OR Today Magazine August 2022

Page 1





Sterile Processing

UV Disinfection Market

Dianna Copley

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A Clean Instrument Starts with the Right Brush Healthmark offers brushes designed specifically for the task at hand

Tube Brushes For Cleaning Lumens From ultra small to large, Healthmark has a tube brush that is the right size to clean your cannulated instruments.

Flexistem Instrument Cleaning System Flexistems are disposable cleaning brushes that are easily customized to the cleaning needs of all small bore items.

LTA Cleaning Brushes External and Internal LTA brushes include latex-free bristles and handles compatible with steam sterilization.

Specialty Cleaning Brushes Healthmark offers cleaning brushes specifically designed for difficult to clean items such as shavers, reamers, bipolar forceps and more.

Flexible Endoscope Brushes Brushes specifically designed to clean a range of channel sizes as well as valves, ports and elevator mechanisms of flexible endoscopes.


For more instrument cleaning solutions including brush storage, shower units, wipes, sponges and spray guns, visit


OR TODAY | August 2022

contents features


HUDDLE UP! An OR huddle is a quick gathering of personnel to review and discuss cases and any issues that might affect them. Ideally, huddles should take place at the beginning of each workday and last no more than 10 to 12 minutes.




The global ultraviolet disinfection

The goal of this course is to provide

Without a mobile spine, you will lack core

equipment market continues to grow,

nurses in all settings with knowledge of

strength and distal joint strength. The first

including in the health care segment.

interview preparation.

place to start is with the hips.




OR Today (Vol. 22, Issue 08) August 2022 is published monthly by MD Publishing, 1015 Tyrone Rd., Ste. 120, Tyrone, GA 30290. POSTMASTER: See 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. © 2022


OR TODAY | August 2022


contents features






Kristin Leavoy

Dianna Copley, DNP, APRN-CNS, ACCNS-AG, CCRN Clinical Nurse Specialist


EDITOR John Wallace




Gift C

Karlee Gower


Taylor Powers


Kameryn Johnson




Win a $25 gift card!

Blackened Alaska Cod Tacos


Megan Cabot


Emily Hise

DIGITAL SERVICES Cindy Galindo Kennedy Krieg


08 News & Notes 16 TJC: Is That Instrument Safe to Use On A Patient? 18 AAMI: SPDs Address Industry Concerns, Evolving Technologies 20 Webinars: Webinar Addresses DEI 22 HSPA: HSPA Conference & Expo Delivers Education, Networking 24 CCI: The Benefits of a Repository

EVENTS Kristin Leavoy


EDITORIAL BOARD Hank Balch, President & Founder,


Beyond Clean

26 M arket Analysis: Pandemic Powers UV Disinfection Market 27 Product Focus: UV Disinfection 30 CE Article: Interviewing for Career Advancement

Vangie Dennis, MSN, RN, CNOR, CMLSO, Assistant Vice President, Perioperative Services with AnMed Health System Sharon A. McNamara, Perioperative Consultant,


44 S potlight On: Dianna Copley, DNP, APRN-CNS, ACCNS-AG, CCRN Clinical Nurse Specialist 46 Health 49 Fitness 50 EQ Factor 52 Nutrition 54 Recipe 56 Pinboard

OR Dx + Rx Solutions for Surgical Safety Julie Mower, Nurse Manager, Education Development, Competency and MD PUBLISHING | OR TODAY MAGAZINE

Credentialing Institute

1015 Tyrone Rd., Ste. 120 Tyrone, GA 30290

David Taylor, President,

800.906.3373 | Fax: 770.632.9090

Resolute Advisory Group, LLC

Email: info@mdpublishing.com www.mdpublishing.com

Elizabeth Vane, Health Science Teacher, Health Careers High School

58 Index



August 2022 | OR TODAY



news & notes

Encompass Group Brings eMax Replacement Surfaces to Acute Care Encompass Group LLC is bringing its line of eMax Replacement Support Surfaces to the acute care market. “With the overwhelmingly positive reception acute care has given our Airisana Therapeutic Support Surface we’re expanding our product offerings in this important market,” said Michelle Daniels, Encompass Group vice president of product strategy and development. “Therapeutic Replacement Support Surfaces are critical in providing proper pressure management and ensuring patient comfort. And now, with eMax, we’re offering the acute care market a complete range of choices.” The eMax portfolio includes three-tiered construction of high-quality, polyurethane foam in these variations: eMax Reassure. With a top layer of viscoelastic foam from head to toe, it provides immersion and protection against skin breakdown; eMax Classic, with a designated viscoelastic foam and sloped heel section, it provides added protection for the hard-to-care-for heels and lower legs; eMax Gentle delivers head-to-toe rotation for extended periods of clinical efficacy. Additional options are also available to support patients with

behavioral health and bariatric care needs. All eMax replacement surfaces include features to assist health care professionals in this difficult time of resources and fatigue, such as: Firm side rails, designed to support patient or resident transport, facilitate ingress/egress, and to remind the patient or resident that he or she is near the edge of the surface. Inverted seams and a unique, patent-pending band design help prevent infection and infestation. Nylon or multi-way stretch covers are available, and three-tiered, zoned construction of high-quality polyurethane aids in pressure reduction and helps ensure optimal performance. All eMax surfaces are available in widths up to 60 inches and lengths up to 96 inches. “Here at Encompass, we’ve worked hard to develop and deliver surface options for every health care industry need. Bringing eMax to the acute care market is one more way we’re doing that,” Daniels concluded. For more information, visit https://hubs.ly/Q01c0GJTO.

Medline Awarded VA Contract The U.S. Department of Veterans Affairs (VA) has awarded Medline a contract, valued at $150 million annually, to be the sole distributor of non-pharmaceutical medical supplies for the VA’s Consolidated Mail Outpatient Pharmacy (CMOP) program. In service of CMOP enrolled veterans, Medline will continue to deliver more than 4.5 million supplies directly to veterans’ homes, including incontinence, diabetes, wound care and enteral feeding supplies. “CMOP is very pleased to continue our partnership


OR TODAY | August 2022

with Medline for the fulfillment and delivery of medical supplies to our nation’s veterans,” said Rick Purko, RPh, associate chief consultant PBM/CMOP. “CMOP views this partnership as a critical service to ensure that the Veterans we serve receive supplies in a timely and accurate manner, without having to leave their home.” In addition to the VA CMOP contract, Medline also has a separate, ongoing contract to provide medical and surgical supplies to VA hospitals and medical centers.



news & notes

Ethicon Launches Echelon 3000 Stapler Ethicon, part of Johnson & Johnson MedTech, has announced the U.S. launch of the Echelon 3000 Stapler, a digitally enabled device that provides surgeons with simple, one-handed powered articulation to help address the unique needs of their patients. Designed with 39% greater jaw aperture and a 27% greater articulation span, Echelon 3000 gives surgeons better access and control over each transection, even in tight spaces and on challenging tissue. These features combined with software that provides real-time haptic and audible device feedback enable surgeons to make critical adjustments during procedures, according to the press release.


“Surgical complications often stem from difficult-toaccess anatomy and compromised tissue, which this next generation Echelon stapler is specifically designed to address,” said Tom O’Brien, worldwide president, endomechanical, Ethicon Inc. “Our goal, with Echelon 3000, is to arm surgeons with a device that helps address the root causes of surgical complications, enabling them to successfully navigate the differing needs of each patient’s anatomy, deliver on their preoperative plans and ultimately make a meaningful difference in patient outcomes.” For more information, visit ethicon.com/echelon3000.

August 2022 | OR TODAY



news & notes

Kinnos Expands Highlight Disinfection Platform Kinnos, the makers of Highlight, a colorizing system for mission critical disinfectants, launched its next generation of product at this year’s Association for Professionals in Infection Control (APIC) conference. Highlight temporarily colors disinfectant wipes hospitals are already using, providing staff with a visual cue to see where they’ve wiped and instantly improve the quality of disinfection. First designed for use with liquid bleach and ready-to-use bleach wipes during the Ebola outbreak in West Africa, Highlight can now color health care’s most common disinfectant type, quaternary ammonium compound (“quat”) wipes. Highlight is now poised for expanded use within health care facilities looking to improve infection prevention practice and patient satisfaction. Highlight for Quat Wipes enables health

care systems that primarily use quat-based disinfectant wipes to take advantage of the benefits of Highlight. Peer-reviewed studies show Highlight for Bleach Wipes improves cleaning scores by up to 70%, demonstrating a significant opportunity to enhance quality of care in hospitals and eventually beyond. “Asking someone to disinfect a surface with a transparent disinfectant is like asking them to clean with a blindfold on. Highlight essentially takes the blinders off cleaning staff, empowering them to improve their own performance,” explains Jason Kang, CEO of Kinnos. “This critical product compatibility means more patients can be protected through the use of Highlight, a step we believe will dramatically reduce the risk of infection. For more information, visit kinnos.com.

Dale Introduces BreezeLock Endotracheal Tube Holder Dale Medical Products Inc. (Dale) is expanding its offering with its new BreezeLock Endotracheal Tube Holder. Like the Dale Stabilock Endotracheal Tube Holder, the new endotracheal tube holder features a soft, comfortable, flexible neckband with no hard plastic parts. The BreezeLock includes a Tube Track for easy repositioning of the endotracheal tube while still allowing easy access to the mouth for oral care.

“Clinicians tell us they appreciate the improved ease of repositioning with the Tube Track and the security of Dale BreezeLock,” says Robert Simpson, president of Dale. “We are pleased to expand the offering with our new endotracheal tube holder to help clinicians provide optimal care for their patients.” For more information, visit dalemed.com.

Olympus Awarded Bronchoscopy Solutions Agreement with Premier Inc. Olympus has been awarded a group purchasing agreement in the single-use visualization devices category for its single-use bronchoscope portfolio with Premier Inc. The Olympus single-use bronchoscope portfolio is made up of the five premium H-SteriScope single-use bronchoscopes that can be used in complement with Olympus’ re-usable bronchoscope portfolio, already available under the Premier flexible surgical endoscopy agreement. As such, Olympus is currently the only provider of a full-range bronchoscopy solution, which is intended to provide physicians the right endoscope, for the right patient, in the right situation. For more information, visit medical.olympusamerica.com/ single-use-bronchoscopes.


OR TODAY | August 2022



news & notes

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Hip Resurfacing System Granted Breakthrough Device Designation Exactech has announced that the U.S. Food and Drug Administration (FDA) has granted a Breakthrough Device Designation for JointMedica’s Polymotion Hip Resurfacing System. Exactech, a minority shareholder of JointMedica Limited, is collaborating with the United Kingdom-based orthopedic device designer and manufacturer to deliver the next generation of hip resurfacing to the global market and holds exclusive global distribution rights to the product. “This designation by the FDA is a validation of our core belief at JointMedica – that our hip resurfacing device addresses an acute unmet need of relatively younger, active hip arthritis patients,” said Terence Smith, managing director of JointMedica. The Breakthrough Devices Program is a voluntary program for certain medical devices and device-led combination products that provide for more effective treatment or diagnosis of life-threatening or irreversibly debilitating diseases or conditions. With more than three decades of experience using hardon-hard articulations in hip resurfacing, Derek McMinn MD, FRCS, and Ronan Treacy, MD, FRCS, designed the Polymotion Hip Resurfacing System to leverage the clinically successful design principles of their previous hip resurfacing devices, now with advanced polyethylene and titanium manufacturing technology. The Polymotion hip offers the biomechanical benefits of hip resurfacing but eliminates metal-on-metal articulating surfaces.

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August 2022 | OR TODAY



news & notes

Healthmark Announces New Website Healthmark has a newly redesigned website at Hmark. com. When visitors go to hmark.com, they will see a fresh redesign that enhances the look and overall user experience. Besides the new look, the website has new features that include: • Featured products • Product filtering • Optional Customer Registration − allows for sav-

ing favorite products and documents. • Customer Inquiry Feature − allows customers to send saved products of interest to Healthmark’s customer service for support. • Support Document Library − easily filter and search for any available support document at your fingertips. For more information, visit hmark.com.

Digital Tool Gives Surgeons Pre-Theatre Rehearsal Jawbone reconstruction – or orthognathic surgery – is a complicated medical procedure whereby a person’s jaw is treated for significant trauma, such as from a car crash or gunshot wound, or diseases like oral cancer. The surgery involves replacing damaged or diseased bone tissue with an implant, typically a titanium plate or prosthesis, with patient recovery taking as long as 12 weeks. Complications like implant failure and infections are common, potentially requiring repeat procedures which can place significant burden on a patient. In recent years, biomedical engineers have developed a new generation of medical implants designed to not only substitute bone, but to help regenerate tissue back to its original state using 3D-printed tissue scaffold-fixation systems. These devices enhance the innate healing potential of human tissue, using a scaffold as a temporary support structure for the surrounding cells to attach to and grow. Eventually, the scaffold is expected to dissolve into the blood stream, leaving new tissue in its place. Ben Ferguson, a Ph.D. student in the University of Sydney’s School of Aerospace, Mechanical and Mechatronic Engineering, is developing a surgical planning tool to assist surgeons in planning complex jawbone reconstruction procedures using these new generation devices. Using advanced computational technology and decision-making algorithms, the tool works by generating a “digital twin” of the patient using CT scan data. It then rapidly simulates different designs of the implant before 3-D printing the final, optimal design, allowing surgeons to perform a digital “rehearsal” prior to theatre.


