OR Today Magazine August 2021

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STAYING CURRENT WITH AAMI ST79 The steam sterilization working group has collected feedback from users about the 2017 ANSI/AAMI ST79 update and spent two years researching and developing amendments. The result is the ANSI/AAMI ST79:2017’s 2020 amendments.




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OR Today (Vol. 21, Issue #8) August 2021 is published monthly by MD Publishing, 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. POSTMASTER: Send address changes to OR Today at 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. For subscription information visit www.ortoday.com. The information and opinions expressed in the articles and advertisements herein are those of the writer and/or advertiser, and not necessarily those of the publisher. Reproduction in whole or in part without written permission is prohibited. © 2021


August 2021 | OR TODAY






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Amanda Heitman, BSN, RN, CNOR

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ACCOUNT EXECUTIVES Jayme McKelvey Megan Cabot



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DIGITAL SERVICES Cindy Galindo Kennedy Krieg Erin Register

INDUSTRY INSIGHTS 11 News & Notes 16 TJC: Clarifying Scoring In Instrument Handling and Processing 19 Avante Health Solutions: 3 Questions to Help You Find the Right Anesthesia Machine for Your Facility 20 CCI: The Importance of Early Career Certification 22 IAHCSMM: 2021 Annual Conference & Expo Boost Quality and Safety in SPD, OR & Beyond 24 AAMI: Clinical and Sterilization Highlights from AAMI eXchange REWIRED 26 Webinars: Bioburden, Biomaker Session Crushes Record

28 M arket Analysis: Covid-19 Propels UVC Market 29 Product Focus: UV Disinfection 32 CE Article: Succession Planning in Nursing: Who Are Tomorrow’s Leaders?

OR TODAY | August 2021

Diane Costea

WEBINARS Jennifer Godwin

EDITORIAL BOARD Hank Balch, President & Founder,

Vangie Dennis, MSN, RN, CNOR, CMLSO, with AnMed Health System Sharon A. McNamara, Perioperative Consultant, OR Dx + Rx Solutions for Surgical Safety

MD PUBLISHING | OR TODAY MAGAZINE 1015 Tyrone Rd., Ste. 120 Tyrone, GA 30290 800.906.3373 | Fax: 770.632.9090 Email: info@mdpublishing.com www.mdpublishing.com




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news & notes


Georgia Council of periOperative Registered Nurses Announces Conference Dates This year, the Georgia Council of periOperative Registered Nurses has teamed up with OR Today to host its annual conference at the Renaissance Atlanta Waverly Hotel on October 22 and 23. The Georgia Council of periOperative Registered Nurses is the collective voice of Georgia Chapters of the Association of periOperative Registered Nurses (AORN). Its mission is to advocate for excellence in perioperative practice and health care in Georgia as they unite and empower perioperative nurses. For nearly 20 years, OR Today magazine has provided perioperative professionals with up-to-date news and information about their profession. The magazine aims to educate readers about new guidelines, techniques and equipment. It also offers practical information for career building, problem-solving and overall well-being. The annual conference includes an excellent chance to network at its opening reception on the first day of the conference followed by a second day filled with educational sessions, a keynote and networking with exhibitors. For more information, visit gacouncilnurse.org.


Newly Released AAAHC Quality Roadmap Probes Data, Highlights Surveyor Insights In June, AAAHC released its 2021 Quality Roadmap, a comprehensive analysis of data from more than 1,120 accreditation surveys conducted in 2020. The Quality Roadmap serves as a resource for health care organizations to identify themes for careful consideration and provides useful benchmarks for strengthening ongoing quality improvement efforts. “Complying with AAAHC Standards requires relentless vigilance on practices that impact staff and patient safety,” said Noel Adachi, MBA, president and CEO of AAAHC. “By reviewing the successes and challenges of peer ambulatory health care facilities outlined within the Quality Roadmap, organizations can identify best practices for conducting quality improvement studies, comply with credentialing and privileging standards, manage documentation, and more as they work to provide the highest quality of care.” The 2021 report examines accredited organization compliance ratings for AAAHC Standards based on onsite surveys conducted January 1-December 31, 2020. Organizations surveyed include ambulatory surgery centers (ASC), Medicare Deemed Status ASCs (MDS ASC), office-based surgery practices (OBS) and primary care settings (PC). “The Quality Roadmap brings 1095 Strong, quality every day to life by outlining common pain points and highlighting the importance of accreditation readiness, quality improvement, and ongoing monitoring of processes and procedures,” said Hallie Brewer, senior vice president, learning and development. “The goal of accreditation is ongoing compliance with AAAHC Standards in order to consistently deliver high quality, safe patient care. This report provides an overview of common areas of high deficiency along with expert advice for strengthening and maintaining compliance all 1,095 days of the accreditation term.”

August 2021 | OR TODAY



news & notes

Kinnos Launches Highlight for Bleach Wipes Product Kinnos has introduced its new health care-focused flagship product, Highlight for Bleach Wipes. Highlight for Bleach Wipes colors the disinfecting wipes that hospitals worldwide depend upon for keeping surfaces clean, enabling users for the first time to visualize disinfection coverage instantly. “Disinfecting surfaces is a critical part of preventing the healthcare-associated infections (HAIs) that afflict 2 million patients in the U.S. annually,” explained Kinnos’ CEO Jason Kang, “but due to the transparency of disinfectants, health care cleaning staff can easily miss surfaces that might harbor pathogens. Highlight for Bleach Wipes quantifiably improves disinfection technique, taking the guesswork out of a previously invisible process and giving confidence to both staff and patients alike. Unveiling it at APIC 2021 gives infection preventionists,

the experts whose key focus is patient safety, a chance to learn about this game-changing product.” Highlight’s patented color technology adds bright blue color to bleach to show disinfectant coverage, then fades automatically in a few minutes. First developed to protect Ebola health care workers from contracting the virus during PPE removal, Highlight for Bleach Wipes now gives hospitals the same ability to visualize coverage of ready-to-use disinfectant wipes. “Bleach is the standard for disinfecting the hardest-tokill pathogens in health care facilities,” Kang explained. “We also plan to release compatibility with quaternary ammonium compound wipes, the most commonly used health care disinfectant, by the end. of 2021.”

Report: Global Surgical Equipment Market Approaches $60 Million At an estimated value of over $31.65 billion in 2019, the global surgical equipment market is predicted to thrive at a compound annual growth rate (CAGR) of 5.8% and valued at over $58.85 billion over the forecast year 2020-2030. Surgical equipment are specially designed tools that help health care specialists to carry out specific actions during an operation. Such equipment enables health care professionals access to internal human organs and modify biological


OR TODAY | August 2021

tissues. Various types of surgical equipment include hand instruments, electrosurgical devices and closure devices. Such equipment is used in various surgeries, such as hip and knee replacement, cesarean deliveries, gall bladder removal, hernia repair and urology ailments. For more information, visit tinyurl.com/75ua6by5.



news & notes

Torin AI Solution Targets Hospital Efficiency The introduction of the Torin Artificial Intelligence (AI) functionality is designed to improve efficiency in managing schedules for surgical procedures and comes in the wake of a new Getinge survey. Among the participating hospitals 41% report significant backlogs and only 44% have implemented new digital tools that can improve proficiency in OR scheduling and patient management. Getinge now introduces Torin with AI in the United States. The company also announced results from a survey of hospital executives and surgeons in the U.S. showing hospitals are taking steps to speed up OR turnover times, hire new staff and require staff to work longer hours to address backlogs. “For almost 18 months during the COVID-19 pandemic, both surgeons and patients made decisions to defer many forms of surgery if possible. As more patients feel confident about considering surgery, demand to schedule procedures at all types of hospitals and surgery

centers has exploded in recent months,” says Eric Honroth, president, North America at Getinge. “While hospitals can take steps to hire more people and have staff work longer hours to address this backlog, they must also look at the most effective technology options to improve scheduling efficiency and utilization of resources.” Getinge’s Torin software uses artificial intelligence technology that can quickly and seamlessly improve the speed and efficiency of scheduling surgical procedures. The Torin solution was launched in 2020 as a new resource to help with the planning, management and optimization of surgical procedures. The introduction of a new suite of advanced functions for Torin, significantly expands capabilities in key areas including predicting surgery times, managing wait lists and data security. The system can produce highly accurate assessments of surgical procedure timing based on a range of variables including surgery type, patient data,

relevant devices and staffing. To address scheduling backlogs, the software ranks pending procedures based on clinical and resource parameters, proposes optimized pre-schedules and integrates the process with existing scheduling functionalities. “The new capabilities now available with Torin are specifically designed to help hospitals and surgery centers address many areas that are major challenges, including accurate assessments of surgery times, scheduling and wait list management, applications of mobile devices and data security requirements based on their specific prerequisites,” says Charlotte Enlund, vice president integrated workflow solutions at Getinge. “For long term acute care facilities, which our study found to be extraordinarily challenged by surgical backlog, we are happy to offer support with Torin OptimalQ, our stand-alone tool, for quick relief in planning and optimizing the waiting list.”

Dräger Awarded VHA Contract Dräger announced that the U.S. Veterans Health Administration (VHA) has awarded the company a contract for surgical lighting to support its operating room (OR) workspaces. Dräger is dedicated to improving critical care while lowering total costs in a way that eases the burden on staff and enhances the patient and family


experience. The company’s Polaris surgical lighting is built for the future with versatility, cost-effectiveness and advanced technologies to support precision and efficiency in the OR. “We are honored to be the only company to which the VHA has awarded this type of contract,” said Dräger Senior Vice President of Sales

Hospital Solutions Steve Menet. “This new agreement will streamline the VHA’s ordering processes and access to our clinically vetted equipment, along with our 24/7 service and support. This Non-Expendable (NX) Equipment Program contract will also expedite procurement and enable the VHA to leverage volume discounts.”

August 2021 | OR TODAY



news & notes

IAHCSMM Announces New Vice President Damien Berg, BA, BS, CRCST, AAMIF, joined the International Association of Healthcare Central Service Materiel Management (IAHCSMM) as vice president, strategic initiatives, on July 1, 2021. In this position, he will assist Executive Director Susan Adams, BA, CAE, in aligning and executing the association’s strategic goals. He will work closely with IAHCSMM chapters, other health care associations, administrators and regulatory bodies to increase awareness of the association and the profession. “Because of his depth of experience, I feel Damien is well positioned to assist IAHCSMM from a strategic perspective and help our association continue to grow, expand and better serve our members and the profession at large,” said Adams. Berg, an IAHCSMM past-president (2018-2019) and a veteran sterile processing leader who most recently served as regional manager for UCHealth in Northern Colorado, has a firm understanding of IAHCSMM, its policies and procedures and its goals/vision. He also possesses strong leadership, management and speaking skills. He has a degree in business administration and management and extensive experience working closely

with health care organizaDamien Berg tion leadership and for various regulatory bodies and standards making groups such as the American National Standards Institute and the Association for the Advancement of Medical Instrumentation (ANSI/ AAMI) and the International Standards Organization (ISO). He is also a confident speaker and sterile processing representative on a global scale, such as at chapter events, legislative/advocacy meetings and numerous conferences (including the World Forum where he serves as an executive committee member). Additionally, he has spent many years as chair of the IAHCSMM Advocacy Committee. “It is an honor and privilege to be able to serve in this strategic role,” Berg said. “I have a passion for this profession, and the profession is all about the people. Working closely with the executive director and board of directors will help me advance IAHCSMM’s mission to best support those in this critical discipline.”.

oneSOURCE, Ecolab Expand into Australia, New Zealand oneSOURCE Document Management Services Inc., an RLDatix company with an existing presence in Australia, announced that the company has partnered with Ecolab to expand its sales distribution network in Australia and New Zealand health care environments. Both organizations understand the importance of compliance and how this partnership will create streamlined access to oneSOURCE’s archive of documents necessary for departments like sterile processing and infection prevention. “Strategic partnerships like this one with Ecolab continue to amplify oneSOURCE’s mission of providing health care professionals with the most up-to-date tools and resources for patient safety,’’ said Heather Thomas, CMO of oneSOURCE. “By partnering with Ecolab we will be able to leverage the power of their expansive health care capabilities and expand further into these two key markets. The impact of COVID-19 has only further cemented the need for a worldwide health


OR TODAY | August 2021

care standardization for following IFUs in order to keep patients safe and this international partnership will enable us to help others reduce health care acquired infections and keep patients and staff safe.” Servicing thousands of health care providers across the world, Ecolab and oneSOURCE’s partnership will provide facilities with over 60,000 critical documents and materials across its full suite of products which includes seven specialized databases. “The Ecolab team is excited to be bringing oneSOURCE to our hospital, health care and nursing facility partners,” said Ecolab’s Stephen Graham. “Ecolab is a trusted resource for the health care industry and has substantial experience in providing our customers with great digital tools to help provide quality patient care – this tool will particularly benefit in our sterile processing and infection prevention solutions.”


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news & notes

PDI Healthcare has announced a new softpack format for its Super Sani-Cloth Germicidal Disposable Wipes. The new Super Sani-Cloth Wipes Softpack package is designed with ease of use and portability at the forefront and contains 80 wipes per pack allowing for multiple applications. Most notably, the Super Sani-Cloth Softpack contains 80% less plastic than the company’s traditional large canister formats. According to a 2019 JAMA study, “Waste in the U.S. Health Care System,” the cost of waste in the U.S. health care system ranges from $760 billion to $935 billion annually, while 85% of the total waste generated by health care activities is general, non-hazardous waste. “PDI’s goal is to prevent healthcare-associated and community-acquired infections through innovative and sustainable infection prevention products,” said Earl Adamy, senior director of marketing, environment of care. “The new Super Sani-Cloth Softpack demonstrates PDI’s commitment to sustainability by reducing the amount of packaging waste that impacts our environment.”



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August 2021 | OR TODAY



Clarifying Scoring in Instrument Handling and Processing By Diane M. Cullen, MSN, MBA, RN, CIC s an infection preventionist (IP) working in the Standards Interpretation Group of the Joint Commission, an important function of my job is to answer infection prevention-related questions from health care organizations. As one might imagine, some of these questions can be very specific, especially when they refer to cleaning and reprocessing medical equipment.


