OR Today Magazine September 2021

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contents features


LEAN AND PATIENT SAFETY Experts discuss how Lean principles and tools help teams identify waste and improve processes and how these processes are perfect for application in the perioperative setting.




The goal of this program is to provide

American workers place a higher value

nurses with information on nursing and

on getting feedback about how they’re

The global patient positioning systems

its image so they can improve the image

doing than getting an increase in pay.

market size has been valued at $942.8

of the profession.




million and is expected to expand.

OR Today (Vol. 21, Issue #9) September 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


September 2021 | OR TODAY






Kristin Leavoy



David Walz , MBA, BSN, RN, CNN, FACHE

EDITOR John Wallace




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Jonathan Riley


Karlee Gower


Taylor Powers

ACCOUNT EXECUTIVES Jayme McKelvey Megan Cabot



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10 News & Notes 18 ASCA: Medicare Releases 2022 ASCA Payment Proposal 21 CCI: The Importance of Preceptors 22 IAHCSMM: Transparency, Integrity Boost SPD Quality, Accountability 24 AAMI: Human Factors Experts Improve Clinical Environment 27 Webinars: Experts Share How to Optimize Perioperative Performance


Diane Costea

WEBINARS Jennifer Godwin

Hank Balch, President & Founder, Beyond Clean Vangie Dennis, MSN, RN, CNOR, CMLSO,


Assistant Vice President, Perioperative Services 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

54 Index



28 M arket Analysis: Patient Positioning Market Expends 29 Product Focus: Patient Positioning 32 CE Article: Do you reflect a positive image of nursing?

42 Spotlight On: David Walz, Senior Director, Women & Newborn Health 44 Fitness 46 Health 47 Nutrition 49 EQ Factor 50 Recipe 52 Pinboard

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Julie Mower, Nurse Manager, Education Development, Competency and Credentialing Institute David Taylor, President, Resolute Advisory Group, LLC Elizabeth Vane, Health Science Teacher, Health Careers High School


OR TODAY | September 2021







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news & notes

Healthmark Industries Acquires McGan Technology LLC

First Magnetic Robotic-Assisted Surgeries Performed with New Platform Levita Magnetics has announced that the first ever robotic-assisted surgical procedures have been performed using the company’s newest system in development, the Levita Robotic Platform. The first case was a reduced-incision laparoscopic cholecystectomy (gallbladder removal) completed by Dr. Ignacio Robles, a minimally invasive surgeon at Clínica INDISA in Santiago, as part of a current clinical study of the system in Chile. The new robotic platform is intended to deliver the clinical benefits of the company’s first commercial product, the Levita Magnetic Surgical System, including less pain, faster recovery and fewer scars for patients. The platform is intended to improve visualization, maintain surgeon control of instruments and increase hospital efficiency with fewer assistive personnel required to conduct the procedures. With its compact footprint, the robotic platform is specially designed for high volume ambulatory or same-day discharge abdominal surgeries. The aim of these combined benefits is to increase the volume of high-quality, efficiently performed procedures while improving surgical access to patients. The Levita Robotic Platform is an investigational system. It is not available for commercial sale in the United States and has not been cleared by the Food and Drug Administration (FDA).


OR TODAY | September 2021

Healthmark has announced the acquisition of McGan Technology LLC. McGan Technology has been an industry leader offering an insulation testing device designed to electrically test electrosurgical instruments. The low-frequency high voltage McGan Insulation Testers are used to detect and locate defects such as pinholes, cracks and bare spots in the jacket or coating of laparoscopic and bipolar electrosurgical instruments. They are handheld, portable units that test the insulation integrity of electrosurgical equipment for flaws in protective coatings applied over conductive instrument surfaces to prevent inadvertent tissue burns, which may occur during electrosurgical instrument procedures. Manufactured with a rechargeable battery, the McGan Insulation Tester maintains applied test voltage with a constant current source, features full test current at low voltages, limited output current for operational safety, and easy-to-read LED Indicators, as well as an LED display of alarm and battery charge. Healthmark looks forward to expanding the global distribution of the McGan Insulation Testing Devices to help eliminate incidents involving electric shock due to inadequate surgical device insulation. For more information, visit hmark.com.



news & notes

CCI Collaborates on Demographic Survey In an effort to better understand the perioperative nursing community, the Competency and Credentialing Institute (CCI) is collaborating on a study of the demographics of the profession. Nurses who participate in the surveybased research will be entered into drawings for prizes. Nurses holding CCI or ABPANC certifications may also earn professional development points for their recertification. The study can be found online at https:// survey.alchemer.com/s3/6390658/ Gatekeeper-Recruitment-ScreeningQuestions. Jim Stobinski, the CEO of CCI, is one of the investigators for the study and encourages perioperative nurses to participate. “From a professionalism standpoint, this data will substantiate the anecdot-

al information we have about staffing shortages and difficulty recruiting into the profession. Information gathered from the study will be disseminated via peer-reviewed publications and presentations and will assist the strategic planning and direction for the Competency and Credentialing Institute,” he said. “On a personal level participants will have the satisfaction of contributing to their profession, they will earn points toward their recertification, and they might win some nice prizes,” Stobinski added. “Participation is one small but realistic and achievable thing they can do to assist in a larger effort. We often talk about large problems in health care and what we can do as an individual nurse. This study is one way an individual nurse can contrib-

ute. Even a few minutes completing a survey would be a great help to our researchers.” He went to say that he finds this research vital for the nursing profession. “On a personal level, I have been studying this issue since beginning my doctoral work nearly 20 years ago. With CCI, I now have the resources and expertise to do a study with the potential for far-reaching impact in the profession. We have long needed this information and this is a wellresourced and carefully crafted study which may finally get some answers. This would be a great thing to accomplish and share with the profession at this stage of my career,” Stobinski said. Questions regarding the survey may be directed to jstobinski@cc-institute.org

Ethicon Launches Enseal X1 Curved Jaw Tissue Sealer Ethicon, part of the Johnson & Johnson Medical Devices Companies, has launched the Enseal X1 Curved Jaw Tissue Sealer, a new advanced bipolar energy. The device is indicated for colorectal, gynecological, bariatric surgery and thoracic procedures. The Enseal X1 Curved Jaw is the first of several new advanced laparoscopic bipolar devices the company plans to launch in the coming months as it expands its extensive energy portfolio, which includes Harmonic ultrasonic devices and Megadyne core electrosurgical tools. Among the Enseal X1 Curved Jaw’s new features are


separate seal and cut capabilities, a 360-degree continuous shaft rotation and Ethicon’s Adaptive Tissue Technology. “Ethicon is the only company with the expertise deep enough and the energy portfolio broad enough to offer tailored, proven and reliable product and service solutions that span virtually every energy modality, surgical specialty and procedure,” said Ethicon President Kate Masschelein. “We will continue to develop innovative solutions that leverage our decades of experience in surgery and our deep understanding of the science of tissue management, device-tissue interaction and OR safety to set new standards of performance in surgery.”

September 2021 | OR TODAY



news & notes

IAHCSMM Announces Name Change Stryker Introduces Tornier Shoulder Arthroplasty Portfolio Stryker has officially introduced the Tornier shoulder arthroplasty portfolio and launched its first new Tornier product, the Perform Humeral Stem. “The Tornier shoulder arthroplasty portfolio will set Stryker apart in the shoulder market,” said Mike Panos, president of Stryker’s trauma & extremities division. “We are proud to offer surgeons one of the most robust, comprehensive product lines available. We’re delivering on our mission to make health care better – for surgeons and the patients they serve.” Elevated by Blueprint planning software and the market-leading Perform anatomic and reverse glenoid, the new Tornier Perform Humeral Stem offers clinical solutions for the simplest to most complex shoulder arthroplasty cases. It is intended for use in anatomic, reverse and hemiarthroplasty of the shoulder. It also allows for conversion from an anatomic to a reverse shoulder prosthesis in the case of revision. The Tornier Perform Humeral Stem was designed with four collar diameters and is available in multiple lengths to optimize humeral fit and give surgeons the power to perform and the options to choose. The focus on smaller stem options make it ideal for addressing smaller patient anatomies that present unique challenges. The Tornier Perform Humeral Stem is compatible with the full line of standard and augmented Perform glenoid options – for anatomic and reversed procedures – to fit the patient’s unique anatomy. Blueprint planning software allows surgeons to plan their Perform cases in advance and provides real-time, precise virtual surgery for added confidence prior to stepping foot in the operating room. “The Tornier Perform Humeral Stem allows me to further leverage the full range of Perform glenoid options,” said George Athwal, MD, designing surgeon. “Coupled with the ability to confirm my surgical plan using Blueprint, it gives me the ability to address the needs of patients with either simple or highly complex cases.”


OR TODAY | September 2021

From June 22-July 12, 2021, members of the International Association of Healthcare Central Service Materiel Management (IAHCSMM) cast their votes regarding the proposed name change from IAHCSMM to the Healthcare Sterile Processing Association (HSPA), with a tagline of “Professionals Instrumental to Patient Safety.” Upon reviewing the certified results from the third-party voting service provider Survey & Ballot Systems, the association’s board of directors announces that 82.3% of voting members voted in favor of the name change. A two-thirds “yes” vote by members who voted was needed for the name change to pass. The switch from IAHCSMM to HSPA will officially take effect January 1, 2022. In the coming weeks and months, the association will be updating its logo, corporate documents and marketing materials to reflect the new name and will continue communicating with membership throughout the process. “For many years, discussions took place regarding a formal name change for the association within the bylaws and articles of incorporation,” said IAHCSMM Executive Director Susan Adams, BA, CAE. “We are excited to adopt a new name that more clearly reflects the profession and will help us better educate others about how sterile processing professionals impact patient safety. One thing that will not change is our organization’s commitment to delivering the high level of support and services that our members and certification holders have come to expect over the past 63 years.” For more information visit www.iahcsmm. org/processingchange.html.



news & notes

HST Pathways Unveils Product Rebranding HST Pathways has announced the launch of its newly rebranded product offering, “HST Case Coordination.” Formerly known as Casetabs, HST Case Coordination will be fully integrated into the HST Pathways end-to-end software solution, creating a simplified user experience for ambulatory surgery center (ASC) audiences. HST Pathways is a leader in ASC cloud-based technology with more than 15 years of experience in the industry. Seeing the immense benefit to its shared client base, HST Pathways and Casetabs began bi-directional integration of their products in 2019, and were formally merged in November 2020 under one company through a majority investment led by Bain Capital Tech Opportunities with a minority investment from Nexxus Holdings. The rebranding aligns the Ca-

setabs product offering with other HST Pathways solutions, including HST eChart and HST Practice Management. HST Case Coordination will be integrated into the full product suite of HST Pathways offerings. HST Case Coordination is a cloud-based scheduling software that ensures health care practices, physicians and case teams are viewing the same real-time schedules. The AI-driven HST Case Coordination features smart scheduling with focus on operating room (OR) utilization, mobile access, HIPAA compliant chat functions, digital surgery boards, patient texting with ID and insurance uploads, and patient ride texting. Additional features include ASC surgery schedule sharing with physicians, advanced block time capabilities and scheduling analytics.

