Standards, Guidelines and Position Statements for Perioperative Registered Nursing Practice

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1 Standards, Guidelines and Position Statements for Perioperative Registered Nursing Practice Promoting Excellence OPERATING ROOM NURSES ASSOCIATION OF CANADA (ORNAC) 10 TH Edition Copyright registration number All rights reserved. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without the written permission of the ORNAC Executive.

2 Table of Contents Foreword... 7 A Message From the President... 9 Section 1 ORNAC Beliefs, Professional Standards and Competencies Part A ORNAC's Fundamental Principles and Position Statements ORNAC Philosophy ORNAC Mission, Values, Vision National Standards for Perioperative Registered Nursing Practice Conceptual Model for Perioperative Registered Nursing Practice ORNAC Scope of Perioperative Registered Nursing Practice Scope of Practice for Expanded Perioperative Nursing Practice Scope of Practice for Advanced Perioperative Registered Nursing Practice ORNAC Position Statements a) Staffing the Surgical Suite b) Perioperative Certification c) Perioperative Nursing Experience in Basic Nursing Education Programs d) Environmental Responsibility e) Perioperative Registered Nurses are Essential to Quality Care in the Operating Room f) The Perioperative Registered Nurses Role in Primary Healthcare Safe Surgery Saves Lives Page Part B Standards for Perioperative Registered Nursing Practice Professional Standards Professional Standards for Perioperative Registered Nurses Professional Standards for Perioperative Registered Nurse Managers Professional Standards for Perioperative Registered Nurse Educators Professional Standards for Expanded Practice Perioperative Registered Nurses Professional Standards for Perioperative Registered Nurse Researchers Professional Standards for Advanced Practice Perioperative Registered Nurses Part C Competencies for Perioperative Registered Nursing Practice Purpose Knowledge and Skills Expected of the Perioperative Registered Nurse Prior to Entering the Specialty of Perioperative Nursing Characteristics of Each Competency Competencies of the Perioperative Registered Nurse Competencies of the Perioperative Registered Nurse Manager Competencies of the Perioperative Registered Nurse Educator Competencies of the Advanced Practice Perioperative Registered Nurse Competencies for Expanded Practice Perioperative Registered Nurses Registered Nurse First Assist (Appendix A) ORNAC Beliefs, Professional Standards and Competencies Introduction Revision Date: March 2011 Page 2 of 334

3 Section 2 Infection Prevention and Control Routine Practices and Additional Precautions Routine Practices Airborne Precautions Droplet Precautions Contact Precautions Classic Creutzfeldt-Jakob disease (CJD) Implementing CJD Precautions CJD Perioperative Precautions Reference Guide Assessment Tool (Appendix A) Environmental Cleaning/Sanitation General Practices Preliminary Cleaning Intraoperative Cleaning End of Procedure Cleaning (Between Cases) Terminal Cleaning Weekly and /or Monthly Cleaning Traffic Control People Supplies and Equipment Dress Code Patients Visitors Staff Scrubbing, Gowning, Gloving Scrubbing Gowning Gloving Aseptic Technique Establishing an Aseptic Environment Establishing the Sterile Field Dispensing Sterile Supplies Maintaining the Sterile Field Storage of Sterile Supplies Instrument Management and Reprocessing Intraoperative Instrument Care Reprocessing Surgical Instruments Loaned and Leased Surgical/Medical Equipment Packaging for Sterilization Rigid Sterilization Containers Sterilization Emergency (Flash) Sterilization High Level Disinfection ORNAC Beliefs, Professional Standards and Competencies Introduction Revision Date: March 2011 Page 3 of 334

