described
that review, they determined that the idea of iden- modification of a previously offered 64-hour clin-
tifying and defining perioperative competencies is ical preoperative and postoperative experience to

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CREATING THE FUTURE PERIOPERATIVE WORKFORCE
include eight hours of OR experience. In addition
to the clinical experience within the OR, Mott
added a skill training period in the school labora-
tory and an on-site orientation to the OR before the
beginning of the clinical experience.13 Messina
et al14 described the introduction of two new ex-
periences: a 15-week clinical experience for stu-
dents as an elective course and development of a
clinical placement in perioperative units as one of
the clinical placement options within a senior-level
Capstone practicum.
Although none of the literature described expe-
rience with an externship, the review of the literature
supported perioperative nursing as an appropriate
practice area for student learning. Because the fac-
ulty of the school had indicated that current medical-
surgical courses were already filled with content,
semesters were already heavy in credit hours, and the
VCU nursing students could take an upper-division
elective, it was decided to design an elective course
in the form of a summer externship.
DEVELOPMENT PROCESS
In spring 2005, the associate dean, the director, and
the nurse manager from perioperative nursing began
developing a nursing student extern course program
with the purpose of building a pipeline for periop-
erative nurses through collaboration and teamwork
with the School of Nursing. The associate dean for
academic programs at the School of Nursing and two
nurse leaders in perioperative services collaborated
to design and gain university approval for offering a
clinical practicum course (ie, an extern course). The
development team created the course as an upper-
division clinical elective worth 1.5 credits to be
offered in the summer between the students junior
and senior years. The students completed 180 hours
of clinical practicum as a part of the externship. The
team designed a perioperative extern course in a
manner that would provide a platform for developing
a comparable course for any clinical specialty
practice area. The associate dean identified that this
strategy would demonstrate to the total faculty of the
school, who had to approve the offering of the
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course, that there was potential that their specialty
clinical areas also could develop such an elective
and that it would have academic rigor. The first
cohort of students enrolled in the extern course in
summer 2005.
Another integral component to establish for the
extern program was the faculty of record. The two
perioperative unit leaders who collaborated on de-
veloping the course were appointed to the School of
Nursing as adjunct faculty members and served as
the faculty of record for the course. Both faculty
members held masters degrees in nursing, and one
also held a post-masters certificate in nursing ed-
ucation. This academic preparation made them
ideal candidates for this role because the school
requires that all employed faculty members hold
masters degrees at a minimum. This is necessary
to meet national nursing education accreditation
standards.15 These adjunct faculty members served
as coaches and mentors to staff nurses who served
as preceptors for the daily clinical practicum ac-
tivities of the students.
Course Content and Expectations
The course consisted of 180 hours of clinical ex-
perience, and the objectives for the successful stu-
dent were to
n demonstrate beginner clinical competency in a
specialized area of clinical practice;
n apply theoretical and research knowledge to
practice;
n collaborate with health care team members to id-
entify, analyze, and resolve patient care problems;
n use effective communication skills in the mentor-
student relationship; and
n apply standards of practice in the assigned clin-
ical area.
We used Benners From Novice to Expert: Excel-
lence and Power in Clinical Nursing Practice16 as
the textbook for the extern course because the
principles outlined in it already were used as the
foundation for the hospitals clinical ladder for
professional advancement of clinical nurses.
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Precourse Requirements and clinical observations, students attended de-

To start their perioperative extern experience, stu- partment morning report and safety huddles.
dents were required to participate in the hospitals They reviewed the patients history, physical,
orientation designed for all care partners. Addi- consent, site marking, and proposed surgical pro-
tionally, all externs had to complete the perioper- cedures with the RN circulator and/or the preop-
ative unit orientation, which included observation erative care nurse. During the morning safety
and return demonstration of competencies on med- huddles, the student externs review the OR
ication labeling. schedule more closely as part of an interdisci-
plinary care team. This process identifies potential
Clinical Experiences and Learning Activities safety concerns (eg, inadequate supplies or staffing
Externs participated in scenarios in the simula- levels, look-alike patient names, latex allergies).