OR TODAY | August 2022

“Nowadays, it would be unthinkable to construct a building without running an engineering simulation on it beforehand. This is the industry standard in civil engineering – the same expectation should be applied to surgery on a human being,” said Ferguson, who is due to submit his Ph.D. in September. “The jaw is a complex area – required to talk, eat, chew and perform tasks that require both finesse and strength. Because of its complexity, we want to give orthognathic surgeons the best tools so they are set up for success – hopefully reducing repeat surgeries and improving patient outcomes,” he said. “A bone implant design may work in one patient, but it may fail in another. If it was you – you would probably want a team of surgeons and biomedical engineers to run a simulation and assessment of the medical device in your body before it is actually implanted.” The surgical planning tool combines computer-aided design (CAD) tools with high-fidelity computer-aided engineering models and optimization algorithms that can accurately simulate the medical device while under physiological load. Ferguson’s supervisor, Professor Qing Li, said: “In addition to pre-surgical planning, this simulation data can also assist the surgeon in optimizing the medical device’s design, helping them resolve issues that inevitably arise when designing a device that must meet multiple design and medical objectives.”



news & notes

Inhance Shoulder System from DePuy Synthes Receives FDA 510(k) Clearance Johnson & Johnson MedTech announced that the Inhance Shoulder System from DePuy Synthes, the Orthopaedics Company of Johnson & Johnson, has received 510(k) clearance from the U.S. Food and Drug Administration (FDA) for use in reverse total shoulder arthroplasty procedures. This clearance is in addition to the system’s already cleared use in anatomic shoulder arthroplasty and provides surgeons with interoperative flexibility. “The Inhance Shoulder System can be used for an anatomic or reverse shoulder procedure offering the surgeon and OR staff a streamlined and effective shoulder system,” said Andrew Jawa, MD, Orthopaedic Surgeon, New England Baptist Hospital. “This system contains the necessary tools from pre-op planning to intra-op

flexibility with two trays of instruments to help ensure a consistent outcome.” Features of the reverse system include: • 135-degree neck shaft angle with lateralized options • Sizing options to address a full range of patients • 3D laser printed R/SPEED Baseplates and Modular Baseplates with Central Screw and Central Post options • Advanced cross-linked Vitamin E polyethylene for desired wear characteristics and oxidative stability • ONE STEP PREP Glenoid Reamers For more information, visit depuysynthes.com.

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August 2022 | OR TODAY



news & notes

Arjo Announces New Single-Use Intraoperative Doppler System Huntleigh, a member of the Arjo family, has announced a new intraoperative Doppler system that includes a single-use, sterile intraoperative probe and Dopplex DMX Vascular Doppler. This latest system provides immediate evidence of a successful vascular reconstructive procedure by capturing the bloodflow waveforms with the surgical probe and displaying it on the high-resolution color display of the DMX Doppler. The Doppler results can then be stored on the micro SD card for later review or transfer to a computer. Bloodflow sound is also improved with the Dynamic

Digital Noise Reduction (DDNR) system that eliminates background noise when moving the probe. The probe is single-use and provided sterile to reduce the risk of infection during surgery. By providing quality assurance of blood flow intraoperatively, time and costs of a potential re-operation can be avoided and ischemic time can be significantly reduced. The Dopplex singleuse intraoperative probe and DMX Doppler can assist in the performance of safe surgery. For more information, visit huntleigh-healthcare.us.

Inova Health System Develops User-Friendly Gown The personal protective equipment (PPE) shortages brought about by the COVID-19 pandemic proved to be an opportunity for a Virginia health system to not only address supply chain issues, but also to improve their environmental footprint. By designing and producing a custom, reusable isolation gown, Inova Health System, based in the Washington D.C. suburbs, ensured adequate supply of their second-most used type of PPE, while also eliminating 213 tons of waste per year. The team from Inova presented its success story at the Association for Professionals in Infection Control and Epidemiology’s (APIC) 49th Annual Conference. Before 2020, the five-hospital system used 3.1 million single-use, disposable gowns each year, amounting to about 213 tons of waste. When COVID hit, the gowns, along with other PPE, were in short supply. “During the pandemic when supplies were scarce, we used any gowns that we were able to procure that met infection prevention standards, regardless of the brand,” said Michelle Peninger, BSMT, CIC, assistant vice president of infection prevention at Inova. “Our infection prevention team realized we had an opportunity to create a better gown that would protect our frontline workers and reduce waste. By assessing all of the products in use, we were able to develop a more comfortable, safe and user-friendly option that was also sustainable,” Peninger added. Inova contracted with a sports apparel manufacturer to produce a new isolation gown that is better fitting, cooler to wear, easier to don and doff, and can be laundered and reused up to 100 times. The new gowns are currently in use at two of the system’s five hospitals. “The process involved a lot of trial and error, but it was so worth the effort,” said Lucy He, MLS(ASCP)CM, CIC, director of infection prevention and control at Inova. “The innovative thinking of our team resulted in the development of a great product and our team members are very happy with the new gowns. We look forward to introducing them into all Inova hospitals.”


OR TODAY | August 2022


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Joint Comission

Is That Instrument Safe To Use On A Patient? By Sylvia Garcia-Houchins, RN, MBA, CIC veryday health care organizations’ sterile processing and perioperative staff work together to ensure that instruments used during surgical procedures are clean, sterile and safe for use. Most staff members would say in no uncertain terms, “if it isn’t clean, it isn’t sterile.”1


Specifically, that is, if tissue, bone, or other soil is left behind on a surgical instrument, its unsterile condition obviously could carry risk of infection to the next patient, and it should not be reused. Yet, Joint Commission surveyors have noted that the very same staff do not seem as concerned about using surgical instruments with pitting, etching, corrosion, oxidation, cracks, damaged insulation, and/or connectors, and even those with pieces of the instrument missing. It is also noted that staff often continue to use instruments with flaking or sticky instrument tape. At most health care organizations, identification of an instrument with bioburden leads to an “incident report” and an investigation into error with the current process. Some health care organizations track a soiled instrument directly to an individual employee and subsequently use it as an opportunity to review normal practices and provide constructive feedback. Many health care organizations also collect data and trend the number of soiled instruments found, as a quality indicator. Trending totals may also be used as an opportunity to ensure that all users are aware to report instruments with bioburden and ensure that staff are following manufacturer instructions for use for reprocessing instruments. Joint Commission surveys routinely identify breaks in processes that may increase the likelihood of ineffective instrument cleaning. Observing the following 16

OR TODAY | August 2022

helps ensure proper instrument cleaning is occurring: • Are manufacturer instructions for use available to staff performing reprocessing and has staff been trained on these instructions? • Are users removing soil and keeping instruments moist as indicated in each instrument’s instructions for use? • Is terminal cleaning completed as soon as possible after use? Or are instruments sitting for extended periods before being cleaned? • Are cleaning chemicals being diluted appropriately and are cleaning solutions maintained at the correct temperature? • Is the instrument inspection process before packaging occurring in a welllit location with magnification? Instruments with peeling, cracking or corrosion to identification tape could potentially flake tape particles into an open wound during surgery and result in a foreign body being left in the wound. Such instruments should be taken out of service until the tape can be removed, and if necessary, replaced. Broken instruments could delay a procedure until a replacement, break further during use, or worse, injure a patient during use. Broken instruments should be taken out of service until they are repaired or replaced. Joint Commission surveyors are routinely identifying these types of hazards that put patients and health care organizations at risk. Careful inspection and an effective maintenance and refurbishment processes can keep surgical instruments in optimal condition and improve patient safety. Identifying unsafe conditions should involve all staff, including those in sterile processing and other areas that use instruments. Staff should work together to ensure potentially unsafe instruments

(such as those with bioburden) do not enter the sterile field. In addition to instruments in disrepair making their way to the sterile field, Joint Commission surveyors have unfortunately noted with increasing frequency, the reprocessing of single-use devices (SUDs) – items labeled by their manufacturer as “single use” or disposable. These devices often consist of lower-quality material and as a result, develop pitting and oxidation which indicates possible hazard to a surveyor. Reprocessors are regulated by the Food and Drug Administration (FDA) and are subject to all regulatory requirements currently applicable to the original device manufacturer, including premarket submission requirements. If a health care organization reprocesses a single-use device, it is dangerously allowing itself to become a manufacturer of a medical device – and thus assumes all of the manufacturer’s liability, should that device fail. In addition, it takes on the liability of possible FDA rule violation. Single-use instruments must be removed from trays and discarded or sent to an FDA-approved reprocessor of SUDs. Sterile processing and perioperative staff should obey the following key measures to ensure that their instruments are appropriate for use on patients: • Review the manufacturer’s validated reprocessing instructions before reprocessing any device. Ensure that following the instructions will meet the level of reprocessing based on the use of the item and that appropriate equipment and products are available to follow the instructions. • Correctly dismantle and inspect instruments for soil or damage. Staff should request, and leaders should provide, necessary lighting and tools such as lighted magnifiers to ensure ample vision while inspecting in WWW.ORTODAY.COM

sterile processing areas. • Establish effective maintenance and refurbishment processes to keep instruments in optimal condition. All staff should be empowered to identify instruments of subpar quality and prevent their use – even if it causes delaying or rescheduling of affected cases. • Provide clear training and direction to reprocessing staff on when to remove an instrument or seek guidance from a supervisor while identifying an item that is no longer safe to undergo reprocessing. • Ensure staff at point-of-use can identify when an instrument should not be used – even if it is in sterile packaging – and know how to return and report the occurrence for quality monitoring. • Train users to appropriately discard SUDs and support the process by ensuring disposal containers at point of use for safe disposal. • Train users on key issues that can lead to damage of instruments and devices, including erroneously using delicate instruments meant for


use on tissues, to be used on other items (e.g., gauze, tape, tubing, etc.); prolonged exposure to blood and other body fluids or allowing these substances to dry on instruments; use of saline or corrosives such as bleach or inappropriate cleaning chemicals; use of abrasives; or transporting instruments incorrectly so that there is risk of damage. • Create and effective process for identifying instruments that require repair or replacement, in areas where they are used since sometimes instruments are damaged during use. • When tracing sterilization practices, periodically open and inspect instruments in peel pouches and trays to ensure that they are appropriate for sterilization and use. • Create a “good catch” reporting process that rewards identification of instruments that should not be reprocessed or used so that tracking and trending is accurate for budgeting and quality purposes. It is imperative that ASC leaders and staff work together to prevent use of a soiled, damaged or inappropriately reused


Joint Comission

SUD that put patients at risk. Since patients face risks related to health care every day, they should not have to be placed at risk from soiled, damaged or inappropriately reused SUDs. All staff involved in reprocessing and use of instruments in health care procedures must take personal responsibility for both providing and using safe instruments and preventing use of unsafe instruments. Health care staff should be empowered to stop the line and ask, “Is this instrument safe to use on a patient?” — Sylvia Garcia-Houchins, RN, MBA, CIC, is the director of infection prevention and control in the office of quality & patient safety at The Joint Commission. ECRI If It’s Not Clean, It’s Not Sterile: Reprocessing Contaminated Instruments. Event Reporting & Analysis – Alerts. Published 4/11/2017. Accessed November 21, 2021, at https://www.ecri.org/components/PSOCore/Pages/e-lert041117.aspx 1

August 2022 | OR TODAY



SPDs Address Industry Concerns, Evolving Technologies hile the AAMI eXchange 2022 is an industry event most commonly attended by medical device manufacturers and the hospital technicians who maintain those devices, it features a robust track of sessions dedicated to the sterile processing of devices starting from manufacturing, to shipping, to everyday use and reuse in the operating room.


This year, sessions included lessons learned from the pandemic, tips for processing news technologies such as surgical robots, and calls to action from leading thought leaders. Here are just two of the highlights:

Kilmer Innovations in Packaging Group Calls for Members/Next Steps When the Kilmer Innovations in Packaging Group (KIiP) presented at the 2022 AAMI eXchange, one audience member stood up to address the room even before the session began. “I just wanted to tell everyone here that this is a great group,” said Jonathan Wilder, Ph.D., managing director of Quality Processing Resource Group LLC, and Max Planck Fellow. “This is a bunch of packaging professionals who are doing this for no vested or selfish reason!


OR TODAY | August 2022

That’s a remarkable thing to witness. It’s utterly delightful to work with such smart people.” As a member of the group, Wilder’s take on KIiP may be a tad biased, but his qualifications and enthusiasm alike provide a good snapshot of what KIiP volunteers are bringing to the table for sterile processing and biological assurance. The KIiP movement started in 2019 during the lauded Kilmer conference, a global forum hosted by J&J which is focused on sterility assurance and sterilization for professionals from industry, academia, government agencies and healthcare delivery organizations. According to presenters Ralph Basile of Healthmark and SPD consultant Dave Jagrosse, the group initially began as a LinkedIn page for individuals dedicated to “improving patient outcomes and clinician delight ​through the science and engineering of sustainable packaging​.” Since then, the closed group has accrued more than 390 members and outlined a specific mission: “The collaboration, connection, education and promotion of the v​ alue of medical device sterility assurance and its maintenance ​t hroughout the value chain f​ or protecting patient safety and improving health care outcomes.”

During the worst of the COVID pandemic, “we started meeting virtually a lot,” said Basile. As a result, multiple projects have been started to solve commonly shared problems across the stakeholders’ fields. Ongoing projects include: 1. Standardizing terminology between health care and industry professionals: • “Figuring out who means what has sometimes been like peeling an onion. There’s too many layers and a lot of crying,” Jagrosse joked, “but this work has led to a lot of necessary discovery and ‘aha’ moments that will make everything easier.” 2. Informing the development of AAMI TIR109 with academic and industry evidence: • A new AAMI technical information report (TIR) will provide comprehensive guidance on externally transporting medical devices between one health care facility and facility, either for patient use, sterilization, disinfection or decontamination. 3. Ongoing study on repetitive handling of sterile packaging: • “Health care workers load/ unload case carts with re-


quired and ‘just in case’ sterile packaged medical devices. We want to know, ‘does repeated handling pose additional risk for the contamination of a device?’ ” the presenters explained. 4. Ongoing study on external transport of medical devices: • Seeking to inform thorough, “evidence-based decision-making regarding the safe external transport of medical devices/medical packaging.” The presenters finished by outlining their need for experts on the end-user side, specifically clinicians, to join their efforts. Interested parties should apply to join at linkedin.com/groups/12301596.


