STANDARDS OF PERIOPERATIVE

Introduction The perioperative RN’s partnership with the patient and other providers is recognized in the ORN is dedicated to enhancing the profes- standards. It is assumed that the nurse will work with sionalism of perioperative registered nurses other health care providers in a coordinated manner (RNs), promoting standards of perioperative throughout the process of caring for patients undergo- nursing practice to better serve the needs of ing operative or other invasive procedures. The Asociety, and providing a forum for interaction and involvement of the patient and designated support exchange of ideas related to perioperative health care. person(s) is paramount. The appropriate degree of par- Standards are authoritative statements that describe ticipation that is expected of the patient, designated the responsibilities for which RNs are accountable and support person(s), and other health care providers is that reflect the values and priorities of the profession. determined by the clinical environment and the The history of the Standards of Perioperative Nursing patient’s unique situation. is detailed in Exhibit A. It is beyond the scope of documents such as these to As recipients of care, patients are entitled to privacy, confidentiality, personal dignity, and quality health ser- account for all possible scenarios that the perioperative vices. The delivery of patient-focused care is guided by RN may encounter in practice. The nurse will need to ethical, legal, and moral principles. These inherent exercise judgment based on education and experience principles serve as a foundation for perioperative nurs- to determine what is appropriate, pertinent, or realis- ing practice and are paramount in achieving optimal tic. Further direction also may be available from docu- patient outcomes. ments such as recommended practices, guidelines for The standards of perioperative nursing focus on the care, agency standards, policies, procedures, protocols, process of providing nursing care and performing pro- and current research findings. fessional role activities. These standards apply to all The standards of perioperative nursing provide a nurses in the perioperative setting and were developed mechanism to delineate the responsibilities of RNs by AORN using the American Nurses Association’s engaged in practice in the perioperative setting. (ANA) scope and standards of practice for nursing and nursing administration as the foundation.1,2 These standards serve as the basis for quality moni- It is the perioperative RN’s responsibility to meet toring and evaluation systems; databases; regulatory these standards, assuming that adequate environmental systems; the development and evaluation of nursing working conditions and necessary resources are avail- service delivery systems and organizational struc- able to support and facilitate the nurse’s attainment of tures; certification activities; job descriptions and these standards. It is the responsibility of health care performance appraisals; agency policies, procedures, employers to provide an appropriate environment for nursing practice. It is important to recognize the link and protocols; and educational offerings. The stan- between working conditions and the nurse’s ability to dards of perioperative nursing are generic and apply deliver care. to all RNs engaged in perioperative practice, regard- Several related themes underlie the standards of less of clinical setting, practice setting, or educational perioperative nursing. Nursing care must be individ- preparation. ualized to meet a patient’s unique needs and situa- tion. This care should be provided in the context of disease or injury prevention, health promotion, A. Perioperative Patient Focused Model health restoration, health maintenance, or palliative care. The cultural, racial, and ethnic diversity of the A.1. Conceptual Framework patient always must be taken into account while pro- The Perioperative Patient Focused Model (Figure 1) viding nursing care. is the conceptual framework for perioperative nurs- The perioperative RN must respect the patient’s ing practice and the Perioperative Nursing Data Set goals and preferences in developing and implement- (PNDS).3 At the core of the Model, the patient and his ing a plan of care. One of nursing’s primary responsi- bilities is patient education; therefore, nurses should or her designated support person(s) provide the focus provide patients with appropriate information to of perioperative nursing care. Concentric circles make informed decisions regarding their care and expand beyond the patient and designated support treatment. It is recognized, however, that some state person(s) representing the perioperative nursing regulations or institutional policies or procedures domains and elements. The Model illustrates the may prohibit full disclosure of information to relationship between the patient, designated support patients. person(s), and care provided by the perioperative RN. 2015 Guidelines for Perioperative Practice 693 Last revised: November 2009. Copyright © 2015 AORN, Inc. All rights reserved. STANDARDS OF PERIOPERATIVE NURSING

ses and selection of nursing interventions for each Figure 1. The Perioperative Patient Focused Model patient.