While answering these questions, my colleagues and I often begin our responses with the caveat, “The Joint Commission Standards are not written to that level of detail … ” If we were to stop there, our response may not seem very helpful, but we continue by referring to a concept called the “Infection Prevention Hierarchy” (Hierarchy) as the key to helping organizations find the solutions they seek. The “Infection Prevention Hierarchy” was originally published in the April 2019 issue of Joint Commission Perspectives (tinyurl.com/ykjdckrr). Following the rules of the Infection Prevention Hierarchy helps ensure that health care organizations comply with local, state and federal regulations (which may require organizations to follow specific evidence-based guidance), Centers for Medicare and Medicaid Services (CMS) Conditions of Participation, and abide by all manufacturer’s instructions for use (IFU) for any specific product. If those sources fail to provide the guidance needed, a health care organization may then choose to follow a specific evidencebased guideline (EBG) or consensus documents. The Joint Commission receives numerous questions from health care 16

OR TODAY | August 2021

organizations every week inquiring about requirements for reprocessing medical equipment. This stands to reason since there are so many medical devices and types of cleaning equipment and supplies, each with its own specific instructions for use. Some instructions offer very complex and precise requirements while others are more general and lack sufficient direction. The Food and Drug Administration (FDA) regulates labeling requirements for medical devices and requires that manufacturers provide information on intended use, directions for the consumer on how to use a device safely and how to properly clean and reprocess it. The FDA uses the Spaulding Classification System to guide device manufacturers to develop reprocessing instructions for medical devices based on intended use. So, how does a health care organization develop its policies, procedures and practices for instrument reprocessing with so many instructions to navigate? By exploring ultrasound transducers as an example, we can take a closer look. Many organizations struggle with understanding how to reprocess ultrasound transducers and seek help to ensure they comply with The Joint Commission Standards. The Joint Commission suggests the following: Surface Ultrasound Transducers Surface ultrasound transducers (transducers) are used for both diagnostic and therapeutic purposes and are found in various departments, locations and types of health care settings. Transducers are used on intact skin, mucous membranes and within sterile body cavities during surgical procedures. Each of these intended uses would result in a different requirement for reprocessing, based on

Diane M. Cullen, MSN, MBA, RN, CIC Spaulding criteria. If a transducer is used in a sterile body cavity, it is considered a critical device and requires sterilization. If a transducer is used on non-intact skin or mucous membranes, such as a vaginal, rectal or oral, it is a semi-critical device and should undergo high-level disinfection. If a transducer is only used on intact skin, it is considered non-critical and, regardless of whether it is contaminated with blood, the minimum requirement is low level or intermediate level disinfection. If the transducer manufacturer reprocessing instructions indicate that an instrument should be high-level disinfected if used to assist with percutaneous procedures or if contaminated with blood, the organization must follow the manufacturer instructions for use unless they have evidence to negate that instruction from the manufacturer. A transducer sheath (probe cover), considered a medical device by the FDA, WWW.ORTODAY.COM

must be approved for use as a barrier. Transducer sheaths cannot be interchanged with items that have not been approved for barrier use (e.g., transparent IV dressings) and are intended to be used during procedures to protect the transducer from body fluids. Sheaths may be sterile or unsterile, latex or latex-free and are available in a variety of shapes and sizes. Sheaths are applied to surface transducers, endocavity transducers or transducer probes used in surgical procedures. There is confusion in the industry as to whether the use of a transducer sheath on any transducer would negate the need to perform the minimum level of disinfection specified in the reprocessing instructions, as required by the manufacturer. The FDA has stated that use of a transducer sheath does NOT change the Spaulding Classification of the transducer (as these sheaths may leak or tear) and therefore would not change the minimum level of reprocessing required for the transducer based on clinical use, unless otherwise indicated by the manufacturer. The Joint Commission expects all organizations to comply with the instructions provided by the manufacturer based on intended use of the device. If the manufacturer requires a specific product, we will look for that product at your health care organization during survey. If the manufacturer requires a certain time or temperature for reprocessing, The Joint Commission will expect your organization to establish a means and process to measure both. Health care organizations will be cited for: not having IFU available, not following the steps of cleaning and reprocessing described in IFU, not having on-hand the products indicated

in IFU, not providing adequate personal protective equipment to staff (per IFU) to complete the cleaning and for failing to provide training or assessment of competence for staff who perform those procedures. Ensuring that health care organizations are reprocessing medical devices will be easier if leadership takes all requirements into consideration. Sometimes manufacturer instructions might not conform to rules about intended use nor provide enough information. It is very important for health care organizations to understand how a device will be used, what reprocessing should be required as a result of the intended use and that the manufacturer instructions will meet the level of disinfection required for each item’s use. If it does not – it is time to contact the manufacturer. If the instructions for reprocessing do meet the level of reprocessing based on intended use, health care organizations should ensure they are following all the manufacturer’s instructions for reprocessing. If there is a question or possible conflict with the instructions provided, then, it is the health care organization’s responsibility to refrain from using the device until the manufacturer is contacted and differences are reconciled. The Joint Commission understands that instrument handling and processing can be complex, and we encourage you to contact Diane Cullen at dcullen@jointcommission.org with any questions. Diane M. Cullen, MSN, MBA, RN, CIC, is associate director of the Joint Commission’s Standards Interpretation Group.

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August 2021 | OR TODAY



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OR TODAY | August 2021




news &Avante notes

3 Questions to Help You Find the Right Anesthesia Machine for Your Facility By Matt Cameron, CBET ll anesthesia machines perform essentially the same function in any operating room or procedure suite, but no system is one size fits all. Before choosing a new anesthesia system for your practice, make sure you have a firm understanding of the features and specifications that will best suit your unique needs, making it a worthwhile investment for your facility. To help you in your search, I recommend you answer these three guiding questions:


• Which anesthesia machine configuration works best in your facility? • Does a refurbished machine make sense for your facility? • Is this anesthesia system a good investment?

Which anesthesia machine configuration works best in your facility? The easiest way to approach this question is by determining whether your facility needs an anesthesia ventilator. Ventilators are necessary for all procedures requiring general anesthesia where the patient requires deeper sedation. If your facility performs these kinds of procedures, you will need an integrated anesthesia system. Integrated Systems An integrated system is designed for a full operating room with a packed surgical schedule. Integrated units usually offer ventilation with volume and pressure control and other advanced modes. They typically have the capacity to fit two or three vaporizers and feature integrated monitoring, gas delivery management. Integrated systems are also compatible with electronic data systems. WWW.ORTODAY.COM

Portable Systems If your facility doesn’t perform procedures that require a ventilator, then a tabletop or portable anesthesia system is a good option. Portable anesthesia machines are commonly used in monitored anesthesia care (MAC), where a clinician delivers local anesthesia together with sedation and analgesia.

Does a refurbished machine make sense for your facility? Opting for a refurbished anesthesia system can certainly benefit your facility’s bottom line, but cost isn’t the only benefit. A refurbished unit can also save your facility staff valuable time and effort that would otherwise be spent training your staff on the latest technology of your factory new unit. To be sure you’re choosing a reputable refurbishing company, make sure that they have the necessary experience, inventory, and refurbishment process to guarantee a quality product. The benefits of refurbished equipment need to be considered with the caveat that a reconditioned anesthesia system is only as good as the company who completes the refurbishing process.

Is this anesthesia system a good investment? Ascertaining the true value of your new anesthesia machine involves assessing a few important factors. Consider the initial price of purchase along with the expected maintenance costs to make sure your facility is prepared to cover those expenses. Prepare contingencies for equipment problems that occur outside the realm of routine maintenance. Ask yourself, “what’s the most expensive thing that could go wrong?”

Matt Cameron End-of-Life Considerations Determining the eventual “end of life” (EOL) for an anesthesia machine is important – especially when comparing refurbished systems. Despite the finitesounding name, EOL simply refers to the time set by the original equipment manufacturer after which they will no longer provide support. Anesthesia machines can function for years after their designated EOL with the help of qualified, third-party maintenance services. If your machine is nearing its EOL, be sure to find a trusted maintenance provider with access to quality new or used parts and experience in serving your specific brand of machine. Choosing the right anesthesia system can be a daunting task, but it helps to consider your facility’s unique needs during the selection process. When in doubt, let Avante Health Solutions use our expertise to help you find the best system within your facility’s budget. Matt Cameron is a Biomedical Support Specialist at the Avante Health Solutions Louisville Center of Excellence. For more information about new and refurbished anesthesia systems and support, please visit avantehs.com.

August 2021 | OR TODAY



The Importance of Early Career Certification By Benjamin Dennis, A.S. here are an increasing number of employers that are requiring certification in addition to education or in place of academic degrees to work in specialized fields. Job specific certification is fast becoming the seal of excellence in information technology, financial planning, and with fitness instructors. However, in nursing specialties, such as perioperative nursing, certification remains almost entirely a voluntary endeavor. The Competency and Credentialing Institute (CCI) believes there is a compelling case to hold voluntary nursing specialty certifications. CCI also believes it is especially advantageous to earn a certification early in a career.


In an increasingly demanding hiring market those now entering nursing, or committing to a specialty such as perioperative nursing, will maximize their opportunities with certification. Certified nurses can separate and elevate themselves as candidates as facilities become more critical in their hiring practices. Certification validates an area of specialty expertise and is necessary to maintain knowledge in an ever-changing world. As health care evolves at a rapid pace with new technology the need to stay current in these developments will also increase. It is difficult for an individual nurse or health care facility to muster 20

OR TODAY | August 2021

the resources to remain aware of these developments. The certification process and the resources offered by CCI can be part of the solution to this dilemma. All nurses holding a CCI certification can access the CCI Learning Management System (LMS) with dozens of learning activities that can be used to fulfill recertification requirements. All content in this system is vetted by certified nurse volunteers and supported by industry partners. The LMS content is available without additional charge to certificants. CCI also believes that reflective learning can be a powerful adjunct in professional development. The CCI LMS has numerous reflective learning exercises. CCI also recently validated the PPCS-R survey instrument for self-assessment of perioperative nursing competency for use by American nurses (2018). This instrument is an integral part of the CFPN credentialing process but will soon be available to all perioperative nurses as an aid to reflective learning. The Emerging Professionals Advisory Committee, dubbed EPAC, reports to the CCI Certification Council and is composed of nurses early in their career. The EPAC was integral to developing the CFPN credential and informing CCI of the professional development needs of those early in their career. The CFPN credential isdesigned for nurses who have recently completed orientation but do not yet have two years of experience. Through this work, we were able to gain valuable insights that shaped the development of the credential. We also

learned that these early career nurses valued certification and professional development opportunities early in their career trajectory. Through the CFPN credential, which launches in July, CCI endeavors to first engage perioperative nurses early in their career. Secondly, we wish to share the diversity of CCI resources, such as the LMS content, with these nurses. We believe that an early introduction to quality resources such as the latest evidence supporting perioperative nursing care, the standards that guide our practice and information on current hot topics will provide a sound foundation for perioperative care. Our goal at CCI is to improve care rendered to surgical patients and facilitate the professional development of perioperative nurses. Perioperative nursing is not only unique in its services, but we are the people that deal with patients in their most vulnerable states. We not only owe it to our profession, but to the patient, family, and friends that ensure high quality care to them. In the work of EPAC and through mechanisms such as the CFPN certification we seek to provide the resources necessary for the increasing numbers of perioperative nurses entering the specialty. Reference Gillespie, B.M., Harbeck, E.B., Falk-Brynhildsen, K. et al. Perceptions of perioperative nursing competence: a cross-country comparison. BMC Nurs 17, 12 (2018). https://doi.org/10.1186/s12912018-0284-0 WWW.ORTODAY.COM


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August 2021 | OR TODAY




2021 Annual Conference & Expo Boost Quality and Safety in SPD, OR & Beyond By Julie E. Williamson

ontinuing education and the commitment to staying abreast of the latest industry standards and best practices is the foundation of quality, safety and positive outcomes in the sterile processing department (SPD) and other areas where instruments and equipment are processed or otherwise managed.


Those who attend the 2021 IAHCSMM Annual Conference & Expo this October in Columbus, Ohio, will learn from some of the industry’s most renowned and respected experts in the field. Attendees will glean valuable information they can take back to their departments to drive better outcomes for their health care customers and patients who rely on clean, sterile and well-functioning instruments.. 22

OR TODAY | August 2021

Because of the pandemic and the uncertainties that existed over the past year-plus, IAHCSMM moved its conference and expo from May to October and adopted an innovative scheduling approach with two attendance options (Conference Option A takes place Oct. 9-11; Conference Option B immediately follows Oct. 12-14). The educational sessions and speakers for Option A will repeat for Option B, aside from each conference option having its own keynote speaker (Option A’s keynote is Steve Pemberton, an inspiring business and human resources leaders who overcame seemingly insurmountable odds to become a man of resilience, determination and vision; Option B’s keynote is Jon Dorenbos, an NFL veteran who retired following open heart surgery and is now a sleight-of-hand magician

who showcased his talent on America’s Got Talent, Ellen and The Today Show, and marries his magic and incredible life story to motivate and inspire audiences). Regardless of the option attendees choose, they’ll receive outstanding education and networking opportunities at every turn to advance their knowledge and skills sets, share their experiences and best practices, and tap new-and-improved ways to address their health care customers’ and patients’ needs. The two-day expo will be held on the last day of conference Option A and the first day of conference Option B (Oct. 11-12). Julie E. Williamson, serves as IAHCSMM’s Senior Editor and Director of Communications.



IAHCSMM Option A Schedule

Option B

Saturday, Oct. 9

Tuesday, Oct. 12

10:30-11 a.m. – Opening Remarks 11 a.m.-12 p.m. – Opening Keynote (Steve Pemberton) 1:30-2 p.m. – Educational Session (Advocacy Update) 2:15-3:15 p.m. – Educational Session (Update on Sterile Processing Best Practices) 3:30-4 p.m. – Educational Session (Water Safety & Quality During Medical Device Reprocessing) 4:15-4:45 p.m. – Educational Session (Instrument Care & Handling: How to Care for Your Microsurgical Instruments in 5 Easy Steps) 5-6 p.m. – Educational Session (Is It Clean? Building a Quality & Audit Program Around Critical Elements Before Packaging) 7 p.m. – Opening Reception for Attendees

10:30-11 a.m. – Opening Remarks 11 a.m.-12 p.m – Opening Keynote (Jon Dorenbos) 1:30-2 p.m – Educational Session (Instrument Care & Handling: How to Care for Your Microsurgical Instruments in 5 Easy Steps) 2:15-3:15 p.m. – Educational Session (Advocacy Update) 2-6 p.m. – Expo Open 6:30 p.m. – Evening Reception

Sunday, Oct. 10 7:30-8 a.m. – Educational Session (Infection Prevention 101) 8:15-8:45 a.m. – Educational Session (How to Evaluate Stains After Steam Sterilization) 9-10 a.m. – Educational Session (Are You Ready for the New AAMI ST91 for Endoscope Reprocessing?) 10:15-11:15 a.m. – Educational Session (Bringing Quality & Innnovation to Sterile Processing) 11:30 a.m.-12 p.m. – Educational Session (How to Tackle Steam Sterilization Failures) 1:30-2:30 p.m. – Educational Session (Sterile Processing Unscripted) 2:45-3:45 p.m. – Educational Session (Lessons from the Field: Preparing for the Next Pandemic) 4-5 p.m. – Educational Session (Fact or Facebook Fiction?) 5:15-5:45 p.m. – Educational Session (What You Should Know About the Physical Ergonomic Challenges Facing Sterile Processing Professionals) Monday, Oct. 11 7:30-8 a.m. – Educational Session (Your Future Is in Your Hands: Building a Career Ladder in Sterile Processing) 8:15-8:45 p.m. – Educational Session (A Joint Commission Survey: What You Need to Know in Regard to High-Level Disinfection) 9-10 a.m. – Educational Session (Infection Control for the COVID-19 Era and Beyond) 10:15-11:15 a.m. – Educational Session (When Everything Goes Wrong: A Patient’s Perspective) 11:30 a.m.-12 p.m. – Educational Session (Understanding Enzymes and How to Get the Most out of Enzymatic Detergents) 1:30-2 p.m. – Educational Session (A Practical Guide for Disinfectants in SPD) 2:15-2:45 p.m. – Educational Session (Putting First Things First: What’s Your Priority?) 2-6:30 p.m. – Expo Open