4 Specialized Instruments and Equipment Prosthesis Care and Handling Power Equipment Management Single Use Medical Devices (SUMeDs) Selection, care and handling of materials Wrappers, Surgical Gowns, and Drapes Bundles Skin Preparation (Prep) Draping Dressing(s), Drain(s), Irrigation Dressings Drains Irrigation Section 3 Safety/Risk Prevention and Management Introduction to Risk Management Risk Avoidance/Minimization Patient Safety Ambulatory Patient Care Recommendations Patient Admission and Identification Consent for Surgical Intervention Surgical Site Verification Surgical Pause/ Time Out Surgical Counts Surgical Positions Visitors to the Surgical Suite Gathering Medicolegal Evidence in the Surgical Suite Guidelines for Collection of Evidence: (Appendix E) Specimen Management Medication Management Nursing Documentation Electronic Health Records Organ and Tissue Procurement Protocol Team Safety Credentialing Occupational Health & Safety Students/Preceptors Orientation/In-service/Continuing Education Environmental/Equipment Safety Construction/Renovation ORNAC Beliefs, Professional Standards and Competencies Introduction Revision Date: March 2011 Page 4 of 334

5 Equipment Selection/Trialing Preventative Maintenance Programs Risk Alerts/Recalls Intra-operative Equipment Malfunction Specialized Surgical Equipment Electrosurgery (ESU) Laser Safety and Administration Minimally Invasive Surgical Equipment Section 4 Environmental Hazards and Responsibilities Physical Hazards Environmental Factors Light Noise Ventilation Electricity Radiation Fire/Explosion Chemical Hazards Anesthetic Agents Sterilizing Agents - Ethylene Oxide Other Sterilizing Agents/Disinfectants Formaldehyde Glutaraldehyde Methyl Methacrylate Drugs: Cytotoxic, Dyes, Pharmaceuticals Waste Management Infectious Waste Latex Sensitivity/Allergy: Staff Section 5 Nursing Care of the Anesthetised Patient Preoperative Considerations Intraoperative Considerations Postoperative Considerations Local Anesthesia Procedural Sedation/Analgesia ORNAC Beliefs, Professional Standards and Competencies Introduction Revision Date: March 2011 Page 5 of 334

6 Intravenous Regional Anesthesia (Bier Block) Regional Anesthesia-Spinal, Epidural, Peripheral Nerve Blocks Herbal Remedies Blood and Blood Products Emergency Situations Malignant Hyperthermia Latex Allergy Cardiac Arrest Disseminated Intravascular Coagulation Death Glossary Evaluation Form CSA Standards ORNAC Beliefs, Professional Standards and Competencies Introduction Revision Date: March 2011 Page 6 of 334

7 FOREWORD ORNAC was inaugurated in 1983, and by June 1986, the Standards Committee had developed Standards for Operating Room Nursing Practice. Two years later, in 1988 Recommended Technical Standards were published. This was a significant milestone for a young organization. The body of knowledge required in the specialty was defined as required by the Canadian Nurses Association to meet the requirements of a certification process. The two documents were combined in a single issue in 1993 and also included a chapter on competencies. That issue was used as a primary resource for the development of the Canadian Nurses Association (CNA) Certification exam in Perioperative Nursing Practice. The document continued to evolve with the 1998 edition, which reflected the movement towards ambulatory surgery. The 2003 revision incorporated a major format change. This edition was re-designed into modules. The constant rapid change in healthcare requires a design that enables more consistent review/revision. ORNAC is a volunteer organization of committed perioperative Registered Nurses. Revision/review of modules is more easily facilitated on a continuous basis by these volunteers. According to the Canadian Nurses Association (CNA), a standard is a desired and achievable level of performance against which we can measure actual performance. Self regulating professions are characterized by standards of practice, based on the values of the profession. This document is meant to complement not replicate other standards in existence. The 9 th edition, 2009 revision was published in a bound format as a result of feedback and requests from perioperative nurses across the country. A bound publication provides assurance that each and every copy contains all of the most current revisions. Committee energy was focused on the fourth and fifth sections of the publication. Minor revisions were made to the remaining sections based on questions the committee received through the ORNAC website. For the current (10 th edition) revision, the committee focused on Section 2, with minor revisions to the remaining sections. It is the mandate of the Standards Committee to develop and review standards on an ongoing basis. Content expertise has been provided by perioperative Registered Nurses across Canada and reflects current practice, research, and review of medical/surgical literature. The Standards Committee has endeavoured to develop a user-friendly document that will serve as a guide and reference for perioperative Registered Nurses, health care facilities that care for surgical patients, and other professional associations. It is the responsibility of individual perioperative Registered Nurses and health care facilities to ensure that the most recent recommendations are being used. Those who served as reviewers and validators are to be commended for a job well done. Thank-you to the ORNAC Board and Executive, and perioperative Registered Nurses from across the country for their assistance and to colleagues from other specialty areas who assisted us. ORNAC Beliefs, Professional Standards and Competencies Introduction Revision Date: March 2011 Page 7 of 334