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news & notes

First Patient Treated with VeriSight Pro Royal Philips announced the first minimally invasive heart procedure using its new real-time 3D intracardiac echocardiography (ICE) catheter. The Left Atrial Appendage Occlusion (LAAO) procedure was carried out by Mohamad Adnan Alkhouli, M.D., at Mayo Clinic. Used together with Philips Premium Cardiology Ultrasound System (EPIQ CVx), the real-time 3D Philips Intracardiac Echocardiography Catheter – VeriSight Pro – offers superior 2D and 3D live image guidance for a wide range of procedures in structural heart disease and electrophysiology, allowing interventionalists to navigate procedures with ease, provide superior care and optimize cath lab performance. Live ultrasound imaging during structural heart disease and electrophysiology procedures typically relies on transesophageal echocardiography (TEE) imaging, in which an ultrasound probe is passed down the patient’s


OR TODAY | September 2021

throat and into their esophagus, until it lies next to the heart. TEE requires the patient to be sedated or given general anesthesia, lengthening preparation, procedure, and recovery times and carrying a degree of risk. Philips’ ICE catheter VeriSight Pro uses the same ultrasound technology, miniaturized to fit on the tip of a 1.98mm diameter (9 French) catheter so that it can be navigated to the patient’s heart via their vasculature - the same route used to introduce other catheters during minimally invasive cardiac surgery. General anesthesia is typically not required, reducing patient risk, and opening up procedures to patients who are not good anesthesia candidates. “Securing the best-possible live images enables interventional cardiologists and electrophysiologists to boost procedure confidence and deliver optimum outcomes for more patients,” said Chris Landon, senior vice president and

general manager image guided therapy devices at Philips. “The exceptional 2D and 3D imaging capabilities of Philips Intracardiac Echocardiology Catheter – VeriSight Pro – make it a superb choice for image guidance in interventional procedures, reducing reliance on general anesthesia and the logistical hurdles that go with it.” Philips Intracardiac Echocardiology Catheter – VeriSight Pro – is designed to be used with Philips Premium Cardiology Ultrasound System (EPIQ CVx). Philips offers integrated solutions for the treatment of structural heart disease, combining interventional X-ray, 3D ultrasound and related interventional tools that are designed to enable confident navigation and positioning of devices to optimize outcomes while reducing procedure time. Philips Intracardiac Echocardiology Catheter – VeriSight Pro – is available on a limited basis in the U.S.



news & notes

Konica Minolta Healthcare Selects Distributor Konica Minolta Healthcare Americas Inc. has reached an agreement with Mercury Medical for the company to serve as a distributor for ultrasound solutions in the anesthesia market. The agreement builds on Konica Minolta’s recent partnership with Medovate to provide a total solution promoting safer ultrasound-guided regional anesthesia. The agreement, effective immediately, covers the distribution of the SONIMAGE HS2 Compact Ultrasound System throughout the U.S. “With the growing use of and interest in image-guided regional anesthesia, Konica Minolta recognized an opportunity to best serve the needs of providers and health care facilities by collaborating with Mercury Medical,” says Eric Sumner, executive vice president ultrasound sales at Konica Minolta. “Aligning


with Mercury Medical provides anesthesiologists and medical centers with a familiar and trusted source for image-guided regional anesthesia solutions. Our companies have a common goal to maximize patient outcomes, and we are excited to partner with Mercury Medical to further enhance patient safety and clinical efficiency with our image-guided regional anesthesia solution.” The two companies have already partnered by promoting the HS2 System with Medovate’s SAFIRA (SAFer Injection for Regional Anesthesia) for a total solution that enhances patient safety and transforms regional anesthesia into a one-physician procedure by allowing a single anesthesiologist to conduct the entire procedure.

September 2021 | OR TODAY



news & notes

Positive Leadership WalkRounds Improve Health Care Worker Well-Being Interventions to decrease burnout in health care are urgently needed. A new study in the July 2021 issue of The Joint Commission Journal on Quality and Patient Safety (JQPS) evaluates the association between Positive Leadership WalkRounds (PosWR), and health care worker (HCW) well-being and organizational safety culture. The study, “Safety Culture and Workforce Well-Being Associations with Positive Leadership WalkRounds,” was completed at Duke University Health System, Durham, North Carolina, and involved senior leaders who were encouraged to conduct PosWR, an organizational practice in which leaders conduct rounds and ask staff about what is going well. A cross-sectional survey of clinical and nonclinical HCWs included a question about recall of exposure of to PosWR – “Do senior leaders ask for information about what is going well in this work setting (e.g. people who deserve special recognition for going above and beyond, celebration of successes, etc.)?” – along with measures of well-being and safety culture. Electronic surveys were returned by 10,627 out of 13,040 possible respondents (81.5% response rate) from 396 work settings. Exposure to PosWR was reported by 63.1% of re-


OR TODAY | September 2021

spondents overall. Exposure to PosWR was most commonly reported by HCWs in leadership roles (83.8%). The researchers compared the responses about well-being and safety culture across quartiles of exposure to PosWR. Compared to work settings in the lowest quartiles, HCWs in work settings in the top quartiles reported a higher percentage of favorable responses, including strong: • Readiness to engage in quality improvement activities • Leadership accessibility and feedback behavior • Teamwork norms • Work-life balance norms Additionally, compared to the fourth quartile, the first quartile had a lower percentage of respondents reporting emotional exhaustion (burnout) in themselves and in their colleagues. The findings in the study are “promising and serve as an important reminder about the role of leaders at all levels of the organization in preventing and mitigating health professional burnout,” notes an accompanying editorial by Kanekal Suresh Gautham, MD, DM, MS, FAAP, and Colin P. West, MD, Ph.D. “It reminds us that every leader is a CEO – a Chief Emotional Officer.”






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Medicare Releases 2022 ASCA Payment Proposal By bill prentice

ue, in part, to patients’ decisions to delay the outpatient surgical care they needed during the early days of the COVID-19 pandemic and growing interest in outpatient care as the pandemic continues, ASCs are getting a lot of attention these days. Across the country, they are reporting new interest in the services they provide and increased popularity among patients and physicians in their communities. During July, as demand for the care ASCs deliver continued to swell, the number of Medicarecertified ASCs in the U.S. exceeded 6,000 for the first time in the industry’s 51-year history.


Also in July, the Centers for Medicare & Medicaid Services (CMS) released its 2022 proposed payment rule for ASCs and hospital outpatient departments (HOPD). Its contents affect the services ASCs can provide to Medicare beneficiaries, payment rates for those services and many of the regulatory requirements ASCs must meet to be able to serve Medicare patients. For ASCs, the 2022 proposal is a mixed bag with some provisions that the ASC community has supported for many years and others that could inhibit ASCs’ ability to provide care to more Medicare beneficiaries who would benefit from being able to access care in an ASC. 18

OR TODAY | September 2021

Which anesthesia machine configuration works best in your facility? Perhaps most notably, the 2022 proposed payment rule reverses policy changes CMS adopted last year that added a sizeable number of codes to the ASC Covered Procedures List (ASC-CPL) and began the process of eliminating the inpatient-only (IPO) list. As a result, the current proposal would remove 258 codes from the ASC-CPL and put 298 codes back on the IPO list. ASCA will be asking that a number of the procedures that CMS is proposing to remove from the ASC-CPL be retained since they are procedures ASCs have already demonstrated they can perform safely and many Medicare beneficiaries would benefit from having those procedures in an ASC. Also in this proposed rule, CMS is proposing to establish a new procedure nomination process – something ASCA has long requested – that would be used to bring new procedures into ASCs. Using this process, ASC physicians with hands-on experience and entities like the professional specialty societies would be able to nominate procedures for addition to the ASC-CPL list. Decisions about which procedures to add would be finalized during the agency’s annual rulemaking process. Under this proposal, CMS also agrees to provide its rationale anytime it denies the addition of a nominated procedure – again, something ASCA has been requesting for several years.

Bill Prentice

Improved Reimbursement for Device Intensive Procedures CMS is also proposing new policies for determining which procedures are considered device-intensive in the ASC setting and how to reimburse for the devices involved in those procedures. These proposals are much more aligned with what ASCA and the ASC community have been requesting than prior policies. If adopted, the new policies would add more than 60 device intensive procedures to the ASC setting and provide more adequate payment for more than 440 codes.

2022 Inflation Update CMS’ current proposal continues a five-year trial period that uses the same inflationary update factor – the hospital market basket – for both ASCs and HOPDs. ASCA has been advocating for this adjustment for many years and is pleased to see the trial period, which is scheduled to run through 2023, continue. For 2022, WWW.ORTODAY.COM


news & ASCA notes

after applying that measure, the proposed update for both ASCs and HOPDs is expected to be 2.3 percent. ASCA’s request for parity in the ASC and HOPD annual updates, however, is tied to a larger issue the ASC community has been asking CMS to address for some time: the growing disparity in ASC and HOPD payment rates. ASCA will continue to talk with Medicare officials about the negative impact the growing disparity in ASC and HOPD payments has on the program’s beneficiaries and work for a system that will prevent further divergence.

Quality Reporting The CMS proposal also breathes new life into Medicare’s ASC Quality Reporting (ASCQR) Program. Specifically, this proposal would • add a COVID-19 vaccination measure beginning with data collection in 2022 • resume data collection for four previously suspended measures beginning with data collection in 2023 • make mandatory a measure related to cataract surgery that was previously optional beginning with 2023 data collection • require ASCs to report on Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems (OAS CAHPS) Survey-Based Measures beginning in 2024. The four measures the proposal would reinstate are • ASC-1: Patient burn • ASC-2: Patient fall • ASC-3: Wrong site, wrong side, wrong patient, wrong procedure, wrong implant • ASC-4: Hospital transfer/admission CMS suspended reporting on all four of these patient outcomes measures previously because ASCs had performed so well that CMS determined further improvement was unlikely. Despite those findings, in the face of growing demand for current quality data from ASCs, ASCA supports the reinstatement of these measures. ASCA, however, does not support mandated reporting on the cataract measure CMS is proposing to add. That measure, ASC 11 Cataracts: Improvement in Patient’s Visual Function within 90 Days Following Cataract Surgery, WWW.ORTODAY.COM

relies on post-surgery data that ASCs do not possess, and after careful consideration several years ago, ASCA and CMS agreed that measure should remain optional. In addition to opposing mandatory reporting on this measure, ASCA will be working with CMS to try to ensure that ASCs can reasonably accommodate any new reporting requirements and deadlines that are adopted. The proposed rule also asks for comments from stakeholders about ways the ASCQR Program could support facilities in improving the quality of care available to all Medicare beneficiaries, regardless of their socioeconomic status or other risk factors. ASCA has long supported increased access to care in the ASC setting for all patients in need of outpatient surgical care and will be considering several options for responding to this request.

Support for opiod alternatives Finally, the proposed rule, like ASCA, continues to support separate reimbursement for non-opioid pain management alternatives. ASCA will also be recommending that CMS support some additional non-opioid pain management tools that decrease the use of post-operative opioids that we shared with CMS officials in comments to last year’s proposed payment rule

What’s Next? ASCs have always provided top-quality care at economical prices, but their ability to provide outpatient surgery to patients in need even during the height of the pandemic drove home the critical need for multiple providers in the marketplace and the important role that ASCs play in the U.S. health care system. At ASCA, we are looking forward to working with CMS and President Joe Biden’s administration to expand access to the value and benefits ASCs provide. Bill Prentice is the CEO of the Ambulatory Surgery Center Association (ASCA). ASCA has released the results of its 2021 ASC Salary and Benefits Survey. ASCs that participated get access to the report for free. ASCs that did not participate can purchase access. The report’s digital platform allows users to filter and sort results and compare their own facility to comparable facilities based on size, geographic location, specialty mix and other variables. September 2021 | OR TODAY



news & notes

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CCI news & notes

The Importance of Preceptors By James X. Stobinski, Ph.D., RN, CNOR, CSSM(E), CNAMB. n April, I attended the second American Nurses Credentialing Center (ANCC) Practice Transition Accreditation Program (PTAP) Symposium along with hundreds of nurses from around the globe. For those not familiar, PTAP is the ANCC’s program, “ … for residency or fellowship programs that transition registered nurses (RNs) and advanced practice registered nurses (APRNs) into new practice settings.” Although relatively new in the world of nursing, this accreditation program has experienced phenomenal recent growth as health care facilities realize the long-term value of quality residency and fellowship programs. The work of preceptors was prominently featured at the symposium, and this caused me to reflect on the role of nurse preceptors in the perioperative nursing specialty.