Wednesday, Oct. 13 7:30-8 a.m. – Educational Session (Water Safety & Quality During Medical Device Reprocessing) 8:15-8:45 a.m. – Educational Session (Infection Prevention 101) 9-10 a.m. – Educational Session (Update on Sterile Processing Best Practices) 10:15-11:15 a.m. – Educational Session (Is It Clean? Building a Quality & Audit Program Around Critical Elements Before Packaging) 11:30 a.m.-12 p.m. – Educational Session (How to Evaluate Stains After Steam Sterilization) 1:30-2:30 p.m. – Educational Session (Are You Ready for the New AAMI ST91 for Endoscope Reprocessing) 2:45-3:45 p.m. – Educational Session (Bringing Quality & Innovation to SP) 4-5 p.m. – Educational Session (Sterile Processing Unscripted) 5:15-5:45 p.m. – Educational Session (What You Should Know About the Physical Ergonomic Challenges Facing Sterile Processing Professionals) Thursday, Oct. 14 7:30-8 a.m. – Educational Session (Understanding Enzymes and How to Get the Most out of Enzymatic Detergents) 8:15-8:45 a.m. – Educational Session (A Practical Guide to Disinfectants in SPD) 9-10 a.m. – Educational Session (Lessons from the Field: Preparing for the Next Pandemic) 10:15-10:45 a.m. – Educational Session (A Joint Commission Survey: What You Need to Know in Regard to High-Level Disinfection) 11 a.m.-12 p.m. – Educational Session (When Everything Goes Wrong: The Patient’s Perspective) 1:30-2:30 p.m. – Educational Session (Infection Control for the COVID-19 Era and Beyond) 2:45-3:15 p.m. – Educational Session (The Future Is in Your Hands: Building a Career Ladder in Sterile Processing) 3:30-4:30 p.m. – Educational Session (Fact or Facebook Fiction) 4:45-5:45 p.m. – Educational Session (How to Tackle Steam Sterilization Failures) 6-6:30 p.m. – Educational Session (Putting First Things First: What’s Your Priority?) 7 p.m. – Closing Reception August 2021 | OR TODAY



Clinical and Sterilization Highlights from AAMI eXchange REWIRED he recent AAMI exchange REWIRED online event featured several expert discussions about techniques and technologies that could impact the future of the clinical setting. Be sure to follow OR Today and AAMI News for more.


Sterilization insights: Updated AAMI ST91:2020 for Endoscope Reprocessing “Where endoscopes are used and processed in the health care facility varies greatly from one health system to the next,” said Mary Ann Drosnock, director of clinical affairs for Healthmark Industries. “Everyone needs to be in sync when it comes to what standard practices are.” On April 1, the FDA issued recommendations to help providers deal with infections caused by or related to reprocessed urological endoscopes, noting that the agency “has received numerous Medical Device Reports (MDRs) which describe patient infections post procedure or other possible contamination issues associated with reprocessing these devices.” That’s why Drosnock and AAMI Working Group 84 are working toward an updated version of ST91. Drosnock explained what’s in store in an education session at AAMI 24

OR TODAY | August 2021

eXchange REWIRED. The updated version of ST91, expected to be available this month, includes stronger guidance to help health care professionals best work to ensure the safety of their facilities’ scopes. “What’s great about ST91 is it covers all kinds of endoscopes, from bronchoscopes to ureteroscopes … to GI scopes, you name it,” Drosnock said. Some of the updates include: • Adding classification for high-risk scopes, such as bronchoscopes and ureteroscopes • Changing guidance for drying of scopes, as well as proper storage and handling • Recommendations against manual disinfection • Guidance for testing water in automated endoscope reprocessors (AERs) to avoid the final-rinse water re-contaminating the scopes Guidance for determining the length of storage, or “hang time,” that a scope can withstand before needing to be reprocessed. The updated document will also include “lots of references to support” the stronger guidance, making ST91 a more evidence-based document, Drosnock added. In addition to ST91, there is also

work being done on a technical information report, TIR99, which will cover the reprocessing of ultrasound probes and dilators. “[I’m] hopeful that next year we’ll have this … document, because there’s nothing that’s out there right now on how to properly process probes and dilators,” Drosnock said.

How Combining Clinical Informatics and Medical Devices Can Improve Care On the first day of AAMI eXchange REWIRED, Dr. Christoph Lehmann, director of clinical informatics at UT Southwestern Medical Center, joined the hosts of “Good Morning HTM” as a special guest to talk about combining clinical informatics and medical devices for better patient care. Leiman, who is also a pediatrician and professor in clinical science at UT Southwestern, said he started his foray into clinical informatics in a way that’s hard to talk about. “It’s a difficult story for me to tell because it starts with the death of a patient,” he explained. At just 18 months old, Josie King died at Johns Hopkins Hospital due to a number of medical errors made during her care. This terrible moment triggered several events – most notably, the founding of the Josie King Foundation for patient safety and a rapid transition among hospital WWW.ORTODAY.COM


AAMI news & notes systems in how they account for and prevent medical errors. These events also ultimately created a patient safety center that Lehmann found himself a part of. “That was my first opportunity to spend time on developing informatics solutions that could improve the quality and safety of patient care,” he said. Since then, Lehmann has been working to improve patient safety and reduce costs of care using the immense amounts of data that are part and parcel to the modern health care system. “It has been more fun than work. With informatics, we can turn this data into knowledge that helps us understand what works and functions better for patients and then turn those lessons into powerful applications,” Lehmann said. An example of this powerful field

applying to the clinical setting, Lehmann offered, is an automated calculator for infusion pumps. First, a physician will use the calculator to order the appropriate infusion speed and concentration. This also informs the printing of the correct label. Finally, a pump is used that similarly calculates the rate given the correct data. Nurses are trained to start an infusion only if the rate on the pump is identical to the rate on the order and also identical to the rate on the label. “This drastically reduced the number of infusion errors we had been seeing,” said Lehmann. However, overall, he wants to see much more of this kind of “crossfertilization” between medical device design, informatics and device endusers. “I see devices coming up with solutions to problems that really don’t ex-

ist,” he said, “but the fact that I’m here talking today with you and the AAMI community is a really good first step!” He added that he’d love to see a future where there is a seamless integration between medical health records and medical devices. “And the communication has to be bi-directional,” he added, envisioning a device which can update records in real-time. AAMI eXchange co-host Danielle McGeary, whose career started on the front lines as a biomedical equipment technician (BMET), was thrilled by the possibilities. “It’s all about safety,” said McGeary, vice president of HTM at AAMI. “In an emergency where there’s very little time to set up a device … if there’s decision support available, you want it right there at the point of care!”










August 2021 | OR TODAY




Bioburden, Biomaker Session Crushes Record Staff report he OR Today webinar “Biomarker Technologies and Bioburden Detection: Elements to Consider in the Surgical Processing Department” broke registration and attendance records. The webinar, presented by Jose Rodriguez, DNP, RN, CCNS, CNOR, and sponsored by Ruhof, was eligible for (1) CE credit. OR Today has been approved and is licensed to be a Continuing Education Provider with the California Board of Registered Nurses, License #16623.


The webinar drew 689 registrations (new record for 2021) with 285 individuals attending the live presentation. The 285 live attendees is also a new record for 2021. Rodriguez, assistant professor for the adult-gerontology clinical nurse specialist program of Uniformed Services University of the Health Sciences, discussed the assessment of cleanliness in surgical instrument reprocessing in the webinar. He addressed understanding the negative outcomes of contaminated surgical instruments and described the qualities 26

OR TODAY | August 2021

of an effective point-of-use cleaning detection system. He also discussed using the information learned to determine which system could best meet an organization’s needs. During a question-and-answer session, Rodriguez replied to the question “With the ATP swabs, how do you account for lumens that are larger or smaller than the swab tip and can’t control with the walls of the lumen?” “That’s a great question,” Rodriguez said. “Now, I can tell you that for the ones that are large, usually you don’t have much of an issue, if it’s short enough for you to manipulate that swab. I found that the one that Ruhof makes that the design is very good for you to manipulate where it won’t break. You can go back and forth with it. The best advice I can give you is always follow the manufacturer’s instructions for use. But I can tell you that the challenging work comes when you’re trying to test less than one millimeter.” Attendees provided positive feedback via a post-webinar survey that included the question, “How will today’s webinar help you improve in your role?” “We are a small hospital where the surgical techs perform all the roles –

pull the case, do the case, clean the room, clean and sterilize the instruments. This has made me more aware of the vital steps of cleaning before sterilization. We are supposed to remodel our OR next year and will be more active in the choosing of more items to make sure our instruments are actually clean,” said K. Roush, case coordinator, CST. “Looking at the role that SPD plays in mitigating SSI risk from a processing perspective and utilizing a rapid soil indicator testing protocol to ensure processes are consistently met,” SPD Practice Leader P. Vanni said. “I will have a better understanding regarding the testing done in SPD to ensure our instruments are safe for the next patient,” said D. Wilken, infection prevention RN. “Feel more assured we are doing the right thing,” Risk Manager V. Friesen said. For more information, visit ORTodayWebinars.live. Thank you to the sponsor:


BD ChloraPrep™ and BD PurPrep™ Patient Preoperative Skin Preparations with sterile solution

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market analysis

COVID-19 Propels UVC Market Staff report


he global ultraviolet disinfection equipment market size was valued at $2.3 billion in 2019 and is expected to grow at a compound annual growth rate (CAGR) of 19.0% from 2020 to 2027, according to Grand View Research. The report also states that product manufacturing has increased since the outbreak of the COVID-19 pandemic. The Defense Research and Development Organization (DRDO) has launched UV Blaster, which is useful for disinfecting high-tech surfaces and areas with a large flow of people, such as airports, hotels, offices, metros, shopping malls and factories. Ease of installation and low maintenance, supervision, and space requirements have also led to the growing demand for this technology. Future Market Insights (FMI) released a report that expects the ultraviolet-C (UVC) market to experience growth in coming years. This technology if growing in popularity for the disinfection of hospital rooms and medical spaces. The global UVC disinfection products reached $1.2 billion in 2019, and is expected to be valued at nearly $6 billion by 2030, according to Future Market Insights’ recently published report. Deepening smart technology penetration combined with need for efficient cleansing solutions is primarily steering growth. Lucrative opportunities are in store with respect to automation and robotics as organizations look to leverage these solutions to ensure a safe and healthy working environment. According to FMI’s UVC disinfection products market analysis, the COVID-19 pandemic is further broadening growth prospects, with adoption growing in residential and commercial settings. Over the years, disinfection procedures have undergone 28

OR TODAY | August 2021

significant transformations technology-wise. Smart disinfection solutions have clearly emerged as the winner in the 21st century, with the scope of robotic and automated cleaning solutions acquiring immense precedence. This shift toward robotic automation is not just an outcome of deepening technological penetration, but also that of the hazards posed by manual cleaning and disinfection approaches. A major area of concern is the alarming increase in the number of hospital-acquired infections (HAIs). As the coronavirus pandemic intensifies, numerous start-ups and existing manufacturers are foraying into the UVC disinfection business profile, offering novel solutions. For instance, Dutch start-up UV Smart provides the Impelux short-wavelength UVC technology which kills nearly 100% micro-bacteria, fungi and viruses without damage to medical instruments. A critical challenge posed to the UVC disinfection products market is the issue of over exposure to UVC radiation by the personnel handling such equipment. While UVC radiation can effectively rid any premises of pathogens, constant exposure to these rays by the human body may lead to undesirable impacts. Prolonged direct exposure to UVC light have led to extensive skin damage and eye injuries such as corneal injuries and redness or ulceration of the skin. Chronic exposure to such radiation could lead to even more detrimental impacts, the worst being the onset of melanoma or other types of skin cancers. Such perceived and documented instances could restrict the growth prospects of the UVC disinfection products market. On the other hand, health care settings are providing their personnel with personal protective equipment while handling these devices, thus offsetting the hazards posed by UVC radiation exposure, according to the FMI report. WWW.ORTODAY.COM


market analysis


UVC Disinfection Robot The Tru-D device, part of PDI’s infection prevention solutions, is a portable UVC disinfection robot that delivers one automated, measured dose of UVC to consistently disinfect a room, resulting in the ability to document disinfection results after each and every room treatment. The Tru-D robot operates from one placement within the room, ensuring significant pathogen reduction in direct and shadowed areas and reducing the threat of human error in the disinfection process. Validated by more than 20 independent studies, the TruD device’s combined automated, measured dosing capabilities and real-time usage-tracking features make it one of the most precise and advanced UVC disinfection systems available.

Intelligo Technologies UVC Dosimeters

Is your UV-C disinfection system reaching all the critical areas of your OR? Is it delivering enough energy to kill harmful pathogens? UVC Dosimeters provide visible evidence of successful germicidal irradiation so you can validate your UV-C equipment and verify your disinfection processes in real-time, any time. The yellow center reacts to UV-C exposure and changes color to indicate how much germicidal irradiation has been delivered. Reaching doses of 50 and 100 mJ/ cm² has been correlated to a 3-log reduction of MRSA and C. Diff spores, respectively. Patented and proven, UVC Dosimeters by Intellego Technologies provide an accurate, reliable and simple way to see your success with UV-C disinfection.


August 2021 | OR TODAY



product focus


LightStrike GermZapping Robots Xenex LightStrike Germ-Zapping Robots quickly deactivate pathogens on surfaces without damaging expensive OR materials. They are the only UV disinfection technology proven effective by more than 40 published, peer-reviewed studies, including multiple studies focused on the OR environment. Using intense bursts of pulsed xenon emitting UV light across the entire germicidal spectrum, LightStrike robots quickly deactivate pathogens at the wavelengths where they are most susceptible. The robots don’t require warm-up or cool-down time, so they can be used in ORs between surgical cases, at terminal disinfection, and in patient rooms, restrooms and other areas. features make it one of the most precise and advanced UVC disinfection systems available.

Bolb Inc.

High-Power UVC LED Array Bolb Inc., a world leader in high-output, high-efficiency ultraviolet c-band (UVC) light emitting diodes (LEDs), has demonstrated 99.95% kill rate against aerosolized bacteria and viruses at up to 3,000 liters per minute flow rate by a third-party lab. UVC light has been recognized as a universal, future-proof and chemical-free method to effectively combat mutating pathogens such as SARSCov-2. Solid-state emitters produced by Bolb Inc. brings benefits such as extremely high surface brightness, compactness, easy scalability, design flexibility and instant responsivity to a market traditionally dominated by mercury lamps.