8 Kathy Radcliffe RN, BSN, CPN(C) Chair, Standards Committee, Ontario Loraine Best, RN, BSN, CPN(C) British Columbia Chris Downey RN, BScN, CPN(C), MSc, RNFA, CMLSO, Ontario Cathy Ferguson RN, BScN, RNFA, CNOR, CPN(C) Nova Scotia Carol Knudson RN, BN Manitoba Rupinder Khotar RN, BScN, CPN(C) British Columbia Kelly Kuz RN, BScN, MN, CPN(C) Alberta Corenia Price RN, CPN(C), CMDRT Newfoundland & Labrador Leah Restall RN - Manitoba Anne Smith RN, Prince Edward Island Cathy Timmons, RN Nova Scotia Margot Walsh RN Newfoundland & Labrador 1 10 th edition committee members Notes: 1. The intended application of these standards, guidelines, and position statements, is for the perioperative environment. It is the responsibility of the users of this document to apply it in the context of their individual setting respecting provincial/national and professional regulations and laws within each province and jurisdiction. 2. This document was developed from broad input of perioperative Registered Nurses and the final document represents consensus of the content. Consensus is defined as agreement in collective opinion and belief. Consensus is more than a simple majority, but not necessarily unanimity. 3. ORNAC standards, guidelines, and position statements are subject to periodic review. 4. Shall is used to express a requirement, i.e., a provision that the user is obliged to satisfy in order to comply with the standard, should is used to express a recommendation or that which is advised but not required, and may is used to express an option or that which is permissible within the limits of the standard. ORNAC Beliefs, Professional Standards and Competencies Introduction Revision Date: March 2011 Page 8 of 334

9 A MESSAGE FROM THE PRESIDENT... Promoting Excellence Promouvoir l Excellence A MESSAGE FROM THE PRESIDENT On behalf of the Operating Room Nurses Association of Canada s Board and Executive, it is my pleasure to preface the tenth edition of the ORNAC Standards, Guidelines, and Position Statements for Perioperative Registered Nursing Practice. During the fall ORNAC strategic planning process, the executive, provincial and affiliate representatives confirmed that the production and continuous review of the Standards is a strategic priority to support best practices in perioperative patient care. This edition represents the ongoing validation and revision of the Standards, necessary to keep pace with the health care environment and maintain safe patient care. As demonstrated by the ORNAC conceptual model, this document is the foundation of registered nursing practice in the perioperative setting and represents our professional practice to our colleagues. While the Standards have evolved since the first publication, ORNAC Recommended Standards for Operating Room Nursing Practice, June 1986, the intent remains the same to guide the delivery of safe patient care and perioperative registered nursing practice in Canada. The review and compilation of the Standards document is an enormous task coordinated by the volunteers of the ORNAC Standards committee. Their generous donation of time, knowledge and expertise to develop and inform this document is commendable. The Operating Room Nurses Association of Canada is a professional organization dedicated to the promotion and advancement of excellence in perioperative practice. The ORNAC Standards, Guidelines, and Position Statements for Perioperative Registered Nursing Practice provides the vital reference to demonstrate to the public, government and other stakeholders that as a profession, perioperative registered nurses are dedicated to maintaining the public trust and to upholding standards for excellence in professional practice. Bonnie McLeod, RN, BScN, MN, CPN(C) ORNAC President, ORNAC Beliefs, Professional Standards and Competencies Introduction Revision Date: March 2011 Page 9 of 334