tion OR, where they reviewed patient assess- During the huddle, the team also reviewed the
ments and 12-lead electrocardiograms. They also scheduled patients; specific student assignments;
learned about instrumentation, scrubbing, gown- goals and objectives for the assignments; and skills
ing, and gloving. During the course, students and knowledge needed to ensure continuous, safe,
rotated through all areas of perioperative surgical effective outcomes for the assigned patients.
services: the acute inpatient OR and postanesthesia
care unit (PACU), the ambulatory care OR and Preceptors and Clinical Guidance
PACU, the perisurgical unit, and the preanesthesia Each student in the extern program was assigned
clinic. During each clinical rotation, every student to a preceptor. The preceptor and the student
actively participated extern scheduled a
in direct clinical pa- daily post-clinical
tient care experi- In preparation for clinical care and clinical conference to reflect
ences, in addition to observations, students attended department on the assignment and
spending assigned morning report and safety huddles, during the clinical experi-
time with a staff which they helped review the patients history, ence. The debriefing
nurse and a charge physical, consent, site marking, and proposed focused primarily on
nurse. These assign- surgical procedures. the students clinical
ments provided stu- experience in relation
dent externs with to meeting the defined
opportunities to observe and understand the re- objectives and identified accomplishments and any
levance of effective communication within and barriers to meeting them. The student and preceptor
outside the department and to observe and ask reviewed areas of concerns related to safety, effi-
questions regarding different perspectives of ciency, and productivity and identified the stu-
responsibility and delegation. dents objectives for the next assigned clinical
Perioperative surgical services routinely admits experience, as agreed to by the student, faculty
patients on the day of their surgical experience. members, and the preceptor. The entire cohort of
Team members print a final schedule of impending students met with the faculty of record every Friday
surgical procedures at 5:30 AM the day of surgery, to discuss their clinical week.
and thus the students were able to participate in
daily debriefing conferences and in reading and Evidence-Based Projects
assessment assignments that provided them with Another requirement of enrollment in this clinical
tools necessary to assess their patients in a timely, elective was for the student extern to have com-
thorough manner. In preparation for clinical care pleted an evidence-based project course, which

100 j AORN Journal

CREATING THE FUTURE PERIOPERATIVE WORKFORCE
provided the student with the foundational knowl-
edge and skills to successfully investigate and
complete an evidence-based project in one of the
extern programs clinical assigned units. The ex-
ternships evidence-based project requirements
comprised a poster and an oral presentation of the
project to the clinical staff members and fellow
students. Students identified projects based on their
clinical observations and interests and were ap-
proved by the preceptor as appropriate for a quality
initiative for the unit. Examples of the students
projects included the following:
n Immediate use steam sterilization. These pro-
jects led to an overall reduction in the use of
immediate use steam sterilization from 59% to
5%.
n Effectiveness of teamwork in the perioperative
environment. The focus of this project was the
development of a safe surgery process based on
the book The Checklist Manifesto: How to Get
Things Right,17 which presents compelling
stories of the need for use of checklists in health
care as well as other industries and the World
Health Organization guidelines for the surgical
safety checklist.18
n Effectiveness of color-coded armbands. The
focus of this project was the use of standardized
colored armbands to identify allergies, surgical
packing, and non-lateral site markings.
Preceptors served as evaluators of the students
clinical performance, with review by the faculty
member of record, and the faculty member of
record evaluated the evidence-based project. Fac-
ulty graded the course on a pass/fail basis.
RESULTS
The overwhelming interest by nursing students in
the first extern course resulted in offering a second
session of the extern course in 2007 and a third
session in 2008. As a result, we added the intro-
ductory extern course to the course schedule for
all three semesters of the academic year and added
two upper-division elective courses in the fall and
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spring semesters for extern students who desire
more in-depth perioperative nursing experiences.