OR TODAY | August 2021



product focus


360 Room Sanitizer

The UVDI-360 Room Sanitizer is proven to reduce healthcareassociated infections and high-risk pathogens in over 15 peer-reviewed, published clinical studies. It has proven 99.99% disinfection of over 35 pathogens, including C. difficile spores and MRSA in 5 minutes at a distance of 8 feet and SARS-CoV-2 in 5 minutes at 12 feet. Design-driven for rapid UV-C disinfection, ease of use and operator safety, over 2,000 UVDI360 Room Sanitizers are used in more than 1,000 hospitals across 25 countries to combat HAIs.

R-Zero Arc

R-Zero’s flagship product, Arc, is a touchless, hospital-grade UV-C disinfection device, designed to be operationally and financially accessible to organizations of all shapes and sizes. BLE and LTE-M connectivity shares usage data in real-time, providing organizations with an auditable trail of all disinfection activities for the first time. Results from recent (CDC and EPA recognized) independent lab tests prove Arc’s hospital-grade efficacy, successfully destroying over 99.99% of surface and airborne pathogens (including human coronavirus and norovirus) in a 1,000-square-foot space, in just 7 minutes


August 2021 | OR TODAY




continuing education

SUCCESSION PLANNING IN NURSING WHO ARE TOMORROW’S LEADERS? By Deborah K. Zastocki, DNP, EdM, MA, RN, NEA-BC, FACHE ou are the new CNO at a 200-bed hospital with a strong, seasoned leadership team. Monday morning brings the ED director to your office. He tells you he is going to retire in 90 days and wants you to know so you can find his replacement. When you ask about potential candidates in his department, he tells you that he has never really thought about it. The hospital does not offer leadership development programs for staff below the level of manager. You did not even realize that your ED director was eligible for retirement. On investigation, you discover more than 50% of your managers or directors will retire in the next three years. The loss of this many seasoned leaders in such a short time could devastate the hospital. What are you going to do?


Changing Workforce Succession planning is essential in healthcare today. Succession planning in nursing encompasses the focused, formal assessment and development of people for future positions in leader32

OR TODAY | August 2021

ship.1 Similar to the 2015 results, the 2017 Workforce Study revealed 51% of the RNs were age 50 years or older. Forty-two percent of RNs had a BSN or higher degree as their initial credential, while 64% had obtained a baccalaureate or higher degree as their highest level of education. In 2017, the number of nurses with master’s degrees increased 3% since 2013 to 17.1%. RNs with a DNP has doubled to 1.1% since 2015.2 With half the nursing workforce retiring within the next 15 years, it is concerning not all organizations have processes in place to identify neither potential nurse leaders nor succession plans. One source noted that nearly half of nurse managers may retire by 2020. Nurse leadership turnover effectively creates more of a leadership gap.3 The Bureau of Labor Statistics lists registered nursing as the top occupation in terms of job growth through 2022, with an expected growth from 2.71 million in 2012 to 3.4 million in 2022. This equates to a 19% increase (526,800 actual positions) in the need for registered nurses. The Bureau projects there will be a need for 525,000 replacement nurses due to those leaving the workforce. When coupled with the total projected growth, 2022 promises to demonstrate a shortage of 1.05 mil-

lion registered nurses 1, 4, 5 The increased rate of retirement of the baby boomers (those born between 1946 and 1964)

Relias LLC guarantees this educational program free from bias. The planners and authors have declared no relevant conflicts of interest that relate to this educational activity. See Page 41 to learn how to earn CE credit for this module.

Goal and Objectives The goal of this continuing education program is to discuss succession planning for nursing, including methodologies, the importance of a “succession environment,” and success measurements. After studying the information presented here, you will be able to: • Explain why a succession plan for nursing is critical. • D iscuss methodologies used to establish a succession plan in nursing. • Explain metrics to measure the effectiveness of a nursing succession plan.



continuing education may mean that many nursing departments will have a large number of open leadership positions and a small pool of trained leaders to replace retiring leaders. In a Florida nurse leader study, 71% of the sample was over age 50 years, and 59% plan to retire in the next 10 years while 20% intend to leave within three years. In this study, 73% of nurse leaders reported a lack of succession plans.6 Unfortunately, many nurse leaders are of the baby boomer generation whose professional and organizational history and knowledge will be lost unless steps are taken now. The next generation of nurse leaders, Generation X (born between 1964 and 1981), not only is much smaller than the baby boomers (41 million vs.75 million) but has often started nursing education later in life. Its members do not have the experience at age 40 that many of the baby boomers had. However, some may have leadership experience in professions other than nursing and could be among those educated for succession. Millennial or Generation Y (those born between 1982 and 2003) have noted the lack of financial rewards in leadership positions beyond what they can earn as clinicians or nurse practitioners, which discourages some from entering nursing leadership. Many factors influence the supply and demand for nursing talent, including the growth of new roles in managing health status and preventing acute health issues, aging of the population as well as the nursing workforce, changes in technology and healthcare reimbursement, and overall economic conditions.7 Succession planning is dynamic and of strategic importance in leadership continuity. Succession allows for continued organizational momentum by creating the nurse leader pipeline, promoting nurse satisfaction, and creating healthier work environments, which support improved patient outcomes.8,9,10 It is important to note that although the term leadership development and succession planning may be used interWWW.ORTODAY.COM

changeably, there is a distinct difference. Leadership development, as the term implies, refers to education and growth of current leaders while succession planning aims to identify potential leaders and to develop them for leadership positions, thereby creating the future leader pipeline.11 In the past, nursing leader candidates were selected from more experienced “senior” clinical nurses and were provided with didactic and on-thejob training. This process occurred over a longer period, yet, at times, resulted in new leaders who were undereducated, unprepared, and overwhelmed in their new position.11,12 Although the number of nurses entering the workforce is increasing, these novices may be faced with considering a nursing leadership role at a much earlier stage in their careers.8,9 Of nursing leaders surveyed to gain an understanding of their views of the method of preparation for growing nursing leaders, 62% described leadership roles as not desirable to the possible nursing leaders of the future, and 56% perceived a lack of necessary resources and appropriate training to develop future leaders.13 One study revealed encouraging results in that the average age of the study participants in a succession planning program for potential nurse managers was 29 years compared to the average of 45 years in other studies.14 The ability to engage earlier careerists into the leadership pipeline is essential. It is no wonder younger potential leaders are hesitant to pursue nurse manager roles as they observe the stressful nurse manager role in balancing organizational expectations for patient outcomes, productivity, budgetary compliance, and patient care. Emerging leaders witness the challenges in the environment and have come to expect the nurse manager to advocate for staff and balance the desires of senior leadership as well as the needs of the front-line staff member.8,15 Generation Y staff may be idealistic and expect their leaders to thoroughly know their staff and to participate

in routine unit activities.15 Emerging nurse leaders may have unrealistically high expectations of their leaders and lack understanding of the full range of responsibilities and time commitments needed. Developing a trusted and candid relationship with a nurse leader can help create a willingness to explore potential roles. Because of focus groups with Generation Y emerging leaders, the authors of one study described the theme of cautious but optimistic as the approach regarding their potential leadership and the future. They may see that they are the future of nursing leadership and recognize their potential to change the environment to make it healthier with better teamwork and stronger relationships with frontline staff.15 However, younger staff look for professional development opportunities when selecting a position. Generation Y nurses are an ideal pool from which to identify emerging leaders. They have reached a point in their careers where they are making decisions for the future and embracing gaining knowledge and skills to position them for the future. It is difficult at this point to accurately anticipate the adequacy of the future pool of nursing leaders.15

External vs. Internal Creating a deep pool of potential candidates require looking both within and outside an organization. Employees who are part of an organization understand the resources of an organization (such as budget, supplies, equipment, and knowledge) and the limitations and strengths of their team members. But drawbacks may exist with internal candidates. Excellent clinicians do not necessarily have the personality and interpersonal relationship skills for leadership. Issues inherent in moving from the bedside to management (jealousy, friendships, etc.) may be difficult to overcome as well. Internal candidate advantages include improved staff morale as promotions are opportunities for growth and job security for good performers. Internal August 2021 | OR TODAY



continuing education

candidates have had the opportunity to demonstrate performance and familiarity with certain skills to known colleagues. They understand the culture and organizational strategy. Disadvantages of internal candidates are the risks of inbreeding, employee conflict and resentment over the selection of another candidate, and the need for extensive training and development for the new role that creates a vacancy elsewhere.16 External candidate advantages include new ideas, fresh approaches, and a lack of any conflicts with current staff and/or the organization’s politics. Less training may be required due to existing experience level. External candidates also bring disadvantages such as unfamiliarity with organizational culture and staff, which can lead to questionable organizational fit. External candidates also may lead to situations regarding morale issues with internal staff who were not selected for a position. A longer socialization period is needed to learn both the role and the organization’s norms.16 A 2015 national survey of hospitals revealed 60% of survey participants were externally recruited leaders, indicating a perception that external candidates have a leadership advantage in being selected.17

Formal vs. Informal Succession plans can range in scope and formality; in the past, plans probably were more informal. As discussed previously, creating a succession plan is essential in this tumultuous period of healthcare reform as well as workforce and delivery system challenges. Some organizations may have limited resources while others may be more elaborate. Developing a succession plan is discussed in a following section. Succession planning identifies employees with high potential by nature of their work performance, cultural assimilation, and employee relations. High-potential employees are successors to “high-potential” positions, also 34

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known as positions that the organization must fill with the most capable employees. Common principles in succession plans usually include identified required skills and competencies specific to that position; competency gaps; opportunities to develop the identified skills and competencies, including mentoring and coaching; tracking and reassessment of progress; identification of talent; and organizational support.14 Depending on the organization’s culture, it may not be wise to openly declare succession candidates for high-potential positions since feelings of entitlement and jealousy may emerge. If an organization has created a transparent plan (i.e., a plan in which all succession candidates are known), it must make clear that inclusion in the plan is not a guarantee of a promotion; the plan is only to optimize talent inherent in certain people.

Who is in the Plan? Deciding who is in the plan is based on multiple factors: areas where turnover and retirements are the highest and most at risk for organizational impact; what positions are more pivotal in the future healthcare models; and what level of organizational resources and commitment are available to support a succession plan. Ideally, extending the plan deeply provides broader leadership potential. Yet, resources in many organizations are limited. Some organizations focus resources on middle manager/nurse managers as the key positions that interface with bedside care, interprofessional teams, and organizational tactics.8 Nurse leaders need to adopt a longer-range perspective for long-term leadership roles compared to dealing with the short-term anticipated vacancies. This changing in thinking includes understanding that many factors fluctuate over time such as age, work experience, and personal life situations. These factors may influence interest and readiness for career planning.10

Selecting Candidates: Numerous ways exist to select candidates for succession planning. A best practice in succession planning is developing organizational profiles for key leadership positions, yet many organizations have not completed them. Some methods used to determine eligibility for promotion are as simple as grouping staff into high, middle, and low performers.18 Depending on the organization, a succession planning committee may be a transparent starting point. The committee would: • Identify high vacancy and turnover positions • Establish role competencies and critical leadership roles • Develop methods for identifying potential leaders internally19 No matter what method is used, leaders must determine which individuals support the culture and values of the organization. Part of the organization’s workforce planning should include an annual assessment that identifies when positions will become available based on current risk for a vacancy (such as a potential retirement), its importance to the organization, and future anticipated needs.

A Succession Environment Healthcare reform and reimbursement changes have placed a great deal of pressure to contain costs, which affects staffing and leadership positions. Nurse leadership is faced with improving quality through evidence-based practices, designing new models of care to use nurses at the maximum of their licensure, and accomplishing all of this in a decreasing reimbursement environment. The scope and responsibilities of nursing leaders can be daunting. Nurse manager span of control affects nursing staff engagement and empowerment as well as patient satisfaction. Span of control includes range of operational, clinical, and financial accountability.20 In a Florida Nurse Leader survey, 75% WWW.ORTODAY.COM


continuing education

of current nursing leaders ranked that one major hurdle for nurses obtaining leadership roles was related to the perception that nurses, as compared to physicians, are not seen as primary producers of profit. An additional major barrier (70%) included the lack of visibility for nurses in influencing policy, with 54% citing lack of available resources to enhance nurse leadership skills.6 As cost pressures increase, leaders may find their scope of responsibilities subtly increasing so that management span becomes larger as vacant positions are not replaced. Organizations need to commit to regularly collecting data and monitoring the environment to evaluate nurse manager roles and where support is needed. Some examples of support are assistant nurse manager positions and staffing coordinator positions.20 To build a strong succession pipeline, hospitals must make succession planning a priority. Nursing leadership expectations include nurse leaders as both mentors, giving advice and assistance to novices, and role models, which include mentoring and demonstrating positive interpersonal relationships.18 Nurse managers note that the support and encouragement of a mentor is one of the major factors in their seeking management positions. Organizations must also address barriers to advancement, such as wage compression. Wage compression occurs as new nurses are hired at higher salaries than long-time nurse employees. Wage compression also occurs when the salary of a nurse manager does not take into consideration the salary that an assistant nurse manager can earn when they are paid overtime, shift/weekend differential and holiday pay. Barriers can be inadequate funding (to attract leadership talent), an aging workforce, lack of nurses’ interest in 24hour leadership responsibility, current leaders’ negative views of the workplace and their roles, lack of organizational WWW.ORTODAY.COM

opportunity for promotion due to size or leadership positions, cultural mindset about longevity and promotions vs. actual readiness, and level of organizational readiness.18

Learning to Lead A learning environment plays a critical role in succession planning. Although some people are “born” leaders, most people are “made” leaders. The age-old discussion of whether leaders are “born” or “made” was explored in multiple studies. Effective leadership skills can be developed; however, in 2015, 80% of survey respondents reported developing future leadership is enhanced with candidates who have innate abilities.17 Most nurse leaders are interested in their leadership legacy and in passing key organizational knowledge on to the next generation of nurse leaders. Viewing the plan and assessing knowledge transfer through a legacy lens may be a more positive way to engage nursing leaders.21 Knowledge transfer is a fundamental part of developing the plan. A strong business case has been made for identifying and developing emerging nursing leaders to achieve effective transitions in organizations.13,15,16 Nursing leader core skills and competencies are evolving in response to the rapidly changing health care environment. Despite best efforts (such as candidate selection, leadership assessment, observing and shadowing leaders, mentoring, and didactic learning), one study revealed that many plans are missing the necessary focus of developing trusting relationships. It is important to develop trusting relationships that are grounded in the constructs of social immersion, social learning, and growth from interaction in social networks.22 Verbal and written communication and technical business skills are touted frequently. Building and managing relationships among the interprofessional team are crucial for a successful leader. Behaviors such as the ability to

make others feel respected and comfortable, embracing diversity and change, and having well-developed interpersonal and emotional intelligence skills lead to being able to maintain composure and model leadership behaviors.18 Along with formal education in leadership, candidates may benefit from mentoring and coaching in leadership skills. The terms mentor, coach, and preceptor each have different processes. Yet expectations often are used interchangeably. Mentoring can create a sense of belonging, positive feelings about career development, competency, professional development, confidence, a sense of safety and preparedness for leadership.23,24 Although current leaders must be involved in succession planning, nurse leaders do not always develop relationships conducive to effective succession planning. Mentors are selected from outside the direct supervisory link frequently, which provides clarity and confidentiality with the mentee and mentor. Also, selection from outside the direct supervisory link helps remove any issues with nurse leaders who may not have the necessary mentoring skills and may view mentoring as negative, burdensome, or threatening (as planning for a potential successor may seem premature).21,23 An excellent example of a Nurse Leader Mentoring Program with a defined tool kit was developed by the Organization of Nurse Leaders of New Jersey.25 The program was designed as a three-year model to develop a statewide mentorship based on evidence-based resource materials and structured mentorship with education and a mentorship tool kit. More than 75 mentor-mentee dyads have been matched and prepared to lead change, advance healthcare, and elevate nursing leadership.26 The program has been successful in providing a standardized approach; more importantly, it helps nurse leaders network and learn together. It also brings a level of August 2021 | OR TODAY



continuing education

development to all (which may not have been available in all organizations). In an interview with the Hunterdon Medical Center (New Jersey) nurse executive involved in the Nurse Leader Mentoring Program in August 2018, the program continues to be successful in developing nurse leaders.