10 Section 1 ORNAC Beliefs, Professional Standards and Competencies

11 Section 1 ORNAC Beliefs, Professional Standards and Competencies Part A ORNAC's Fundamental Principles and Position Statements ORNAC Philosophy ORNAC Mission, Values, Vision National Standards for Perioperative Registered Nursing Practice Conceptual Model for Perioperative Registered Nursing Practice ORNAC Scope of Perioperative Registered Nursing Practice Scope of Practice for Expanded Perioperative Nursing Practice Scope of Practice for Advanced Perioperative Registered Nursing Practice ORNAC Position Statements a) Staffing the Surgical Suite b) Perioperative Certification c) Perioperative Nursing Experience in Basic Nursing Education Programs d) Environmental Responsibility e) Perioperative Registered Nurses are Essential to Quality Care in the Operating Room f) The Perioperative Registered Nurses Role in Primary Healthcare Safe Surgery Saves Lives Part B Standards for Perioperative Registered Nursing Practice Professional Standards Professional Standards for Perioperative Registered Nurses Professional Standards for Perioperative Registered Nurse Managers Professional Standards for Perioperative Registered Nurse Educators Professional Standards for Expanded Practice Perioperative Registered Nurses Professional Standards for Perioperative Registered Nurse Researchers Professional Standards for Advanced Practice Perioperative Registered Nurses Part C Competencies for Perioperative Registered Nursing Practice Purpose Knowledge and Skills Expected of the Perioperative Registered Nurse Prior to Entering the Specialty of Perioperative Nursing Characteristics of Each Competency Competencies of the Perioperative Registered Nurse Competencies of the Perioperative Registered Nurse Manager Competencies of the Perioperative Registered Nurse Educator Competencies of the Advanced Practice Perioperative Registered Nurse Competencies for Expanded Practice Perioperative Registered Nurses Registered Nurse First Assist (Appendix A) ORNAC Beliefs, Professional Standards and Competencies Section 1 Revision Date: March 2011 Page 11 of 334

12 Part A ORNAC'S FUNDAMENTAL PRINCIPLES AND POSITION STATEMENTS ORNAC Beliefs, Professional Standards and Competencies Section 1 Revision Date: March 2011 Page 12 of 334

13 The Operating Room Nurses Association of Canada (ORNAC) is an organization of professional perioperative Registered Nurses dedicated to the promotion of excellence in perioperative nursing. ORNAC serves as a spokesperson for perioperative Registered Nurses on issues affecting Registered Nurses, nursing practice, patient care, and societal needs/ expectations. We believe: ORNAC Philosophy Perioperative nursing is a dynamic process guided by theoretical knowledge, ethical principles, research, specialized clinical skills, and caring practice. Perioperative Registered Nurses respond to complex and changing clinical needs during a crucial period of a person s surgical experience. The scope of perioperative nursing practice is continually evolving as Registered Nurses respond to societal and technological changes. Standards of nursing practice, as well as collegial and interdisciplinary collaboration, enhance perioperative nursing practice. People are unique individuals whose needs change and may be compromised during the perioperative experience. They have a right to high-quality health care that promotes informed and responsible decision making. Health encompasses the whole being and is influenced by one's environment. Using a wellness approach, individuals and communities shall be proactive and responsible for achieving optimal health. Education is an ongoing life-long process and perioperative Registered Nurses are responsible for their learning. ORNAC is committed to enabling perioperative Registered Nurses to meet this responsibility. The introduction to perioperative nursing should be a component of the basic nursing curriculum. To fully practice the scope of perioperative nursing, the Registered Nurse needs to acquire additional knowledge and clinical skills. ORNAC s Motto Promoting Excellence demonstrates commitment to meeting the needs of its members and society. Approved by Board and Executive: April 1994 Revised: May 2003, June 2007, February 2009, March 2011 ORNAC Beliefs, Professional Standards and Competencies Section 1 Revision Date: March 2011 Page 13 of 334