Your SPD Needs Dedicated Endoscope Staff, Says ST91 Co-chair If you or your loved ones are being driven somewhere, you want to make sure that person behind the wheel is trained to drive, right? It should be the same for reprocessing important and complex medical devices, such as endoscopes. That’s at least according to Garland Rhea Grisby Sr. of Kaiser Permanente and co-chair of the AAMI WG84, the standards development working group responsible for ANSI/ AAMI ST91:2021. At AAMI eXchange 2022, Grisby presented “Endoscope Processing: The Importance of Dedicated Staff” to professionals during a special spotlight on the expo hall floor. Grisby explained how adverse events related to improper scope reprocessing can often be tied back to professionals with outdated training missing fluid channels for these evolving and complex devices. He also pointed to the U.S. FDA’s MAUDE database, which records all reported adverse events related to improper reprocessing. He noted how many adverse events even as recent as 2021 are so shocking that “they made the hairs on my bald head stand up!” In one facility’s case, for instance, officials recorded that a leak test had not been performed on any equipment in over 20 years. “When you have blood seeping out of a scope that has supposedly been reprocessed, you should realize something is wrong,” he said to a horrified audience. But Grisby is also quick to point out that while it sounds like many of these offending departments simply lacked the common sense most responsible SPD departments have, it often comes down to leveraging manpower in a responsible way. It may not be reasonable to spend the time and resources to retrain an entire SPD department after every single update to manufacturer instructions for use and standards such as ANSI/AAMI ST91. However, he argues it does make sense to have one dedicated member of a team to stay on top of this crucial information and inform changes to processes as needed. Staying in the know about changes in the technology and science of your profession, he said, is part-and-parcel of a health professional’s commitment to patient safety.


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August 2022 | OR TODAY




Webinar Addresses DEI Staff report he OR Today webinar “CCI’s Diversity, Equity & Inclusion Awards: Program Overview” was presented by Jim Stobinski, CEO and Lisa Rosenfield, special projects and partnerships lead at the Competency & Credentialing Institute. It was eligible for 1 CE credit. OR Today is approved and licensed to be a Continuing Education Provider with the California Board of Registered Nurses, License #16623.


The Competency & Credentialing Institute (CCI) is a non-profit credentialing body dedicated to perioperative nursing. Its mission is to improve patient outcomes through nursing competency assessment and lifelong professional development. In this 60-minute webinar, Stobinski and Rosenfield shared information about CCI’s newest initiative, the Diversity, Equity & Inclusion Awards Program. This endeavor is designed to facilitate access to resources and increase diversity in the field of certified perioperative nursing, specifically for facilities which are under-resourced, in-need and/or underrepresented. 20

OR TODAY | August 2022

The presentation included information about the development and history of the program as well as its goals, program components and application information. Attendees were also invited to submit questions. One question was, “Why is CCI starting this DEI initiative now?” The presenters said that after gathering data CCI discovered that it had to do a better job of understanding the overall makeup of all of perioperative nursing and making sure that the group represents the population. The presenters were also asked about the importance of different certifications and expressed a desire to promote continuing education among nurses. The complete question-and-answer session is available via an ondemand recording of the webinar at ORTodaywebinars.live. Attendees provided feedback via a survey that included the question, “What were the most helpful components of the webinar?” “Knowing there is training out there for RNs wanting to go into the OR,” said Tammy Ralls, associate vice president quality and safety operations, LifePoint Health. “Noting the new OR

Jim Stobinski

Lisa Rosenfield certification options,” said Patricia Wouters from St. Lucie Surgery Center. For more information, visit ORTodayWebinars.live.



HSPA Conference & Expo Delivers Education, Networking By Julie E. Williamson ollowing a two-year, pandemic-related hiatus of the Healthcare Sterile Processing Association (HSPA) in-person annual conference, this year’s event brought more than 900 attendees together for five days of top-quality education and networking in San Antonio, Texas. The expansive and technologically advanced Henry B. Gonzales Convention Center housed the conference and expo. It provided an ample and inviting space for attendees to learn, grow, share best practices, and engage with peers, renowned industry experts and leading product and service vendors in the sterile processing (SP) space.


Hundreds of attendees arrived early to participate in HSPA’s preconference events on April 23, including hands-on labs that let attendees sharpen their technical skills, and the prepaid Hot Topics in SP Management workshop as well as the Educators Forum. From Sunday through Wednesday, attendees had access to 30 educational sessions spanning a broad range of research- and best-practice-based topics for SP leaders and technicians of every experience level. Just some of many essential session topics included instrument clean-


OR TODAY | August 2022

ing imperatives; water quality; instrument inspection; container compliance; industry standard and legislatives updates; cognition and mental health in the SPD; instrument transport; sterilization cycle load optimization; SP-related supply chain updates; impact of time and environmental conditions on instrument contamination; challenges in processing robotic instruments; cost analysis strategies; safe medical device care and handling; navigating instructions for use; and core qualities of effective leadership and mentorship. Educational opportunities weren’t limited to session rooms. More than 60 peer-provided poster presentations covering various SPrelated learning experiences, best practices and research from around the world were on display. Dozens of poster creators were on hand during scheduled times to meet with attendees, discuss their key findings and answer questions. This year’s inspiring keynote speakers drew standing ovations from attendees and underscored the importance of leading with purpose, staying resilient in the face of challenges and uncertainty, taking risks to build a better career and reach personal and professional goals, and tapping a commitment to quality and teamwork to elevate others and promote positive change. Opening keynote speaker

Ben Nemtin, the best-selling author of “What Do You Want to Do Before You Die?” and star of “The Buried Life,” shared five steps to help “make the impossible possible”: 1. Document dreams in writing to make the ideas more real and help put them into action. 2. Share dreams with others to solicit help when needed and increase personal accountability. 3. Persist and stay consistent in your effort. 4. Take “moonshots,” reaching for big dreams and setting goals that others might consider unrealistic. 5. Give back to others by doing what you love and inspiring others to do the same. “In your important roles, in your career and personal life, you have to find ways to keep setting goals, reaching for your dreams and leading powerfully by positive example and determination,” Nemtin reminded attendees. “Life can be hard, but it’s how we deal with those challenges and look to find ways of overcoming them by tapping into our strengths and what inspires us is what helps us get where we need and want to be.” Closing keynote speaker Shola Richards shared an equally inspiring message that urged attendees to lead with kindness, embrace a



spirit of teamwork and togetherness, leave the world better than they found it, and be one’s own hero through grace, patience and understanding. “What you do to keep patients safe every day is so important. You are heroes, even when you might not always get the respect and understanding you deserve,” he said to enthusiastic applause. “It’s important to lead with civility and realize that we are defined by how we treat each other – and how we treat ourselves.” He stressed to the audience the importance of eliminating thoughts that weaken us, such as “I’m not good enough” or “I am incapable,”

or “I don’t matter” and advocated for going farther together instead of faster on our own – all messages that should resonate with every human being and certainly every SP professional. No HSPA Annual Conference would be complete without the vendor expo, and this year’s event did not disappoint. More than 113 exhibiting companies filled the sprawling exhibition space and had representatives on hand to demonstrate the latest products and services and answer attendee questions. Some exhibiting companies also provided targeted education on the show floor, providing yet another valuable opportunity

for attendees to earn continuing education credits. HSPA would like to thank all who participated in our 2022 Annual Conference & Expo and helped make the event so successful. More in-depth editorial coverage of some of HSPA’s 2022 educational sessions will be featured in future issues of OR Today. NOTE: This article is an abbreviated version of the conference summary published in the July/August 2022 issue of HSPA’s PROCESS magazine. — Julie E. Williamson serves as HSPA’s director of communications and editor-in-chief.





August 2022 | OR TODAY



The Benefits of a Repository By James X. Stobinski, Ph.D., RN, CNOR, CNAMB, CSSM(E) ursing faces a significant challenge in the dissemination of new nursing knowledge. We have record numbers of nurses engaged in doctoral studies, but the vital findings from this research – essential new knowledge – does not consistently make its way to the point of care. Life events do happen and many dissertations are never widely disseminated. In 2012, I completed the required forms, paid my fees and placed my dissertation in the ProQuest database. With some work you can find my dissertation. Some researchers have figured this out as my work has been cited in seven other papers. I would venture that few perioperative nurses routinely search databases for new evidence.


As much pride as we take in the accomplishment of our doctoral work, I must admit that I did not publish my work in a peer-reviewed journal. Without databases such as ProQuest these findings are not widely known or used in perioperative nursing. There has been an exciting development on this front. In late April, I received a notification from Sigma Theta Tau International (the honor society of nursing), offering to place my dissertation in the Sigma Repository’s Electronic Thesis and Dissertation (ETD) collection. They describe their repository as an active, dynamic dissemination mechanism with a robust search capacity. No subscription is required to use the repository.


OR TODAY | August 2022

The usability and accessibility of the Sigma ETD collection gives us another route for dissemination. It took just a few minutes to complete an online form and in a few days I was sent a link to my dissertation. This link at http://hdl. handle.net/10755/22616 is a permanent identifier which can be shared. This is some great work by Sigma Theta Tau International (STTI) and provides a valuable resource to many stakeholders. The utility of this repository to researchers is clear. However, in the case of my work, anyone with an interest in the assessment of perioperative nursing competency could access my study within minutes. Another useful feature in the repository are links/suggestions to related research. In example, while checking the link to my study I noted a link to a study completed in 2013 by Randolph William Schild at Capella University. This qualitative study, “Transformational Learning Experiences of Perioperative Registered Nurses Who Have Completed a Perioperative Training Program”, has some connection to my quantitative study completed in 2011. I read Schild’s work with interest, and I will contact him for a follow-up conversation. Prior to this work by STTI, I could not have easily found this excellent resource. I see the Sigma repository as having great potential to fill the dissemination gap and facilitate the transfer of knowledge to the point of care in perioperative nursing. The Competency and Credentialing Institute (CCI) and the CCI Research Foundation (CCIRF) wish to publicize the excellent work done by

STTI. We have a simple ask in this regard. We would like to make original perioperative-related research available on the CCIRF website. If you have contributed your work to this repository please contact me and we can place a link to your contribution on the CCIRF website. If you have not yet placed your research findings in the STTI repository, please consider this opportunity. As we aggregate additional studies we hope to keep adding to this resource. Our collective nursing knowledge gains exponentially in value when shared and utilized. The STTI ETD collection is a tremendous opportunity in this respect. Kudos to STTI for this great work. – James X. Stobinski, Ph.D., RN, CNOR CNAMB, CSSM(E), is CEO of the Competency and Credentialing Institute.

References • ProQuest (2022). Accessed May 18th, 2022 at: https://www.proquest.com/advanced • Schild, W. (2013). Transformational Learning Experiences of Perioperative Registered Nurses Who Have Completed a Perioperative Training Program. [Doctoral dissertation]. Accessed May 18th, 2022 at: https://sigma.nursingrepository. org/bitstream/handle/10755/622548/Dissertation.pdf • Sigma Theta Tau International. (2020). Sigma Repository Electronic Theses and Dissertations (ETD) Project. Accessed May 18th, 2022 at: https://www.sigmarepository.org/etd_information/ • Stobinski, J. X. (2012). Competency and work environments among military and civilian perioperative registered nurses: A predictive model. [Doctoral dissertation]. ProQuest/UMI.



The benefit of Mr. Clear™ anti-fog is right there in its name. This visibilityenhancing solution is intended for use during endoscopic, laparoscopic, gastroscopic, and arthroscopic procedures to prevent fogging of the endoscope lens. Maintain a clear operating field with a solution that’s well-named and well-loved. call 800. 54 1.7 99 5 o r visit keysur g ical . com


market report

Pandemic Powers UV Disinfection Market staff report report from Grand View Research predicts continued growth in the ultraviolet (UV) disinfection market.