B. Goal for Perioperative Nursing Practice

The goal of perioperative nursing practice is to assist patients and their designated support person(s) with achieving a level of wellness equal to or greater than that which they had before their operative or other invasive procedures.

C. Scope of Perioperative Nursing Practice

C.1. Definition of Perioperative RN C.1.1. Perioperative RNs use the to develop individualized plans of care and to coordinate and deliver care to patients undergoing operative or other invasive pro- cedures. Perioperative RNs identify patient needs, set goals with patients, and imple- ment nursing interventions and activities to achieve optimal patient outcomes. C.1.2. Perioperative RNs address the physiological, Petersen C, ed. Perioperative Nursing Data Set. 3rd ed. Denver, CO: psychological, socio-cultural, and spiritual AORN, Inc; 2011. Reprinted with permission. responses of patients. C.1.3. Perioperative RNs use standards, knowl- edge, judgment, and skills based on scien- A.2. Patient Centered tific principles. The patient is at the center of the Model, which clearly represents the true focus of perioperative patient care. C.1.4. Perioperative RNs are ethical, responsible, Regardless of practice setting, geographic location, or and accountable for quality patient care. nature of the patient population, there is nothing more C.1.5. Perioperative RNs use evidence as the foun- important to the perioperative RN than the patient. dation for practice. A.3. Four Domains C.1.6. Perioperative RNs assume responsibility for lifelong learning. The Model is divided into four quadrants, three repre- senting patient-centered domains: • patient safety, C.2. Definition of Perioperative Nursing Practice • patient physiologic responses to operative and C.2.1. Perioperative nursing practice is consistent other invasive procedures, and with the ANA’s definition of nursing, which • patient and designated support person(s) behav- states, ioral responses to operative and other invasive Nursing is the protection, pro- procedures. motion, and optimization of The fourth quadrant represents the health system in health and abilities, preven- which the perioperative care is delivered. The health tion of illness and injury, alle- system domain designates administrative concerns and viation of suffering through structure elements essential to successful perioperative the diagnosis and treatment of outcomes. human response, and advo- cacy in the care of individuals, A.4. Outcome Focused families, communities, and The Model focuses on patient outcomes. This is impor- populations.4(p6) tant, because nursing theories and models should C.2.2. Perioperative nursing practice is based on embrace and represent all elements of the nursing pro- holistic caring relationships that facilitate cess. AORN’s Model represents the outcomes focus of health and healing within the range of perioperative RNs by placing outcomes immediately human experiences. adjacent to the patient care domains. Perioperative RNs have a unique knowledge base that supports high- C.2.3. Perioperative nursing practice is enhanced by quality patient outcomes. An individualized patient interdisciplinary collaboration and appropri- assessment guides the identification of nursing diagno- ate resource utilization. 694 STANDARDS OF PERIOPERATIVE NURSING

C.2.4. Perioperative RNs use AORN guidelines as a D.1.1.4. Involves the patient, designated foundation for practice and specialized edu- support person(s), and health care providers cational preparation. in the data-collection process. D.1.1.5. Reviews the results of diagnos- C.3. Span of Perioperative Nursing Practice tic studies relevant to the patient’s current status and planned operative or invasive C.3.1. Perioperative RNs provide care across the sur- procedure. gical continuum, beginning when patients are D.1.1.6. Documents relevant data in a first informed that they need an operative retrievable format. or invasive procedure and ending when they return to their usual roles and Additional measurement responsibilities. D.1.2. Advanced practice RN: C.3.2. Perioperative RNs focus on patients and D.1.2.1. Uses advanced assessment tech- their designated support person(s). niques, independently or collaboratively, to gather appropriate data pertinent to patients C.4. Settings of Perioperative Nursing Practice and populations. Perioperative RNs provide care in a variety of clinical D.1.2.2. Recognizes complex physiologic settings. These settings include traditional ORs, ambu- responses. latory surgery centers, physicians’ offices, cardiac cath- D.1.2.3. Initiates