14 The Operating Room Nurses Association of Canada (ORNAC) is a professional organization of perioperative Registered Nurses dedicated to: Mission Statement The promotion and advancement of excellence in the provision of perioperative care to our patients. The professional growth, competence and personal enhancement of perioperative Registered Nurses. The ongoing development of Standards, Guidelines and Position Statements for Perioperative Registered Nursing Practice The promotion and advancement of perioperative nursing practice at a regional, provincial and national level through political activity. Vision Statement The Operating Room Nurses Association of Canada (ORNAC) is a strong, unified national association that enhances and advances the practice of perioperative Registered Nurses. Values Statement Values reflect the basic beliefs that are most important to the Operating Room Nurses Association of Canada (ORNAC): KNOWLEDGE RESPECT PROFESSIONALISM CONTINUOUS QUALITY We recognize and are committed to education and research which are essential components guiding our practice. We promote and demonstrate critical thinking skills in the delivery of perioperative nursing care. We recognize the worth, quality, diversity, and importance of the patients we care for, and of each other. We promote and continually develop our unique specialized body of knowledge. We encourage all perioperative Registered Nurses to become certified through the Canadian Nurses Association (CNA). We collaborate with nurses, organizations /agencies, other disciplines and medical industries that impact our practice. We are responsible and accountable for our actions and decision-making. We comply with the Canadian Nurses Association (CNA) Code of Ethics. We strive to achieve excellence in perioperative practice, and the activities influencing our Association. ORNAC Beliefs, Professional Standards and Competencies Section 1 Revision Date: March 2011 Page 14 of 334

15 LEADERSHIP PATIENT ADVOCACY STEWARDSHIP We are role models who communicate a vision and who empower others to achieve perioperative nursing excellence. We promote the perioperative patient s right to be informed and to make autonomous decisions regarding their care. We strive to protect the rights, health and safety of the patient throughout the perioperative experience. We strive to be fiscally and environmentally responsible while optimizing patient outcomes. National Standards for Perioperative Registered Nursing Practice ORNAC holds the following beliefs regarding standards: The implementation of standards contributes to the continued improvement of safe patient care and perioperative registered nursing practice in Canada. Standards assist the perioperative Registered Nurse in attaining and maintaining competence in the performance of quality patient care. Standards define safety measures for patients and the health care team. Standards provide a baseline and tool for measurement when evaluating perioperative registered nursing practice. Standards are an integral part of a facility's quality assurance and improvement program. Standards provide a consistent reference base for programs such as orientation, in-service, continuing education, research, and formal perioperative post basic education programs. Standards are the benchmark from which the perioperative Registered Nurse Manager and Educator provide the structure, resources, and environment for the health care team. ORNAC Beliefs, Professional Standards and Competencies Section 1 Revision Date: March 2011 Page 15 of 334

16 CONCEPTUAL MODEL FOR PERIOPERATIVE REGISTERED NURSING PRACTICE The conceptual model provides direction for perioperative registered nursing practice. The surgical patient is the focus of perioperative registered nursing practice, which has as its foundation professional and clinical standards, and competencies. The professional standards provide guidelines for the perioperative Registered Nurse on which to base decisions in such areas as ethics, legal aspects, and professional conduct. The competency statements reaffirm that perioperative Registered Nurses are responsible and accountable for the nursing care of the surgical patient during the perioperative phase. In order to implement the standards and develop competence, the perioperative Registered Nurse shall be cognizant of the qualities necessary to become a Registered Nurse. Competence integrates the characteristics of knowledge, clinical and ethical decision-making, communication skills, psychomotor skills, safety, accountability, responsibility, team organization, continuing education, and leadership skills. The perioperative Registered Nurse is guided in the clinical area by these characteristics in order to function both independently and in collaboration with other members of the health care team. The clinical standards provide a basis for consistent, uniform, and acceptable outcomes of nursing practice. The perioperative Registered Nurse is systematically guided through the perioperative phase. The clinical standards are the benchmarks for quality improvement. The standards are implemented during the immediate preoperative, intraoperative, and immediate postoperative phases of the surgical patient's experience. Administration and management provide support, direction, leadership, resources, and commitment to the practice of these standards. ORNAC Beliefs, Professional Standards and Competencies Section 1 Revision Date: March 2011 Page 16 of 334