“The global ultraviolet disinfection equipment market size was valued at $7.13 billion in 2020 and is expected to grow at a compound annual growth rate (CAGR) of 12.1% over the forecast period,” Grand View Research reports. “Increasing demand for ultraviolet (UV) disinfection equipment in health care facilities is expected to have a positive impact on the market growth. The rising prevalence of COVID-19 cases coupled with the increasing R&D spending is expected to boost the demand for UV disinfection equipment over the forecast period. Furthermore, factors, such as disruptions across several end-use industries caused by the COVID-19 pandemic and increased concerns about germs, are expected to have a positive impact on the market growth.” The Grand View Research report adds that, “UV air purification is a proven technology, and in many cases, the WHO


OR TODAY | August 2022

and CDC have promoted the use of purification in laboratories, hospitals, operating rooms, and universities. In addition, UV air purifiers are recommended to improve air quality in both the residential and commercial sectors to remove particulate matter and dust, which is speculated to curb the spread of coronavirus. The novel coronavirus pandemic has put a few health care systems under immense pressure and stretched others beyond their capacities.” “Now with the increasing cases of the disease, a lot of hospitals have started incorporating UV systems to disinfect the high-risk indoor setting, which, in turn, is expected to increase the product demand over the coming years. UV disinfection systems have minimum environmental impact compared to sodium hypochlorite and chlorine gas as UV is mostly affected by the electrical grid composition. This makes it a versatile technology,” the report continues. “As more and more electricity sources are becoming green, UV is expected to reduce its environmental footprint. Public health departments have recognized UV disinfec-

tion systems as an effective method of treating drinking water, reclaimed water and wastewater. This has encouraged countries across the globe in incorporating these systems as they are safe and do not require any harmful chemicals to protect water resources and achieve sustainability goals.” Future Market Insights (FMI) also predicts market growth. As per FMI, sales represent nearly 75 percent of disinfection equipment market, driven by the continuous development of the disinfection technologies. Factors such as increasing need of UV lights, UVC disinfection robots, UVC disinfection chambers, UVC portable sanitizers and other ultraviolet disinfection systems aresre expected to continue pushing sales in the forthcoming years. A growing need for these products to disinfectant air, water and surfaces in hospital and medical centers, retail and shopping complexes, corporate offices, public transit, and to mitigate the risk of COVID-19 is anticipated to augment the growth of the market over the forecast period, FMI adds.



product focus


UV Cabinets/Clean Room UV-Cabinets come in three sizes and disinfect shareable technology – laptops, VR/AR headsets, tablets, equipment, and more without the use of chemicals, liquids, or heat. They are fully lab tested and certified in line with IEC 62471 and ISO standard to ensure maximum effectiveness. UV- Cabinets offer short cleaning cycles, Secure Magnetic Ring Lock™ Technology and inbuilt charging stations. Clean Room (not pictured) disinfects any size room and is Ideal for clinical environments. A fully programmable wireless control system provides unparalleled safety and presence detection. Reduce room turnaround time with a 10-minute cleaning cycle. Available fully installed or for self-installation. For more information, visit uvisan.com.


UVDI-360 Room Sanitizer UVDI recently introduced the next generation UVDI-360 Room Sanitizer – equipped with UV Smart Connect cloud communications technology – making it even easier and more efficient to use. The newest UVDI-360 features the same independently proven effectiveness and user safety features trusted by over 1,100 hospitals worldwide. UV Smart Connect technology simplifies device usage, fleet management and device servicing with automatic, real-time Smart Device communications. Instant UV Smart Connect cloud communications are driven by advanced cellular and wireless technology, connecting the UVDI-360 to UVDI’s easy-to-use, cloud-based operator portal. It features automatic, realtime transfer of device usage data to the cloud as well as 24/7 device health monitoring by UVDI and end user notifications. It has automated over-theair (OTA) software updates for continuous device improvement and secure dual network connectivity via cellular and Wi-Fi communications. Offline communications are enabled through an onboard battery. It has an intuitive remote control included, allowing approximately 45 feet of range through walls. It also has enhanced servicing via remote device monitoring as well as a detachable power cord. The UVDI-360 Room Sanitizer equipped with UV Smart Connect will be available later this year. For more information, visit uvdi.com.


August 2022 | OR TODAY



product focus


MoonBeam3 Technology in ORs Turnover with a Boost MoonBeam3 is a fast, effective, portable and affordable UV-C disinfection device. The device adds assurance beyond manual cleaning and disinfection in the OR, is designed for fast disinfection and turnover between cases, and at the end-of-day. The system offers three, individually adjustable arms that can be positioned at almost any angle, optimizing energy and allowing coverage of horizontal and vertical surfaces, in just 3 minutes. MoonBeam3 has demonstrated reduction of harmful pathogens including bacteria, viruses, C. diff and SARS-CoV-2. MoonBeam3 incorporates a number of safety features and is very easy to use. For more information, visit sdfhc.com.


UVC Dosimeters UVC Dosimeters provide visible proof of successful germicidal irradiation so professionals can easily validate UV-C equipment and verify disinfection processes in real-time, any time. The yellow center reacts to UV-C exposure and changes color to indicate the dose of germicidal irradiation that has been delivered. Reaching doses of 50 and 100 mJ/cm² has been correlated to achieve a 3-log reduction of MRSA and C. Diff spores, respectively. Patented and proven, UVC Dosimeters by Intellego Technologies provide an accurate, reliable and simple way to see your success with UV-C disinfection. For more information, visit UVCdosimeters.com.


OR TODAY | August 2022




Helios System

product focus

UV-C products from American-made and manufactured Surfacide remain the gold standard in hospital-grade UV technology for those seeking trusted, scientifically proven disinfection for their facilities. Surfacide’s Helios System is the only patented triple emitter robotic system to provide the most efficient and flexible solution, disinfecting colonized surfaces by reducing multiple bacteria and virus strains in a single cycle. Surfacide’s evidence-based UV-C light solution reaches more surfaces, reduces shadowed areas and requires less labor. The results are better efficacy in less time. For more information, visit surfacide.com.


LightStrike Reduce bacterial load in the OR between surgical procedures. A recent study showed that 2 minutes of disinfection with a LightStrike pulsed xenon UV robot led to a 72.5% decrease in bacterial load in the OR. Validated by over 45 published, peer-reviewed studies, LightStrike’s intense bursts of UV light quickly deactivate pathogens at the wavelengths where they are most vulnerable. The robots can be used between surgical cases, at terminal disinfection, and in patient rooms, restrooms or other areas. LightStrike robots don’t require warm-up or cool down, and they don’t harm surfaces or expensive OR equipment like mercury lamp UVC devices. For more information, visit xenex.com.


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


August 2022 | OR TODAY


CE570 CE140-60


continuing education

Interviewing for Career Advancement hether you’re a staff nurse, a manager, or an advanced practice nurse, interviewing is an important opportunity to market yourself for career advancement. Whether you’re interviewing for a new position, starting a new career, or seeking a promotion, the key to a successful interview is careful and thorough preparation. If two candidates have almost equal qualifications, it may not be the most qualified, but the best-prepared candidate who gets the offer. The better prepared you are, the more likely you’ll be chosen over the competition. This module will enhance nurses’ ability to prepare for and participate in job interviews.


Meet Linda Because she assisted with a code, Linda was 20 minutes late for her job interview. She had to borrow a lab coat to cover a stain on her uniform, and she forgot her resume, which wasn’t updated. Nevertheless, she was sure she’d get the position in the home health


OR TODAY | August 2022

department. She had put in five good years of medical/surgical nursing for this hospital, and the recruiter would understand that it’s time for a change. She scheduled an appointment to discuss the job with the recruiter at 3:30 p.m. on a day she was working, so she wouldn’t have to get dressed up or come in on her day off. She didn’t have a free minute during the shift to even think about the interview. By the time the interview started, Linda was so tired that she let the recruiter do all the talking while she fought to stay awake. She couldn’t tell the interviewer why she wanted the position in home care except to say she disliked her head nurse. When she was asked for the names of four references, she blanked and said she’d have to send in some names later. Finally, the session was over, and Linda left with great expectations, hoping for a speedy transfer. Instead, she received a letter notifying her that she didn’t get the job. Linda wondered what in the world had gone wrong.

Preparation Whether you’re interviewing for a new position, starting a new career, or seeking a promotion, the key to a successful interview is careful and thorough

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 38 to learn how to earn CE credit for this module.

Goal and Objectives The goal of this course is to provide nurses in all settings with knowledge of interview preparation. After taking this course, you should be able to: • Identify at least four strategies for preparing for an interview. • Select the best responses to typical interview questions. • Choose appropriate questions to ask an interviewer.

preparation. If two candidates have almost equal qualifications, it may not be the most qualified, but the best-prepared candidate who gets the offer. The better prepared you are, the more likely you’ll be chosen over the competition. This holds true for internal interviews as well. Don’t assume because you’ve been work-



continuing education

ing at an organization for several years that you will get the job.

Market Your Strengths Begin by thinking of an interview as a self-marketing strategy to promote a product, YOU. Healthcare organizations face nursing shortages and poor retention rates (Vortman, Bergren, Baur, & Floyd, 2019). When agreeing to interview, keep in mind that you are marketing yourself to potentially meet their nursing or staffing needs. Hiring managers are looking for the key behaviors and attributes that distinguish high-performing candidates from others (Cain et al., 2018). One way to convince customers that you are the best person for the job is to convince them you have the skills to do the job, are a fit for their company, and you really want the job. Just like a salesperson, you need to explain why hiring you for the job is in the best interest for their organization. Be able to provide measurable descriptions of your strengths and skills. Be specific. For example, instead of presenting yourself as an RN with five years of experience, emphasize that you can manage the care of five to six patients and take charge of a unit, as well. To represent yourself realistically, think about your knowledge, skills, and abilities beforehand. Ask a trusted coworker or supervisor to identify your top strengths, and then record three of your most marketable strengths on a card to take with you to the interview. Repeat your key strengths several times during the interview.

Types of Interviews When a potential employer asks to interview you, always ask about the structure of the interview. Some interviews may start with human resources, followed by a tour of the working area, taking a skills test, and then ending with a sit-down interview. The type of interview shapes your preparation. Inter-


views may be conducted in several ways, including behavioral, conversational, screening, panel, and stress: • A behavioral interview views past behavior as the best predictor of future behavior. An example of a question might be, “Tell me about a time you were asked by an employer to do something you did not agree with.” • A conversational or nondirective interview includes a give-andtake discussion of many topics. An example of a question might be, “Tell me about yourself,” or “Why do you want to work for our company?” • A screening interview is designed to weed out applicants and narrow down the field of possibilities before a choice is made. Generally, screenings are handled by a human resources representative or nurse recruiter (Cardillo, n.d.). • A panel interview consists of professionals from various backgrounds who sit across from you in a formal setting. Often behavioral questions are asked during these interviews. You may be asked to give a presentation during a panel interview if the position is academic. During a panel interview you may field questions from up to a dozen interviewers. • A stress interview intentionally generates discomfort for the interviewee to evaluate their ability to deal with taxing situations. Some employers conduct initial or prescreening interviews by telephone before calling in the best applicants for face-to-face interviews. For these, be sure you’re in a quiet location where you won’t be disturbed or distracted (Cardillo, n.d.). Interviews are sometimes carried out

by a team or panel, which must reach a consensus in choosing a candidate. Multiple (second, third, or even more) interviews are not unheard of today for positions in management, education, advanced practice, and highly specialized jobs.

Setting Up the Interview When you schedule your appointment, find out as much as you can about your future interviewer, such as title, department, and contact information. Ask about the interview, such as where it will be conducted, who will be participating, how long it will take, and what you should bring. Schedule your appointment when you’re at your best, early in the day if you’re a morning person or in the afternoon if you’re not. Don’t forget to get detailed directions and parking information ahead of time. Many organizations have specific parking instructions for visitors and staff. You should determine where you are to park before the interview, not the day of. A trial run to the facility at the same time of day as your interview is helpful. Update your resume or curriculum vitae (CV) and make a copy of it before you go. Check your interview materials for any mistakes or misspellings and have someone else review them for another opinion. Be sure to carefully review the job description including key words or points. These items may likely be the same as what the employer asks about during the interview. Make sure you understand the language used in the job description. For example, if the job description mentions knowledge of integrated care, take time to ensure you have a solid understanding of the topic.

Get to Know the Organization Besides marketing and promotion for both the recruiter and the job candidate, an interview provides an opportunity for screening, finding a match or fit, and simply getting acquainted. Regardless of

August 2022 | OR TODAY



continuing education

the type or purpose, following some basic guidelines can improve your chances of getting that important job offer. Research your prospective employer. Doing your homework pays off. You’ll be more successful and at ease if you prepare in advance for each interview. One of the biggest mistakes you can make is to arrive at an interview without any background information about the organization. You may also want to get a copy of the job description, organizational chart, philosophy of nursing, mission statement, and strategic goals. Speaking with those who know about the organization’s reputation, work environment, corporate culture, and competitors can be extremely informative. After learning about the organization, decide why you’d want to work there so when asked, you can answer concisely. Search the organization’s website and check the American Hospital Directory for information about its financial state and utilization data (American Hospital Directory, n.d.). In your search, find out basic information about the organization such as the following: • Number of beds • Size of the staff • Annual budget • Specialties or services offered • History of the organization • Accreditation status

Social Media It helps to know more about those interviewing you. If you know the name of the supervisor interviewing you, review their professional credentials and background on websites such as LinkedIn. It is acceptable to review their background, as they certainly will review yours. If you do not have an account, its recommended that you create one to develop your online professional presence (Reinbeck & Antonacci, 2019). Also take a moment to evaluate all your social media


OR TODAY | August 2022

accounts, such as Facebook, paying attention to what a potential employer might see when they view it. Remove unwanted posts, images, or tags or make your account private.

Interview Questions Be ready for the interviewer’s questions. Interviewers ask three basic kinds of questions: • Background • Professional • Behavioral

Background Questions Background questions ask for elaboration and clarification of information on your resume or CV. Use your answers to these questions to highlight your strengths. For example: • What was your favorite clinical experience? Answer: My favorite clinical experience has been in pediatrics. I volunteer once a week on a pediatric unit. • What did you particularly like about your last position? Answer: I really enjoyed collaborating with other professionals and was a member of an interdisciplinary group that met to discuss quality improvement.

Professional Questions Professional questions relate to your career goals and their relationship to the position you’re seeking. Answers to these questions allow you to demonstrate what you know about the organization as well. For example: • Where do you see yourself in five years? Answer: In five years, I would like to have completed my master’s degree. My long-term goal is to earn my master’s degree as a pediatric clinical nurse specialist, which is why I would like to transition from a full-time to part-

time position. Why do you want to work for our organization? Answer: Your organization offers a range of pediatric services that will allow me to expand my knowledge and skillset in pediatric care. Also, given my long-term goal to become a pediatric clinical nurse specialist, I believe I could contribute greatly to your organization.