To familiarize readers with the terminology, the PTAP program defines RN residency programs as those used with nurses with less than 12 months’ experience and RN Fellowships as programs for experienced nurses who transition to new clinical settings. Each of these types of programs are relevant for perioperative nurses. Often nurses who come to work in the OR have experience in other units and fellowship programs are used. Increasingly, however, facilities are hiring nurses directly into the OR as they complete their pre-licensure training. In this scenario, a residency program can be used to facilitate the transition to WWW.ORTODAY.COM

practice. The salience of programs used to facilitate entry into the complex specialty of perioperative nursing is well-established as is the role of preceptors in this learning process. Many of us can still remember our initial education and training and the many hours spent with experienced nurse preceptors as they shared their wisdom. A prominent feature of orientation programs for perioperative nurses has been the use of extended periods, typically months, of precepted learning experiences for nurses new to the OR. A nurse must master a large body of knowledge and numerous skills in becoming a perioperative nurse. The importance of preceptors in this transition cannot be overstated. Prior to the ANCC PTAP programs, the lack of an accreditation program for residency and fellowship programs was noteworthy. There are numerous programs and curriculum offerings for perioperative nurses in the market. But the individual health care facility has considerable flexibility to design programs to meet their facility or system needs and many develop their own programs. The net result is a decided lack of standardization in orientation processes. The ANCC PTAP program provides much needed standardization and accreditation processes to this diverse landscape. The prominence of the role of preceptors in the PTAP program is a welcome development for our specialty and it provides an opportunity. As a credentialing body closely associated with perioperative nursing, CCI sees a prospect for synergy with the critical work of perioperative nurse preceptors. Consistent with accreditation

James X. Stobinski standards that frame our credentials such as CNOR and CFPN, CCI believes that quality materials and programs supporting perioperative preceptors based in the current evidence would benefit the perioperative nursing community at large. CCI, in 2022, will begin offering additional resources to preceptors with the PTAP accreditation program in mind. As with our certifications, these resources will be based on job analysis findings. The demand for surgery continues to increase and we are bringing in large numbers of nurses to the specialty. The work of perioperative nurse preceptors is essential to the future of our profession. CCI wishes to apply its expertise and resources to support this work. If you are attending an upcoming conference, please stop by our booth and share your thoughts on this topic. We look forward to hearing from you. Reference American Nurses Credentialing Center. (2021). Practice Transition Accreditation Program (PTAP) Accessed June 29, 2021 at: https://www. nursingworld.org/organizational-programs/accreditation/ptap/ September 2021 | OR TODAY




Transparency, Integrity Boost SPD Quality, Accountability By Tony Thurmond, CRCST, CIS, CHL

very sterile processing (SP) professional should strive for greater transparency in their roles within the department and in how they engage with other departments within the health care organization — and other departments should aim for the same.


The ability for individuals to clearly see what is expected of themselves (and their SP teammates) contributes to inter- and intradepartmental success because it affords an opportunity to share challenges, roadblocks and ideas in a way that can drive process and performance improvement. Unfortunately, such transparency is not always sought or practiced in a meaningful way. Some who clamor for greater transparency seemingly only want it to pertain to others. They may want others to share fully and openly, but 22

OR TODAY | September 2021

then they don’t personally take similar actions. Generally speaking, transparency in the workplace can be defined as operating in a way that creates openness between managers and employees, or between departments. When transparency is attained, better trust, communication and employee participation results. Reaching a high level of transparency in the workplace can be challenging but the rewards of doing so far outweigh the efforts. This column addresses what is necessary for transparency to occur fully and effectively in the workplace, and how promoting transparency can benefit the department, its employees, customers and patients.

Setting the stage, securing buy-in It is important to determine the level of transparency being sought in the workplace and with whom engag-

ing in such transparency will be most beneficial. Once these questions have been answered, all parties involved must be willing to commit to the open exchange. Getting to a place of success requires an understanding that transparency is a day-by-day process that involves ongoing commitment, buy-in and an enduring willingness to share, regardless of the issue or circumstance. The way a person or organization defines and pursues transparency may differ slightly, however the underlying goal remains the same: to bring teams together to openly discuss concerns, issues or ideas. As a manager of a busy department, I pride myself on having an open-door policy. I encourage anyone to drop by my office and share what’s on their mind. It’s a terrific first step in building and fostering a healthy, honest (transparent) department. The following are some key “TransWWW.ORTODAY.COM



The SPD is one of the most productive departments in the hospital and it’s important that SP professionals share their story and educate others about their roles, responsibilities, successes and challenges.

parency Buckets/Categories” I strive for in our quest for workplace transparency: • Set The Scope: SP leaders know there is information that should be shared with all employees. Key examples include short- and long-term goals and expectations for the department; needs for the day to meet procedure schedules/customer demands; improvements to be made; updates on processes, policies and procedures; and upcoming events. There will be times, however, where certain information may be shared with mid-level management to help prepare them for an upcoming change or a plan of action that has not been finalized – but sharing that information with all employees won’t be necessary or beneficial. Such instances do not diminish departmental transparency; it’s simply that it’s not necessary to bog employees down with details and information that don’t directly affect them. Each manager should determine the level of transparency/ communication for each circumstance and then filter information to employees when more details can be shared. If questions arise and managers don’t have all the details or are otherwise unable to share more at that time, they should be honest and explain that more details will be given at a more appropriate time. Sharing information too early in the WWW.ORTODAY.COM

process can actually be detrimental to the team’s success. • Prioritize Honesty and Integrity: Although there are many definitions for integrity, it can be summed up by doing the right thing at all times, even when no one is around to witness it. Given the critically important, challenging roles and responsibilities of SP professionals, it’s understandable that integrity is a most essential characteristic. SP professionals expect leaders and employees from other departments to demonstrate integrity and they, understandably, expect the same of with each task and service performed in the SPD. Being honest about shortcomings and taking responsibility for an error will always draw more respect from colleagues, customers and managers. SP professionals often feel they are wrongly blamed for delays and errors and there are times when that might be the case; however, when they consistently act with integrity, honesty and professionalism, fewer of those issues will occur and they will be better able to educate others on the real cause and then work together toward an effective resolution. It’s important that all SP team members demonstrate integrity with all their actions and also encourage it with their coworkers. If someone takes a shortcut, for example, they should be politely reminded (and taught, if necessary)

about the proper way. • Share The Story: The SPD is one of the most productive departments in the hospital and it’s important that SP professionals share their story and educate others about their roles, responsibilities, successes and challenges. They should share some of their brightest moments and outline some challenging situations and how they were effectively addressed. All professionals are most transparent when they share their struggles and ask for suggestions and support. All employees in the department should be asked what they feel is the department’s story. When they seek information from different perspectives and are willing to share the collective story, transparency greatly improves.

Conclusion Instilling and maintaining transparency is vital in all health care environments where patient lives are at stake, including areas where sterile processing functions take place. Trust and respect are gained when information is shared openly and honestly, and when the SP team takes ownership of its mistakes and shortcomings. Tony Thurmond, is an IAHCSMM pastpresident who serves as sterile processing manager for Dayton Children’s Hospital.

September 2021 | OR TODAY



Human Factors Experts Improve Clinical Environment arlier this year, AAMI attended the Human Factors and Ergonomics Society’s annual symposium. Here is just a sample of new developments in the clinical setting that have our attention.


Human Factors Experts Seek Trust and Safety for AI in the Hospital Health care is an innately human experience, but with the introduction of artificial intelligence and machine learning, keeping health care delivery human-friendly can be a challenge. It was a lesson brought up time and time again during the recent 2021 HFES International Symposium on Human Factors and Ergonomics in Healthcare. Though it’s undeniably a burgeoning field in the health care industry, there exists some apprehension in regards to AI/ML usage. That’s why human factors experts have found themselves working at the very foundation of this doubt, devising new ways to make AI/ML-enabled medical devices more trustworthy and facilitating human-AI collaboration. The first step to enabling trust is providing insight into how algorithms reach a decision. That’s at least according to Yuval Bitan, a human factors engineer and lecturer at the Ben-Gurion University of Negev, who spoke during the HFES Symposium. “One of the things that affects trust is the fact that all these algorithms are basically a black box, and we in human factors, need to try and find ways to change this black box algorithm to a clear box,” said Bitan. Another element of trust is user interaction, namely information relevancy and interactivity. If the information and the way it’s displayed by the device does not fit the needs and objectives of the clinician, then the device is of little use. As for interactivity, ideally, the device would allow for some interaction or customization of the user interface by the clinician. Bitan and his research team were able to study such factors in a simulation where an AI was aiding the detection of bacteria in the bloodstream. Their preliminary data, which will be published at a later 24

OR TODAY | September 2021

date, suggests that displaying relevant information and interactivity are an important element of trust in AI/ ML-enabled medical devices. “We really could see that when the physicians felt that if they had relevant information, they felt more confident about the system and had more trust in the system. We [also] saw that when they had more interactive work with the device, they had more trust in the system,” Bitan added.

High Value of Human Factors Engineer Embedded in the Clinical Setting Human factors engineers work to understand how human involvement impacts the use and usability of medical devices. But what can they add to the mix when embedded in a clinical setting? A lot, according to Brittany Anderson-Montoya, a human factors specialist at Atrium Health, who with other embedded human factors engineers (HFEs) discussed their role in the clinical setting and the value of HFE embeds in improving patient health and medical device usability at the symposium. HFE professionals are tasked with understanding how human involvement impacts the use and usability of medical devices, helping end users as well as manufacturers understand how to better design devices with actual application in mind. “Medical device use errors really continue to contribute to adverse patient events despite a lot more focus from FDA and other regulators to make devices more userfriendly,” Anderson-Montoya said. She explained that a common driver of adverse events is that new, sophisticated technology is causing medical devices to become more complex. But it isn’t only new devices that can be difficult for clinicians and patients to grasp. As devices are updated and tweaked, the opportunity for error is reintroduced. “I think any of us who are clinically embedded will state that even a small change, something that seems very innocuous … can have huge ramifications for the usability engineering of the device, and really can have deleterious consequences for WWW.ORTODAY.COM


news & notes

patient safety,” Anderson-Montoya noted. The big-picture issue, though, is the disconnect between the end users and the manufacturers. By encouraging more users — clinicians, HFEs, even patients — to actually report device-related injuries and errors, Anderson-Montoya hopes that a closed feedback loop can be created to better guide usage of potentially problematic medical devices. Part of that starts with the procurement process, as Emily Rose, a biomedical engineer for Providence Health Care, discussed. Procurement focuses heavily on utility and cost, Rose explained, but what she has tried to do is “introduce this idea that there’s a third prong that needs to be considered, and that is usability.” Rose has worked with the Western Canada Human Factors Collaborative to help introduce this line of thinking to the organization handling medical device procurement for the Collaboratives many members. Rose noted that there are three main benefits of embedding the human factors approach into the procurement process: 1. Identify design problems that may affect patient safety and quality of care. 2. Provide additional information for decision-making (e.g., implementation concerns, troubleshooting). 3. Quantify level of consistency between new device and current workflow, including the degree of standardization and error potential. “There’s still a disconnect between the industry work and the applied work creating a ‘work as imagined’ versus ‘work as done’ confound,” Anderson-Montoya noted in her own presentation about the procurement process. The sentiment was echoed by Rose. “The nice thing about being embedded is that we can really bridge this gap. We can translate some of the theory to the applied setting, and we can really tailor our approach to the unique culture and environment of our system.” By focusing on usability from the start of the process, providers can utilize the expertise of their embedded HFEs to help prevent medical device errors before they even pop up in the clinical setting. “We were initially very academic in our application of human factors methodologies,” Rose explained. “We’ve since had to understand [how to] deliver very actionable results to our organizations.” For more information, find full coverage of the event at AAMI.org.


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Annual Conference


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October 22-23, 2021 Atlanta, Georgia

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September 2021 | OR TODAY





the over



from anywhere! THURSDAYS AT 2PM ET | WEBINAR ARCHIVES ONLINE ORTODAYWEBINARS.LIVE OR Today has been approved and is licensed to be a Continuing Education Provider with the California Board of Registered Nurses, License #16623. CBSPD CE credits when applicable.