17 ORNAC Scope of Practice for Perioperative Registered Nurses The Scope of Perioperative Registered Nursing Practice is a continuum of nursing activities that focuses on identifying and meeting the individual needs of the surgical patient throughout the perioperative experience. This nursing practice occurs in, but is not limited to operating rooms, ambulatory care settings, clinics, and physician s offices. The perioperative Registered Nurse provides excellent care to the surgical population using critical thinking skills guided by the ORNAC Standards, Guidelines and Position Statements for Perioperative Registered Nursing Practice and provincial legislation. Basic and expanded nursing knowledge is used to address the physiological, psychological, socio-cultural, and spiritual responses of the patient to the surgical event. The perioperative Registered Nurse possesses the knowledge, skills and abilities to provide quality care for all perioperative patients. Working in collaboration with the health care team, the perioperative Registered Nurse performs skills supported by perioperative nursing education and evidence-based research within the boundaries of the health care facility s policies and procedures. The perioperative Registered Nurse precepts and mentors colleagues. BIBLIOGRAPHY Canadian Nurses Association (2007). CNA joint position statement Promoting Continuing Competence for the Registered Nurse. Ottawa: Author. International Council of Nurses (R2007). The ICN position statement on Ethical Nurse Recruitment. Geneva: Author. Watson D. S. (2008). Patient Safety, an Issue of Perioperative Nursing Clinics. Toronto: Elsevier. Scope of Practice for Expanded Perioperative Nursing Practice Registered Nurse Anesthesia Assistant- RNAA The experienced perioperative Registered Nurse, with additional education, knowledge and skills in anesthesia assists the anesthesiologist to facilitate quality care of patients undergoing anesthetic procedures. The increasing complexity of patient condition and anesthetic procedures provides the perioperative Registered Nurse who has expanded perioperative nursing education with the opportunity to practice in collaboration with and under the direction of the anesthesiologist. The scope of practice of the Registered Nurse Anesthesia Assistant is part of perioperative nursing practice and encompasses the preoperative, intraoperative, and postoperative phases of the anesthetic experience. ORNAC Beliefs, Professional Standards and Competencies Section 1 Revision Date: March 2011 Page 17 of 334

18 BIBLIOGRAPHY Nagelhout, J. J. & Plaus, K. (2010). Nurse Anesthesia (4 th ed.). Toronto: Elsevier/Mosby. Registered Nurse First Assistant - RNFA The experienced perioperative Registered Nurse, with additional education, knowledge and skills in surgery assists the surgeon to facilitate quality care of patients undergoing surgical procedures. The increasing complexity of patient conditions, diagnoses, and surgical procedures provides the perioperative Registered Nurse who has expanded perioperative nursing education with the opportunity to practice in collaboration with and under the direction of the surgeon. The scope of practice of the RNFA is part of perioperative nursing practice and encompasses the preoperative, intraoperative, and postoperative phases of the surgical experience. BIBLIOGRAPHY Schroeder, J. L. (2008). Acute Care Practitioner: An Advanced Practice Role for RN First Assistants. AORN, 87(6), Scope of Practice for Advanced Perioperative Nursing Practice The scope of Advanced Nursing Practice focuses on a specialty clinical service (i.e. Perioperative), providing support to clients and the healthcare team, as a consultant, researcher, administrator, educator, and clinical practitioner. Advanced Practice Nurses include Nurses Practitioners (NP) and Clinical Nurse Specialists (CNS). BIBLIOGRAPHY Canadian Nurses Association. (2008). Advanced Nursing Practice: A National Framework. Ottawa: Author. Canadian Nurses Association. (2008). Nursing Leadership: Do We Have a Global Social Responsibility. Ottawa: Author. Canadian Nurses Association (2008). Advanced Nursing Practice A National Framework. Ottawa: Author. Girard, N. J. (2009). Leadership an Issue of Perioperative Nursing Clinics. Toronto: Elsevier/Mosby. MacDonald, M., Schreiber, R. & Davis, L. (2005). Exploring New Roles for Advanced Nursing Practice, A Discussion Paper. Ottawa: CNA. ORNAC Beliefs, Professional Standards and Competencies Section 1 Revision Date: March 2011 Page 18 of 334