Behavioral Questions Behavioral questions function to gain insight into your skills and abilities. They offer insight into how potential employees will perform in future situations (Smallwood, 2018). They are often some of the most difficult to answer and require preparation on your part. Practice as many behavioral questions related to the position you can find. Again, try to incorporate your strengths into your answers. For example: • How would you handle a situation where you thought you were right and others were wrong? Answer: In healthcare, disagreements can and do occur often. In these situations, I listen to the other party and try to understand why they think they are right. Recently, I was able to convince a patient to participate in their rehabilitation by asking them to explain why they didn’t want to and addressing their concerns. • Tell me about a situation when you had to deal with an angry family member. Answer: Once a woman was very upset about not being allowed into the recovery room immediately after her husband’s surgery. To help set her expectations, I gave her a reasonable time estimate of when she could see her husband and reassured her that my priority was taking care of



continuing education

him, so he could see her as soon as possible. • Tell me a time where you made a mistake and what you did to address it. Answer: I once miscalculated the infusion time of an intravenous medication after a cardiac procedure. Upon discovering this, I informed the doctor. The doctor told me that no harm had come to the patient, but unfortunately the patient had not received the full benefit of the medication. After that, I took the time to fully understand the medication and the guidelines for its administration. Now I explain to other nurses the purpose of this medication and its role in cardiovascular risk reduction.

Open-Ended Questions Some of the most challenging interview questions are open-ended questions that are really asking something else: • Tell me about yourself. (Why should we hire you?) • What is your philosophy of nursing? (Is your philosophy compatible with ours?) • What are your strengths? (Why should we hire you?) • What is the biggest mistake you ever made? (How do you prevent errors from being made?) • How long do you plan to work here? (Are your goals similar to ours?) • What have you heard about us? (Have you done your homework?)

Discriminatory Questions Discriminatory questions are seldom asked intentionally. However, you should be aware of how they are phrased and how to respond. Discriminatory questions ask about these topics:


• Age • Race • Religion • National origin • Political affiliation • Gender • Marital status • Children • Sexual orientation • Physical or mental disabilities If a discriminatory question is asked, try turning the question around by asking how it pertains to the position. If they ask you such a question, you might want to reconsider working for such an employer. You can try to answer it briefly and positively and move on. For example, if the interviewer asks, “What religion do you practice?” Here are two potential responses: • “My religion has never interfered with my work because it has taught me respect for all faiths.” • “Can you please explain how my religion is important to this position?”

Your Questions Have your own questions, too. An interview is a give-and-take exchange of information, so you’ll need to prepare a list of questions to ask the recruiter or manager, so you can evaluate the job. Include questions about the organization, department, or position that remain unanswered by your research. Other questions you might ask include: • What type of nursing care delivery system is used on the unit? • How are report and change of shift performed? • What is included in the hospital and unit orientation? • Will I have a preceptor? For how long? • What are some of the challenges of working in this position? • What are areas of improvement or challenges facing this department?

• • • • • •

• •

Does your organization provide a structure for nurse advancement? Why is this position available? What are the next steps? When do you hope to fill the position? What is the average nurse-topatient ratio? What measures are taken when you are short staffed or overstaffed? Are there opportunities for continuing education? What salary and benefits does this position offer?

Orientation A good orientation program that trains nurses in their specialty setting is associated with lower turnover rates (Vortman, Bergren, Baur, & Floyd, 2019). This means that accepting a position with an adequate orientation means you are less likely to leave your job down the road. Therefore, ask specific details about the orientation or training period. For example: • How long will it last? • Who will you be partnered with during the orientation? • Are you expected to orient for a day and then work on your own? • How will you be compensated during orientation? • What does orientation include (e.g. classroom, one on one precepting, etc.). Additionally, nursing mentorship is associated with lower turnover, so remember to ask about that and other forms of support (Schroyer, Zellers, Abraham, 2020).

Practice Next, using index cards, start a file of practice interview questions, writing down brief answers in positive terms, as well as five short (less than two minutes each) success stories to illustrate your answers. Practice enhances the likelihood

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continuing education

of success, so rehearse until you’re comfortable, confident, and appear spontaneous in answering the practice questions and asking your own questions. You may want to answer and ask questions out loud in front of a mirror, relating everything you’d like to say to your interviewer while watching your facial expression and body language. A good test of your readiness is to role play the interview with a friend as the interviewer.

Salary and Benefits When you discuss salary, you need to know the market value of the position for comparison, as well as the dollar figure you want. Try to determine the employer’s range ahead of time by asking when you call or visit the office or during a screening interview. When asked about salary, give a range. It shows flexibility, but lets the interviewer know what you need to earn. When you quote a dollar range for your desired salary, the lower number is what you could live with and the upper number is a few thousand dollars more. For example, if you need to make at least $45,000 tell them your range is $45,000 to $47,000. If you are offered less, consider the total compensation package, including an additional 25% to 40% that represents benefits, costs of commuting, and childcare. Use key phrases like, “I’m looking for $…” and talk in terms of what the job is worth. If you can’t resolve the issue, keep the door open. Remember, the only way to convince employers you deserve a higher salary is to convince them you can solve their specific problems or meet their needs.

Choosing References When choosing references, first consider what type of information the employer is seeking. Some employers will request personal references, others want work references, and some desire both. With personal references, ideally choose people who have professional credentials or hold


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a professional position in the community. Examples of good personal references would be business or religious leaders, college professors, or professional association leaders. Choose people who know you well enough to attest to your character and your professional strengths. When choosing work references, try to choose someone who holds a position of authority, such as a supervisor, manager, or director. The reference should be someone with whom you have worked and who is familiar with your work style. This person does not have to be a current supervisor unless specifically requested by a prospective employer. Always contact prospective references, both personal and work-related, before using their names. Ask if they would be willing to give you a favorable reference and if you can use their names. It’s better to know up front if a potential reference would be comfortable giving you a good reference rather than risk having that person speak to a prospective employer and say less than favorable things about you. If people are willing to provide favorable references for you, advise them of your current job search. For work references, send them your resume to refresh their memory of when you worked with them and what your title and responsibilities were. Don’t expect your references to remember details of everyone they have ever worked with or been asked to be a reference for. Each time you provide their names as references, advise them that you have done so. Provide your references with details of the specific job, including the characteristics and skills that the employer may want in an employee. In other words, make it easy for them to give you a good reference. Treat your references well. Don’t take them for granted. Keep them updated on your search, and let them know you’ve either accepted a position, are still looking, or have decided to stay where you are. Don’t leave them in limbo. Take the

time and energy to update that person of the outcome. Always thank your references for being available to you and look for ways to support them. Be sure to send a formal note or letter of thanks if they provide a reference that results in a successful job search. Stay in touch with your references even when you are not job hunting.

Final Preparations Come prepared. Be sure you have: • Several copies of your typed resume or CV • The completed application form (if your application was entered online, ensure all sections have been completed) • The questions that you’re prepared to ask the interviewer • A typed list of the phone numbers and addresses of three to five personal friends and three to five professionals who have agreed to be references • Be prepared to take notes, and be ready to access your calendar to schedule a follow-up appointment. Have your professional portfolio easily accessible via a flash drive or Internet access, or carry these items in a professional hardcopy binder or folder: • Letters of recommendation from coworkers, instructors, and other providers • Performance evaluations • Thank-you letters from patients and families • School transcripts (if recent graduate or recent advanced coursework) • Continuing education certificates • Awards • Samples of your writing (reports, teaching aids, and articles) • Other documents (professional license and certificates, Social Security number, driver’s license, fingerprint clearance card, back-



continuing education

ground check status, and proof of citizenship) After you’ve done everything else you can to prepare for the interview, use a little self-imagery and picture yourself going through the process successfully several times. Decide how you would like to look and sound. Begin with the introductions, then small talk to establish rapport. Imagine the interviewer’s questions and your responses. Visualize yourself asking questions, going on tour, and meeting staff and supervisors. Imagine yourself summarizing your strengths and interests and reaching successful closure.

The Big Session Dress appropriately. Consider how you dress for the interview. Wear business attire that is modest, conservative, tasteful, clean, and neat. It conveys confidence, professionalism, and business savvy. A tailored suit, a dress, or a blazer with skirt or trousers are all appropriate. Wear dress shoes and take either a simple purse or a briefcase. Do not wears scrubs to a formal interview. Keep jewelry simple and makeup tasteful. Don’t wear strong perfume, cologne, or aftershave. Avoid chewing gum or candy during the interview. If shadowing in a clinical environment is offered as a part of the interview session, ask if you should bring a uniform, scrubs, or a lab coat to the appointment. You may need to bring these items in addition to your professional interview attire. Be on time or better yet, 10 to 15 minutes early. Be sure to make eye contact and smile at everyone you meet. Finally, wait until the interviewer indicates that you may be seated before you sit down. It’s OK to accept a beverage if it’s offered. First impressions are made in as little as three seconds, and the decision to hire is usually made within the first two minutes, so you’ll need to put your best foot forward from the start. Industrial psychologists describe impression manage-


ment (IM) as a goal directed behavior in which individuals behave and use props to control the impressions of others in their social interactions (Peck & Levashina, 2017). Researchers have found that those with greater IM may have improved job performance ratings (Peck & Levashina, 2017). This means that your attempts to make a good impression can lead to the interviewer having a better perception in your ability to perform your job (Peck & Levashina, 2017).

Communication Style An interview is a two-way street. You should balance listening with talking. Use a conversational tone, a strong voice, and well-paced speech. Don’t rush to answer complex questions. Ask for a moment to organize your response before you speak. Try to match your communication style with the interviewer’s style. Understand the language they use to describe the role and setting. For example, if in the setting for the position, employees use the word client instead of patient, use the term client in the interview. These small alignments in language show you understand the role and the setting. Be aware the interviewer is observing both your verbal and nonverbal communication skills, including speech, posture, eye contact, body language, sensitivity and enthusiasm. Keep in mind that the interviewer is looking for a match between the role’s requirements and your qualifications. Try to maintain a relaxed, comfortable posture, and don’t fidget. Be enthusiastic, optimistic, and positive in your responses. Remember, a great deal of communication is body language, and that’s what people remember about you.

Your Responses Sell yourself not by coming across as overconfident but by stressing your strong points and giving examples. Keep your responses brief, less than two minutes, and to the point. If you don’t know the answer to a question, just say so. If

the interviewer asks a behavioral question such as “Tell me about a time when a patient was angry with you?” and you have never encountered this situation, be honest and tell them. They likely have alternative questions to ask.

Addressing Weaknesses If an interviewer asks about your weakness, be honest. Everyone has weaknesses. Employers look at how you address your weaknesses. By being honest about your weaknesses and taking steps to improve them, you show self-awareness. Selfawareness and the ability to take constructive criticism positively are soft skills that nursing supervisors value (AHC Media, 2019). If you don’t have a skill, admit it but offer to tell the interviewer about related skills you have. Omit negative comments about past employers, supervisors, or coworkers. Be brief, honest, and unemotional about termination.

Tour To determine if the place of employment will provide a good working environment, always ask for a walk through of your potential working area. Not being offered a tour or walk through is a good indicator that the potential employer is not a good fit. Genuinely assess what you observe during a tour or walk through. Some of the questions to ask yourself during the tour include the following: • Is it well lit? • Does the equipment look new or old? • Is the décor up to date? • Do other employees look happy or stressed? • Are people working as a team or are they working in silos? • Is there a break area and if so, what condition is it in? • Are unit or staff awards displayed? • Do you see posters about quality improvement projects? Employers who display staff awards

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continuing education

and certifications indicate that they value the achievements of their staff and organization. Poor lit areas and older equipment can add to workplace stress. Unpleasant, dusty décor can indicate a lack of resources or concern for the work environment. The observation that employees appear stressed is good indicator that you too will likely be stressed as an employee. A nice break room shows that employees and the employer value staff’s ability to step away and recharge during their break. Finally, the presence of quality improvement posters is evidence that nurses are engaged in their work and are driven to improve the outcomes of patients, reach collaborative goals for their organization, and improve their working conditions. If you meet staff and/or the supervisor, do they appear pleased to meet you? Their response to meeting you may be a good indicator of future interactions with them. Also, you may want to request an observation day so you can shadow someone who does the same or similar job. This will give you more detailed information about what it is like to work in that particular setting.

How to Handle Offers During the Interview If you get an offer at the interview, always ask for a few days to think about it. You need to evaluate the entire interview to make the best decision. Remember, just because they want you does not mean you want to work for them. While it may feel good to be sought as a potential employee, you need to really consider the pros and cons of working for the new employer. Give the interviewer a date that you’ll respond to the offer and be sure to make the contact. If you’re not offered the position during the interview, before you leave, ask when a decision will be made, and if you will be notified. Get the names, titles, and business cards of everyone you meet and


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remember to thank all the interviewers for taking the time to meet you.

After the Interview

Write a brief thank you note to each person who interviewed you within 24 hours of your meeting them. By doing so, you score additional points because few applicants send a thank you. In your email or letter , be sure to reiterate your interest in the position, as well as your qualifications. Make a follow-up call to check if references have been received and have additional references to offer if there has been a slow response to the reference request. To help you evaluate important information when you’re interviewing several employers, develop a checklist of questions and compare the employer’s responses. Remember that any question about the position is appropriate if the answer will help you evaluate whether you’re the right person to fill it.

Evaluate the Employers Your checklist might include questions like: • Do I know to whom I report and what the chain of command is in the organization? • Does the orientation plan sound adequate for the position? • Are the salary and differential compensation acceptable? • Does the benefits package (insurance: health, life, disability, malpractice) meet my needs? • Am I satisfied with the holiday, sick, and vacation time offered? • Is flexible scheduling available (for example, working three days on then three days off)? • Are there opportunities for continuing education? With reimbursement? • Does the organization offer tuition reimbursement? • Is there opportunity to advance clinically or administratively in

the organization? Is the facility a reasonable distance from home? Do I feel safe with the security system inside and outside the facility?