diagnostic studies rele- eterization suites, endoscopy suites, radiology depart- vant to the patient’s current status and ments, and all other areas where operative and other planned operative or invasive procedure. invasive procedures may be performed. D.1.2.4. Interprets results of diagnostic Perioperative RNs influence community, regulatory, studies relevant to the patient’s current and legislative activities through employment or vol- status and planned operative or invasive untary participation at the local, state, national, or international level. procedure. D.1.2.5. Synthesizes assessment data to identify trends and improve perioperative C.5. Role Functions outcomes. Perioperative RNs function in a variety of roles that are D.1.2.6. Assigns American Society of dynamic and continually evolving through increased Anesthesiologists (ASA) physical status education and experience to meet the changing needs classification. of society. These may include, but are not limited to, staff RN, RN first assistant, advanced practice RN, manager, administrator, educator, informatics nurse D.2. Standard 2: Diagnosis specialist, and researcher. The perioperative RN analyzes the assessment data to Perioperative RNs act in the public interest when pro- determine nursing diagnoses. viding the unique service society has entrusted to them. Accountability is accomplished through self-regulation, Measurement professional regulation, and legal regulation. Periopera- tive RNs positively influence health care services and D.2.1. Perioperative RN: delivery by promoting a safe environment. D.2.1.1. Identifies nursing diagnoses that are consistent with the assessment data. D. Standards of Perioperative Nursing D.2.1.2. Sets priorities using nursing diagnoses based on assessment data. D.2.1.3. Validates nursing diagnoses with D.1. Standard 1: Assessment the patient, designated support per­son(s), The perioperative RN collects patient health data that and health care providers when possible. are relevant to the operative or invasive procedure. D.2.1.4. Documents nursing diagnoses using standardized nursing language in a Measurement retrievable format. D.1.1. Perioperative RN: D.1.1.1. Determines data collection pri- Additional measurement orities based on the patient’s condition or needs, and the relationship to the proposed D.2.2. Advanced practice RN: intervention. D.2.2.1. Synthesizes assessment data D.1.1.2. Collects pertinent data using using advanced knowledge and clinical systematic, comprehensive, and evidence- judgment to formulate differential diagno- based techniques. ses for risk reduction and clinical problems. D.1.1.3. Conducts a systematic and on- D.2.2.2. Sets priorities using differential going process for data collection. diagnoses. 695 STANDARDS OF PERIOPERATIVE NURSING

D.3. Standard 3: Outcome Identification D.4.1.4. Collaborates with the patient and The perioperative RN identifies expected outcomes designated support person(s), as appropriate, that are unique to the patient. while planning care. D.4.1.5. Creates a plan of care that sup- Measurement ports continuity among providers. D.4.1.6. Specifies a logical sequence of D.3.1. Perioperative RN: interventions to attain expected outcomes. D.3.1.1. Uses ethical principles to deter- D.4.1.7. Identifies human and material mine expected outcomes that are mutually resources necessary to implement the plan formulated with the patient, designated of care. support person(s), and health care providers D.4.1.8. Communicates the plan of care to when appropriate. the patient, designated support person(s), D.3.1.2. Develops culturally and age- and health care providers. appropriate expected outcomes based on the D.4.1.9. Documents the plan of care patient’s present and potential physical capa- using standardized language in a retrievable bilities and behavioral patterns. format. D.3.1.3. Defines expected outcomes that are attainable with considerations to the Additional measurement human and material resources available to the patient. D.4.2. Advanced practice RN: D.3.1.4. Identifies measurable criteria to D.4.2.1. Synthesizes research findings determine outcome attainment. and applies expert clinical knowledge to D.3.1.5. Sets priorities including a time expand the plan of care for individuals and estimate for attaining expected outcomes. patient populations. D.3.1.6. Modifies expected outcomes D.4.2.2. Develops priorities for care based on patient status. reflecting the signs, symptoms, and behav- D.3.1.7. Communicates expected and ioral responses within the realm of care for attained outcomes to health care providers to