Experts Share How to Optimize Perioperative Performance Staff report


he OR Today webinar “Using Dynamic Block Management to Optimize Perioperative Performance” was a hit with attendees. The webinar, sponsored by Hospital IQ, 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. In this 60-minute webinar, experts Shawn Sefton and Kim Hamilton discussed how outdated, manual processes and lack of trusted data limit OR utilization. Traditional approaches for managing perioperative block allocation are rigid and often lead to underutilized ORs and unsatisfied


surgeons. Attendees were able to learn how AI and automated workflows can help dynamically manage blocks and improve perioperative performance by improving access to available OR time. The experts also discussed creating visibility and transparency in block management as well as simplifying the process of booking OR time. They also addressed streamlining the process of managing the block schedule. The webinar was well attended, and participants provided feedback via a survey that included the question, “How well did the content that was delivered match what you were promised when you registered?” “Matched well,” Nurse Manager H. Comeau said. “Very well,” Clinical Director D. Bell said. “Quite well,” Senior Nurse M.

Bueno said. The OR Today webinar series has amassed 2,073 registrations through July 22 and is averaging almost 200 attendees per session. Generous sponsorship from leading perioperative companies make registration free and provide health care professionals an excellent opportunity to further their education. The webinars are also recorded and available for on-demand viewing For more information, visit ORTodayWebinars.live.

Thank you to our sponser:

September 2021 | OR TODAY



market analysis

Reports: Patient Positioning Market Expends Staff report


recent report by Persistence Market Research (PMR) details trends in several high growth markets and on the demand for patient positioning accessories in particular. Patient positioning accessories are utilized in diagnostics and surgical procedures for patients’ wellbeing and experts’ ease of access to the patient. The market for patient positioning accessories is developing based on current medical services requirements. Improvements in prescription and nursing medical care innovation have led to increased demand for patient positioning accessories across regions. The PMR report states that an increasing number of surgeries and technological advancements are major factors driving the patient positioning accessories market, which is slated to expand at a compound annual growth rate (CAGR) of more than 3% from 2021 to 2031. PMR adds that patient positioning accessories are needed for the older population for everyday exercises and for those recuperating from injuries, medical procedures or other ailments. Leading players are focusing on collaborations with other players for geographical footprint expansion for distribution of products worldwide. Players are also focusing on collaborations with hospitals and radiation centers for the supply of products such as thermoplastic masks, sheets, cushions and other similar devices, which provide long-term opportunities in the market. Long-term contracts are expected to have fruitful returns. Favorable reimbursement policies and increasing health care expenditures are also factors that are driving market growth. Grand View Research also predicts market growth. 28

OR TODAY | September 2021

The global patient positioning systems market size was valued at $942.8 million in 2016 and is expected to expand at a CAGR of 4.7% during the forecast period, according to Grand View Research (GVR). The growing geriatric population, increasing prevalence of cancer, rising awareness among the patient population and surging expenditure on diagnostic procedures are expected to boost the patient positioning systems market during the forecast period. “The products analyzed in this study include tables and accessories,” the GVR states. “The tables segment is expected to dominate the market owing to increased demand and a rising number of hospitals, ambulatory centers, and other settings such as specialty centers and diagnostics centers. The tables segment is expected to retain its lead over the forecast period due to rising demand for efficient and accurate diagnostic imaging, which is creating growth opportunities for the segment.” “The accessories segment is expected to witness the fastest growth in the market, owing to the increasing number of patients undergoing different types of surgeries and diagnoses. There is a greater demand for diagnosis in developing countries such as India and China, which may drive sales of patient positioning systems over the forecast period,” the report adds. MarketsandMarkets states that the global patient positioning system market is expected to reach $1.2 billion by 2022 from $990 million in 2017, at a CAGR of 4.5%. The growing hospital investments to upgrade operating rooms and rising geriatric population are major driving factors for the patient positioning equipment market.




product focus

Yellofins Apex Stirrups

The Yellofins Stirrups line from Hillrom represent enhanced safety, with a dual-rod design that prevents medial leg drop, and automatic position-locking technology to safely position the patient while protecting both the patient and the surgical team. In addition, Yellofins Apex stirrups offers greater ease-ofuse with single-point boot release capabilities, alleviating the need for heavy lifting. To help enhance infection control, Yellofins Apex stirrups include welded pads and removable silicon straps that are easy to clean and reduce the surface area accessible to potential contaminants.


AliBlue Gel Positioners AliBlue Gel Positioners are a cost-effective reusable gel positioner for all surgical positioning needs. AliBlue Gel Positioners are made from 100% viscoelastic gel, are impervious to fluids and easy to clean.


September 2021 | OR TODAY



product focus


Schure Loc XPS SchureMed’s Schure Loc XPS extremity positioning system provides rigid fixation as well as an unlimited intraoperative range of motion for shoulder replacement, arthroscopy and rotator cuff surgeries. The Schure Loc XPS attaches to any surgical table by hooking the integrated universal table clamp to the side rail and tightening the star knob. Simply depress the lever to release all six joints. The patient’s limb can be easily secured in an unlimited number of positions, relocking instantly when the lever is released.

Encompass Group Patient Positioners

Encompass Group helps take the pressure off so that professionals can focus on care. Its portfolio of positioners and overlays assists the patient care team with a variety of sizes and designs that provide support, stability and positioning options to sensitive areas during procedures and recovery. Encompass offers a wide range of patient positioners to fit operating room needs including knee, leg, hip, foot, ankle, shoulder, arm, elbow and hand positioners. For more information, visit encompassgroup.com.


OR TODAY | September 2021



product focus

Action Products Inc. OR Table Pad

The Action brand offers head-to-toe pressure injury protection. It has designed a variety of support surface options to fit a facility’s individual needs. Professionals can choose what balance of clinical effectiveness and cost efficiency is right for them. The benefits of every Action OR Table Pad are: • 4-way stretch fabric for shear reduction and immersion benefits • Meets ergonomic weight limits for hospital staff • Biocompatible • Easy to clean • PVC free • Available in multiple styles • Imaging compatible • Available in multiple thicknesses • Silicone and Plasticizer Free • Armboard pads available • Not made with natural rubber latex • Large selection of models For more information, visit ActionProducts.com.

D.A. Surgical

TrenGuard Trendelenburg Patient Restraint Sliding in Trendelenburg can cause post-operative pain or even serious injury. Even the smallest unintended movement can be a big problem in robotic-assisted surgery. The TrenGuard “Speed Bump” bolster is proven to prevent patient sliding in steep Trendelenburg, without the use of shoulder braces or chest straps. Designed to improve OR efficiencies, TrenGuard sets-up under 2 minutes and simplifies patient repositioning. For more information, visit da-surgical.com.


September 2021 | OR TODAY




continuing education

Do You Reflect a Positive Image of Nursing? By Rosalinda Alfaro-LeFevre, MSN, RN, ANEF and Sheila J. Leis, MS, RN-BC very year, Gallup asks the public to rate the honesty and ethical standards of people in 23 professions. Nurses routinely come out on top, higher than physicians, dentists, and clergy members.1


Despite this favorable response, negative images of nursing still exist. Some examples include: • Television (e.g., the demeaning way nurses are treated on medical dramas) • Movies (e.g., Nurse Ratched from “One Flew Over the Cuckoo’s Nest”) • Books (e.g., novels with medical characters often ignore nurses or put them in bit roles) • Greeting cards (e.g., many getwell cards poke fun at nurses) • Stock images Negative stereotypes include nurses as “battle-axes,” physicians’ handmaidens, “airheads,” and sex objects. We can explain this dichotomy of trustworthiness vs. negative stereotypes by understanding that trust is only one component of image. The public may trust nurses but have little understanding of what they do and do not think of them as key players in healthcare. Negative images and unrealistic roles of nurses perpetuated by the media influence people’s perceptions. It is up to us to promote ourselves as qualified profes32

OR TODAY | September 2021

sionals who have valuable knowledge that significantly influences patient outcomes. To recruit and keep competent, caring nurses, we must get the message out that the nursing profession attracts talented, bright people. This module concerns the interplay between public and personal image and offers tactics you can use to promote the image of nursing at work, at home, and in the community.

Link Between Public and Personal Image The public image of nursing includes how the media portray us and how the public perceives us. Public image matters because of the complex relationship between how we view ourselves as professionals and how the public views us. For example, public image affects how we feel about ourselves. Self-concept and self-image is affected and shaped by interactions with others, including patients, co-workers, and the public in general.2 One study concluded that the public image of nursing is “diverse and incongruous.”3 The authors of this study noted that image is partly self-created by nurses due to their invisibility and their lack of public dialogue. They also concluded that nurses derive their self-concept and professional identity from their public image, work environment, work values, education, and traditional social and cultural values.3 One nurse conducted a detailed literature review on the image of nurses, exploring why image remains an issue

given the long history of discussion and proposed solutions to the problem.4 She concluded that public- and self-image are intertwined and that as a profession, nurses do not have a very positive self-image. Because the self-image of nurses drives the social value of nurses, we need a better self-image to ensure a better public image. 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 37 to learn how to earn CE credit for this module.

Goal and Objectives The goal of this program is to provide nurses with information on nursing and its image so they can improve the image of the profession by acting individually and as a group. After studying the information presented here, you will be able to: • Discuss how self-image affects the image of nurses. • Describe at least three ways to promote a positive nursing image in your workplace and to the public. • State five actions nurses can take individually to improve the image of nursing.



continuing education Changing how we feel about ourselves changes how others think about us. Leann Strasen, RN, provided additional insight into the complexity of self-image and public image. She developed a model based on the linkage of thoughts and beliefs to action.4 Thoughts and beliefs, shaped by socialization factors (such as experiences, heredity, environment, gender socialization, and reference groups) influence self-image, action, and performance. Improving how nurses view themselves is likely to influence this cycle.4 For example, nurses who see themselves as professionals will be strong advocates for their patients. Patients experience this advocacy and remember it when talking with others. This simple conversation contributes to the overall public image of nursing, which, in turn, improves nurses’ self-image. Developing nursing’s image begins with exploring how nursing students view themselves and the profession. Using a nurse as a role model is effective for students choosing nursing as a career. In one study, students who were related to a nurse were more likely to carry a positive image of nursing. Most students in this study, who started with a positive image of nursing, reported professional success and satisfaction.5

Who is Responsible? It is easy to sit back and complain. Yet each of us is responsible for nursing’s image, from how we treat patients and colleagues to what we tell relatives, friends, neighbors, and community members about our profession. We have an ethical duty to promote the image of nursing, dating back to the Nightingale Pledge, which states, “I will do all in my power to maintain and elevate the standard of my profession.” The

American Nurses Association’s Code of Ethics for Nurses makes a stronger statement: “The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice and for shaping social policy.”6 One way we can articulate WWW.ORTODAY.COM

nursing values is to speak to the public about what we do. The authors of “From Silence to Voice: What Nurses Know and Must Communicate to the Public” (http://digitalcommons.ilr.cornell.edu/cgi/viewcontent. cgi?article=1024&context=books) recommend imparting knowledge via three tiers of public communication:7 • Professional self-presentation • Anecdotal descriptions of nursing work • Mass media (television, newspapers, radio, and YouTube, blogs, Facebook, Twitter, and other social media). This model enables all nurses to participate at least through tier 1 (professional self-presentation). As you gain new skills through practice and modeling, you can move into the other two tiers. One challenge involves the differing perceptions about what constitutes a “good” image. For example, is the image of nurses as “angels” helpful or hurtful? It may be a little of both. Angels have a positive image, but as one author states, “If virtue is its own reward, nurses cannot claim the importance and value of what it is they do.”4 We want to embrace the fact that people view us as caring. But do we really want people to see us as angels? Perhaps we can all agree to promote nursing as a profession that uses evidence-based practice to improve the care of people who need help. Wear your brains, as well as your heart, on your sleeves.