Evaluate Your Performance Finally, complete a critique of your performance and decide what you might do differently or better the next time. If you don’t receive a timely response from the interviewer, call. If you don’t get an offer, remind yourself that the experience was good practice (and you never know if the first-choice candidate will accept the offer or work out even if he or she does accept). Then begin preparing and practicing for your next interview. Remember, it will pay off. Summary: Now that you have finished viewing the course content, you should have learned the following: •

Identify at least four strategies for preparing for an interview.

Select the best responses to typical interview questions.

Choose appropriate questions to ask an interviewer.

Course Contributor: The content for this course was revised by Elizabeth Kellerman MSN RN. Acknowledgment: Sheila J. Leis, MS, RN-BC was the previous author of this educational activity but did not participate in the revision of the current version of this course.

Resources Behavioral Interview Guide for Nurses https://www.relias.com/blog/behavioral-interview-questions-for-nursecandidates



continuing education

Clinical Vignette After 15 years as a bedside RN, Robert wants to transition to a career as a case manager for an insurance company. During his time at the bedside, he has worked on quality improvement (QI) initiatives performing tasks such as data collection through chart review and educating nurses to reduce restraint use. Robert is bilingual in English and Spanish, has his associates degree in nursing, and is about to finish his BSN. Although he has never worked as a case manager, he is taking steps to understand the role. He has met with a case manager in his hospital to discuss the role and reads literature about case management. For the last month, he has been attending case management rounds at his hospital. Upon discovering an opening at an insurance company for a case manager, Robert decides to apply for the position. An excerpt from the job description is as follows: Case Manager (full-time) at FAST Insurance: This position will require the use of information/data review, ability to evaluate a member’s health needs and plan eligibility. The case manager recognizes risk factors and barriers to health maintenance through care planning to help resolve member issues. The person in this role will need to have interview skills, knowledge of integrated care, and of Medicaid claims. • Experience: At least 2 years of case management experience in an integrated model is a must. Preferably Medicaid Case Management experience. • Bilingual preferred • Minimum of 3 years’ clinical practice experience (home health/critical care/pediatric/adult) 1. Which of the following strengths or skills should Robert be sure to list in his resume? A. Bilingual, 15 years’ clinical practice, data collection for QI projects B. Extensive experience with integrated care and Medicaid C. 2 years’ experience as a case manager and claims experience D. Ability to speak German and Spanish Feedback: The job description specifically mentions a preference for a bilingual individual to fill this role. Probably his biggest strength is his years in clinical practice. He needs to display this prominently in the resume. The job description states the role will require information/data review. Robert performed data collection for QI projects which might apply to the case management role. Never lie in the resume. Robert speaks Spanish and English,


does not have experience as a case manager, and does not have experience with integrated care and Medicaid.

2. Assuming Robert has a positive relationship with all of them, which individual would make the BEST work reference for Robert? A. Hospital case manager B. Hospital administrative assistant C. Friend from college D. Nurse co-worker Feedback: When choosing work references, try to choose someone who holds a position of authority, such as a supervisor, manager, or director. The hospital case manager likely has a similar skill set as the position Robert wants, so they are in the best position to understand what FAST Insurance is looking for in an employee to make the best reference.

3. During the interview and other interactions with the potential employer, how should Robert refer to those the insurance company serves? A. Patient B. Individual C. Member D. Client Feedback: The job description demonstrates how the company uses language. By aligning his language with the company’s, Robert shows that he understands the role and has done his research.

4. During the interview, the employer asks Robert, “I notice you don’t have any experience as a case manager. Why should we hire you over someone who does?” How should Robert respond? A. “I do actually have experience as a case manager. I forgot to put it on my resume.” B. “I do not have experience, but I have spent time researching the role by attending case management meetings at my work and talking with the hospital’s case manager.” C. “I have completed several courses to complete my BSN and expect to graduate soon.” D. “I do not really see this as a weakness because I have so much beside experience.” Feedback: By being honest about your weaknesses and taking steps to improve them, you show self-awareness. If you don’t have a skill, admit it but offer to tell the interviewer about related skills you have.

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continuing education

References 1.

AHC MEDIA. (2019). When Hiring and Training Nurses, the


How to Earn Continuing Education Credit 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.

Smart Focus Is on Soft Skills: Same-Day Surgery, 43(11), N.PAG. 2.

American Hospital Directory. (n.d.). Your best source for hospital information and custom data services. Retrieved from http://www.ahd.com.


Cain, L. B., Cronin, S. N., Nelson, D., Meredith, D. A., Newman, K. P., & Rudolf, S. (2018). A Tool to Identify Key Behaviors and Attributes of High-Performing Nurses. Journal of Nursing Administration, 48(4), 197–202. https://doi.org/10.1097/ NNA.0000000000000599


Cardillo, D. (n.d.). The right approach for the right interview. DonnaCardillo.com Web site. http://www.dcardillo.com/articles/rightapproach.html.


Peck, J. A., & Levashina, J. (2017). Impression Management and Interview and Job Performance Ratings: A Meta-Analysis of Research Design with Tactics in Mind. Frontiers in psychology,

Deadline Courses must be completed by 6/30/23. 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.

8, 201. https://doi.org/10.3389/fpsyg.2017.00201 6.

Reinbeck, D., Antonacci, J. (2019). Tech Notes. How nurses can


use social media to their advantage. Nursing, 49(5), 61–63.

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.

https://doi.org/10.1097/01.NURSE.0000554624.05347.6e 7.

Schroyer, C. C., Zellers, R., & Abraham, S. (2020). Increasing Registered Nurse Retention Using Mentors in Critical Care Services. Health Care Manager, 39(2), 85–99. https://doi. org/10.1097/HCM.0000000000000293


Smallwood. R. (2018). 15 Behavioral Interview Questions for Nurse Candidates. Relias website. Retrieved from https://www. relias.com/blog/behavioral-interview-questions-for-nursecandidates


Vortman, R., Bergren, M. D., Baur, K., & Floyd, V. (2019). Nurse Retention in the Operating Room After Perioperative Core Curriculum Completion. ORNAC Journal, 37(3), 13–27.

Clinical VignettE ANSWERS 1. Answer: A, Bilingual, 15 years’ clinical practice, data collection for QI projects .. 2. Answer: A, Hospital case manager. 3. Answer: C, Member. 4. Answer: B, “I do not have experience, but I have spent time researching the role by attending case management meetings at my work and talking with the hospital’s case manager.” 38

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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




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.




OR TODAY | August 2022


COVER STORY n a football game, the action usually doesn’t begin until both teams huddle up to call the right play. The same thing should happen in hospital operating rooms and ambulatory surgery centers (ASCs).


An OR or ASC huddle is a quick gathering of personnel to review and discuss cases that are scheduled for the day and any issues that might affect them. Ideally, huddles should take place at the beginning of each workday and last no more than 10 to 12 minutes.

Why Huddle Up? According to Deb Yoder, MHA, BSN, RN, CNOR, director of clinical operations and compliance officer with Surgical Management Professionals in Sioux Falls, S.D., daily morning huddles allow teams to get the perioperative

definitions of a daily huddle and these huddles can have different purposes. “For our center, the daily huddle is intended to be a quick gathering to review and discuss any issues that may have occurred on the day of the huddle, as well as a review of the surgery schedule for the coming week,” says Ridout. “The purpose is to look at various areas − such as staffing, equipment and supply needs and constraints, and the surgery schedule − and any pre-op or post-op concerns.” “The huddle needs to be scheduled on a regular basis and start on time,” says Jeffrey Keane, BSN, RN, CNOR, unit based educator, west campus operating room, perioperative services, for Beth Israel Deaconess Medical Center in Boston, Mass. “Those attending need to know that everyone’s time is valuable and will be respected.” Keane believes in a multidisciplinary approach to huddles where each

huddles one or two times a week due to the complexity of our caseload,” she says. “During these huddles we review our caseload for the upcoming week to ensure we have all angles covered.” These multi-departmental huddles are in addition to daily huddles that only include members of the clinical team. “During our daily huddles we review cases for the following day and perform a rundown of staffing assignments, including what trays, supplies and implants are being used,” says Ingalls. “We also review any special equipment or turnover needs to keep the day flowing safely.” “Daily huddles are quick, no more than five to 10 minutes,” Ingalls adds. “Everyone remains standing and it is an ‘all-speak-up’ event.” Yoder distinguishes between daily morning huddles and huddles to regroup after an event so everyone can

“Huddles are intended to be a quick meeting to share pertinent information. I believe huddles should have a consistent structure and an operational focus with the goal of communication, preparedness and ultimately patient safety.”

- Jamie Ridout

area organized and make sure they have easy access to whatever will be helpful to the team. “Setting a time limit is helpful to get everyone going and not delay the day,” she says. “The morning huddle is not the place for catchup, complaints and gossip,” Yoder adds. “It’s the place to share useful information in an efficient manner with everyone.” Jamie Ridout, RN, MSN, MBA, NEA-BC, CNOR, CASC, the administrator for Capital City Surgery Center in Raleigh, N.C., says there are different


discipline can share the status of their team. “These huddles need to be quick, concise and have a defined leader,” he says. “If any conversation is getting long-winded the leader can ask for it to be resumed offline at the end of the huddle. This allows the huddle to be completed within 10 minutes or so.” Trina E. Ingalls, MSN, RN, the CEO of DISC Surgery Center in Newport Beach, Calif., agrees with Keane about taking a multidisciplinary approach to huddles. “We conduct multi-departmental

decompress. “These types of huddles are different in nature and need, but both are very important,” she says.

Structuring Your Huddles Todd Masten, the founder and COO of SurgeryDirect in Salt Lake City, Utah, uses what he calls the three S’s when structuring daily huddles: Standardized, Succinct and Standing. “Standardized means having an agenda and sticking to it,” says Masten. “This helps keep the meeting in flow and allows for two-way communica-

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COVER STORY tion. Our huddles are not orations − they are conversations.” Masten points to studies indicating that the average attention span is no more than 20 minutes, which makes keeping huddles succinct critical. “Therefore, our daily huddles are 10 to 12 minutes long at the most,” he says.

staff, while the 1 p.m. huddle is for all of perioperative leadership.” Keeney stresses the importance of explaining the “why” of huddles to staff and leadership so everyone is on board. “Make your huddles informative and brief and allow staff to engage and express issues they may see

ing to take place in the perioperative area that will affect normal operations. “This is especially important before a weekend since resources can be limited during this time,” he says. “I also think it’s important for staff to get the information from the huddle so they are aware of what is happening

“Leaders must be consistent in holding huddles despite these barriers and obstacles. They should also educate the team about the patient safety aspects of huddles and make sure there’s a standing agenda so the huddle moves quickly and efficiently.”

- Trina E. Ingalls

“Being succinct is a learned trait that only gets better over time.” Finally, Masten believes that making staff just a little uncomfortable (but not in a negative way) by having them remain standing is important so everyone wants to finish the meeting. “When people sit down, it’s easy to drag things out,” he says. “Rarely does this happen with standing meetings, though.” Masten describes the huddle process at SurgeryDirect: “The team starts by talking through preoperative, PACU and then the OR with any add-ons or scheduled case reviews and any potential issues like known allergies or same last name patients. Then, we talk through any patient satisfaction or quality data and let everyone know about any additional critical information before opening up discussion to the staff for any of their concerns.” Erin Keeney, MSN, RN, CNOR, director of perioperative services for Anmed Health in Anderson, S.C., agrees with Masten about the importance of standardizing huddles. “We have five-minute huddles daily at 7 a.m., 1 p.m. and 3 p.m.,” she says. “The first and second shift huddles at 7 a.m. and 3 p.m. are for the charge RNs and


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for the current day or the next day,” she says. “Also keep the huddle in the same location every day.” “Huddles are intended to be a quick meeting to share pertinent information,” says Ridout. “I believe huddles should have a consistent structure and an operational focus with the goal of communication, preparedness and ultimately patient safety.” Ridout offers a few more suggestions for structuring your huddles: • Set an expectation of attendance. • Stick to a consistent agenda and template. • Leave time for discussion, if needed. • Be predicable and consistent. • Follow up on any issues that are uncovered. • Be brief and be gone. Yoder says that any unique patient concerns that are not in the medical record can be communicated during a huddle, as well as any pending needs. “For example, maybe the implants for a case are arriving late and will need to be reprocessed,” she says. “Or maybe SPD is down a staff member today.” Keane says that his team uses the daily huddle to discuss any work need-

around them,” Keane adds. “We have a daily huddle report form that is sent each day after the huddle.” At DISC Surgery Center, different team members are selected to lead the huddle discussion each day. “This promotes an environment where it’s natural for everyone to feel comfortable providing information and feedback regarding the following day,” says Ingalls.

Benefits of Huddling Up Ridout says the benefits of having daily huddles far outweigh any drawbacks. These include: • Greater patient safety • Fewer medical errors • Better team communication • Greater staff and physician satisfaction • More staff accountability “The bottom line is that having daily huddles elevates the quality of care delivered to patients,” says Ridout. Keane believes that the main benefit of daily huddles is informing each department what is happening so they can start to develop priorities for the day. “This gets everyone on the same page to start the day and begin to work


COVER STORY on the most important tasks,” he says. Huddles also present an opportunity to discuss instrument concerns, equipment conflicts, vendor information, staff communication and safety reviews. “Staff can create a plan each day for how the day will be structured and how to deal with any changes that might come up,” says Keeney.