Development Plans Organizations need robust development plans to ensure the effectiveness of succession planning. However, creating such plans is not easy. Creating and building strong relationships forms the basis of trust and leadership power to inspire emerging leaders to take the next step in leadership. There is value in the relationships between emerging leaders and seasoned leaders that can enhance observation and imitation.22 Applying a framework of concept analysis to succession planning is helpful. Critical desired attributes and measurement of data demonstrating the conceptual model may help provide a visual reference illustrating the dynamic interaction between antecedents, attributes and consequences of effective plans.11 Career mapping is another example of an evidence-based program focused on promoting professional development, career enhancement and succession planning (founded on relationshipbuilding with the participants, organizational leaders, and educators).10 Creating a culture of mentoring and succession planning, based on promoting professional excellence and advancement, requires organizational commitment and documentation of evidence of activities as an essential element of Magnet designation.24,27 Nurse leaders, in conjunction with organizational leaders, must develop talent management thinking to identify potential candidates early in their careers. Nurse manager roles are changing, so developing skills and competencies takes on the added burden of trying 36

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to think ahead of skills needed for the future. Possible skills needed for the future include becoming politically astute, attaining comfort with ambiguity, and developing innovative thinking.28 As described in one model, the individual nurse is assisted in defining lifelong career and learning goals, thereby providing a path to retain and attract nursing talent.10 A model, based on Benner’s Novice to Expert Theory stages of professional development, compares acquiring knowledge and skills from novice to advanced beginner to competent and to proficient with succession planning tactics.9,29 The model chosen depends on what is best based on the organization. One way of assuming more autonomy of your professional career development is to review the models to create your own plan while working to advance enhanced succession planning in your organization. Attention must be paid to the depth and breadth of learning available within and outside of the organization. Organizations can use standard/ formal leadership courses, but they must augment them with action-oriented, career-broadening exposure development activities to support competency proficiency, such as coaching, mentoring, peer-to-peer learning, shadowing, and stretch assignments that challenge the candidate. In addition, these kinds of learning activities may increase the employee’s visibility, committee membership, task force assignments and presentations both internal and external.8,16,18 Equally important, researchers found that the confidence in role and retention rates were high for potential nurse leaders who participated in succession planning programs.3,16 Internal resources developed by an organization might include leadership development education and a formal internship/residency program. Meanwhile, external resources to supplement education might include

external conferences, webinars, computer-based learning, formal education with a college degree or certification program and partnerships with other business or nursing leadership organizations or nursing schools for expanded learning options. The scope of the development plan requires consideration of resource allocation and funding.13,16

Competencies Nurses should take responsibility for their personal and professional growth by continuing their education and seeking opportunities to develop and exercise their leadership skills. Nurses should take charge of their professional development and clinical expertise with continuing education activities and other supplemental learning activities. They should look for ways to enhance their practice of nursing with leadership development and clinical acumen. The Committee for Assessing Progress on Implementing the Recommendations of the Institute of Medicine’s Report, The Future of Nursing: Leading Change, Advancing Health, recommendation 7 is to enable and prepare nurses to lead change for the future of health care and encourages nurses to take responsibility for their personal and professional development.32 Identifying competencies and assessing those competencies requires an educational component of structured mentoring, observations, and possibly rotations into expanded areas.14 New models of vertical leadership development, which include concepts such as volatility, uncertainty, complexity, and ambiguity (VUCA) and rapid, unpredictable, paradoxical, and tangled (RUPT), are proposed as skills needed to adapt within highly complex and unpredictable health care systems.33 Care coordination, staff management, and unit operational management are expected core competencies; however, interprofessional teamwork and development of new delivery of care models WWW.ORTODAY.COM


continuing education

Examples of Succession Planning Methodologies Approach

Five Step

Structured Nursing Leadership Development Program (NLDP)

Succession Planning Domains

Future Nursing Unit Manager Program

Career Planning Approach




Systematic framework of inputs and outputs that exist in the internal and external environment. The steps include the following: Organizational factors: incorporates key elements of the organization. High-level commitment to succession planning. Every level needs leaders; those embodying the culture and values of the organization can act as leaders even though they are not “formal” leaders. Assessment of talent needs Identification of individuals for targeted roles in the organization Development: mentoring, coaching, and job rotation Execution: specific and focused plan for developing leaders, including establishing metrics of success Evaluation and dissemination of succession efforts NLDP executive steering committee Nursing leadership competency assessment of 67 items measuring management of the business, art of leading people, and the leader within Nurse Manager Leadership Partnership Used web-based Essentials of Nurse Manager Orientation (ENMO) program with an assigned mentor Demonstrated effectiveness of web-based modular learning when combined with engaged nursing executive mentorship

Shirey (2008)30

Ramseur, Fuchs, Edwards, Humphreys (2018)13

Development of a succession plan based on six domains and listed activities associated with each domain. At least one activity must be accomplished within each of the following: Domain 1: Link strategic planning and workforce planning decisions Domain 2: Analyze gaps Domain 3: Identify talent pool Domain 4: Develop succession plans Domain 5: Implement succession plans Domain 6: Monitor and evaluate Organizational support Identification of skills and competencies required for the position Identification of talent Skills and competencies gap analysis Developmental opportunities

Harper, Leider, Coronado, Beck (2018)31

Manning, Jones, Jones, Fernandez (2015)14

Succession plan tied to organizational strategic plan Individual development plans are based on skills needed to drive the organization’s strategic plan Essential characteristic is top management participation and support Organizational support Key component of talent management is leadership development A two-year mixed didactic and experiential learning plan

Barginere, Franco, Wallace (2013)8

August 2021 | OR TODAY



continuing education might be newer aspects of competency. For Generation Y emerging leaders, teamwork is important.15 A review of the literature reveals numerous models and evolving research on best practices. One model of evidencebased successional planning includes categories of strategic planning, resource allocation, key position and competency identification, high potential leader selection, leadership development, mentoring and coaching, and plan and candidate evaluation in a dynamic loop where each element provides data and informs other actions.11,12 Competency formation delineates knowledge, skill, and abilities that the candidate will need to be successful in his or her chosen role. The development plan itself must incorporate different methodologies for development. Each set of competencies benefits from a development plan. Although there are many sources for competency lists, the professional organizations provide easy reference. For example the American Organization of Nurse Executives (AONE) lists competencies for differing levels of nursing leadership positions. The AONE 2016-2018 key priorities is an excellent resource to identify core competencies for nurse leaders throughout the continuum to support current and expected roles.34 One can find assessment tools, competencies, and targeted development opportunities segmented by earliercareerists, mid-careerists, and executive and certification programs. Two examples of available resources are the Emerging Nurse Leader Institute (ENLI)* and Essentials of a Nurse Manager Orientation (ENMO), programs oriented toward potential nursing leaders.34 One health system’s project provided evidence for the successful use of the web-based modules from the ENMO program and combined it with ongoing nurse executive support. This resulted in enhanced perceived competence in a group of potential future nurse leaders and was deemed significantly effective.13 38

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The Nurse Manager Leadership Partnership Learning Domain Framework, developed collaboratively with the American Association of CriticalCare Nurses (AACN), enables one to establish career development and succession planning, providing an easy first step for professional nurses as well as for organizations without many internal resources. The framework for nurse managers proposes prowess in all these domains: “the science of managing the business; the art of leading the people; the leader within.”34 The science domain details managing the business skills of financial management, human resources management, performance improvement, foundational thinking skills, technology, strategic management and clinical practice knowledge. The art domain is specific to leading the people and composed of skills related to human resources (HR): leading personnel, overseeing relationships, impacting behaviors, supporting diversity and making decisions as a team. The leader-within domain focuses on developing your personal leadership traits with skills in selfand professional accountability, career navigation, self-control and reflection to optimize the leader within.13,34 Since each candidate has different strengths and weaknesses, each needs a custom development plan. These plans may vary by age. For example, Generation Y candidates usually are naturally adept with technology. Are the plan elements tailored to incorporate that technology use and reflect a willingness to accommodate the individual needs of the learner? Approaches that worked well with prior generations may not be effective with Generation Y nurses.15 Some organizations use career mapping to create individual development plans that begin with a career vision, identifying goals, strengths, opportunities for improvement, learning needs (and ways to meet them), performance tracking, and continuing professional development assessment (which accommodates personal needs).10 Map-

ping the future includes areas such as organizational values and agility (if future skills are uncertain) and current talent in the context of level of engagement and stated ambitions. Mapping the future provides a longer perspective. Used in conjunction with mentoring and other development activities, mapping helps prepare future leaders for organizational roles identified in the succession plan.8,18, 23 A candidate must demonstrate all leadership development activities and be evaluated against the development plan, as it is performance criteria-based. The development plan needs to become part of a candidate’s annual performance evaluation, although the performance appraisal does not evaluate the overall succession plan. In addition, managers must give succession candidates regular performance and development feedback.

Transparency Remaining open about succession planning helps maintain a healthy work environment. Through that transparency, the organization can demonstrate that succession is criteria-and performance-based; it is not based on favoritism. The organizational culture encourages professional growth and development and increases engagement of high-potential staff.11,21 Succession planning communicated as a systematic approach offers career pathways with training and development opportunities. The plan also can be an avenue to retain talent and to promote diversity and multiculturalism with an organization-wide approach in identifying and developing the best talent for key positions; it breaks the cycle of managers who hire leaders who resemble them.8,18 All employees should be able to understand the succession planning process through availability of development and training programs and criteria for inclusion in career advancement.17 Using a multimodal approach is effective in communicating opportunities for WWW.ORTODAY.COM


continuing education career paths. Examples are face-toface discussions or personal calls with leaders and potential leaders, staff meetings, huddles, blast emails to staff, posting openings on the organizations’ websites/intranets, and word of mouth.18 Transparency also allows the candidate to understand their standing in the succession-planning process.

Measuring Success There are many ways to measure the success of a succession planning program. Regardless of the metrics selected, they should reflect the strategic initiatives of the organization. Metrics can include the percentage of nurse manager vacancies filled internally (promotions), retention rates, time to fill the vacancy, nurse managers’ views of career development encouraged by their superior, managers’ perception of the availability of developmental opportunities, the percentage of actively engaged nurse managers with reduced role transition stress, increased leadership bench strength, and patient satisfaction. As more universal evidence-based criteria and methods are developed, nursing leaders will have a valuable tool to support succession planning.8,11,18 The impending nurse manager shortage requires immediate action at a time when hospitals are financially constrained and questioning the value of mentoring. Keep in mind that the transition to a nurse manager role occurs over a period of months. A wellplanned strategy includes development and role transition to reduce turnover and replacement costs. Evaluating the effectiveness of succession planning requires a metric-driven model and can be conducted by several approaches. Using a balanced score card is one recommended succession plan evaluation method. The balanced score card defines desired outcomes consistent with organizational strategic goals in areas such as financial goals (including WWW.ORTODAY.COM

recruitment and retention), customer perspective (candidate and stakeholder), internal processes (leadership strength and talent pool), and learning and growth (competency progression).11,12 One excellent example of a business case strategy compared the cost of implementing a nurse manager succession plan to maintaining the typical model of promoting nurse leaders. The template for cost-benefit analysis can be used for advocating for the creation of a succession plan to obtain the necessary resources. The cost-benefit analysis findings in support of succession planning is a better economic outcome than keeping the status quo.3, Evaluation of the succession planning program quantifies the benefits and ensures the plan and program meet an organization’s goals. If a high-potential employee leaves, the organization must evaluate the succession planning program to determine why the program failed and how to modify it to prevent future failures. The literature on succession planning suggests best practices in relation to how the process is accomplished. What is evident is that CNOs and other executives must embrace the succession planning process to ensure a continuity of knowledgeable leadership for the future. Current leaders need to recognize their current mode of thinking and ways of approaching leadership to build new opportunities and relationships. There is no time to waste. Creating future leaders who can adapt and innovate in the rapidly changing environment will provide the best legacy for nursing and healthcare. EDITOR’S NOTE: Sandra Swearingen, PhD, RN, a senior consultant with Courageous Healthcare, an organization that helps organizational leaders in making human factor improvements, was a previous author of this educational activity, but has not had an opportunity to influence this edition.

Relias LLC guarantees this educational activity is free from bias. DEBORAH K. ZASTOCKI, DNP, EDM, MA, RN, NEA-BC, FACHE(R), is founder and president of Legacy Healthcare Management Consulting, LLC, in Naples, Florida. With more than 30 years of experience, her professional career has been highlighted as a clinical professional, author, educator and health care executive.