10 Actions to Take Today How can we take on the image of nursing, given our already busy professional and personal lives? Here are 10 actions you can start to take today. 1. Identify yourself as a nurse. Introduce yourself as a registered nurse or a licensed practical nurse. Consider whether the uniform nurses wear in your organization is consistent for all nurses, thus differentiating them from other caregivers. Patients report that RNs were more easily identified when wearing a standardized uniform style and color.8 Be sure these

uniforms promote a professional image. (We will discuss the research on dress codes later.)

2. Join professional nursing associations. It can be the American Nurses Association, your specialty association, or The Truth About Nursing, a nonprofit association dedicated to improving the image of nursing in the media. Ideally, you should join more than one association.

3. Give nurse-related books as gifts to non-nurses. Choose books that will inspire and inform others about the nursing profession. Check out some of the resources in the sidebar “Resources for Talking About Nursing.”

4. Spread the word about nursing work and contributions. Talk about what you do with friends and family. Make presentations to children and community groups. Here are some age-specific approaches: • Younger than age 9: Use coloring sheets or books, tell stories • Ages 9 to 11: Play interactive games • Ages 12 to 14: Focus on nursing as a “cool” profession • Ages 15 to 24: Point out the many different jobs for nurses throughout the world, the work flexibility, the good salaries, the job security, and the rewards of making a difference in people’s lives

5. Participate in political campaigns and legislative efforts related to healthcare. At the very least, learn the names of your elected officials and email them, identifying yourself as a nurse. Find the contact information for your elected officials at: https://www.usa.gov/electedofficials.

6. Seek donations for scholarship funds. Even small donations add up and remind people about the importance of nursing.

7. Serve on community and organization boards. This gives people the opportunity to see nurses in action. One success story is the tenure of Jennie Chin Hansen, RN, as president of AARP. You do not have to start at the top; the school September 2021 | OR TODAY



continuing education

Resources for Talking About Nursing Internet • discovernursing.com. This site includes free brochures and videos from the Johnson & Johnson Campaign for Nursing’s Future, profiles of nurses in different roles, descriptions of nursing roles, and a free newsletter. • The American Nurse: Healing America, a documentary. • 50 Top Nursing Blogs for 2015: Top RN to BSN • Youtube.com. Put “nursing image” or “nursing careers” in the search field and you get many excellent videos on promoting nursing’s image.

Books For history buffs: • “American Nightingale: The Story of Frances Slanger, Forgotten Heroine of Normandy,” by Bob Welch • “Nightingales: The Extraordinary Upbringing and Curious Life of Miss Florence Nightingale,” by Gillian Gill • “We Band of Angels: The Untold Story of American Nurses Trapped on Bataan by the Japanese,” by Elizabeth M. Norman, RN For those interested in U.S. healthcare: • “Nursing America: One Year Behind the Nursing Stations of an Inner-City Hospital,” by Sandy Balfour • “Nursing Against the Odds: How Health Care Cost Cutting, Media Stereotypes and Medical Hubris Undermine Nurses and Patient Care,” by Suzanne Gordon • “Saving Lives: Why the Media’s Portrayal of Nurses Puts Us All at Risk,” by Sandy Summers and Harry Jacobs Summers For mystery lovers, collectors, and short story lovers: • “Twice Dead,” by Eleanor Sullivan, RN, PhD • “Postcards of Nursing: A Worldwide Tribute,” by Michael Zwerdling, RN • “When Chicken Soup Isn’t Enough: Stories of Nurses Standing Up for Themselves, Their Patients and Their Profession,” by Suzanne Gordon

board or the board of directors of a community association would do the trick. 8. Write a letter to the editor. Make the letter brief and send it promptly. Use only RN, APRN, or LPN after your name. A string of credentials may confuse the public. 9. Use your talent. Combine your nursing and writing or speaking expertise to write articles or give presentations for consumer publications. If you are a photographer or an illustrator, host a local show of works depicting nurses in action. The talents of nurses are endless; so are the possibilities.

10. Be a role model everywhere you go. If nurses want to be treated as professionals, they must act like professionals.

Promoting Nursing’s Image in Organizations The single most important action nurses can take to improve the image of nursing is to “walk the talk,” or behave how 34

OR TODAY | September 2021

you want to be perceived. For example, consider the following questions: Do you gossip and put down coworkers, or are you the one who works with others to find solutions? Do you treat everyone with respect, from the housekeeping staff to the chief surgeon? Be sure you have a professional code of conduct that guides your interactions. (See your organizational code of conduct or download the Health Team Code of Conduct handout from http://www.alfaroteachsmart.com/handouts.html.) Meetings provide ideal settings to model professional behavior. The next time you are in a multidisciplinary meeting defending your point of view, pause and consciously listen to the others in the room. Keep an open mind and consider how to collaborate. Remember that everyone from physicians to nurse assistants takes away an impression of nurses from the interaction.

Other Techniques to Improve Nursing’s Image Pay attention to how you introduce yourself to patients. The way you approach patients leaves a lasting mark. For example, when you introduce yourself, do you say, “Hi, I’m Cindy. I’m your nurse today”? Are you rushing about as you say this, looking at everything in the room except the patient? Instead, look the patient in the eye (if culturally appropriate) and say something like, “Hi, I’m Cindy Saver. I’m the registered nurse (or licensed practical nurse) taking care of you until 7 this evening.” You can even go one step further by pointing to your ID badge and saying something like, “You can tell who’s a registered nurse and who isn’t here because it’s on our badges.” Or if RNs wear specific colored uniforms, you can point to your uniform and say something like, “Navy blue uniforms here signify registered nurses.” This teaches patients how to WWW.ORTODAY.COM


continuing education know when a caregiver is an RN.

Use gratitude to reinforce what nurses do. When patients thank you, do not say, “No problem” or “It was just my job.” Instead, use it as a chance to educate them. Say something like, “I’m glad I could help you understand the importance of how to take your asthma medicine correctly.”

Follow the dress code and dress for respect. What we wear says a lot about who we are. One organization has addressed the complex issue of dress codes by researching how to develop an evidence-based dress code within a healthcare organization.9 Nurses formed an “Image of Nursing” committee as part of the recruitment and retention committee. The committee stated that “as promoters of shared governance, all nursing personnel are responsible for presenting and upholding a professional image. Each nurse is empowered to hold each other accountable to the dress code recommendations that exemplify pride, dignity, and professionalism in appearance.”9 The nurses on the committee reviewed more than 60 sources of evidence, patient perception surveys, and expert and staff nurse opinions to develop an evidence-based dress code to enhance professional image. They concluded that a dress code must consider the following:9 • Identification. The public must be able to identify nurses. While traditional white uniforms help, patient preferences and perceptions of nurse approachability favor bright colors. • Professionalism. Professionalism can be defined by attire and by how nurses interact with patients and families. The literature shows that patients believe they are receiving better care if their nurses look professional. • Functionality and practicality. Nursing attire must be functional and practical. • Hair hygiene. Patients prefer that if nurses have shoulder length or longer hair, they pull it up or back. WWW.ORTODAY.COM

Pediatrics. Children and their parents prefer printed tops or bright colors. Based on the themes of professionalism, identification, functionality, and practicality, the research group gave detailed recommendations that included discipline-specific standardized colors for professional attire of various healthcare team members. The recommendations from this group are lengthy and detailed. If you are working to implement an evidence-based dress code, you may find useful information in this study: What works: Implementing an evidence-based nursing dress code to enhance professional image, American Nurse Today. Do not take dress code requirements personally. For example, those who are fond of piercings and tattoos must keep in mind that dress codes strive to convey a sense of professionalism to consumers (no one is discriminating against you). Also remember the importance of easy-to-read name tags, not only for security but to help others identify you and your role on the healthcare team. Wear them so your name is facing outward even if you do not care for your ID photo. Name tags should clearly state that the wearer is a registered nurse or a licensed practical nurse by including RN or LPN after the name. Some nurses advocate wearing a red RN patch or LPN emblem to enhance identification. To avoid sending a negative image when off duty in public, avoid clothing that does not support the professional image of nursing, such as T-shirts with the slogan “Nurses do it better.” Respect each other. To bolster the self-image of nurses, support each other and celebrate successes. Make recognition meaningful to each person. One nurse might prefer a public pat on the back while another may appreciate a handwritten note. Avoid contributing to the perception that “nurses eat their young” by supporting new nurses and nursing students. •

Understand the business of healthcare. If we want our voices heard by

the “bean counters,” we must speak the language of business. For example, nurses may complain that it does not make sense that they cannot obtain a certain piece of equipment when their hospital is spending so much money on building a new wing. They may not understand that equipment costs come out of the operations budget and construction costs come out of the capital budget; the money cannot be shifted between the two budgets. Use evidence-based practice. Many professions use data and research to support their work. Evidence-based practice encourages clinicians to use the best evidence, in combination with the clinician’s expertise and the patient’s preferences, as the basis for decisions about care. By incorporating evidence-based practice into all levels of nursing practice, nurses align the profession of nursing with other professions and experts who advocate evidence-based practice as a vital method for improving healthcare. Talk about your work with family members, friends, and members of the community. Practice a brief explanation of what you do and use it when you introduce yourself in public. For example, “I’m a registered nurse, and I manage the care of critically ill patients in the ICU.”

Make friends with your organization’s media relations person. Offer that person tours and opportunities to see nurses in action. Offer to provide your contact with news about unique contributions of nurses in your organization.

Build a directory of nurse experts for the media relations department. Media professionals in your organization need to respond quickly to reporters and will appreciate such a resource. Most local television, radio, and newspaper outlets employ reporters who cover healthcare. Learn who they are and offer your services. Remember to respond promptly to any media requests.

Advocate for a link for nursing on your organization’s home page. This sends the message that nursing is important, it attracts job seekers, and it educates the public about nursing. One researcher September 2021 | OR TODAY



continuing education evaluated 72 hospital websites on how they represented nurses, based on specific criteria.10 She found that 44% of Magnet hospitals’ home pages linked to nursing while only 8% of non-Magnet hospitals’ home pages did. You can use this researcher’s criteria to evaluate your own organization’s website and suggest changes. Do not forget students and novices. Teach them the importance of educating the community to dispel the public’s misconceptions about nursing. The National Student Nurses’ Association provides guidelines for educating student nurses and the public on the image of nursing.11 You can also encourage nurses to further their education and offer to mentor new nurses. Write a letter. A letter to the editor can highlight an error in an article, add new information, or present a point of view. Mention your expertise. Include a positive comment even if you are challenging something in the original article. For example, you may write, “I was happy to see your article on snowboarding. But the accompanying photo of adults and children snowboarding without helmets was disturbing. I work in the ICU of a trauma hospital, and every day we treat snowboarding and skiing head injuries, most of which could have been prevented by wearing a helmet.” Keep the letter brief. Send it promptly, before the article or news item becomes dated. You can usually send an email by going to the publication’s website. If you see an offending portrayal on television, write the commercial sponsor, too. Tap into the power of numbers by connecting with media campaigns organized by The Truth About Nursing. When signing your letter, use RN or spell out registered nurse (or use “advanced practice nurse,” or “licensed practical nurse” if applicable). Include only the credentials that are relevant to the topic (e.g., if you are making a comment on wound care, it may be appropriate to add “certified wound specialist” if you spell it out). Too many letters after a name may confuse the public.

Participate in career days and shad36

OR TODAY | September 2021

owing experiences. Volunteer to speak about the nursing profession at elementary, middle, and high school career days to students to promote nursing as a career option.

Encourage the public to use advanced practice nurses. Educate the public about the varied roles of nurses, such as nurse practitioners, certified nurse midwives, and certified registered nurse anesthetists.