The extern course was designed to accommodate
a maximum of 10 students each semester, and a
minimum of three students was required to offer the
course. For the other two upper-division electives,
student enrollment is a maximum of six and a
minimum of three in each course. The maximum
number for each of these two courses is adjusted
based on the enrollment in the extern course and
enrollment in the other elective. Each of these
additional elective courses can be taken for one to
five credit hours; however, the total for the two may
not exceed five credits because five hours of upper-
division elective credit is the program of study for
all students. As with the introductory extern course,
these additional courses required completion of 180
clinical hours and an evidence-based research
project. Unlike with the introductory extern course,
however, for the first of these courses, nursing
students selected a specific clinical area from those
through which they rotated as externs. In this first
course, they became active participants in devel-
opment and implementation of the patients plans
of care. Additionally, they completed an evidence-
based project specific to their unit and were re-
quired to present it to an interdisciplinary group of
health professionals. The second of the upper-level
extern courses focused on leadership and manage-
ment of the intraoperative unit. Students were able
to facilitate care of patient groups, including
scheduling of surgeries, acting in the charge role
with the charge nurse, and communicating with all
interdisciplinary team members and all levels of
personnel. Most importantly, the course allowed
students to develop an understanding of how suc-
cessful interdisciplinary teams promote optimal
patient outcomes.
From spring 2007 to fall 2011, 120 students
completed the introductory extern course. Since the
addition of the second-semester extern course in
2007, 45 students have completed the course, and
since the addition of the third-semester extern
course in 2008, 15 students have completed the
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January 2014 Vol 99 No 1
course. Since 2009, approximately nine to 13 stu-
dents are completing the entire three-course series
each semester. The students who have completed
the three courses have excelled in their roles as
nurses. Two students
are nurse practitioners,
and one is currently Faculty members have come to understand the elective perioperative
completing school to quality of the perioperative environment and
become a midwife. In the nature of professional nursing practice as
addition, another stu- appropriate clinical experiences in preparing a were unfamiliar with
dent who was our new generalist nurse.
champion for adding
the third additional
section is currently in our OR internship. Another
student is returning to our department and will be
working in our PACU.
Students who have completed the extern course
shared comments about their experiences, such as
the following that were shared with the dean of the
School of Nursing:
n If I decide not to pursue a career in periop-
erative nursing, it has been an excellent expe-
rience to prepare me to be a nurse.
n We learn constant assessment of our patients,
how to assess a total environment beyond the
patient, teamwork, advocacy, and a lot about
patient safety.
In March 2006, AORN held its annual confer-
ence in Washington, DC. A group of nursing
students who had completed the extern course
were invited by members of the Richmond
Chapter of AORN to attend this national con-
vention. The students attended the student pro-
gram, and they attended other convention sessions
with chapter members. The School of Nursing
underwrote the cost for six nursing students to
attend the conference, and perioperative nurses
from the hospital served as mentors and coaches
for the students at the conference. The nursing
students returned with accolades for the experi-
ence and indicated that the opportunity was a
positive experience in their development as pro-
fessionals. One student reported that it was career
102 j AORN Journal
GREGORYeBOLLINGeLANGSTON
transforming in terms of his critical thinking and
ability to set priorities.
A positive but unanticipated consequence of
introducing the extern course was the extension
of the collaboration
beyond the extern and
courses. Faculty mem-
bers at the school who
the substantive nature
of the perioperative
clinical experiences
available to students have come to understand the
quality of the perioperative environment and the
nature of professional nursing practice as appro-
priate clinical experiences in preparing a new
generalist nurse. Faculty members understood that
the perioperative environment provides a clinical
learning environment as appropriate as that of an
intensive care unit that provides clinical placements
for the senior-level acute care course.
As a direct result of the faculty members new
understanding of perioperative clinical care, with the
first offerings in 2007 each semester, a clinical group
of eight to 10 senior-level students who were
enrolled in the required senior-level acute clinical
course had their entire 15-week clinical experience
in the perioperative surgical service units. This
clinical course section was originally developed
for students who specifically had selected peri-
operative surgical services. Furthermore, the school
faculty member of the course individually inter-
viewed the students to ensure that they understood
the nature of the experience, in that students would
be in multiple perioperative units rather than one unit,
as they would be if selecting a traditional intensive
care unit for their placement. Furthermore, she at-
tempted to ensure that the students selecting the
perioperative placement were adaptable to the fast
pace and constant change in the patients for whom
they would be providing care and that they evidenced
a level of maturity important for the constantly
changing environment of the perioperative units.
CREATING THE FUTURE PERIOPERATIVE WORKFORCE
Now the perioperative placement process emulates
all other clinical course placements at the school.