Obstacles to Huddling Up If there are so many benefits to daily huddles, then why don’t they occur in every hospital OR and ASC? Unfortunately, there are also a number of obstacles that can hinder the practice of huddling. “Probably the biggest challenge is finding time to prepare for the huddle and determining the best time of the day so all can attend,” says Ridout. “It takes time to prepare for the huddle when everyone’s day is already busy, and the huddle can even lead to more ‘to-do’s’ for some staff.” Sometimes huddles can be repetitive so engagement can be challenging. “And to be honest, not everyone feels they are necessary,” says Ridout. Early case starts, emergent cases, poor timing, lack of staff involvement and huddles that run too long are other potential obstacles to hud-




dling listed by Keeney. Masten says there are always competing priorities that can make it easy not to huddle up. “There’s always an excuse,” he says. “We have removed excuses and made huddling up a priority.” “The biggest obstacle we face is having a time when all team members can come together,” says Ingalls. “With cases being conducted, it’s difficult on some days to communicate with everyone at the same time. We utilize a white board and have key points written on it for those who miss the daily huddle.” Ridout believes that the majority of ASCs are not huddling consistently and effectively. “I think ASCs are still evolving into these types of practices and perhaps still establishing internal shared governance and quality assurance programs,” she says. “The size of the ASC can also be a factor − a oneor two-room single specialty ASC may not see the need.”

Overcoming Obstacles to Huddling The best way to overcome these and other obstacles is for leadership to stress the importance of huddling up. “Leadership can spearhead the initiative by stressing the importance of huddling to improve communication and increase patient safety,” says


Ridout. “In ASCs, the environment is small enough that the director of nursing and/or administrator can be directly involved in the process.” “Leaders must be consistent in holding huddles despite these barriers and obstacles,” says Ingalls. “They should also educate the team about the patient safety aspects of huddles and make sure there’s a standing agenda so the huddle moves quickly and efficiently.” Keeney encourages leadership to meet with perioperative teams to explain the “why” behind daily huddles. “When there are issues that arise, all members of the perioperative team can come together to ensure that proper measures are in place to prevent future issues,” she says. Yoder believes that the key to successful huddling is making sure that there’s value for everyone involved. “If the staff doesn’t think huddling is valuable, they won’t attend,” she says. “Or even worse, they’ll make it a negative experience for everyone else.”


founder and COO of SurgeryDirect




August 2022 | OR TODAY



By matt skoufalos ianna Copley’s nursing career has been one of continuous education, marked by an interest in caring for others, a wealth of positive mentors and a desire to remain close to her Ohio roots.


Copley pursued a career in nursing directly out of high school, enrolling in an associate degree in nursing program at Lorain County Community College in Elyria, Ohio. She graduated in 2008 and started at Cleveland Clinic − the only place she’d wanted to work. In the same month she started her nursing practice, Copley also began the course


OR TODAY | August 2022

of study for her bachelor’s degree in nursing at the University of Akron. “I didn’t apply for a lot of positions,” Copley said. “I was hoping that I would get a job in the surgical intensive care unit, where I’d wanted to work.” During her associate degree program, Copley had worked in a much lower-acuity ICU; at the Cleveland Clinic, her patients were much sicker than she’d expected, but she thrived because the unit there functioned with “phenomenal” teamwork. Copley so appreciated its camaraderie and professionalism, that after completing her bachelor’s degree in May 2010, she chose to

remain with the unit. “I think the teamwork’s really what makes that unit,” Copley said. “Even the days where I wasn’t quite sure and had a lot of questions, I knew somebody was going to be there to answer them.” Copley eventually took a PRN position as she began to explore the next steps in her professional education. Her interest in bringing evidence-based medicine to the bedside practice led her into a master’s degree program at Kent State University, which she completed in 2015. Subsequently, Copley began working as a clinical nurse specialist in the hospital medicine service


line at the main Cleveland Clinic campus in Cleveland, Ohio. “I felt like medical-surgical nursing was the place I wanted to grow in,” she said. “It was a transition.” Her first few months as a CNS were difficult; with a background in critical care, Copley hardly felt like an expert clinician out of the gate. But with the support of her med/ surg nursing colleagues, she soon found her footing. Their support reinforced the feelings Copley had held about the value of mentorship in developing novice nurses. “I think people who are willing to mentor you, if you do the work, absolutely change careers,” she said. “I became a CNS because I had had wonderful mentors; at the time, I didn’t know much about the role. You stay clinically relevant, but you have the ability to affect system outcomes for patients.” In 2020, a position in the surgical ICU opened up when one of her mentors retired, and Copley moved into the assignment, where she remains today. Returning to a surgical environment was exciting, she said; her absence solidified how much Copley truly had missed it. “I think the time away taught me a lot,” she said. “I have an appreciation for other specialties that I think I gained in that role, but I’m happy to be back in the SICU.” In addition to her current responsibilities, Copley has dedicated herself to professional projects, including a part-time role as a nursing ethics faculty fellow. In 2020, she completed a Doctorate of Nursing Practice from Case Western University, and began exploring the intersection of nursing and ethics. Copley views her work as an extension of supporting clinical nurses in the areas of workplace violence, “second victim” phenomenon, and other questions of moral distress. Her interest in these issues has been borne out by her own personal experiences as well as studying those of her peers in the field.


Workplace violence in health care can include verbal intimidation, harassment or physical altercations involving patients, visitors and staff. The issue became much more pronounced during the stresses of the novel coronavirus (COVID-19) pandemic, Copley said; learning to identify and de-escalate such circumstances has been a focus of her studies. “We understand that nobody wants to be in the hospital,” she said. “People are already under additional stress, additional emotions. We understand when people get upset. When the upset becomes threats, that’s not acceptable. When a nurse is afraid to go into a room because they don’t know what’s going to happen, that’s not acceptable.” “Second victim” phenomenon involves experiences that health care providers have after an adverse or unanticipated clinical event or health care error; as Copley describes it, “It’s usually associated with things that didn’t go the way we thought they would.” But when professionals continue to replay such incidents in their head, thinking about what could have gone differently, they can be consumed by doubt. Some can spiral emotionally after such an incident, eventually leaving the profession, or even self-harming. In response, Copley is helping to train peer supporters across the system so that any caregiver experiencing feelings of second victimhood can find support. “I want to be improving the role of the clinical nurse in health care,” she

said. “We have to look at how we support nurses doing the work they do, especially in the hospital ICU setting.” “We see a lot of the patients coming in with one expectation: [that] they’ll undergo surgery because they’re hoping for an improvement in their quality of life, or maybe a cure,” Copley said. “You’re balancing wanting to help maintain hope for that patient, but also recognizing that there are limitations to what we can do in health care.” “We’re learning who they are through their surrogate decisionmakers; trying to talk to them to get a sense of who the patient was prior to their illness, what their values were, so we can honor that to the fullest extent possible,” she said. “We’re trying to help the patient get back to that goal.” When she’s not at work, Copley and her husband enjoy as much time outside as they can get. They enjoy camping, boating, dirt biking and hiking with their two mini dachshunds.

OUT OF THE OR health

Researchers Use AI to Predict Cancer Risk of Lung Nodules n artificial intelligence (AI) tool helps doctors predict the cancer risk in lung nodules seen on CT, according to a new study published in the journal Radiology.


Pulmonary nodules appear as small spots on the lungs on chest imaging. They have become a much more common finding as CT has gained favor over X-rays for chest imaging. “A nodule would appear on somewhere between 5% to 8% of chest X-rays,” said study senior author Anil Vachani, M.D., director of clinical research in the section of interventional pulmonology and thoracic oncology at the Perelman School of Medicine, University of Pennsylvania in Philadelphia. “Chest CT is such a sensitive test, you’ll see a small nodule in upwards of a third to a half of cases. We’ve gone from a problem that was relatively uncommon to one that affects 1.6 million people in the U.S. every year.” Vachani and colleagues evaluated an AI-based computer-aided diagnosis tool developed by Optellum Ltd. of Oxford, England, to assist clinicians in assessing pulmonary nodules on chest CT. While CT scans show many aspects of the nod-

ule, such as size and border characteristics, AI can delve even deeper. “AI can go through very large datasets to come up with unique patterns that can’t be seen through the naked eye and end up being predictive of malignancy,” Vachani said. In the study, six radiologists and six pulmonologists made estimates of malignancy risk for nodules using CT imaging data alone. They also made management recommendations such as CT surveillance or a diagnostic procedure for each case without and with the AI tool. A total of 300 chest CTs of indeterminant pulmonary nodules were used in the study. The researchers defined indeterminant nodules as those between 5 and 30 millimeters in diameter. Analysis showed that use of the AI tool improved

Photo Credit: Radiological Society of North America 46

OR TODAY | August 2022



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estimation of nodule malignancy risk on chest CT. It also improved agreement among the different readers for risk stratification and management recommendations. “The readers judge malignant or benign with a reasonable level of accuracy based on imaging itself, but when you combine their clinical interpretation with the AI algorithm, the accuracy level improves significantly,” Vachani said. “The level of improvement suggests that this tool has the potential to change how we judge cancer versus benign and hopefully improve how we manage patients.” The model appears to work equally well on diagnostic CT and low-dose screening CT, Vachani said, but more study is needed before the AI tool can be used in the clinic. “We’ve taken the first step here and shown that decision making is better if the AI tool is incorporated into radiology or pulmonology practice,” Vachani said. “The next step is to take the tool and do some prospective trials where physicians use the AI tool in a real-world setting. We are in the process of designing those trials.”





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A Flexible Spine is a Strong Spine By Miguel J. Ortiz our spine is an intricate series of 24 individual bones that interact and connect through flexible joints called facets. When these bones and joints cannot work together in order to provide proper movement patterns they also fail to be strong or stable during those said movements. This is why it’s so important to maintain proper flexibility. Without a mobile spine, you will lack core strength and distal joint strength.


The first place we need to start are the hips. They are the foundation of our core, stabilizing and maintaining proper position of every vertebra on the way up. All of the movements also include muscles in the hips that need to be lengthened in order to have proper spine mobility. So, let’s start by grabbing a mat and getting on the floor to set up for your first movement. The Shinbox Extension Tripod and Overhead Reach is a great move because its starts by opening up the hips and simultaneously the Overhead reach provides a nice stretch through WWW.ORTODAY.COM

the lower and mid back. Once in the proper shinbox extension position, the Overhead reach will force a deeper stretch through your hips, obliques and lats which is really what initiates the lower and mid back release. Opening up this tension laterally will increase rotational mobility through the spine and provide better hip stabilization. Our second exercise is the Half Kneeling Cat cow. This movement is meant to focus on two areas. Your adductors, inner thighs, and spine as you will be much more active through your shoulder blades and mid back. Your adductors play a major role in your hips and back. When the adductors are too tight they can cause internal rotation of the femur, preventing proper glute activation and cause the lower back to become over worked. If you want to lessen the tension placed on your lower back use this movement to lengthen your inner thighs thus opening up the hips. As your inner thighs become more flexible, your ability to perform the cat and cow pose in the half kneeling position will provide a huge amount of mobility throughout the spine, espe-

cially since your shoulders are so involved in this motion. Lastly, we have our Total Body Spine Activation and Flow to bring everything together. This one move will expose or loosen up anything that is going on in your spine. The downward dog, wave unload and cobra flow is a move I have done repeatedly for quite sometime to help mobilize my spine for the better. Because of the various movements in this flow, I highly recommend doing it as slow as possible − especially when coming out of the downward dog because that’s where the true mobility comes into play. This transition forces the shoulders to be put to the stabilization test. Make sure you are able to have enough tension on your hands before attempting this move. As you continue to flow into cobra, make sure to keep your chest up. In that bottom position, try to maintain good posture before returning back to a light child’s pose, which gives you a nice break between each rep. Have fun with your movements, enjoy this spine mobility drill of three exercises today and stay active. August 2022 | OR TODAY



Necessary Components of Thinking Win-Win By Daniel Bobinski f you’ve been tracking this series regarding the concepts found in Stephen Covey’s book, “The 7 Habits of Highly Effective People,” we are now entering the section Covey calls “Habits of Interdependence.” These habits (Habits 4-6) help us work better with other people, whereas Habits 1-3 help us be more effective in planning and managing our own tasks.


We start this section with Habit 4, Think Win-Win. Covey stated he thought Habit 3 (Put First Things First) was the most difficult habit to learn, but over the years I’ve found that more people struggle with internalizing Habit 4. The reason? Thinking win-win is not natural. People tend to be raised with one of two mindsets. One is win-lose, an aggressive way to thinking which means “I’m going to win, and you’re going to lose.” The other is lose-win, which is more passive. People with this view often think, “I’m going to lose so that you can win.” Other ways of thinking include “Win,” which could be understood as, “I’m going to win. I don’t care if you win or lose, but I’m going to win.” Another is “Lose-Lose.” This is a sabotage mindset that says, “I’m willing to take a loss so that you lose, too.”

Two Components to Consider The way people think can be easily depicted using a simple graph, with “courage” on the Y-axis and “consideration” on the X-axis. People can have high or low courage, which represents the willingness to stand up for what one 50

OR TODAY | August 2022

wants, and people can have high or low consideration, which represents one’s concern about what others want.