the . provide direction for continuity of care. D.3.1.8. Documents outcomes in a D.5. Standard 5: Implementation retrievable­ format. The perioperative RN implements the identified plan of care. Additional measurement D.3.2. Advanced practice RN: Measurement D.3.2.1. Develops peer education that D.5.1. Perioperative RN: emphasizes identification and use of cul- D.5.1.1. Determines that the nursing turally appropriate patient outcome interventions are consistent with the plan of measures. care. D.3.2.2. Acts as a resource to determine D.5.1.2. Verifies that nursing interven- an outcome-driven plan for individual tions reflect the rights and desires of the patients and patient populations. patient and designated support person(s). D.3.2.3. Synthesizes evidence to deter- D.5.1.3. Implements nursing interven- mine optimal outcomes for individual tions safely and efficiently. patients and patient populations. D.5.1.4. Implements the ongoing plan of care in collaboration with the patient, D.4. Standard 4: Planning designated support person(s), and health The perioperative RN develops an individualized plan care providers based on the patient’s of care to attain expected outcomes. responses. D.5.1.5. Anticipates and responds to sit- Measurement uational changes. D.5.1.6. Modifies the plan of care based D.4.1. Perioperative RN: on the patient’s responses. D.4.1.1. Uses nursing diagnoses to iden- D.5.1.7. Incorporates new knowledge tify nursing interventions. and strategies to initiate change in nursing D.4.1.2. Uses current trends and scientific care practices if desired outcomes are not evidence in the planning process. achieved. D.4.1.3. Designs a plan of care that D.5.1.8. Documents interventions using includes strategies for health promotion standardized language in a retrievable for- and restoration. mat to promote continuity of care. 696 STANDARDS OF PERIOPERATIVE NURSING

Additional measurement D.5.b.1.4. Uses teaching strategies that are appropriate to the situation and the patient’s D.5.2. Advanced practice RN: D.5.2.1. Integrates advanced knowledge developmental level, cog­­nitive ability, learn- and skills to implement the plan of care. ing needs, readiness, language preference, D.5.2.2. Performs ongoing physical exam- culture, and beliefs. inations, selecting, ordering, and interpreting D.5.b.1.5. Alters teaching strategies based diagnostic tests. on feedback. D.5.2.3. Provides advanced interpreta- D.5.b.1.6. Reports information to the tion of conditions and gives rationale for appropriate source regarding local, state, the procedure. D.5.2.4. Performs interventions that and national health issues that affect safety apply advanced nursing therapies and according to policy, guidelines, or include medication management and clini- regulations. cal procedures. Additional measurement D.5.a. Standard 5a: Coordination of Care The perioperative RN coordinates patient care con- D.5.b.2. Advanced practice RN: tinually throughout the patient’s perioperative D.5.b.2.1. Uses advanced theoretical experience. knowledge to organize and deliver educa- tional programs for patients, designated Measurement support person(s), health care professionals, D.5.a.1. Perioperative RN: and the community. D.5.a.1.1. Delegates tasks and functions D.5.b.2.2. Initiates referrals promoting according to applicable laws, regulations, health or risk reduction. and standards, taking into consideration the D.5.b.2.3. Analyzes and disseminates infor- competency of the assignee. mation regarding local, state, and national D.5.a.1.2. Assists the patient and desig- nated support person(s) with identifying health issues that affect safety. alternative options for care. D.5.c. Standard 5c: Consultation Additional measurement The perioperative RN seeks specialized dialogue appropriate to the patient. D.5.a.2. Advanced practice RN: D.5.a.2.1. Uses advanced knowledge to initiate new treatments or change existing Measurement treatment based on changing trends or sci- entific evidence. D.5.c.1. Perioperative RN: D.5.a.2.2. Makes referrals to other health D.5.c.1.1. Facilitates communication be- care professionals and community tween health care professionals to enhance agencies. patient outcomes. D.5.a.2.3. Initiates interdisciplinary team meetings or other communication to improve the health of individual patients Additional measurement and patient populations. D.5.c.2. Advanced practice RN: D.5.c.2.1. Provides independent consul- D.5.b. Standard 5b: Health Teaching— tation services based on expertise using Health Promotion advanced­ knowledge within the scope of The perioperative RN promotes holistic wellness and a practice. safe environment. D.5.c.2.2. Collaborates and coordinates Measurement with medical, nursing, and other disci- plines to plan and implement monitoring of D.5.b.1. Perioperative RN: physiologic responses for individuals or D.5.b.1.1. Teaches modifications for activi- patient populations. ties of daily living. D.5.c.2.3. Consults with the appropriate D.5.b.1.2. Provides information to patients to reduce high-risk behaviors. health care providers to determine a need D.5.b.1.3. Advocates for healthy life­style for new treatments or a change in existing choices. treatments. 697 STANDARDS OF PERIOPERATIVE NURSING