Perioperative surgical services became a routine
clinical placement within the required senior-level
acute care course that is offered twice a year, which
allows 16 to 20 students to have a 15-week place-
ment of a minimum of six hours a week in the
perioperative units.
RESTRUCTURED RN INTERNSHIP
As described earlier, perioperative nursing leaders
identified a two-pronged approach to addressing
recruitment problems. The second approach was to
focus on strengthening the hospitals existing RN
internship for experienced nurses.
New Components
To strengthen the RN internship program, the
clinical director and clinical nurse leader undertook
several initiatives, including
n increasing the duration of the program from six
months to nine months,
n decreasing the number of interns per session
from 10 to six,
n increasing the number of student cohorts admitted
into the program each year from four to 10,
n using behavioral interview techniques to inter-
view qualified applicants, and
n expanding clinical rotations to include the PACU.
Lengthening the duration of the intern program
to nine months provided time for the interns to
rotate through various specialized services such as
cardiac, neurology, and orthopedics. Experiences
also were added for evening shifts that allowed the
interns to have experiences with trauma patients
who were brought in during the evening. By de-
creasing the number of interns in each session, we
could provide each individual with more clinical
opportunities and hands-on time. Using behavioral
interview techniques enabled the selection com-
mittee members to determine which applicants
recognized that the primary role of the OR nurse
was to advocate for the patient and that being an
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OR nurse also includes accountability, teamwork,
communication, unpredictable workloads, and
conflict resolution. Additionally, the applicants
submit an essay, unofficial transcripts, and two
clinical references. These application processes
allowed us to admit only the most qualified appli-
cants. Initially, in 2006, we set the class size for this
program at 10 participants to offset anticipated
attrition. Beginning in 2007, the cohort size was
reduced to six interns, which has provided the op-
portunity for the hospital to consistently maintain a
minimum of four viable OR nurses. With six nurse
intern slots, the units could plan for inevitable
attrition and still be able to sustain an adequate
number of new nurses in the OR to safely staff the
unpredictable workload of this level one medical
center. Also, interns rotated through all units of the
department (ie, the perisurgical unit, ambulatory
care center, preoperative assessment communica-
tion education) and not just the OR, so that their
perioperative exposure could be enhanced to in-
clude the entire perioperative patient experience.
Input from student externs resulted in the revision
of the PACU internship to a perioperative nurse
internship program.
Results
As of March 2012, the applicant pool for the RN
internship program was 40 to 60 applicants for a
cohort size of six. From spring 2007 to fall 2011,
45% of the nurses enrolled in the RN internship
have been baccalaureate graduates who completed
the perioperative extern course. Students who
completed the perioperative extern course consis-
tently have shared their positive experiences with
their peers and friends. This has created a market-
ing and public relations campaign that has resulted
in a productive, effective pipeline for the RN in-
ternship program.
The overwhelming success of the revised in-
ternship program is illustrated by the fact that, as of
2011, 45% of the hospitals OR nurses in the am-
bulatory center and 70% of OR nurses in the crit-
ical care hospital have completed the OR nurse
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internship program. Two years after the revision of
the RN internship and the creation of perioperative
education as a separate accounting unit with
budgeted positions to educate and orient new in-
terns and new hires, use of agency personnel was
totally eliminated. Although the intern program
was successful in attracting nurses into periopera-
tive practice areas, numerous personnel factors
created by having a
bimodal age distribu-
tion of younger and This postanesthesia care unit (PACU) internship staff meetings, partici-
older nurses resulted promoted teamwork, collaboration, and nurse
in pregnancies and re- satisfaction and, as a result, the overall turnover
tirements that in- rate for the PACU slowly declined from 15.9% committed to the in-
creased our turnover in 2008 to 9.2% in 2011.
rate once again in
summer 2011. How-
ever, because of the success of the revised RN
intern program and the pipeline of nurses created by
the extern course, the number of intern classes that
were graduated that year was increased from two
to four to again eliminate the need for agency
personnel. Our success has become a conversa-
tion piece in many professional venues and has
resulted in nurses from hospitals in the community
applying for slots in our perioperative RN intern-
ship programs.