Misunderstanding Win-Win Thinking One reason win-win thinking is difficult to turn into a habit is that people often go straight to talking about win-win outcomes instead of developing the thinking model needed to achieve those outcomes. Thinking win-win means having a win-win mindset going into a discussion. Yes, it means having strong courage, which means one will be firm to speak up for what one wants, but it also means having high levels of consideration, which is listening to what the other person wants and having a desire to help that person achieve what he or she wants. Sometimes resolving differences is quite difficult, but that’s what Habits 5 and 6 are for. For right now, it’s vital to work on strengthening the habit of thinking win-win. If it helps, you can look at the pattern found in Habits 2 and 3. Habit 2 (Begin with the End in Mind) is a thinking step, and Habit 3 (Put First Things First) is the doing step

that becomes much easier when you’ve practiced Habit 2 first. In the same way, Habit 4 is a thinking step that involves developing a desire to help others get what they want while also having a desire to stand up for what you want. With that mindset in place, it’s much easier to succeed at Habit 5 (Seek First to Understand, Then be Understood), but Habit 5 is a topic in the next issue. Daniel Bobinski, who has a doctorate in theology, is a bestselling author and a popular speaker at conferences and retreats. For more than 30 years he’s been working with teams and individuals (1:1 coaching) to help them achieve excellence. He was also teaching Emotional Intelligence since before it was a thing. Reach him by email at DanielBobinski@protonmail.com or 208-375-7606. WWW.ORTODAY.COM

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OUT OF THE OR nutrition

The One Thing You Must Do in the Grocery Store By Kirsten Serrano rocery stores are marketing battlefields where you are getting attacked from all sides. Much of the marketing onslaught comes from processors in the form of packaging claims, but some of it is as subtle as where items are placed. Brands can even pay a premium for shelf end caps and other eye-catching real estate.


Since grocers and food manufacturers are maximizing profit, you need to be a savvy shopper in order to maximize your health. I am going to give you some guidelines on how to do that, but first a few facts about processed foods. Processed food has gone too far: Once food has been grown or raised, it is then processed. That processing may take place in your kitchen, in a factory or in a restaurant. Processing can mean everything from chopping up a pepper to producing a frozen microwaveable meal with 75 separate ingredients. There are high-quality processed foods, but more that are full of food-like substances. Food is engineered to be highly addictive. Food processors and sellers like


OR TODAY | August 2022

to capitalize on health and wellness buzzwords/trends without necessarily delivering on them. The latest trends are about gut health, immune boosting and plant-based diets. Those three concepts have real science behind them, but the way they are wielded in the marketplace is about sales, not science. Big food puts big dollars into nutrition research. In fact, it’s often the only way food science studies get funded at all. The renowned food researcher Marion Nestle found that in 168 studies funded by big food makers, that over 90% produced results in favor of the funder.1 Imagine this: a soda manufacturer funds a study that “proves” lack of exercise is a bigger factor than cutting out sugar to end childhood obesity. This kind of study serves the food manufacturer, not the customer. It also serves to keep us confused about food. Sugar, sodium and fat are the three magic substances that come together in highly processed foods to form a “bliss point.” Bliss point is food processing jargon for the addictive “sweet” spot that keeps you coming back for more. It’s best friends with flavors − both artificial and natural. Together

they make everyone’s favorite addictive substances.

So, what can you do to shop wisely? The most profound change you can make is to ignore package claims and read the ingredient label. Ignore things like “heart healthy,” “sugar free” and “gut health.” There are a million ways to manipulate and influence science, market manipulatively within the dictates of federal regulation and cut corners. Read the ingredients list and think critically. It may feel overwhelming at first, but you can tackle one product at a time. Look for these classic signs of uber-processed junk food: • A long ingredient list with a bunch of unrecognizable ingredients. • Food Dyes − artificial colors have no place in our food. Artificial colors are often made with petrochemicals and have been associated with cancers and attention disorders. • Artificial Sweeteners − worse for you than sugar, increase appetite, increase craving for sweets. • Added Sugars − key to making




addictive foods. From evaporated cane juice and maltodextrin to corn sugar, malt, and lactose, there are many varieties of sugar and it comes with many names. Highly processed foods tend to layer many of them on top of each other. 60% of foods in the supermarket have added sugar.2 • Sodium − elevated amounts of sodium are common in highly processed foods. It’s one of the bliss point ingredients. 70% of the sodium in the U.S. diet comes from processed foods.3 • Poor quality fats − Omega 6 seeds oils (mostly GMO) and other highly refined, poor quality fats like palm oil, soy, canola and corn oil are extremely common in processed foods. • Artificial (and Natural) Flavors. Artificial flavors are just that − synthetic and laboratory made. Natural flavors are natural in that they are derived from something of plant or animal origin. Don’t be fooled though, they are still lab created and may contain hundreds of compounds. Flavor is about making artificial food more exciting than whole foods and about covering up poor food quality. Flavor enhancement is a key way that food manufacturers build addiction. Reading food labels was the most important change I

ever made in my own food journey. I urge you to take it on and follow that path to a better way of eating.


1 Belluz, Julia. “Food Companies Distort Nutrition Science. Here’s How to Stop Them.” Vox. Vox, March 3, 2016. https://www.vox. com/2016/3/3/11148422/food-science-nutrition-research-bias-conflictinterest. 2 Sanger-Katz, Margot. “You’d Be Surprised at How Many Foods Contain Added Sugar.” The New York Times, May 21, 2016. https://www. nytimes.com/2016/05/22/upshot/it-isnt-easy-to-figure-out-whichfoods-contain-sugar.html. 3 CDC. “GET THE FACTS: Sodium’s Role in Processed Food What Do Sodium and Processed Food Have to Do with Heart Health?,” 2012. https://www.cdc.gov/salt/pdfs/sodium_role_processed.pdf.

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







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OUT OF THE OR recipe

Blackened Alaska Cod Tacos INGREDIENTS: • 2 cups slaw mix


• 2 tablespoons mayonnaise


• 1 teaspoon hot sauce, plus additional for serving • 1 lime, divided • salt, to taste • pepper, to taste • nonstick cooking spray • 1/2 pound Alaska cod • olive oil • blackening seasoning, to taste, plus additional, divided • sea salt, to taste • 4 small flour tortillas • 1 avocado, sliced

By Family Features


OR TODAY | August 2022



Add Sustainability to Family Menu


Serve wild, sustainably produced seafood By Family Features ooking delicious family meals is surely the focus of many home chefs, from quick dishes on busy weeknights to homestyle favorites on the weekend. Equally important, however, is dishing up foods and ingredients you can feel good about serving to your loved ones.


The next time seafood is on the menu, consider the source of your main course. Available fresh, frozen, smoked and canned yearround and nationwide, seafood from Alaska is sustainably harvested, and you can trust it comes from a responsibly managed fishery. Utilizing a science-based approach, the state sustains the long-term vitality of species and

their natural habitats, as well as the fishing communities that rely on them. Fishermen and scientists work together to ensure they only harvest what science tells them the ecosystem can support, so that fish stocks, communities and the marine environment can thrive for generations to come. Wild, sustainable and harvested in the USA, Alaska seafood is full of flavor and high-quality protein, vitamins, minerals and oils essential to good health, including omega-3s and vitamin D. You can feel good serving your loved ones Blackened Alaska Cod Tacos as a classic way to spice up your dinner table. Visit alaskaseafood.org to find more information and familyfriendly recipes.

Blackened Alaska Cod Tacos Recipe courtesy of the Alaska Seafood Marketing Institute and Sari Diskin

Prep time: 10 minutes


Cook time: 10 minutes Servings: 2-3

1. 2.


Blackened Alaska Cod Tacos (Photo courtesy of Sari Diskin)


Preheat oven to 400 F. In bowl, mix slaw with mayonnaise, hot sauce, juice from 1/2 lime and salt and pepper, to taste; set aside. Line baking dish with parchment paper and spray with nonstick cooking spray. Place Alaska cod on top and coat lightly with olive oil. Gener-


ously season with blackening seasoning and sea salt, to taste. Bake 5 minutes, set oven to broil and broil 3-5 minutes. When fish is done (when it flakes easily with fork and is opaque throughout), remove from oven and break into small chunks with fork. In flour tortillas, add avocado and slaw. Top with chunks of cod and drizzle with additional hot sauce, squeeze of lime juice from remaining 1/2 lime and additional blackening seasoning. August 2022 | OR TODAY


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SAVVIER SHOPPER By FAMILY FEATURES hether you’re shopping online or in-store, you

W can ensure you’re getting the most for your

money with a little extra planning.

These savvy shopping tips can help you score the most savings and added benefits while you’re at it.

Time Your Purchase Before any big purchase, spend time researching the product and retailers to find potential upcoming sales or promotions. Also be conscious of the calendar and holidays or gift-giving events that might prompt special offers on an item you’re looking to buy. Another smart strategy: shopping end-of-season sales when items are marked down to make way for new inventory.

Use Digital Shopping Tools You may be leery of signing up for promotional emails but remember – it’s only junk mail if it isn’t useful. Putting your name on mailing lists of your favorite retailers and brands is a good way to get early or exclusive access to special offers and coupons. Downloadable browser extensions and plug-ins are other cost-saving tools that are increasingly popular. When you’re shopping with one or more of these tools installed, your browser automatically checks for coupons or price comparisons that allow you to get the best available deal.

Shop Refurbished Whether it be for savings or sustainability (or both) refurbished products are a top choice among savvy shoppers. An option like eBay Refurbished delivers quality, like-new products at deep discounts from premium brands that are thoroughly vetted to meet high performance standards. You can shop across multiple condition grades and a wide range of price points within categories like tablets, smartwatches, laptops, desktops and smartphones – giving you more choice and the reassurance of buying a product that fits your specific needs and budget. Score big savings on trusted refurbished products at eBay.com/ eBayRefurbished.

Save on Shipping When you’re researching an online purchase and comparing prices, be sure to factor shipping into your total cost. Many


retailers offer free shipping once you spend a certain amount, extend free shipping to preferred shoppers or offer periodic shipping promotions, so it’s worth exploring the options. Also beware that buying items on sale can drop you below free shipping minimums, so ultimately you pay more than you would have by paying full price. In some cases, you can also save money by having an item shipped to the local brick-and-mortar store and picking it up there.

Take Advantage of Benefits Understanding the terms of your purchase can help protect you if there’s a problem and may even allow you to take advantage of special rewards. Before finalizing a transaction, check into the warranty options. Even refurbished products can come with warranties for a specified time. For example, all eBay Refurbished products are backed by one- or two-year warranties. For new items, some retailers offer the option to extend your warranty beyond what the manufacturer provides. In addition, some retailers offer money back incentives on certain purchases or allow you to accumulate rewards for discounts on future purchases.

Shopping Refurbished is Easy on the Pocketbook and the Planet

With inflation and scarcity issues remaining top of mind for consumers, shopping refurbished provides another option to buy in-demand products. In addition to value and availability, sustainability is another motivator for purchasing like-new. Shopping for refurbished goods, including those from eBay Refurbished, extends the life of the product and reduces harmful waste. For example, the United States Environmental Protections Agency estimates: • Purchasing a refurbished desktop computer displaces the energy used to charge more than 30,000 smartphones. • Purchasing a refurbished TV displaces around 360 miles driven in a car. • Purchasing a refurbished gaming console displaces around 180 miles driven in a car.

August 2022 | OR TODAY




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C Change Surgical………………………………………………17 CIVCO Medical Solutions………………………………… 11


ALCO Sales & Service Co.……………………………… 47 CIVCO Medical Solutions………………………………… 11 Cygnus Medical………………………………………………… BC Healthmark Industries Company, Inc.…………… 5 TouchPoint Medical……………………………………………13


CIVCO Medical Solutions………………………………… 11 MD Technologies Inc.……………………………………… 48 Ruhof Corporation…………………………………………… 2,3


ALCO Sales & Service Co.……………………………… 47 CIVCO Medical Solutions………………………………… 11 Cygnus Medical………………………………………………… BC Healthmark Industries Company, Inc.…………… 5 MD Technologies Inc.……………………………………… 48 Ruhof Corporation…………………………………………… 2,3


CIVCO Medical Solutions………………………………… 11 Cygnus Medical………………………………………………… BC Key Surgical……………………………………………………… 25 Ruhof Corporation…………………………………………… 2,3


Key Surgical……………………………………………………… 25

CIVCO Medical Solutions………………………………… 11 Cygnus Medical………………………………………………… BC Ruhof Corporation…………………………………………… 2,3



Avante Health Solutions……………………………………21

ALCO Sales & Service Co.……………………………… 47 CIVCO Medical Solutions………………………………… 11


CIVCO Medical Solutions………………………………… 11 Cygnus Medical………………………………………………… BC Healthmark Industries Company, Inc.…………… 5 MD Technologies Inc.……………………………………… 48 Ruhof Corporation…………………………………………… 2,3


ALCO Sales & Service Co.……………………………… 47


MD Technologies Inc.……………………………………… 48


AIV Inc.…………………………………………………………………51


ALCO Sales & Service Co.……………………………… 47

USOC Medical…………………………………………………… 59


OR Today Webinar Series……………………………… 39


AIV Inc.…………………………………………………………………51


AIV Inc.…………………………………………………………………51 Avante Health Solutions……………………………………21 USOC Medical…………………………………………………… 59


Cygnus Medical………………………………………………… BC


Healthmark Industries Company, Inc.…………… 5 Key Surgical……………………………………………………… 25


Ruhof Corporation…………………………………………… 2,3




I.C. Medical, INC.………………………………………………… 4


Cygnus Medical………………………………………………… BC Healthmark Industries Company, Inc.…………… 5 MD Technologies Inc.……………………………………… 48


Avante Health Solutions……………………………………21 MD Technologies Inc.……………………………………… 48


C Change Surgical………………………………………………17 Cygnus Medical………………………………………………… BC Healthmark Industries Company, Inc.…………… 5 Key Surgical……………………………………………………… 25


AIV Inc.…………………………………………………………………51 USOC Medical…………………………………………………… 59


C Change Surgical………………………………………………17


MD Technologies Inc.……………………………………… 48

Avante Health Solutions……………………………………21


Cygnus Medical………………………………………………… BC


CIVCO Medical Solutions………………………………… 11 MD Technologies Inc.……………………………………… 48 Ruhof Corporation…………………………………………… 2,3


OR TODAY | August 2022








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