In August, the School of Nursing rolled out its Transitions in Care Clinical Immersion Experience. The first installment of this pilot project was created to fulfill a need, one that weighs on hospital operating rooms across the country: OR nurses are in short supply.

Assistant Professor Louise Fleming, who was influential in initiating this OR-focused clinical experience, said this shortage can be traced back to the education student nurses are—or aren’t—receiving when it comes to the operating room.

“It creates a system of a lot of new graduates not considering a job in the OR because they’re not sure what it’s like,” said Fleming. The UNC School of Nursing was no different: she said students would observe in the operating room for one day—six total hours—out of the entire curriculum.

The Transitions experience works to rectify that.

Fleming said the former undergraduate site placement coordinator, Hilary Mendel, approached her, Rachael Lorenzen, and Janet Chadwick on behalf of UNC Hospitals, expressing the concern that new graduate nursing students weren’t interested in careers in the OR. They wanted to change that.

The first step was creating a track focused around the patient surgical experience—and the perioperative pilot project was born. Next came crafting the curriculum: Fleming said no one in the School of Nursing had ever constructed a perioperative experience like this one, built in such a way that students are able to see the experience a patient has from admission to recovery. And from there, Fleming said, the OR pilot has blossomed.

Now, BSN and ABSN students enrolled in Nursing 591, Nursing Care of Adults with Major Health Problems II, have the option to sign up for the perioperative clinical experience through a lottery system. They spend several shifts in pre-op,  the operating room, PACU, and on a post-surgical floor.

“They really see the full patient transition this way. Even though they may not have followed the same patient through, they are now exposed to the entire process. We’re dedicated to making it an objective for them to see the multiple roles of the nurse,” Fleming said.

ABSN students KaRae Carey, Aimee Podraza and Allison Schmidt are the lucky students who were selected for the launch of the program. They spoke of the pressing need for OR nurses that this course addresses.

“Too often, nurses do not get the full picture of their patients’ stay while in the hospital,” said Podraza. “But with this program I am able, as a future circulator, to have experience in pre-care, pre-op, the OR, and PACU, which will assist me in better understanding the care my patient needs.”

Schmidt said she felt the same. “We can see the care and treatment a patient receives in the many steps throughout the hospital system when coming in for surgery. This allows an opportunity to experience more nursing roles and make connections between units.”

Beyond providing the visualization of transitions among patient care, this perioperative track provides yet another advantage to those who partake in it: professional marketability.

Podraza said the track will be invaluable to her during the interview process.

In that way, the perioperative track addresses two needs: the need for more OR nurses and the need among nursing students to have more choices in where they’ll someday work.

Louise Fleming

“If our students don’t have that operating room experience, it can decrease their competitiveness for entry level jobs associated with the surgical services,” Fleming said.

This benefits not only the students, but the hospitals looking to receive more OR nurses, as well.

“It’s a win-win for everyone. The nurse managers have a pool of new grads like they’ve never had, and the students have an opportunity to explore. It gives them a unique ability to look at all the different roles of the nurse and how they interact with different patient populations,” said Fleming.

Currently, this perioperative section of the Adult Health course is in high demand. Only three students of the more than 100 enrolled in the course were initially selected for the perioperative track. But Fleming said this demand will only help support and grow the program.

And this spring, the program has already seen great expansion. Along with the perioperative track, students may now sign up to partake in a cardiac track, as well. Much like the perioperative track, they’ll spend shifts in the emergency department, cardiac ICU,  cardiac step-down unit, and cardiac rehabilitation. The course has added a similar neurology track, as well.

Fleming said they don’t plan to stop there. She said she’d like to see tracks with a focus on the military, critical care, women’s’ health, pediatric oncology, and even some rotations outside of the hospital setting.

“I think there is a lot of potential to grow and be diverse, to offer students the ability to see nurses in multiple roles working with the same patient population, and to really appreciate the patient experience in a deeper way than we’ve been able to show them before,” said Fleming.

She also said she hopes the niche tracks will soon become their own capstone course, rather than being housed within the Adult Health course. But for now, funding is a priority: Fleming and her colleagues hope to write a grant next year to further expand the program. Not only to give it its own course, but to allow more students to participate than the limited number who are currently able to.

“We want to be able to expose students to the OR environment and other focused areas in a richer way so that students would consider new opportunities after graduation.” In turn, Fleming hopes, this will start a trend to get more nurses in the operating room.

But beyond that, Fleming said, “how great is it for students to now be able to see the entire patient experience?”

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