PACU INTERNSHIP
In 2007, we developed the first nurse internship
in the PACU to address similar attrition issues in
partnership with the pediatric intensive care unit
(PICU). This two clinical specialty focus was
developed to provide experiences that would pre-
pare the nurse for another clinical practice area in
the event the intern decided that the PACU was not
really where he or she wanted to practice. Re-
quirements of the program included that the PACU
nurse intern spend six months in the PICU, while
simultaneously having assigned preceptors in both
the PACU and PICU. This new collaboration en-
sured that the PACU nurse intern received tools
necessary to successfully orient to the clinical
culture and environment of the PACU and that the
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GREGORYeBOLLINGeLANGSTON
nurse intern acquired critical care skills needed in the
PICU. At the end of the six months, the intern could
choose either to remain in the PICU or to complete
the remainder of the program in the PACU.
Despite the decision made by the RN interns, the
managers and clinicians from both departments met
every two weeks to continue to provide support to
the interns and to monitor their progress. Nursing
preceptors in both de-
partments attended
pated in weekly safety
checks, and were
terns successful
completion of the
program. At the suc-
cessful completion of the nine-month program, in-
terns had the option to transfer to the PICU as their
clinical practice unit or to remain in the PACU.
This PACU internship promoted teamwork,
collaboration, and nurse satisfaction. As a result,
the overall turnover rate for the PACU slowly
declined from 15.9% in 2008 to 9.2% in 2011. Our
institution participates in the National Database of
Nursing Quality Indicators, and in 2010 and 2011,
our participation by PACU nurses in the nurse
satisfaction survey was 100%. Furthermore, the
scores on six of the quality indicators, including job
satisfaction, were above the national means for
both years. The success of this endeavor was
attributed to the collaborative relationships among
the nurse leaders of the two departments.
CONCLUSION
Partnerships, such as those between AORN and the
NLN, also can occur between educational institutions
and perioperative units to effectively address the
perioperative nursing shortage by creating new
models of education for nursing students. The part-
nership between the School of Nursing and Nursing
Services of the hospital resulted in an innovative
learning program that can be used to sustain a future
supply of nurses for perioperative practice and that
CREATING THE FUTURE PERIOPERATIVE WORKFORCE
was successful for faculty, hospital staff, students,
and administrators alike. These efforts not only
addressed the issue of providing perioperative courses
at the nursing school but also provided a sufficient
number of quality clinical experiences to enable the
School of Nursing to expand its enrollment. Collab-
orative partnerships like the one between the school
and nursing services also can result in significant
outcomes not originally envisioned by either party.
National and local accrediting bodies such as the
Magnet" program, the National League for Nursing
Accrediting Commission, and the Virginia Board
of Nursing have cited the partnership between the
School of Nursing and Nursing Services as note-
worthy, characterized the success as nirvana and
inspiring, and identified the partnership as a model
to be emulated nationwide. Here at VCU, whether at
the School of Nursing or Nursing Services of Medical
College of Virginia Hospitals, we believe that the
time is now4 for creating new models of academic
and practice partnerships to strengthen the perioper-
ative workforce throughout the country.
Editors note: Magnet is a registered trademark of
the American Nurses Credentialing Center, Silver
Spring, MD.
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Sabrina Gregory, MSN, RN, CNML, is a nurse
manager, Perioperative Surgical Services, at the
Medical College of Virginia Hospitals of VCU
Health System of Virginia Commonwealth
University Health System, Richmond, Virginia.
Ms Gregory has no declared affiliation that
could be perceived as posing a potential conflict
of interest in the publication of this article.
Deborah R. Bolling, MS, RN, NE-BC, NEA-BC,
is nursing director, Perioperative Surgical Ser-
vices, at the Medical College of Virginia Hospitals
of VCU Health System of Virginia Common-
wealth University Health System, Richmond,
Virginia. Ms Bolling has no declared affiliation
that could be perceived as posing a potential
conflict of interest in the publication of this article.
Nancy F. Langston, PhD, RN, FAAN, ANEF, is
emeritus professor and dean at the Virginia
Commonwealth University School of Nursing,
Virginia Commonwealth University, Richmond,
VA. Dr Langston has no declared affiliation that
could be perceived as posing a potential conflict
of interest in the publication of this article.
AORN Journal j 105
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permission.