D.5.c.2.4. Initiates new treatment based on D.6.1.6. Involves the patient, designated consultation. support person(s), and health care providers in the evaluation process whenever D.5.d. Standard 5d: Prescriptive Authority possible. The advanced practice RN prescribes medications, D.6.1.7. Disseminates evaluation results treatments, and therapies in compliance with state and as appropriate to the patient and others federal laws and regulations. according to state and federal laws and regulations. Measurement D.6.1.8. Recommends policy, procedure, protocol, process, or structural changes, as D.5.d.1. Prescriptive authority does not apply to the appropriate, based on evaluation data. perioperative RN. Additional measurement Additional measurement D.6.2. Advanced practice RN: D.5.d.2. Advanced practice RN: D.6.2.1. Evaluates responses to inter- D.5.d.2.1. Uses prescriptive authority ventions systematically and revises dif- within the scope of practice. ferential diagnoses as needed in relation D.5.d.2.2. Uses scientific evidence to to the patient’s progress toward attaining order, prescribe, or initiate diagnostic, ther- outcomes. apeutic, or pharmacologic interventions D.6.2.2. Uses advanced knowledge of based on patient status. learning and change theories, human behav- D.5.d.2.3. Monitors the patient for thera- ior, stress and coping mechanisms, crisis peutic and potential adverse effects in response to diagnostic or pharmacologic management, growth, and development to interventions. evaluate patient responses to care. D.5.d.2.4. Modifies diagnostic, therapeu- D.6.2.3. Modifies the patient’s plan of tic, or pharmacologic interventions based care, recommending additional diagnostic on the patient’s status and responses. testing and treatments if necessary to attain D.5.d.2.5. Educates patients and desig- outcomes. nated support person(s) about intended and D.6.2.4. Synthesizes knowledge of diag- potential adverse effects of proposed pre- nostic tests, therapeutic regimens, and the scribed therapies. patient’s responses as they relate to progress D.5.d.2.6. Informs patients and designated toward attaining expected outcomes. support person(s) about potential costs, D.6.2.5. Uses advanced knowledge to alternative treatment options, and proce- synthesize evaluation data that have a poten- dures as appropriate. tial effect on current and future health care practices for individual patients and patient D.6. Standard 6: Evaluation populations. The perioperative RN evaluates the patient’s progress toward attaining outcomes. Standards of Perioperative Measurement Criteria Professional Practice D.6.1. Perioperative RN: D.7. Standard 7: Quality of Practice D.6.1.1. Conducts a systematic and ongo- The perioperative RN systematically evaluates the ing evaluation measuring the effectiveness of quality and appropriateness of nursing practice. the interventions in relation to achieving identified outcomes. D.6.1.2. Monitors the patient’s progress Measurement toward achieving outcomes in the time frame D.7.1. Perioperative RN: identified in the plan. D.6.1.3. Documents the patient’s progress D.7.1.1. Demonstrates the quality of peri- toward achieving outcomes accurately and operative nursing care by documenting use of consistently using standardized language in a the nursing process using standardized lan- retrievable format. guage in a retrievable format. D.6.1.4. Revises diagnoses, outcomes, and D.7.1.2. Participates in ongoing quality the plan of care, based on ongoing assess- improvement activities as appropriate to ment and evaluation. the individual’s position, education, and D.6.1.5. Documents revisions in diag­ practice environment. Such activities noses, outcomes, and the plan of care using may include, but are not limited to, the standardized language in a retrievable format. following: 698 STANDARDS OF PERIOPERATIVE NURSING