References 1. Fact sheet: Nursing shortage. American Association of Colleges of Nursing (AACN) Web site. https://www. aacnnursing.org/Portals/42/News/ Factsheets/Nursing-Shortage-Factsheet. pdf. Updated April 2019. Accessed Aug. 8, 2019. 2. Smiley RA, Lauer P, Bienemy C, et al. The 2017 national nursing workforce survey. J Nurs Regul. 2018;9(3):S1-S88. doi: https://doi.org/10.1016/S21558256(18)30131-5. 3. Phillips T, Evans JL, Tooley S, Shirey MR. Commentary. Nurse manager succession planning: A cost–benefit analysis. J Nurs Manag. 2017;1-6. doi: 10.1111/ jonm.12512. 4. The 2013 national nursing workforce survey of registered nurses. J Nurs Regul. 2013;4(2):S3-S65. doi: https://doi.org/10.1016/S21558256(15)30136-8. 5. Table 8: Occupations with the largest projected number of job openings due to growth and replacement needs, 201 and projected 2022. United States Department of Labor, Bureau of Labor Statistics Web site. http://www.bls. gov/news.release/ecopro.t08.htm. Last updated Dec. 19, 2013. Accessed Aug. 8, 2019. 6. Denker AL, Shernan RO, HuttonWoodland M, et al. Florida nurse leader survey findings: Key leadership competencies, barriers to leadership, and succession planning needs. J Nurs Adm. 2015;45(7-8):404-10. doi: 10.1097/ NNA.0000000000000222. 7. American Association for Colleges of August 2021 | OR TODAY



continuing education Nursing. Talking points: HRSA report on nursing workforce projections through 2025. http://www.aacnnursing. org/Portals/42/News/Nursing-Shortage/HRSA-Nursing-Workforce-Projections.pdf?ver=2017-12-11-115743-493. Updated Feb. 22, 2015. Accessed Aug. 8, 2019. 8. Barginere C, Franco S, Wallace L. Succession planning in an academic medical center nursing service. Nurs Admin Q. 2013; 37(1):67-71. doi: 10.1097/ NAQ.0b013e31827857a7. 9. Titzer JL, Shirey MR, Hauck S. A nurse manager succession planning model with associated empirical outcomes. J Nurs Adm. 2014;44(1):37-46. doi: 10.1097/NNA.0000000000000019. 10. Webb T, Tammy Diamond-Wells T, Jeffs D. Career mapping for professional development and succession planning. J Nurses Prof Dev. 2017;33(1):25-32. doi: 10.1097/NND.0000000000000317. 11. Titzer JL, Shirey MR. Nurse manager succession planning: A concept analysis. Nurs Forum. 2013;48(3):155-164. doi: 10.1111/nuf.12024. 12. Titzer J, Phillips T, Tooley S, et al. Nurse manager succession planning: Synthesis of the evidence. J Nurs Manag. 2013;21(7):971-979. doi: 10.1111/ jonm.12179. 13. Ramseur P, Fuchs MA, Edwards P, Humphreys J. Implementation of a structured nursing leadership development program for succession planning in a health system. J Nurs Adm. 2018;48(1):25-30. doi: 10.1097/ NNA.0000000000000566. 14. Manning V, Jones A, Jones P, Fernandez R. Planning for a smooth transition: Evaluation of a succession planning program for prospective nurse unit managers. Nurs Admin Q. 2015;39(1):58-68. doi: 10.1097/ NAQ.0000000000000072. 15. Dyess SM, Sherman RO, Pratt BA, Chiang-Hanisko L. Growing nurse leaders: Their perspectives on nursing leadership and today’s practice environment. Online J Issues Nurs. 2016; 21(1). doi: 10.3912/OJIN.Vol21No01PPT04. 16. Trepanier S, Crenshaw JT. Succession 40 OR TODAY | August 2021

planning: A call to action for nurse executives. J Nurs Manag. 2013; 21:980985. doi: 10.1111/jonm.12177. 17. Collins SK, McKinnies R, Lieneck C, Watts S. A trend analysis of succession planning in health care as perceived by chief executive officers in US hospitals. Health Care Manag. 2016;35(4):333-339. doi: 10.1097/ HCM.0000000000000126. 18. Fray B, Sherman RO. Best practices for nurse leaders: Succession planning. Prof Case Manag. 2017;22(2):88-94. doi: 10.1097/NCM.0000000000000214. 19. Titzer Evans JL. Three first steps for effective succession planning. American Nurse Today. 2016;11(9):36-40. https://www.americannursetoday.com/ wp-content/uploads/2016/09/ant9Succession-planning-824.pdf. Accessed Aug. 8, 2019. 20. Jones D, McLaughlin M, Gebbens C, Terhorst L. Utilizing a scope and span of control tool to measure workload and determine supporting resources for nurse managers. J Nurs Adm. 2015;45(5):243-249. doi: 10.1097/ NNA.0000000000000193. 21. Scholes J, Trapani J. Succession planning: A case for revisiting the process in critical care. Nurs Crit Care. 2017;22(4):193-194. doi: 10.1111/ nicc.12308. 22. Pedersen A, Sorensen J, Babcock T, et al. A nursing leadership immersion program: Succession planning using social capital. J Nurs Adm. 2018;48(3):168-174. doi: 10.1097/ NNA.0000000000000592. 23. Jakubik LD, Eliades AB, Weese NM, Huth, JL. Part 1: An overview of mentoring practices and mentoring benefits. Pediatr Nurs. 2016;42(1):37-38. 24. Cusanza S. Magnet tips and tricks. Mentoring or succession planning: Which is it? American Nurses Association Web site. https://www.nursingworld.org/organizational-programs/ ana-consultation-services/tips-articlesand-videos/mentoring-or-successionplanning/. Accessed Aug. 8, 2019. 25. Kempin B, Kowalski M. Developing leadership talent: A statewide nurse

leader mentorship program. Organization of Nurse Leaders of New Jersey Web site. http://www.njha.com/ media/391996/EDU1618PPTKempinKowalski.pdf. Accessed Aug. 8, 2019. 26. Rich M, Kempin B, Loughlin MJ, et al. Developing leadership talent: A statewide nurse leader mentorship program. J Nurs Adm. 2015;45(2):63-66. doi: 10.1097/NNA.00000000000000166. 27. ANCC Magnet Recognition Program. American Nurses Credentialing Center Web site. https://www.nursingworld. org/organizational-programs/magnet. Accessed Aug. 8, 2019. 28. Sherman R, Dyess S, Hannah E, Prestia A. Succession planning for the future through an academic-practice partnership: A nursing administration master’s program for emerging nurse leaders. Nurs Adm Q. 2013;37(1):18-27. doi: 10.1097/NAQ.0b013e31827514ba. 29. Benner P. From Novice to Expert. San Francisco, CA: Addison-Wesley Publishing; 1984. 30. Shirey M. Building the leadership development pipeline: A 5-step succession pipeline. Clin Nurse Spec. 2008;22(5):214-217. doi: 10.1097/01. NUR.0000325365.08303.47. 31. Harper E, Leider JP, Coronado F, Beck AJ. Succession planning in state health agencies in the United States: A brief report. J Public Health Manag Pract. 2018;24(5):473-478. doi: 10.1097/ PHH.0000000000000700. 32. National Academies of Sciences, Engineering, and Medicine. Assessing Progress on the Institute of Medicine Report The Future of Nursing. Washington, DC: The National Academies Press; 2016. https://doi.org/10.17226/21838. 33. Till A, Dutta N, McKimm J. Vertical leadership in highly complex and unpredictable health systems. Br J Hosp Med (Lond). 2016;77(8):471-475. doi: 10.12968/hmed.2016.77.8.471. 34. AONL nurse leader competencies. American Organization for Nursing Leadership web site. https://www.aonl. org/resources/nurse-leader-competencies. Accessed Aug. 8, 2019.



How to Earn Continuing Education Credit

Clinical Vignette

You have been reading a lot about succession planning in nursing. As the CNO, you realize that you have no idea if you are at risk for losing additional personnel. You start by looking at employee records to figure out the age of your staff. You realize that 15 of your 45 leaders are at retirement age or will be in the next five years. There is no time to waste in starting a formal succession plan for nursing. 1. What is your first step in creating a formal succession plan? a. E valuate all staff to deterinitiative. mine “high potentials.” c. H ire a leadership developb. P resent your findings to ment trainer. the CEO to get support d. Ask around to see who for a succession planning wants to be promoted. 2. You wonder why many of the younger nurses are not seeking leadership positions. One answer may be: a. They may be retiring in money as clinicians or five to 10 years. nurse practitioners. b. They prefer to be staff d. They plan to switch nurses. careers. c. They can make more 3. You realize that a candidate selected for succession planning should be: a. A favorite employee. b. A long-term employee. c. Selected for specific positions. d. A proven high-potential employee. 4. You notice that some nurse leaders do not always mentor and coach appropriately. That may be because: a. They do not have time. b. They see it as threatening. c. They were never mentored. d. They cannot learn how to mentor and coach.

Clinical VignettE ANSWERS 1. Answer: B, Before starting a succession plan, you must get the support of the CEO to demonstrate the importance of the program. 2. Answer: C, One reason Millennial or Generation X employees have not shown a great interest in leadership is the lack of financial rewards beyond what they can earn as clinicians or nurse practitioners. 3. Answer: D, Candidates selected for succession should be picked for their potential to become leaders. This is determined through competencies, portfolio reviews, performance indicators, and their ranking as to readiness to develop. 4. Answer: B, Nurse leaders may view mentoring and coaching as negative and threatening. This results in a lack of participation in the education and development of other leaders. WWW.ORTODAY.COM

1. Read the Continuing Education article. 2. Go online to ce.nurse.com to take the test for $12. If you are an Unlimited CE subscriber, you can take this test at no additional charge. You can sign up for an Unlimited CE membership at https://www.nurse.com/ sign-up for $49.95 per year.

Deadline Courses must be completed by 09/2022 3. If the course you have chosen to take includes a clinical vignette, you will be asked to review the vignette and answer 3 or 4 questions. You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer. 4. Once you successfully complete the short test associated with the clinical vignette (if there is one), proceed to the course posttest. To earn contact hours, you must achieve a score of 75%. You may retake the test as many times as necessary to pass the test. 5. All users must complete the evaluation process to complete course. You will be able to view a certificate on screen and print or save it for your records.

Accredited In support of improving patient care, OnCourse Learning (a Relias LLC company) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. OnCourse Learning is also an approved provider by the Florida Board of Nursing, the District of Columbia Board of Nursing, and the South Carolina Board of Nursing (provider #50-1489). OnCourse Learning’s continuing education courses are accepted by the Georgia Board of Nursing. Relias LLC is approved by the California Board of Registered Nursing, provider # CEP13791.



Nurse.com You can take this test online or select from the list of courses available. Prices subject to change.

Questions or for a complete listing of our courses Phone: 877-843-8374 Email: nursesupport@relias.com

August 2021 | OR TODAY


By Don Sadler


n 2017, AAMI released a long-awaited update to the widely used steam sterilization standard for health care facilities that had previously been updated in 2010. Known as “ANSI/AAMI ST79, Comprehensive guide to steam sterilization and sterility assurance in health care facilities,” the standard provides comprehensive information on how to achieve sterilization in a health care facility. Soon after the updated standard was released, the Steam Sterilization Hospital Practices Working Group that updated the standard began receiving feedback and requests for clarification in key areas. “The working group decided to initiate 42

OR TODAY | July 2021

amendments to add the recommendations to the standard now rather than wait for the complete revision of the document,” says Susan Klacik, BS, FSC, ACE, CHL, CIS, CRCST, AAMIf, IAHCSMM clinical educator and co-chair of the working group. “Users need this detailed information to fully support best practices in steam sterilization,” says Erin Kyle, DNP, RN, CNOR, NEA-BC, editor in chief, Guidelines for Perioperative Practice for the Association of periOperative Registered Nurses (AORN), who also serves on the working group. “One of the great things about working with AAMI to develop and maintain sterilization standards is that the working group has the ability to make these updates when they are needed,” Kyle adds. “The documents are dynamic and the update process is agile enough to

respond to requests for clarification and new knowledge when they arise.”

A trusted method Steam sterilization is one of the oldest, safest and most common methods used in health care facilities, says Klacik. “Many people believe that because steam sterilization has been available for so many years, it’s a simple process that’s well understood and controlled.” “However, the efficacy of any sterilization process depends on a consistent system for lowering and limiting bioburden before sterilization,” Klacik adds. “It also depends on preparing items for sterilization, selecting the sterilization parameters, and establishing and implementing controls to maintain the sterility of sterilized items until they are used.” The steam sterilization working group spent one year collecting feedback from WWW.ORTODAY.COM

users about the 2017 ANSI/AAMI ST79 update and two years researching and developing the amendments. The result was the ANSI/AAMI ST79:2017’s 2020 amendments, which were released early this year. These amendments offer new clarity and fresh guidance to maintain the integrity of the sterile processing area and help users stay in compliance with accrediting bodies. “Having the most current editions of the standards is a must because reprocessing continues to change and evolve as procedures become more complex along with the devices that are released to the market,” says Delores O’Connell, LPN, BA, AGTS, ASQ-CQIA, CRCST, CIS, CER, CHL, CSPDT, senior clinical education specialist with STERIS who previously served on the working group. “The guidance from ANSI/AAMI WWW.ORTODAY.COM

ST79:2017 and the 2020 amendments addresses the process that should be followed alongside the specific manufacturer’s instructions for use (IFU),” O’Connell adds. “This is paramount to successful reprocessing of all reusable medical devices.” ANSI/AAMI ST79 is an especially important standard because it provides comprehensive guidance to health care personnel who use steam for sterilization – regardless of the size of the sterilizer or type of facility. This includes hospitals, ASCs, physician offices, cardiac catherization labs, endoscopy suites, radiology departments and dental offices. “The standard remains a go-to for The Joint Commission,” says Klacik. She calls writing a standard “a balancing act” because it covers such a broad swath of venues. “But everyone also needs the right

specifications,” she says. “Through AAMI, we have this wonderful collaborative community. We can collect everybody’s views in one place and really iron out what is working versus what isn’t.

What’s in the Amendments? According to Klacik, the amendments contain even “common sense” additions like stipulating that there should be no food or drink in the sterile processing area. Other amendments were made to best practices, like how often sterilizers in health care facilities should be cleaned. In addition, the working group built upon recommendations for the instrument inspection process. “We recognized that relatively new technologies like borescopes and Adenosine Triphosphate August 2021 | OR TODAY


(ATP) monitoring enable more thorough inspections and recordkeeping,” says Klacik. Here are the four amendments that were made to ANSI/AAMI ST:79: Amendment 1: Additions were added to Section General design considerations, Environmental Services/ Fans/Food and Drink; and Section Heating, Ventilation, and Air Conditioning (HVAC) Operating Parameters. “Both additions include new recommendations for maintaining the integrity of the sterile processing area,” says Klacik. Amendment 2: Section 8, Inspection of Insulated Instruments, added two new sections. “New guidance in Section 8.2 addresses the general instrument inspection process,” says Klacik. “And a new section – 8.2.1 – addresses the inspection

44 OR TODAY | August 2021

of insulated instruments intended for use with electrical current (otherwise known as electrosurgical instrumentation).” Amendment 3: “Content was modified regarding the frequency of cleaning for sterilizers in sterile processing areas of health care facilities,” says Klacik. The changes can be found in Section 12.4, Routine Care of Sterilizers. Amendment 4: Content was modified regarding the recording of biological indicator lot numbers in sterilizer records for sterile processing in health care facilities. “The changes better clarify the specific number to document when the biological monitor and control are recorded,” says Klacik. One problem the amendments address from prior additions is that previously, directives were mixed with rationales. “When technicians were attempting to align the operations in their facilities with the standards, they often felt the passages were confusing and sometimes even repetitive,” says O’Connell. During the update for ANSI/AAMI ST79:2017, O’Connell says the working group paid very close attention to this feedback. “Now the directives are easily identified and illustrate what should occur during a specific portion of the process,” she says. “The rationale following the directive provides additional information for circumstances where the reader may need clarification,” O’Connell adds. “Or it may highlight particular reprocessing considerations for specific processes and allow for a deeper understanding of the intent of the section.”