Suggestions for Nurse Leaders For leaders, the following are ways to promote nurses’ self-image. •

• •

• •

• •

• •

Recognize achievements, offer encouragement, and be willing to listen and coach your nurses Make sure to put nurse representatives on key committees Make sure articles on nurses appear in general hospital newsletters Work with your staff development department to provide continuing education programs on how to work effectively on a team Review recruitment material to ensure the tone is professional Implement shared governance. See the Forum for Shared Governance for more information Help your organization obtain Magnet status, market it to the community, and live up to its criteria Provide media training for key nurses Promote ways for the community to interact with nurses, including participating in national job shadow days and offering summer camps to kids Implement evidence-based practices in your organization Make sure your nurses know that you have zero tolerance for bullying and lateral (peer to peer) and vertical (leader to subordinate) abuse12 Encourage nurses at all levels

to increase their education and achieve advanced practice degrees

It is Up to You In today’s diverse workplace, your actions and motives are constantly under scrutiny; manage your own professional image before others do it for you.13 As Harvard Business School professor Laura Roberts says, professional image is “[a] set of qualities and characteristics that represent perceptions of your competence and character as judged by your key constituents.”13 Key constituents include patients, families, and co-workers. They are measuring your competence based on the image you project. To promote nurses’ image, you must be able to communicate effectively, negotiate, project a positive attitude, and be receptive to others’ ideas. Work to gain these skills you are the one who holds the power to create a positive image. Relias LLC guarantees this educational activity is free from bias. Rosalinda Alfaro-LeFevre, MSN, RN, ANEF, is the president of Teaching, Smart/Learning Easy in Stuart, Fla. She’s known nationally and internationally for her writings and programs on teaching critical thinking and improving personal and professional performance. Sheila J. Leis, MS, RN-BC, is a full-time nursing faculty member at Indiana Wesleyan University. Her professional experience includes more than 15 years as a professional development specialist in a centralized nursing education department at an 800+ bed Magnet hospital. She has been certified in medical-surgical nursing for more than 25 years.

References 1. Gallup News Service. Honesty/ethics in professions. www.gallup.com/poll/1654/ Honesty-Ethics-Professions.aspx. Published 2018. Accessed July 31, 2019. WWW.ORTODAY.COM


How to Earn Continuing Education Credit 2. Oware-Gyekye F. Projecting the corporate image of nursing and midwifery: Insight from Ghana. West Afr J Nurs. 2015;26(1):60-64. 3. ten Hoeve Y, Jansen G, Roodbol P. The nursing profession: Public image, self-concept, and professional identity: A discussion paper. J Adv Nurs. 2014;70(2):295-309. doi: 10.1111/ jan.12177. 4. Strasen L. “The Image of Professional Nursing: Strategies for Action.” Philadelphia, PA: Lippincott, Williams, & Wilkins; 1992. 5. Elibol E, Harmancı Seren AK. Reasons nursing students choose the nursing profession and their nursing image perceptions: A survey study. Nursing Practice Today. 2017;4(2):67-78. 6. American Nurses Association. Code of Ethics for Nurses with Interpretive Statements. Washington DC: Nursesbooks. org; 2015. 7. Buresh B, Gordon S. “From Silence to Voice: What Nurses Know and Must Communicate to the Public.” 2nd ed. Ithaca, NY: Cornell University Press; 2006. 8. Hatfield L, Pearce M, Del Guidice M, et al. The professional appearance of registered nurses: An integrative review of peer-refereed studies. J Nurs Adm. 2013;43(2):108-112. doi: 10.1097/NNA.0b013e31827f2260. 9. Sulanke J, Shimp K. What works: Implementing an evidence-based nursing dress code to enhance professional image. American Nurse Today. https://www.americannursetoday.

com/works-implementing-evidence-based-nursing-dresscode-enhance-professional-image/. Published October 2015. Accessed July 31, 2019. 10. Kasoff J. How do hospitals represent the image of nursing on their web sites? J Nurs Admin. 2006;36(2):73-78. 11. National Student Nurses’ Association Guidelines for Planning. NSNA Web site. https://www.nsna.org/guidelines-forplanning.html. Published 2018. Accessed July 31, 2019. 12. Murray A. Helping the healers: Identifying and halting lateral violence in nursing. Kentucky Nurse. 2018;66(2):11-13. 13. Wile E. The importance of image in the workplace. The Nest Web site. https://woman.thenest.com/importanceimage-workplace-2396.html. Published 2018. Accessed July 31, 2019.


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

September 2021 | OR TODAY



OR TODAY | September 2021



he United States spends more money on health care as a percentage of gross domestic product (GDP) than any other developed country in the world: nearly 17% of GDP in 2018. This compares to around 10% of GDP in Australia, the UK and Canada. The average spending for health care as a percentage of GDP among Organization for Economic Cooperation and Development (OECD) nations is about 9%. And what do we get in return for this spending? Among 11 wealthy nations included in a recent study conducted by The Commonwealth Fund, the U.S. ranked last in health care quality, access, efficiency and equity, as well as indicators of healthy lives such as infant mortality. “The U.S. health care industry has been struggling with process improvement, quality and cost for a long time,” says Rachel I. Mandel, MD, MHA, senior health care advisor with Operation Performance Solutions,Inc. (OPS). “The amount of waste in health care is estimated to be 25% of the total spend, or more than $800 billion a year.” Statistics like these make now the time for adoption of Lean Six Sigma (or Lean for short) methodologies and tools in health care, and in the perioperative area in particular. “Because Lean principles and tools are intended to help teams work together to identify waste and improve processes to decrease waste, these principles are perfectly suited for application in the perioperative setting,” says Erin Kyle, DNP, RN, CNOR, NEA-BC, editor in chief, Guidelines for Perioperative Practice.

Powerful Operational Philosophies Lean principles originated in the automobile industry where they were originally derived from the Toyota Production System, says David Taylor, MSN, RN, CNOR, the president of Resolute Advisory Group LLC. “These principles are powerful operational philosophies that can help health care organizations, including surgical services, improve their performance,” he says. Although Lean is generally associated with manufacturing and the automobile industry specifically, its philosophies and methodologies can be applied to the operating room, says Mandel. “Process improvement is focused on achieving better results by removing waste,” she says. Taylor stresses that non-health care organizations have utilized Lean methodologies for several decades to eliminate waste, decrease expenses and improve efficiency. “This approach to problem-solving can be successfully applied to health care process improvement projects,” says Taylor. “Research has shown that the elimination of wasted steps and the ability to perform certain tasks in parallel to others can significantly improve efficiency in the operating room.” Mandel lists a few other factors that make this an especially good time for health care organizations to adopt Lean, including the COVID-19 pandemic. “COVID has exposed the gaps in care, especially for the underserved and underinsured,” she says. “Some of these processes were broken even before COVID.” There’s also the need for hospitals and ambulatory surgery centers (ASCs) to become more nimble. “We have a big opportunity right now for improvement,” says Mandel. Reduced waste and cost savings aren’t the only potential benefits of Lean in the health care setting. Robert Klym, chief operating officer with OPS, places improved patient outcomes and experiences at the top of his list of benefits. “Guaranteeing ‘Quality at the Source’ is a core tenet of Lean systems,” says Klym. “We always want to have things done correctly the first time. This intense focus on quality outcomes directly correlates to patient safety.”


September 2021 | OR TODAY


Focus on Eliminating Waste Klym defines Lean as “a set of principles, systems and tools that strives to develop a strong organizational culture. The objective of Lean is continuous improvement through relentless focus on the elimination of waste by every person, at every level, on every process, every day.” Kyle lists a number of different lean tools that can be used effectively in the health care setting: • 5S (Sort/Set in order/Shine/Standardize/Sustain) – This can be used to organize and maintain storage areas for positioning equipment and supplies. • Gemba (the real place) – Here, perioperative leaders make it a priority to systematically spend time where the work happens, such as in the OR, PACU and sterile processing departments. • Just-In-Time (JIT) – JIT inventory planning has been effective in reducing the amount of inventory on hand and costs associated with storing this inventory, as well as improving control of product expiration while on the shelf. • Value Stream Mapping – This powerful tool allows visual mapping of processes in the perioperative environment. In fact, the foundation of a strong Lean organization is built on the stability and standardization of its processes, says Klym. “One example is standardizing instrument packs in an OR so surgeons are confident they will have the tools they need at the time of surgery,” he says. Creating process and equipment stability within the sterile processing department is another example. “This helps ensure that surgeries are not delayed because of equipment breaking down or not running at a consistent rate, thus causing delays or the need to purchase excess instruments,” says Klym.

A Lean Success Story Amy Troy, RNFA, MHA, BSN, CNOR, says that Randolph Health, a small rural hospital in Asheboro, North Carolina, where she previously worked, realized numerous benefits by implementing Lean concepts. “The Huddle was the single most effective Lean tool for us,” she says. As the name suggests, the Huddle involves getting together and talking through issues and problems as a group. “The Huddle created more open communication not only in the OR but also within the anesthesia, sterile processing, PACU, SDS and other departments,” says Troy. Creating Kaizen boards with OR statistics was another effective Lean application at Randolph Health. “Some of the items tracked on the boards included on-time starts, turnover time, OR utilization and supply discrepancies 40 OR TODAY | September 2021

to ensure we were capturing charges,” says Troy. “No one, including surgeons, wanted to see their name in last place on the board.” By implementing a Lean concept known as Kanban, Randolph Health was able to cut its annual cost of supplies in half – from $1.3 million to $635,000. “This affected multiple departments including materials management, which had to be on board with the program,” says Troy. “And it was a hard sell for the OR staff, which wanted 100 items in the supply room bins.” Process mapping was yet another effective Lean tool Troy used at Randolph Health. “This helps you look at the inner workings of a process and it really makes the gaps pronounced,” says Troy. “Having staff sit down and talk about the way they work is an eye-opening experience,” Troy adds. “Nothing works better than a process map to point out gaps that need attention so staff can function more efficiently.” Troy summarizes some of the potential benefits of adopting Lean practices in the OR: • Cost savings, including lower inventory levels and less staff overtime. • Greater staff satisfaction due to more flexible scheduling. • Higher patient satisfaction scores due to shorter wait times and a more streamlined patient flow. • Happier surgeons due to better patient outcomes. • More repeat business from satisfied patients who return for future surgeries.

Lean Challenges and Keys to Success The single biggest challenge to implementing Lean in hospitals and other health care organizations, says Kyle, is the magnitude of change in mindset and operations it requires. “Getting every leader and each of their teams to embrace the change is no easy task,” says Kyle. “Ultimately, the success of Lean is dependent on organization-wide adoption.” Troy believes that the biggest key to a successful Lean implementation is getting OR staff involved early. “There’s often a fear of losing jobs because staff hear that Lean is all about reducing manpower,” she says. “So managers need to explain to staff that Lean isn’t about losing manpower – it’s about maximizing the productivity of the existing OR staff and helping prevent burnout.” Mandel agrees. “The OR staff needs to be a part of the solution and contribute to the process so they understand the rationale behind the changes,” she says. “Otherwise, they won’t embrace it or commit to it. “Ultimately, the goal of Lean is to create culture change,” Mandel adds. “Lean is not a ‘project’ – it’s a way of thinking.” Klym stresses the importance of getting Lean buy-in at WWW.ORTODAY.COM

Top Wastes In the top of the organization. “Very few Lean initiatives are successful without executive sponsorship,” he says. “Lean success starts at the executive level with things like strategy alignment and continues with executive engagement as active members of the implementation efforts.” Health care organizations should focus more on the cultural aspects of Lean, Klym adds, and less on the technical and engineering principles and language. “The use of Lean technical terms can be overwhelming to new adopters, especially those in a health care setting,” he says. “The real power of Lean is in engaging as much of your workforce as possible in the pursuit of activities that eliminate errors, employee frustration and waste,” says Klym. “You want to empower all employees to become the CEOs of their ‘mini-companies.’ ” According to Troy, creating a culture that allows staff to feel comfortable with each other and think outside the box is another important key to Lean success. “Let your staff have full control of the changes brought about by Lean and support them by helping them through the inevitable roadblocks that emerge,” she says. Taylor recommends that health care organizations hire a consulting firm that specializes in Lean to assess their needs and help with Lean implementation throughout the surgical and procedural areas. “A consultant who not only understands Lean, but also all aspects of the surgical environment, will give you better, longerlasting results,” he says.