• Identifying aspects of the perioperative D.7.2.5. Maintains certification in ad­­ nursing practice that are important for vanced nursing practice. quality monitoring. • Assigning responsibility for quality moni- D.8. Standard 8: Education toring and evaluation activities. The perioperative RN acquires and maintains special- • Identifying dimensions of performance ized knowledge and skills in nursing practice. related to perioperative nursing practice. • Developing quality indicators for each identified dimension of performance. Measurement • Establishing benchmarks to evaluate the D.8.1. Perioperative RN: quality indicators. D.8.1.1. Completes an individualized ori- • Collecting data related to the di­mensions entation based on identified learning needs. of performance and quality indicators. D.8.1.2. Demonstrates skill proficiency • Evaluating perioperative nursing practice relevant to perioperative nursing practice. and care based on the cumulative data D.8.1.3. Seeks experiences to maintain collected. skills and competency necessary to practice • Identifying strategies to improve periopera- perioperative nursing. tive nursing care or services based on qual- D.8.1.4. Participates in ongoing educa- ity indicators as necessary. tional activities relevant to professional • Taking action to improve perioperative issues and trends in perioperative nursing. nursing care or services. D.8.1.5. Maintains records and docu- • Assessing the effectiveness of the action(s) ments to support competence in periopera- taken. tive nursing. • Communicating the data collected D.8.1.6. Strives to achieve certification ­organization-wide to other agencies, regu- in perioperative nursing. latory bodies, or data repositories while maintaining confidentiality. Additional measurement D.7.1.3. Initiates changes in periopera- tive nursing practice through knowledge D.8.2. Advanced practice RN: gained and shared via the quality and per- D.8.2.1. Incorporates current re­search, formance improvement process. national guidelines, standards, and evidence- D.7.1.4. Improves perioperative nursing based practices to develop advanced clinical practice, services, and care through the knowledge and augment performance in peri- quality improvement process. operative nursing. D.7.1.5. Monitors perioperative nursing D.8.2.2. Develops, coordinates, imple- practice and compares it to national guide- ments, and evaluates educational programs lines, standards, or existing research. for individual patients, designated support D.7.1.6. Uses internal and external data person(s), patient populations, and local, to create innovative quality indicators. regional, or state communities based on identified needs. Additional measurement D.8.2.3. Maintains educational require- ments necessary for advanced certification D.7.2. Advanced practice RN: and licensure to practice. D.7.2.1. Applies advanced theoretical knowledge, research findings, and assess- D.9. Standard 9: Professional Practice Evaluation ment data to design and implement ongoing The perioperative RN evaluates his or her practice in quality monitoring activities to evaluate context with current professional practice standards, perioperative nursing practice. rules, and regulations. D.7.2.2. Works with multidisciplinary groups to design or implement advanced Measurement practices and alternative solutions to patient care issues based on quality moni- D.9.1. Perioperative RN: toring data. D.9.1.1. Provides care consistent with D.7.2.3. Synthesizes data from clinical the institution’s policies and procedures. investigations and scientific research to D.9.1.2. Practices nursing in accordance improve the safety, efficiency, and effective- with the state statutes, as ness of perioperative patient care. well as the standards and guidelines of D.7.2.4. Publishes or presents results of accrediting and regulatory bodies. quality monitoring and evaluation activities D.9.1.3. Maintains current knowledge of to influence and improve perioperative and adheres to ANA standards, practice nursing practice. guidelines, and position statements. 699 STANDARDS OF PERIOPERATIVE NURSING