Methods of Instrument Cleaning Klacik stresses the importance of thorough cleaning of the sterile processing environment, as detailed in Amendment 1. “Otherwise, dust and debris can contaminate the instrumentation,” she says. “Methods of cleaning to prevent the spread of dust and debris are discussed in the amendment – in particular,

controlling items permitted in areas that process medical devices.” Amendment 1 provides a few new recommendations to monitor the cleanliness of the sterile processing environment. “First, a cleaning schedule should be developed along with a checklist to demonstrate compliance and areas of focus,” says Klacik. Kyle points out that a new sample housekeeping checklist is included in the amendments. “Sterile processing teams can easily monitor adherence to housekeeping procedures by using and monitoring checklists,” she says. In addition, cleaning verification tools have been added to measure the adequacy of environmental cleaning. “These include ultraviolet light visible markers, protein tests and ATP bioluminescence, as well as direct observation of employees performing environmental cleaning,” says Klacik. The amendments also include recommendations that only the ventilation system exhaust fans should be used and that neither fixed nor portable fans should be permitted in any area of sterile processing, Klacik adds. “The HVAC system is a very important part of the environment since ventilation patterns and other environmental controls affect the proliferation and spread of potentially pathogenic microorganisms,” she says. Meanwhile, Amendment 2 discusses the use of enhanced inspection. “This enables the technician to better visualize bioburden, foreign material or damage and prevent it from going unnoticed,” says Klacik. Enhanced inspection is performed with the use of magnification, borescopes or other inspection methods to verify


cleanliness and integrity. “Borescopes are a great tool for inspecting internal channels of instrumentation for cleanliness and integrity since the naked eye cannot see into these areas,” says Klacik

Dangers of Using Malfunctioning Equipment According to Kyle, using a malfunctioning piece of equipment could result in harm to the patient – including burns that can go unrecognized. “This is especially true if they are outside the field of view during the procedure,” says Kyle. “The electrical current can escape the instrument at the point where the insulation is damaged through capacitive coupling,” Kyle explains. “Burn injuries can be prevented by recognizing these defects before the instruments make it to the OR and are used for patient care.” Smaller insulation breaches are especially problematic because they can concentrate the escaped energy and cause more serious tissue injury, says Klacik. “Insulated electrical current instruments are susceptible to physical and mechanical damage and degradation with repeated use,” Klacik says. “These defects in insulation are not always visually detectible – some are only detectible by using insulation and continuity testing devices.” Kyle says that during the revision of the AORN Guideline for Electrosurgical Safety last year, they found a study where researchers evaluated the electrical current leakage from robotic instruments with visually intact insulation. “They found that all of the instruments had electrosurgical current leakage,” says Kyle. “This tells us that visual inspection for defects alone is not effective. Evaluation with an insulation tester is crucial to protect patients from burns due to capacitive coupling.” The AORN Guideline for Electrosurgical Safety recommends the use of an active electrode monitoring and shielding device as an additional safeguard to prevent these burn injuries. To help prevent this kind of damage to instruments, it’s recommended that instruments be organized and protected from damage through processing and use, says Klacik. “Organizing instrument trays can help here,” she says. “Also, electrosurgical insulated instruments should be tested for integrity each WWW.ORTODAY.COM

time they are processed,” Klacik adds. “The insulation should be checked at appropriate inspection points for the instrument.” Cables and cords are another source of concern. “These must be inspected and checked for integrity and continuity,” says Klacik. “The amendment includes a table demonstrating the instrumentation inspection points and possible damage for various instruments and devices, as well as photos of insulated instruments with damaged insulation as a reference,” says Klacik.

Auditing Your Processes and Policies Now that the amendments have been released, health care organizations should audit their processes, policies and daily operations for steam sterilization in light of them. “Health care organizations are already monitoring quality in these areas,” says Kyle. “What they need to do in light of these amendments is to integrate these changes into their process by first integrating them into their policies and procedures.” “Next, they should comprehensively educate members of the perioperative team about these changes,” Kyle adds. “This includes both sterile processing personnel and clinicians who work in the operating room. These two things really need to happen simultaneously.” The amended document is available through AAMI at aami.org/ST79. “ANSI/ AAMI ST79, Comprehensive guide to steam sterilization and sterility assurance in health care facilities” will be automatically updated for users with an AAMI eSubscription. If you previously purchased the printed version or who have a PDF of the current edition, you should have received a PDF of the amendments at no charge. If you haven’t received one, send an email to customerservice@aami.org. If you don’t have a current edition of the standard, you can purchase one with the amendments included from the AAMI store at aami.org. For more information about the AORN Go Clear program, visit https:// www.aorn.org/member_apps/Product/ Detail?productID=9709.

DOLORES O’CONELL LPN, BA, AGTS, ASQ-CQIA, CRCST, CIS, CER, CHL, CSPDT, senior clinical education specialist with STERIS who previously served on the working group.

ERIN KYLE DNP, RN, CNOR, NEA-BC, editor in chief, Guidelines for Perioperative Practice for the Association of periOperative Registered Nurses (AORN), who also serves on the working group.

SUSAN KLACIK S, FSC, ACE, CHL, CIS, CRCST, AAMIf, IAHCSMM clinical educator and co-chair of the working group. August 2021 | OR TODAY


BSN, RN, CNOR, Education Resource Specialist WakeMed Cary Hospital in Cary, North Carolina

AMANDA HEITMAN As a young child growing up on a farm in Kansas, Amanda Heitman remembers visits to her grandfather, an osteopath who worked from his home, as influential in her eventual career in nursing. “When my mom would go and take me to the house, I would help him in his office,” Heitman said. “Something as simple as that just sparked something in me that I wanted to be a nurse someday.” On the advice of a working nurse who was a friend of her older sister, Heitman began pursuing her BSN right out of high school, which she completed in 2001 at Fort Hays State University. During the course of her studies, Heitman got the opportunity to work as a labor and delivery surgical technician at Hays Medical Center, which instilled in her a love of the operating room. “My first case, I’ll never forget it, was a vaginal hysterectomy,” she said. “Working with that team lit that fire for the OR for me. I thought maybe I would work in labor and delivery.” Instead, fortune dictated that her nursing career would begin in dermatology, where Heitman gained real-world experience in practical skills like suturing and assisting. She also began precepting other colleagues. The foundations she built in both skills came in handy when Heitman and her husband, Josh, moved to Iowa, where she took a job at a Boone County Hospital. Although the small community hospital hadn’t been looking for a surgical nurse, Heitman’s experience got her a job offer and a place in its OR. There she learned pre-operative care, circulating as well as scrub nursing, endoscopy and perioperative services. “It was really a great experience to develop me into where I’m at today,” she recalled. Before the family relocated to North Carolina in 2007, Heitman knew she would have to pursue her certified perioperative nursing credential (CNOR) to advance her career. WakeMed Health and Hospitals in Raleigh, North Carolina, hired her as a clinical circulating scrub nurse. Six months


OR TODAY | August 2021

into her

third pregnancy, Heitman transitioned from a rural community hospital to a busy Level One trauma center. Fortunately, she was assigned to nurse educator Patsy Davis, who helped fully immerse her in the career. “I had never seen a nurse educator before,” Heitman said. “She was the motherly figure and the vital source of the OR. She’s very wise; she wasn’t clinical all the time, but was very helpful to new people, providing support and being a role model for them.” Heitman flourished under the opportunity to learn more and hone her skills further. At Patsy’s behest, she joined Capital AORN, the local Association of periOperative Registered Nurses (AORN), and eventually became an active board member, chapter president and newsletter editor. After a year in Raleigh, Heitman moved on to WakeMed Hospital in Cary, North Carolina, where she began as a circulating scrub nurse before eventually following in her mentor’s footsteps to become a nurse educator. It started with being a resource for peers pursuing CNOR credentials, and evolved into helping new staff ori-


ent themselves within the department, and establish their annual competencies. By 2010, Heitman had effectively developed an educator position for herself, and has been an education resource specialist in the department ever since (although Heitman is also quick to point out that she’s very active in the OR, scrubbing and circulating frequently). In addition to those roles, Heitman established a new nursing graduate residency program for the OR at WakeMed Cary, and helped develop a curriculum specifically to teach her peers what they need to know in the perioperative environment. Using AORN resources and her own passion for the curriculum, Heitman said she’s found her outlet to help her peers grow into nurses “who have rationale and understanding, and who aren’t just task nurses.” “I always tell them, ‘I know you’re not going to stay here forever, but my goal is for you to be a perioperative nurse forever. I’m giving you the tools so that you can continue this profession,’ ” Heitman said. “It’s all about the role of the perioperative nurse, specifically the patient safety side,” she said; “developing that surgical conscience that they never had before.” Patient advocacy is one such fundamental skill for a good perioperative nurse, and it’s among those Heitman said is most important to instill into a young nursing professional early. “You want to be in perioperative nursing for patient advocacy,”


she said. “We’re there for when patients can’t speak for themselves; we all have to be nurse leaders. Most of us are assertive, but some have to develop that. I hope that I give them that voice, and show them the right things to do so they can make those clinical decisions on their own.” Heitman’s love of education comes from her own lifelong love of learning.

From technology, to new procedures, to the steady stream of patients and colleagues who flow through the doors, “all of this keeps you constantly learning, and it helps drive that continual passion to be in the OR,” she said. “To see the excitement when they come through, and learn, ‘Here’s where you’re supposed to be,’ I want to continue that,” she said. Heitman believes nurse educators are

critical to the function of any good OR because they are plugged into the social and professional networks of the hospital itself, from staff and vendors to surgeons and leadership. They also help evaluate and reform policies, manage a variety of relationships, and even train and develop new nurse educators. Someday, Heitman hopes to become a consulting nurse educator, helping to build other resource specialist programs in hospital ORs across the country. “Right now, I think an educator is the key person to have in the OR,” Heitman said. “I would love to help be a part of shaping new educators. It’s a daunting task if nobody’s ever helped you get it started. I developed my program from scratch, and I would love to help other institutions do that.” Similarly, by reaching out to local colleges and universities through the years, Heitman has made the most of opportunities to connect with young nursing students. She provides them with a glimpse of what perioperative nursing is about. She believes sharing real-world experiences is critical to building future OR nurses. When she’s not working, Heitman enjoys returning to Kansas to visit her Extended family. She and Josh have been married 20 years, raising their three children, Kale, Brynn and Lana. Heitman said her WakeMed colleagues also feel like an extended family, and sometimes, the hours they share can be more than they might get to spend with their own loved ones. “We’re a community hospital in a rapidly growing region,” Heitman said. “There’s a million people in Wake County, but I feel like I’m still in a small community because of the strong relationships I have with my coworkers.”

OUT OF THE OR fitness

Try These Exercises to Overcome a Fear of Falling By Miguel J. Ortiz he percentage of people with a fear of falling is fairly high, but I’ve come to understand that it is also about the ability to get up or move after doing so. It can also be difficult for people to find a safe place where they feel comfortable exercising or even practicing movements that would help someone get off the floor.


Light calisthenics and regular exercises are great, but I’ve found a great place to do all the exercises needed to help get off the floor after a fallyour bed. When my father had a stroke eight years ago, he was required to do exercises on what looked like a very large stretching table during rehab. It was a little firmer than a bed but it was soft on jis joints. This “bed” helped him practice rolling over and utilizing his core to assist him in getting up which 48

OR TODAY | August 2021

is required learning when it comes to developing certain sides of the brain. In any case, I continued to think of ways to help people get off the floor when they need extra padding to progress. And it hit me, utilizing the bed to practice getting on all fours helps the ability to crawl and come to a kneeling position. For these bed-assisted exercises, we want to start simple. You can do glute raises to strengthen the hips, lateral rolls to help develop core strength and pushing off the bed into a kneeling position. These three general moves will greatly impact someone’s ability to recover and get up off the floor. First., how to do a glute raise. While laying on your back, bend your knees until your feet are flat on the bed, then thrust your hips into the air while squeezing your glutes together to strengthen your hips and stretch your hip flexors. This can also relieve tension in your back as it also

strengthens your core. Second, how to perform a lateral roll. Start on either side of the bed and roll over until you are on your back facing up. Doing this in both directions will help your core and assist in your ability to recognize your space, timing and even your points of contact with the bed. As you get better, you can try to roll over with fewer points of contact. Now, how to do a hip flexor. When lying on your stomach, flatten your hands in a push up position and push yourself up into a crawling position. Doing this repeatedly will help strengthen your upper body. When you are ready, try to come to a full upright kneeling position with your hands off of the bed. The simplicity in crawling around on your bed and kneeling upright will help joint movement and core stability. Also, it is soft enough for you to practice daily. Enjoy practicing these movements in a safe place and stay active. WWW.ORTODAY.COM

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August 2021 | OR TODAY


OUT OF THE OR health

Study: Short Breaks May Help Brains Learn New Skills n a study of healthy volunteers, National Institutes of Health researchers have mapped out the brain activity that flows when we learn a new skill, such as playing a new song on the piano, and discovered why taking short breaks from practice is a key to learning. The researchers found that during rest the volunteers’ brains rapidly and repeatedly replayed faster versions of the activity seen while they practiced typing a code. The more a volunteer replayed the activity the better they performed during subsequent practice sessions, suggesting rest strengthened memories.


“Our results support the idea that wakeful rest plays just as important a role as practice in learning a new skill. It appears to be the period when our brains compress and consolidate memories of what we just practiced,” said Leonardo G. Cohen, M.D., senior investigator at the NIH’s National Institute of Neurological Disorders and Stroke (NINDS) and the senior author of the study published in Cell Reports. “Understanding this role of neural replay may not only help shape how we learn new skills but also how we help patients recover skills lost after neurological injury like stroke.” The study was conducted at the NIH Clinical Center. Cohen’s team used a highly sensitive scanning technique, called magnetoencephalography, to record the brain waves of 33 healthy, righthanded volunteers as they learned to type a five-digit test code with their left hands. The subjects sat in a chair and under the scanner’s long, cone-shaped cap. 50 OR TODAY | August 2021

An experiment began when a subject was shown the code “41234” on a screen and asked to type it out as many times as possible for 10 seconds and then take a 10 second break. Subjects were asked to repeat this cycle of alternating practice and rest sessions a total of 35 times. During the first few trials, the speed at which subjects correctly typed the code improved dramatically and then leveled off around the 11th cycle. In a previous study, led by former NIH postdoctoral fellow Marlene Bönstrup, M.D., Cohen’s team showed that most of these gains happened during short rests, and not when the subjects were typing. Moreover, the gains were greater than those made after a night’s sleep and were correlated with a decrease in the size of brain waves, called beta rhythms. In this new report, the researchers searched for something different in the subjects’ brain waves. “We wanted to explore the mechanisms behind memory strengthening seen during wakeful rest. Several forms of memory appear to rely on the replaying of neural activity, so we decided to test this idea out for procedural skill learning,” said Ethan R. Buch, Ph.D., a staff scientist on Cohen’s team and leader of the study. To do this, Leonardo Claudino, Ph.D., a former postdoctoral fellow in Cohen’s lab, helped Buch develop a computer program which allowed the team to decipher the brain wave activity associated with typing each number in the test code. The program helped them discover that a much faster version – about 20 times faster – of the brain activity seen during typing was replayed during the rest periods. Over the course of the first 11 practice trials, these compressed versions of the activity were replayed many

times – about 25 times – per rest period. This was two to three times more often than the activity seen during later rest periods or after the experiments had ended. Interestingly, they found that the frequency of replay during rest predicted memory strengthening. In other words, the subjects whose brains replayed the typing activity more often showed greater jumps in performance after each trial than those who replayed it less often. “During the early part of the learning curve we saw that wakeful rest replay was compressed in time, frequent, and a good predictor of variability in learning a new skill across individuals,” said Buch. “This suggests that during wakeful rest the brain binds together the memories required to learn a new skill.” As expected, the team discovered that the replay activity often happened in the sensorimotor regions of the brain, which are responsible for controlling movements. However, they also saw activity in other brain regions, namely the hippocampus and entorhinal cortex. “We were a bit surprised by these last results. Traditionally, it was thought that the hippocampus and entorhinal cortex may not play such a substantive role in procedural memory. In contrast, our results suggest that these regions are rapidly chattering with the sensorimotor cortex when learning these types of skills,” said Cohen. “Overall, our results support the idea that manipulating replay activity during waking rest may be a powerful tool that researchers can use to help individuals learn new skills faster and possibly facilitate rehabilitation from stroke.” This study was supported by the NIH Intramural Research Program at the NINDS.