19 ORNAC POSITION STATEMENTS STAFFING THE SURGICAL SUITE For the patient undergoing surgical intervention, one of the most critical periods of care occurs in the operating room theatre. Every patient has a right to an optimal level of nursing care, and each facility has the responsibility to provide appropriate staffing in order to: Meet individual patient's needs and surgical complexity. Maintain acceptable levels of safety for patients, personnel and physicians. Function within legal limitations of the provincial scope of practice. Facilitate appropriate initial and specialty orientation, and continuing education. Attain and maintain perioperative Registered Nurse competency. Each surgical patient care encounter occurs in an environment where each individual theatre is a specific unit of care that shall be staffed independently with the staffing levels as defined. To promote excellence in perioperative nursing care, the position of the Operating Room Nurses Association of Canada (ORNAC) is: The surgical patient in each theatre shall be under the direct supervision of an appropriately experienced perioperative Registered Nurse who is physically present in each theatre, and who is immediately available, i.e. Circulating Role to respond to unstable, unpredictable and emergency situations. That in order to maintain competency in the circulating role, the perioperative Registered Nurse shall be competent in the scrub role. Each case or surgical procedure shall be staffed by a minimum of two perioperative professional nurses competent within their scope of practice. The circulating role shall be assigned only to a perioperative Registered Nurse. The scrub role may be filled by another healthcare professional. A second perioperative Registered Nurse shall be immediately available within the surgical suite. It may be necessary for additional circulating perioperative Registered Nurses and competent healthcare personnel to be present in the theatre to provide care within their scope of practice or job description. Only a perioperative Registered Nurse may relieve the circulating Registered Nurse for coffee, lunch, or other duties. Each procedure or case shall be staffed with a minimum of one perioperative Registered Nurse and a second perioperative Registered Nurse immediately available. Documentation shall include all personnel in attendance and clearly identify who provided direct patient care. The surgical theatre shall be managed by an experienced perioperative Registered Nurse. ORNAC Beliefs, Professional Standards and Competencies Section 1 Revision Date: March 2011 Page 19 of 334

20 BIBLIOGRAPHY Bull, R. & FitzGerald, M. (2006). Research Paper, Nursing in a technological environment: Nursing care in the operating room, International Journal of Nursing Practice, 12, 3-7. Canadian Health Services Research Foundation (CHSRF), (2006). Staffing for Safety: A Synthesis of the on Nurse Staffing and Patient Safety, CHSRF, Ottawa, ON retrieved March 29, 2009 from Canadian Health Services Research Foundation (CHSRF), (2006). Evidence Boost Implement nurse staffing plans for better quality of care, The Problem: Current nurse staffing strategies are not adequate to improve patient safety, CHRSF, Ottawa: Author. Canadian Nurses Association. (2007). C NA Policy Brief # 2, Meeting Future Health-Care Needs Through Innovations to Nursing Education. Ottawa: Author. Canadian Nurses Association. (2006). CNA joint Position Statement, Practice Environments: Maximizing Client, Nurse and patient Outcomes. Ottawa: Author. Canadian Nurses Association. (2005). CNA Position Statement Interprofessional Collaboration. Ottawa: Author. Evidence Canadian Nurses Association (CNA), (2005). Evaluation Framework to Determine the Impact of Nursing Staff Mix Decisions. Ottawa: Author. Canadian Nurses Association. (2003). Patient Safety: Developing the Right Staff Mix, Report of the Think Tank. Ottawa: Author. Craddick, S. (2009). Quality Indicators, An Issue of Perioperative Clinics. Toronto: Elsevier/Mosby Garrett, C. (2008). Effective Nurse Staffing Patterns on Medical Errors and Nurse Burnout. AORN, 87(6), International Council of Nurses, (ICN). (2008). Nurse Retention & Migration. Geneva: Author Springer, P. J., Corbett, C. & Davis, N. (2006). Enhancing Evidence-based Practice through Collaboration, The Journal of Nursing Administration, 36(11), ORNAC Beliefs, Professional Standards and Competencies Section 1 Revision Date: March 2011 Page 20 of 334

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