Evolving models of healthcare delivery are affecting perioperative nursing practice across diverse settings, prompting the Association of periOperative Registered Nurses (AORN) to study perioperative nurse staffing issues and to revise an official position statement on “One Perioperative Registered Nurse Circulator Dedicated to Every Patient Undergoing an Operative or Other Invasive Procedure” and an official position statement on “Perioperative Safe Staffing and On-Call Practices.” The two AORN statements “were developed with the patient’s safety and a safe and healthy work environment for perioperative nurses in mind,” according to Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN, Executive Director/CEO of AORN. “Although the perioperative RN works collaboratively with other perioperative professionals to meet patient needs, the RN is ultimately accountable for the patient outcomes resulting from the nursing care provided during the operative or other invasive procedures,” explains Groah.

The statements were approved by AORN member delegates at AORN’s second meeting of the House of Delegates on April 2 in Chicago, Ill.

Perioperative Registered Nurse Circulator
In conjunction with the escalating changes in healthcare, there is a continuous need to provide optimal nursing care that is high quality, safe, accessible, cost-effective, and affordable for patients undergoing invasive procedures in all settings. In its position statement on “One Perioperative Registered Nurse Circulator Dedicated to Every Patient Undergoing an Operative or Other Invasive Procedure,” AORN recognizes that studies have demonstrated higher nurse-to-patient ratios are associated with lower mortality rates, fewer incidents of failure to rescue, shorter lengths of stay, fewer medication errors, and reduced incidences of pressure ulcers and pneumonia.

The key principle of the statement, “at a minimum, one perioperative RN circulator should be dedicated to each patient undergoing an operative or other invasive procedure and be present during that patient’s entire intraoperative experience” is consistent with the AORN legislative policy statement on RN as circulator. Several states have legislation requiring an RN as circulator. AORN recommends that perioperative RNs know and comply with their individual state statutes, rules, and Board of Nursing guidance regarding the role of the RN as the circulator in the perioperative setting. Perioperative RNs must work within their health care facilities to ensure RN circulator staffing is in accordance with AORN recommendations and best practices of one RN Circulator dedicated to every patient during every procedure.

Safe Staffing and On-Call
The purpose of the position statement on “Perioperative Safe Staffing and On-Call Practices” is to provide a framework for developing a staffing plan throughout the continuum of perioperative patient care. It provides staffing strategies to accommodate safe perioperative patient care while promoting a safe work environment and includes an addendum with suggested staffing formulas to meet safe staffing and on-call practices.

Among other key principles in this statement, AORN supports that “perioperative clinical staffing guidelines should be based on individual patient needs, patient acuity, technological demands, staff member competency, skill mix, practice standards, health care regulations, accreditation requirements, and state staffing laws.”

The position statement notes that “staffing plans must take into consideration the effect of extended shift hours. Requirements for on-call schedules are subject to facility type, location, nature of services provided, and patient population served.”

The entire AORN position statements on RN as circulator and on perioperative safe staffing and on-call can be viewed online.