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How To Build Trust By daniel bobinski, M.Ed. rust is a unique factor in relationships. It often takes a long time to create trust, but it can be lost in mere seconds. To make matters worse, some people try to lubricate the gears of workplace productivity by using manipulation. Such approaches do little to foster trust in relationships. In fact, they often result in the exact opposite.


One question people sometimes ask is, “How can I develop trust?” The pithy answer is, “Be trustworthy,” but that answer still leaves people asking for specifics. Because trust is vital for enhancing workplace productivity, allow me to present what I believe to be a practical approach for developing trust. Please know that the recommendations I’m about to present do not originate with me. I came upon them when studying the concept of emotional bank accounts, an analogy proposed by the late Dr. Stephen Covey, author of “Seven Habits of Highly Effective People.” The idea is that every time we meet someone, an emotional bank account is automatically created, and in that bank account, every word, every facial expression and every action we take is interpreted as either a deposit or a withdrawal. The way to build trust is to work WWW.ORTODAY.COM

on making deposits. This parallels your relationship with your bank and your actual bank account. If you regularly make a lot of deposits and very few withdrawals, when you go to the bank to take out a loan, they see your track record of deposits and view you as trustworthy. Conversely, if you are regularly overdrawn, they won’t likely trust you to repay a loan. In terms of your emotional bank accounts with others, here are some “deposits.” That is, actions that build trust. • Keep commitments. If you say you’ll be somewhere, be there. And on time. • Be kind and courteous. “Please” and “thank you” go a long way. • Seek first to understand. Before making your case, listen first to the opposing point of view. • Show personal integrity. Keep confidences. • Be open to feedback. Listen to suggestions for improvement without being defensive. • Attend to the little things. Being helpful in small things adds up to being a big thing. • Keep promises. If you say you’re going to do something, do it. • Clarify expectations. Be clear about when things are due and what the specific deliverables should be.

• Be loyal to the absent. Speak about absent people as if they were in the same room with you. • Apologize sincerely if you make a withdrawal or otherwise offend someone. Sometimes we make withdrawals. If that happens, an apology soon after doesn’t restore all the trust lost, but it usually restores some. In short, trust is an atmosphere we can create. It has to do with how people feel about their interactions with us. Granted, we have no direct control over how others feel, but our actions, attitudes and words act as deposits. And the more deposits we make without making withdrawals, the more trust we establish. Daniel Bobinski, M.Ed. is a best-selling author and a popular speaker at conferences and retreats. For more than 30 years he’s been working with teams and individuals (1:1 coaching) to help them achieve excellence. He was also teaching Emotional Intelligence since before it was a thing. Reach him through his website at MyWorkplaceExcellence.com or call his office at 208-375-7606.

August 2021 | OR TODAY


OUT OF THE OR nutrition

It Starts With A Plan By KIRSTEN Serrano he biggest hurdle to better eating is often just having a plan. The what to make for dinner problem is real. Our lives are busy and convenience food is just so …. well, convenient. Eating well balanced meals at home is a real game changer health-wise, but it can feel like the hardest part of your day. I get it. I promise you that a plan makes a huge difference. Even if it is just a few notes on the back of an envelope, it takes away the decision fatigue and spurs you to action.


Breaking meals into types helps me plan and execute them more efficiently and it can help you too. Consider each type a master recipe that you can fill in to suit your needs. A particular meal type may really speak to your cooking style or family needs. I will describe each type and then give you ideas of what that meal may look like. Meal Type One: The Classic One, Two, Three. This is your basic protein plus two sides meal. It might be the meal you are most familiar with if you grew up, like me, in the Midwest. Examples: Pork Chop + Roasted Asparagus + Sweet Potato Salmon Filet + Cucumber and Red Onion Salad + Wilted Spinach. Meal Style Two: The All In. This 54

OR TODAY | August 2021

is the meal you make on a day when you don’t mind being in the kitchen for a while. The important thing about this meal is the time it provides to work ahead on future meals. You can be working your batch cooking magic while you tend to this meal. Here are some of the meals I make when I have a bit more time. Examples: Lasagna + Green Salad + Homemade Vegetable Soup Shepherd’s Pie + Baked Apples + Roasted Broccoli. Meal Style Three: The Customizable. This kind of meal can be both quick to put together and please a crowd of picky eaters. A customizable meal has some sort of base that is then dressed up by the diner. Here are some examples: Examples: Custom Sushi Bowls Custom Cobb Salads Custom Omelets (or Scrambles). Meal Style Four: The Skillet Meal. I often refer to myself as the queen of the skillet meal. What’s not to love? They are easy, fast and clean-up is minimal. This is most often my go-to meal when I am short on time and don’t have enough leftovers to make another meal. Make this meal super quick by processing produce (chop, shred, slice, etc.) ahead of time and using a protein that is ground or already cut up. Skillet meals are such a winner

because you are using small pieces of everything involved. Smaller cooks faster. When you have done your produce prep in advance, you can make these meals in 15 to 20 minutes max. They also make amazing leftovers. Examples:Tacos or Stir-fry. Meal Style Five: Something Out of Nothing. This is the emergency meal when all your best-laid plans fail. Ideally, you have leftovers or something you can just pull out of the freezer, but things don’t always work that way. Here are some fallback ideas that have worked for me. Examples: Frittata (fancy name for crustless quiche) Egg or Salmon Salad Challenge yourself to come up with meals to fit these meal styles. They will make it easier to get dinner on the table and help you avoid health sacrificing convenience meals.

Kirsten Serrano is a nutrition consultant, chef, farmer, food literacy educator and the best-selling author of “Eat to Your Advantage.” You can find out more about her work at SmallWonderFood.com.


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OUT OF THE OR recipe

Breakfast burrito INGREDIENTS: 2 teaspoon canola oil • 1 small red onion, diced


• 1 red bell pepper, seeded and diced


• 1 can black beans, drained and rinsed • 1/4 teaspoon red pepper flakes • salt, to taste • pepper, to taste • 4 eggs • 4 egg whites • 1/2 cup shredded pepper jack cheese • nonstick cooking spray • 4 flour tortillas • 1/4 cup sour cream • 1/4 cup salsa • 1 large tomato, seeded and diced • 1 avocado, sliced • hot sauce (optional)

By Family Features


OR TODAY | August 2021



Breakfast With A Powerful Punch


By Culinary.net ou know the feeling: You eat breakfast, but by 11 a.m. your stomach is growling. You feel like you just ate but somehow you’re hungry and craving something hearty and rich.


Switch up your breakfast habits with a wholesome and filling breakfast burrito. It’s got protein to keep you full, veggies for a touch of added nutrition and hot sauce to pack a powerful punch of flavor in every bite. No more snacking between breakfast and lunch. This hearty breakfast bite will keep you full and bursting with energy until it’s time for your next meal. It’s easy to make in a matter of minutes and it’s totally customizable to accommodate every palate. Made with beans, eggs and egg white proteins, it can help keep you energized and full until it’s time for lunch. The red onion, red bell peppers, salsa, tomatoes and avocado provide some fresh, nutritious vegetable options and the chili flakes and hot sauce bring the heat. To make this burrito, start with canola oil in a skillet. Add red onion and red bell peppers then cook for 8 minutes. Add black beans, chili flakes, salt and pepper then stir. Whisk eggs and egg whites in a mixing bowl. Add pepper jack cheese then scramble the egg and cheese mixture in a hot skillet. On a tortilla, spread sour cream, salsa, the bean mixture, scrambled eggs, tomatoes, avocado and hot sauce, if desired. Roll up the burrito and it’s ready to serve. Just like that you have a breakfast that is not only nutritious but equally as appetizing. Watch how to make this dish online at youtu.be/4rSC5LFxwAI. Find more filling breakfast recipes at Culinary.net.

Breakfast burrito: Servings: 4 1. In large skillet, heat canola oil over medium heat. Add red onion and red bell pepper; cook 8 minutes. Add black beans and red pepper flakes; cook 3 minutes. Season with salt and pepper, to taste. Transfer to dish. 2. In medium bowl, whisk eggs and egg whites. Stir in cheese until combined. Heat large skillet over low heat, add egg mixture and scramble 3 minutes, or until cooked through.


3. Spread sour cream over tortilla. Spread salsa over sour cream. Spoon 1/4 bean mixture over salsa. Spoon 1/4 scrambled eggs over bean mixture. Top with diced tomatoes and avocado. Drizzle with hot sauce, if desired. Rollup burrito. Repeat three times with remaining ingredients and serve. Recipe courtesy Culinary.net.

August 2021 | OR TODAY


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OR TODAY | August 2021


The News and Photos


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arm, sunny days are the perfect setting for making family memories, but they’re also ideal op-

portunities to encourage kids to get creative and let their imaginations soar. These ideas for summertime activities encourage family interaction, and the more kids get to help plan and organize the details, the more engaged you can expect them to be. Visit Your Local Park Pack all the kids’ favorite snacks and beverages to keep cool and hydrated. Choose your spot under a big shady tree and spread out for an impromptu picnic. Be sure to bring along outdoor toys for a game of catch or lighten the load and create a nature scavenger hunt with different types of leaves, rocks and flowers for kids to discover. If they come across an unfamiliar plant or animal, snap a picture with your phone so you can do some research on it when you get home. Encourage the kids to draw or design a piece of art reflecting the things they saw. Create Watercolor Paintings Away from the school setting, kids sometimes have fewer opportunities to practice expressing their ideas and getting creative. Fun tools can make an artistic session more exciting, so look for unique methods like blending Zebra Pen Mildliner Brush Pens with water and a paint brush to create fun, pastel watercolor paintings with minimal mess. The pens are conveniently double-ended with a paint brush-like tip on one end and fine marker tip on the other so you can precisely draw a design then create softer swirls of color using water and a brush.


Water Sponge Challenge Cool off with a fun and refreshing water fight with a few creative twists. First grab sponges, or water sponge balls and a full bucket of water. The sponges are reusable so you can use them all summer long. Make it extra fun by organizing teams with kids against adults or everyone fending for themselves. Encourage kids to devise their own blockades and targets or adapt a classic game like baseball or dodgeball using water sponges in place of the usual balls. You could also do a sponge scavenger hunt to load up everyone’s buckets before the dousing begins. Find the Animals Visit your local Association of Zoos and Aquariums accredited zoo or aquarium and have your kids find as many animals as they can from the AZA SAFE: Saving Animals From Extinction species list. It’s a good opportunity to talk about the concept of extinction and why these animals are on the list. Follow up the visit with an activity that reinforces how everyone has a role in conservation and look for ways to help protect each family member’s favorite animal. Make Oven S’mores On a rainy night (or any night) make a s’more by putting it in the oven. They turn out just as melty and gooey as the campfire version but with easier prep and cleanup. This is a tasty way to get those creative juices flowing. Experiment with different candies, such as peanut butter cups in place of chocolate bars. Or add different ingredients and have other family members guess the flavors. - Family Features

August 2021 | OR TODAY


The Heart of PeriOperative Nursing


Save the date

The Georgia Council of periOperative Registered Nurses Annual Conference October 22-23, 2021 Atlanta Georgia About the Georgia Council of periOperative Registered Nurses Georgia Council of periOperative Registered Nurses is the collective voice of Georgia Chapters of the Association of periOperative Registered Nurses (AORN). Our mission is to advocate for excellence in perioperative practice and healthcare in Georgia as we unite and empower perioperative nurses.

60 OR TODAY | August 2021


Preliminary Schedule Friday October 22, 2021 6:00 pm Registration 6:30-8:30 pm Welcome Reception – Recognition of Chapter Presidents/ Guests All Invited Celebrate our nurse leaders


October 23, 2021 7:30 am Registration/Continental Breakfast 8:00 am Welcome GA Council/OR Today 8:15-8:30 am Advocacy Partnership: AORN and You Holly Ervine, MSN, RN, CNOR, AORN President The importance of the relationship between AORN and grassroots members has stood the test of time. Now more than ever before nurses need to understand how AORN advocates for all nurses—not just AORN members. 8:30-9:15 am Workplace Advocacy: Clear the Air Vangie Dennis, MSN, RN, CNOR AORN President Elect What nurses and technicians are breathing and the longterm health effects make it clear


Renaissance Atlanta Waverly Hotel 2450 Galleria Pkwy Atlanta, GA 30339


Registration open online!

that evacuation of surgical smoke should be foremost in the minds of healthcare providers. 9:15-9:45 am Break—Visit Exhibits 9:45 -10:30 am Evidence Based Practice: Covid Smoke Research Doreen Wagner, PhD, RN Christopher Hudgins, BS, ASN Original research from Georgia nurses on how Covid influenced surgical smoke evacuation will be presented along with other evidence on the importance of evidenced-based practice. 10:30-11:30 am Advocacy: The Heart of PeriOperative Practice William J. Duffy, RN, MJ, CNOR The operating room is a practice area where the veil between heaven and earth is thin. The trust from patient’s creates a bond from our vow to protect that is also sacred and powerful. It is the heart of perioperative practice. 11:30 am-1:00 pm Lunch with Exhibitors 1:00-1:45 pm The Importance of Self Care for Nurses Perioperative practitioners have spent many months caring for patients, often without regard for

REGISTRATION PRICES: Attendee $75 Student $30 Virtual* $25 * Education will be accessible online and eligible for CE credits. NOTE: Education will be accessible online and eligible for CE credits.

their own safety. Mental and physical self-care is important to refuel the spirit and the soul. One of the best medicines is laughter. 1:45-2:15 pm Your Voice for Change Dustin Cain, CST, FAST AST - Georgia 2:15-2:30pm Break 2:30- 3:15 pm The Seat of Power: Meet the Lawmakers Invited Officials Who makes the laws and why is that important to us? Perioperative nurses will partner with lawmakers to point out how far we’ve come and how far we’ve yet to go. 3:15-4:00 pm Closing Keynote: TBD 4:00-4:15 pm Closing Remarks and Adjourn


www.GACouncilNurse.org August 2021 | OR TODAY




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OR TODAY | August 2021

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