D.9.1.4. Maintains current knowledge of D.10. Standard 10: Collegiality and adheres to AORN standards, recom- The perioperative RN interacts with and contributes to mended practices, guidelines, and position the professional growth of peers, colleagues, and others. statements. D.9.1.5. Maintains current knowledge of Measurement and adheres to standards, recommended D.10.1. Perioperative RN: practices, guidelines, and position statements D.10.1.1. Shares knowledge and skills from other nursing organizations as relevant through a variety of methods including, but to practice. not limited to, D.9.1.6. Participates in an ongoing evalua- • providing inservice education, programs, seminars, and workshops; tion process to ensure practice is current, • precepting; legal, ethical, culturally competent, and age- • mentoring; appropriate. • role modeling; D.9.1.7. Seeks evaluative input from • participating in peer evaluation; peers, colleagues, patients, and patients’ des- • publishing; and ignated support person(s) regarding nursing • participating in professional associations. D.10.1.2. Contributes to a supportive and practice. healthy work environment by using appro- D.9.1.8. Participates in peer review to eval- priate verbal and nonverbal communication uate nursing practice of fellow RN colleagues. techniques. D.9.1.9. Identifies goals and develops an D.10.1.3. Builds trust by being approach- action plan for professional development as able, honest, and accountable. part of an ongoing evaluation process. D.10.1.4. Acts as a role model for profes- D.9.1.10. Interprets and facilitates staff sional behavior. member and agency compliance with current D.10.1.5. Supports colleagues’ professional development. local, state, and federal regulations and D.10.1.6. Interacts with team members and standards. others in a respectful and courteous manner. D.9.1.11. Participates in legislative and D.10.1.7. Uses conflict resolution skills to policy-making activities that influence manage difficult behavior, promote positive health services and nursing practice. working relationships, and advocate for D.9.1.12. Respects diversity in all patient safety. interactions. Additional measurement Additional measurement D.10.2. Advanced practice RN: D.9.2. Advanced practice RN: D.10.2.1. Shares knowledge and skills as a D.9.2.1. Devises innovative, evidence- role model and mentor. based evaluation strategies to ensure that D.10.2.2. Uses advanced knowledge to care is being delivered in a legal, ethical, assist staff members with applying the nurs- culturally competent and age-appropriate ing process to complex patient situations in manner. the perioperative setting. D.9.2.2. Applies advanced theoretical D.10.2.3. Develops evidence-based guide- knowledge, research findings, and assess- lines to influence policy, change practice, and support professional development of ment data to design, implement, and evalu- colleagues. ate perioperative nursing practice. D.10.2.4. Acts as a preceptor for ad­vanced D.9.2.3. Works with multidisciplinary practice nurses. groups to design or implement advanced practices and alternative solutions to patient care issues based on quality moni- D.11. Standard 11: Collaboration toring data. The perioperative RN collaborates with the patient and designated support person(s) when practicing profes- D.9.2.4. Synthesizes data from clinical sional nursing. investigations and scientific research to improve the safety, efficiency, and effective- ness of perioperative patient care. Measurement D.9.2.5. Publishes or presents results of D.11.1. Perioperative RN: quality monitoring and evaluation activities D.11.1.1. Communicates pertinent infor- to influence and improve perioperative mation relating to patient care to internal and nursing practice. external stakeholders as appropriate. 700 STANDARDS OF PERIOPERATIVE NURSING

D.11.1.2. Demonstrates accountability and D.12.1.8. Formulates ethical decisions by flexibility when interacting with others. using available resources. D.11.1.3. Includes the patient and desig- D.12.1.9. Reports illegal, incompetent, or nated support person(s) and health care impaired practices. team members, as appropriate, in decision D.12.1.10. Recognizes own physical and making when providing perioperative nurs- psychological limitations to provide safe, ing care. competent patient care. D.11.1.4. Provides continuity of care when D.12.1.11. Participates on ethics commit- implementing referrals. tees as appropriate. D.11.1.5. Supervises allied health care providers and support personnel with Additional measurement appropriate authority. D.11.1.6. Delegates tasks and functions D.12.2. Advanced practice RN: according to applicable law, regulation, and D.12.2.1. Develops treatment plans while standards, taking into consideration the com- instructing the patient and designated sup- petency of the assignee. port person(s) about the risks, benefits, and possible outcomes of the plan. Additional measurement D.12.2.2. Contributes to the development of consistent policies and services that are D.11.2. Advanced practice RN: comparable in all settings and that are within D.11.2.1. Participates with the interdisci- the legal and ethical scope of advanced plinary