Some Lean Best Practices Mandel suggests that perioperative nurses discuss their interest in Lean ahead of time with leadership in order to get buy-in and initial resources. “Explain your rationale for why you think Lean is important from a patient safety and quality care standpoint,” she says. “Start with something that is a pain point for everyone, including the surgeons, and then pilot an initiative that can be used to support the adoption of a broader Lean strategy.” Troy emphasizes the importance of working on a manageable number of Lean projects at a time. “Don’t work on multiple Lean projects at once because staff will get overwhelmed with all the changes and shut down,” she says. “Then you’ll loss the support from staff and the changes will not stick.” Perioperative managers also need to understand that there’s no one-size-fits-all Lean solution for every situation. “Moving toward better outcomes is the key,” says Troy. “Think of lean tools as being a method of continuous improvement.” According to Klym, one of the biggest complaints patients have about health care is delays and having to wait for their surgeries and other procedures. “With so many patients now having the ability to choose where they receive care, it’s more important than ever to create a positive patient experience,” he says. “Health care organization can decide to invest in more comfortable chairs and nicer TVs in their waiting rooms, or they can adopt Lean systems that aggressively attack processes that might lengthen patients’ wait times,” he adds. “I believe investing in Lean is a better choice.” WWW.ORTODAY.COM

Health Care

Much of the estimated $800 billion that’s wasted in health care each year falls into one of these categories: • Transportation: Long distances between processing and storage locations. • Overproduction: Opening large packs for one instrument or sterilizing vendor sets that aren’t used. • Motion: Inefficiently designed set assembly stations, supplies and cabinets that are remote from the work area. • Defects: Bioburden, torn packaging and putting up sets with missing instruments. • Waiting: Waiting for instruments in the OR and prolonged turnaround times. • Inventory: Carrying excess instruments to cover for slow cycle times and replacing instruments that can’t be located • Processing: Putting instruments through a one-hour sterilization


DNP, RN, CNOR, NEA-BC, editor in chief


Rachel Mandel

MD, MHA, senior health care advisor with Operation Performance Solutions,Inc

September 2021 | OR TODAY



DAVID WALZ to “the energy that came with the care” when he worked as an orderly. Third would be the inspirational connection he felt with the stories of Florence Nightingale, the mother of modern nursing, and her courage in pioneering the field. Finally, his time spent in youth sports cemented in Walz the essential nature of team dynamics, and the strength that can be drawn from comrades in arms, whether mentoring younger players or learning from veterans. “In nursing, you’re part of a broader team, and that always drove me,” Walz said. “I gained an appreciation for the special health needs of others, and how to help them. Being a role model to others went hand-in-hand with the reason I wanted to get into nursing.”

Although it’s not a straight line from there to the human health care field, the execution of such duties “aligns with many of the things we have to do as nurses,” Walz said. His childhood was also colored by a close look at the health care profession from the perspective of his mom, a home health aide nurse, and later, from his wife, Dena, whose career as a gastrointestinal nurse he followed since college. (Walz himself attended St. Cloud State for elementary school education while simultaneously studying nursing at St. John’s University, and graduating with degrees in both.) He credits more than a few influences for his decision to pursue the profession of nursing. The first is his Catholic faith, and its principal tenet of treating others as they would want to be treated. Secondly, the compassion he witnessed in those close to him caring for others was a formative experience, from his mother’s career path in hospice, and the empathy she showed those at the end of their lives,

His first role in nursing came in a dialysis position at St. Cloud Hospital in Minnesota. Walz didn’t select nephrology work out of any innate connection with the discipline, but soon found a great camaraderie with the members of the program at St. Cloud, and rapidly gained an appreciation for the complexity of the specialty. In the chronic care unit, he built relationships with the patients he’d see a few times a week, learning to observe even slight changes in their condition that could be warning signs, and developing an ability to have “critical conversations” with people who “become like a second family.” From there, Walz transitioned into acute kidney care, eventually leaving St. Cloud for an administrative position with Total Renal Care, which eventually became DaVita Kidney Care. “I’ve always loved the high-intensity acute dialysis cases,” he said. “You go into the ICU with them, they’re in dire straits, and then you can maybe pull them back into rhythm. I love really helping people who need your help.”

David Walz enjoys time with family when not busy at work or as ANNA president.


OR TODAY | September 2021


Over the course of the next decade, Walz advanced from administrator to regional operations manager to national manager at DaVita, adding business development skills as he went. When St. Cloud invited him to rejoin its nephrology unit, Walz spent another 10 years advancing the dialysis program at the hospital, expanding its home care lines of service – and, more importantly, remaining at home, where he could put in some years coaching his daughters’ intermediate-grade basketball teams. “I had been traveling 46 to 48 weeks out of the year,” Walz said. Along the way, he also completed an MBA degree, and fell into the American Nephrology Nurses Association (ANNA). From the earliest days in his career, when Walz attended an ANNA meeting in San Antonio, Texas, he found that the organization was not only a critical piece of his professional development, but a bridge to his other colleagues in the field. Back in Minnesota, Walz became a key part of his local ANNA chapter leadership, which qualified him to run for the national board. Eventually, he became the first male president in the history of the organization. “I love connections and building those relationships,” Walz said. “I did local leadership in my chapter, and always wanted to run for the national board. I wasn’t going to, initially, but my dad’s voice was in my head, telling me, ‘Why don’t you leave a legacy? Do something unique that sets yourself apart.’ ” “If I wasn’t elected, I would have moved on,” he said. Tragically, Walz’s father died suddenly of an embolism at 74, and never got to see his son fulfill the advice he’d handed down to him. But during his term as ANNA president, Walz solidified the message his father had sent him by working to shape the course of the national organization during the scope of his term. “Leaving a legacy, no matter how small that may be in your mind, could prove beneficial for others to want to follow in your footprints,” he said. “I think there will be other


men in ANNA who will lead the association in the future; I just happened to be the first. But ANNA has been blessed with some great presidents. There’s a lot of smart women out there. They’re empathetic and they really lead with the heart, which I try to do. I’m just trying to follow.” Today, Walz is the senior director of women’s and newborn health at Centracare-St. Cloud Hospital, a move he made after hospital leadership invited him to help grow that line of service. Emotionally, it returned him to “my roots of the birthing process” from his childhood; “those connections from the past to bring into the present,” Walz said, “but it’s been definitely rewarding.”

September 2021 | OR TODAY


OUT OF THE OR fitness

Taking Care of Your Feet at Every Stage of Life By Miguel J. Ortiz rom the time we start crawling to our very first steps our body and brain are working overtime to create neurological pathways that will ultimately be the building blocks of movement. We commonly know this as “muscle memory.” The more we practice these movements consistently the better we get.


However, as we age the activities and movements we did as a child – crawling, climbing trees, playing tag or more athletic sports – tend to go away. When these movements aren’t practiced as often the rest of the body is affected. And it all starts with your feet. Regardless of the activity, your feet consistently hit the ground. The feet start to adapt and change to a more comfortable lifestyle. When the feet start to change, it affects every joint on the way up. So, no matter your level of activity taking better care of your feet will have you walking better and could relieve quite a bit of pain in your knees, 44 OR TODAY | September 2021

hips and lower back. So, here are three quick daily exercises and stretches you can do to start improving the mobility in your feet. Keep in mind these exercises can (and in my opinion should be) done daily by everyone. The intensity of work may vary from person to person, but these three basic movements can help tremendously. Our first movement starts in a seated position with either a tennis ball, lacrosse ball or golf ball, going from easiest to hardest. Simple place the ball under your foot and lightly massage back and forth slowly for about 1 minute. While rolling, pay attention to any spots that are tighter than others. After the first minute, pick one tight spot and hold that for 30 seconds. Repeat this in three different spots of each foot, for about 5-7 minutes a foot at minimum. By the way, if you have a desk job there is no reason you shouldn’t be able to massage your feet and work at the same time. Second is a stretch done seated or lying down. It is a towel foot/ calf stretch. Place a towel or band

around the bottom of your foot, using your arms grab the towel or band and pull toward you, at the same time try to point your toes toward your face which assist in stretching the calf and bottom of your feet. Hold the stretch for 2 seconds then release while keeping light tension on the band or towel, repeat for three sets of 10 reps each. The third exercise involves some stretching but with more activation to strengthen the bottom of the feet. In a seated position place a towel in front of you rolled out on the floor. Start by placing one foot on the towel. Begin the movement by opening up your toes and foot in order to curl the towel toward you. Try not to move your foot too much so that the focus can be on the balls of your feet and your toes doing more of the curling of the towel versus the bottom half of your leg. The full length of the towel is one set. Perform five sets per side daily. Have fun getting your feet back to a more mobile state in order to stay ready to tackle the day.


EVERYDAY BENEFITS: Regulatory Updates ASCA has the resources to help your ASC remain regulation compliant at both the federal and state levels.

Ambulatory Surgery Center Association



Professional Development ASCA offers several resources to help with your professional development, including education, networking, career boards and training. Legislative Advocacy ASCA strongly promotes the interests of the ASC community before federal and state legislative, regulatory and executive agencies. Medicare Resources ASCA keeps you informed on the Medicare proposals and policies that affect your ASC with weekly updates. Inquire about ASCA membership at membership@ascassociation.org

A membership with ASCA supports professionals like YOU. WWW.ORTODAY.COM

September 2021 | OR TODAY


OUT OF THE OR health

Study Shows Children Recycle Brain Regions When Acquiring New Skills cientists studied the brain activity of school-aged children during development and found that regions that activated upon seeing limbs (hands, legs, etc.) subsequently activated upon seeing faces or words when the children grew older. The research, by scientists at Stanford University in Palo Alto, California, reveals new insights about vision development in the brain and could help inform prevention and treatment strategies for learning disorders. The study was funded by the National Eye Institute and is published in Nature Human Behaviour.


“Our study addresses how experiences, such as learning to read, shape the developing brain,” said Kalanit GrillSpector, Ph.D., a professor at Stanford University’s Wu Tsai Neurosciences Institute. “Further, it sheds light on the initial functional role of brain regions that later in development process written words, before they support this important skill of reading.” Grill-Spector’s team used functional 46

OR TODAY | September 2021

MRI to study areas in the ventral temporal cortex (VTC) that are stimulated by the recognition of images. About 30 children, ages 5 to 12 at their first MRI, participated in the study. While in the MRI scanner, the children viewed images from 10 different categories, including words, body parts, faces, objects and places. The researchers mapped areas of VTC that exhibited stimulation and measured how they changed in intensity and volume on the children’s subsequent MRI tests over the next one to five years. Results showed that VTC regions corresponding to face and word recognition increased with age. Compared to the 5- to 9-year-olds, teenagers had twice the volume of the word-selective region in VTC. Notably, as word-selective VTC volume doubled, limb-selective volume in the same region halved. According to the investigators, the decrease in limb-selectivity is directly linked to the increase in word- and face-selectivity, providing the first evidence for cortical recycling during childhood development. “The loss of limb-selective volume surprised us,” said first author Marisa Nordt, Ph.D., a postdoctoral fellow in Grill-Spector’s lab. “This challenges a the-

ory of cortical development, which states that new representations, like emerging regions involved in word recognition, are sculpted on previously uncommitted cortex. Our study suggests that during childhood, cortical selectivity can change from one category to another.” The study authors suggest that cortical recycling in VTC likely reflects adjustments to changing visual demands during childhood. For example, infants tend to look at faces. As they grow into toddlers and learn language, they are exploring objects and deciphering gestures. Word recognition becomes increasingly important as children learn to read. In future studies, Grill-Spector and colleagues will explore whether decreases in limb-selective VTC volume have behavioral implications, asking if deviations from observed trends have bearing on development disorders. This research was supported by the National Eye Institute (EY022318, EY020485, and F31EY027201) with additional funding from the National Science Foundation (DGE-114747) and the German National Academic Foundation (NO 1448/1-1).


OUT OF THE OR nutrition

Does Water Need an Upgrade? By KIRSTEN Serrano e all know we need water to

W live, but is “upgrading”

your water worth it? An entire industry has built up around not just bottled water, but also water with additives from vitamins to caffeine and even CBD. Let’s cut through some of the nonsense and look at a few water upgrades that are worth your time and money. Remineralizing your water. If you, like me, are drinking filtered water (especially by reverse osmosis), remineralizing your water is a smart investment. Water is meant to come to us with trace minerals, but filtration can remove them. Water usually contains calcium and magnesium, but also trace minerals like zinc, selenium, copper, sodium and manganese (among others). In the case of reverse osmosis filtration, the minerals are removed completely and that is a problem. A World Health Organization report laid out the very real health risks from demineralized water including hypertension and coronary heart disease, gastric and duodenal ulcers, chronic gastritis, goiter, pregnancy complications and several complications in newborns and infants.1 Options for remineralizing your water: Some water filtration systems offer remineralization, but you can add your own after the fact. Add mineral rich salt. Himalayan salt contains 84 trace minerals and is inexpensive. Adding a pinch to your water will improve flavor while nourishing you. Cooking with this kind of salt is another way to make sure you WWW.ORTODAY.COM

are getting these trace minerals. Add mineral drops. I have a bottle of trace minerals sitting next to my reverse osmosis water faucet and add drops before I drink. You can experiment with the amount that tastes good to you. Apple Cider Vinegar. If all the hype was true, apple cider vinegar would have already cured everything and everyone. Despite the overblown claims, there are compelling reasons to add some ACV to your water. It improves digestion. If you have reflux, taking some ACV in water a few minutes before eating may help. By boosting the acidity of the stomach, the entire digestive process is enhanced. It improves blood sugar. Numerous studies have shown decreased postprandial (post meal) blood sugar levels decrease significantly in insulin resistant and type 2 diabetic individuals when ACV is taken before a meal. The acetic acid in ACV helps glucose get out of the bloodstream and into muscles and has been compared to Metformin.2 If the idea of drinking some vinegar in your water is not appealing, there are a few ways to make it easier to swallow. Here are a couple to check out: Sipping vinegars: These are products designed to make drinking vinegar more enjoyable. Some are meant to be drunk straight from the bottle as a “tonic” and are highly diluted and others are concentrates meant to be added to water. In general, they have some fruit juice added and perhaps a sweetener. Shrubs: Shrubs are really a type of

sipping vinegar that was developed to preserve fruits in England and colonial America. Vinegar would be poured over seasonal fruits. The fruit would later be strained out, sugar or honey would be added, and the liquid reduced into a concentrate. In this way, the fruit could be stored to enjoy yearround. Shrubs are making a comeback now as Americans rediscover the benefits and discover new tastes. Water is already the perfect beverage. All of the drops and packets meant to flavor and sweeten water are usually doing nothing for your health. Remineralization and adding a little vinegar are ways you can smartly “upgrade” water to enhance your health.

– 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.

1. HEALTH RISKS FROM DRINKING DEMINERALISED WATER Frantisek Kozisek National Institute of Public Health Czech Republic, https://www.who.int/water_ sanitation_health/dwq/nutrientschap12. pdf Diabetes Care 2004 Jan; 27(1): 281-282. https://doi.org/10.2337/diacare.27.1.281 2

September 2021 | OR TODAY


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Employees Want More Feedback, Fewer Meetings By daniel bobinski, M.Ed. n recent months I’ve used this space to talk about the value of empathy, because lack of empathy from managers is one of the main reasons people leave their jobs. But in addition to empathy, what else helps people stay and be more productive? According to a recent survey of 2,000 employees conducted by OnePoll, feedback tops the list. In fact, American workers place a higher value on getting feedback about how they’re doing than getting an increase in pay.


Getting more money runs a close second, but it’s interesting to see what else appears among the top 10 answers. I’ve listed the top 10 here, along with the percentage of people who thought those factors were important in the manager-employee relationship. As you read them, take note of how many are related to feedback: • Feedback on their role: 53% • Money: 48% • Honest communication: 48% • Higher titles: 47% • Appreciation: 41% • Recognition: 41% • Frequent one-on-ones: 40% • Responsibilities: 38% • Transparency on company direction: 38% • Willingness to listen to their feedback/concerns: 21% WWW.ORTODAY.COM

By definition, feedback is not advice, praise or evaluation, but rather information. Of course, positive or negative feedback can be perceived as praise or evaluation, but bottom line, at the heart of a desire for feedback is people wanting to feel assured that they are doing what’s expected. People want to know that their work brings value to the team. This idea is supported by how many factors in the top 10 list are related to employees getting feedback. Did you notice that honest communications tied for second place? Employees also want transparency on company direction. In other words, they want to be informed as to how their doing and they want to be kept up to date on the organization’s goals, all in an authentic, straightforward manner. Not only do employees want to receive feedback, the last item on the list indicates they also want to give it! Did you also notice that frequent one-on-ones is important to them? This indicates to me that employees prefer supervisors who see employees as individuals, not as cogs in the wheel. They also don’t want all this feedback dropped on them at team meetings. Interestingly, the OnePoll survey also asked what employees dislike the most. Topping the list was pointless meetings (55%), and second was last-minute emergencies (47%). To avoid these buzzkills, manag-

ers do well to spend time planning and organizing. Thinking through projects and assignments minimizes the number of last-minute emergencies that crop up. And, as mentioned previously in this space, make sure all meetings have a clear purpose and an agenda. Curtail rabbit trail dialog so that meetings can wrap up quickly and team members can get back to work as soon as possible. Looking over the above list, I think it’s fair to say supervisors and leaders having quality conversations with employees is key to keeping them around. This probably ought to be a major focus. With help wanted signs just about everywhere, it’s the employees who are in demand – not the employers.

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 Daniel through his website, MyWorkplaceExcellence.com, or his office: 208-375-7606.

September 2021 | OR TODAY


OUT OF THE OR recipe

Brown & wild rice bowl with veggie burger INGREDIENTS: • 1 cup Minute Ready to Serve Brown and Wild Rice • 1 precooked veggie burger patty


• 1/2 cup of shredded lettuce • 1/2 cup halved grape tomatoes • 2 tablespoons shredded cheddar cheese • 2 tablespoons ranch dressing


By Family Features

50 OR TODAY | September 2021



Fast, Flavorful Meals When You’re Short on Time


By Family features uality meals don’t have to drain hours from your day; satisfying taste is possible in just minutes when you have a few strategies that can help make meal prep easier and the results more enjoyable.


Eat better with veggies. If eating better is your goal, explore veggie-based recipes that are hearty and filled with nutrients and vitamins. This Brown and Wild Rice Bowl with Veggie Burger is perfect for a meatless Monday or any other day when you need a fast, filling and flavorful meal in short order. If you don’t have veggie burgers at home, or simply prefer a meat-based option, a cooked frozen beef patty is a good time-saving alternative. Make simple swaps for variety. When you find a dish that’s easy and tasty, you may find yourself falling back on the same thing again and again. Prevent taste bud boredom by mixing up your ingredients. You can transform a rice-based recipe by changing up the veggies, cheese, dressing and other toppings. Try pickled jalapenos for spice. Add corn if you like things sweet. Swap a creamy dressing with a zesty vinaigrette for fewer calories and a whole new taste. Shop for convenience. Takeout may let you skip prep time completely, but you can easily make versions of many favorite to-go meals at home in just a few minutes. Perfectly portioned Minute Ready to Serve microwavable rice cups help you put together a delicious lunch or dinner without measuring or overeating. Choosing products like portion-controlled rice and other ready-to-serve ingredients can help shave time off your prep work. Tempt your taste buds with more convenient meal ideas at minuterice.com.

Brown & Wild Rice with veggie burger Prep time: 5 minutes Servings: 1 1. Prepare rice according to package directions.

Microwave on high 60-90 seconds, or until veggie burger is heated through. 3. Toss together rice and veggie burger. Top with lettuce, tomatoes and cheese. Drizzle with ranch dressing

2. Break veggie burger into large chunks and place in small, microwave-safe bowl.


September 2021 | OR TODAY


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ible until it ss o p im s m e se s y a “It alw

’s done.”

– Nelson Mandela


OR TODAY | September 2021


The News and Photos


that Caught Our Eye This Month




hile adults may joke about needing to relearn how to

low or stomp my feet to get the feelings out of my body.” As a

be around others in a post-pandemic world, children

family, try practicing some simple emotion regulation strategies

can also benefit from a refresh of certain soft skills – especially

like deep breathing. To help younger children breathe deep, hold

young children who may not remember pre-pandemic life.

up two fingers and ask them to smell the flower as they inhale

Building on these skills can also help children prepare for a successful school year. In fact, data from Mintel shows parents’

(one finger) and blow out the candle as they exhale (the other). Play with other children: Play gives children an opportunity

top learning priorities for their children prior to entering grade

to freely express their emotions and thoughts, work out feel-

school are how to play well with others (67%) and good man-

ings and explore relationships in a safe, lighthearted way. If you

ners (66%).

feel comfortable and can follow health and safety guidelines,

“Summertime is a great time for families to help their

visit a playground or set up play dates with other children

children focus on social skills that may not have gotten much

of similar ages then take a step back to let the children play

attention this past year, particularly if families were social

together. If your children aren’t ready to play with others, allow

distancing or in quarantine,” said Taunya Banta, inclusion

them to stay close to you until they feel ready to join the other

services manager for KinderCare


Learning Centers. “Parents can set

Once the children are playing to-

their children up for success when

gether, observe their interactions and

school starts again in the fall by

talk with your children (in the moment

helping them work on these soft

or later) about how they felt. If they had

skills in relaxed settings like family

fun, ask what they enjoyed. If disagree-

gatherings and on the neighbor-

ments or awkward moments came up,

hood playground.”

help your children problem-solve ways

Consider these ways parents

they could address those situations next

can help their children build social


skills. Name emotions: Naming emotions is an important part of

“Most importantly, remember children of all ages have an incredible capacity for resiliency,”

learning how to regulate them. If your children don’t un-

Banta said. “Just knowing they have a steady base to return

derstand what emotions they’re experiencing, they may be

to, a safe place where they’re loved and appreciated for who

confused or upset by how they feel and that could amplify the

they are, can give children the courage they need to face the

feelings and make it more difficult to regulate the emotions.

challenge of a new or uncertain social situation with self-confi-

Talk with your children about your own feelings, or the feelings of characters in books, to help them learn to identify emotions and appropriate ways to address those feelings. For

dence and courage.” For more tips to help your children build or improve their social skills, visit kindercare.com.

example, “I’m sad, but I know a hug will help me feel better,” or “I’m mad and that’s OK. It’s not OK to hit, but I can punch a pil-


- Family Features

September 2021 | OR TODAY




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FLUID MANAGEMENT MD Technologies Inc.…………………………………………17

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Action Products, Inc.…………………………………………15 Innovative Medical Products…………………………… 9


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AIV Inc.………………………………………………………………… 4 Avante Health Solutions…………………………………… 6 Jet Medical Electronics Inc…………………………… 48


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C Change Surgical………………………………………………13

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OR TODAY | September 2021




TBJ’s SurgiSonic® 1211X features a patented dual hook up method for pre-cleaning da Vinci® instruments utilizing a filtered, independent flushing system combined with ultrasonic action. The unit is independently tested for cleaning effectiveness and exceeded AAMI TIR 30. Three instruments can be pre-cleaned simultaneously.

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