team to promote the use of nationally practice. accepted clinical practice guidelines and stan- D.12.2.3. Provides independent or collab- dards in advanced nursing practice. orative care that is nondiscriminatory and D.11.2.2. Serves as a resource for perioper- nonprejudicial regardless of the setting. ative staff members, surgeons, ancillary D.12.2.4. Initiates treatments in a nonjudg- departments, and community groups requir- mental and nondiscriminatory manner that is ing advanced nursing expertise. sensitive to the patient’s cultural, racial, D.11.2.3. Fosters a collaborative environ- socioeconomic, and ethnic diversity. ment and recognizes the value of each pro- D.12.2.5. Considers ethical implications vider’s contribution to comprehensive health of scientific advances, cost, and clinical care. effectiveness, as well as patient and D.11.2.4. Acts in partnership with appro- ­designated support person(s)’ acceptance or priate health care providers to initiate new satisfaction. treatments or change existing treatments to promote positive outcomes. D.13. Standard 13: Research The perioperative RN incorporates research findings D.12. Standard 12: Ethics into practice. The perioperative RN uses ethical principles to deter- mine decisions and actions. Measurement Measurement D.13.1. Perioperative RN: D.13.1.1. Uses the best available research D.12.1. Perioperative RN: evidence to guide practice. D.12.1.1. Practices nursing according to D.13.1.2. Initiates change using scientific the ANA Code of Ethics for Nurses with Inter- evidence to develop policies and procedures pretive Statements (Exhibit B). or influence perioperative nursing practice. D.12.1.2. Acts as a patient advocate. D.13.1.3. Supports nursing practice changes D.12.1.3. Encourages patient self-advocacy. based on research evidence. D.12.1.4. Maintains patient confidentiality D.13.1.4. Seeks new knowledge that is within legal and regulatory guidelines. evidence-based through print, web-based, D.12.1.5. Delivers care in a nonjudgmen- and other sources. tal and nondiscriminatory manner that is D.13.1.5. Participates in research activi- sensitive to cultural, racial, and ethnic ties by involvement in one or more of the diversity. following: D.12.1.6. Delivers care in a way that pre- • identifying clinical problems pertinent to serves and protects patient autonomy, dig- perioperative nursing practice; nity, and human rights. • participating in data collection; D.12.1.7. Upholds the professional and • reading, analyzing, critiquing, and inter- therapeutic boundaries of the nurse-patient preting research findings to determine relationship. applicability to practice; 701 STANDARDS OF PERIOPERATIVE NURSING

• sharing research activities and findings Additional measurement with others; • participating on a research committee; D.14.2. Advanced practice RN: • participating in a research study; or D.14.2.1. Uses advanced knowledge to • joining a journal club. provide consultation services to the organi- zation to achieve high-quality, cost-effective outcomes for populations of patients across Additional measurement settings. D.13.2. Advanced practice RN: D.14.2.2. Promotes system-wide commu- D.13.2.1. Collects and aggregates data to nication to reduce costs by avoiding unnec- essary duplication of diagnostic tests. analyze care decisions, patient responses, D.14.2.3. Collects and evaluates data and health outcomes for potential research­ regarding the effectiveness of care, cost- projects. benefit relationship of the care being pro- D.13.2.2. Synthesizes current and emerg- vided, and patient satisfaction. ing research findings that contribute to posi- D.14.2.4. Maintains knowledge of the orga- tive patient outcomes and incorporates them nization’s methods of financing the delivery into advanced practice decisions. of care. D.13.2.3. Performs a literature review and D.14.2.5. Implements a cost-benefit evalua- critically appraises findings to advocate for tion of new technology and participates in analysis or review of system-wide clinical product review committees. practices. D.14.2.6. Considers health care access, fis- D.13.2.4. Conducts research to contribute cal responsibility, efficacy, and quality when to nursing knowledge and evidence-based providing advanced nursing care. practice. D.13.2.5. Disseminates research findings D.15. Standard 15: Leadership through writing, publishing, and presenting The perioperative RN provides leadership in the pro- to influence general and advanced nursing fession and professional practice setting. practice. D.13.2.6. Pursues funding for perioperative . Measurement D.15.1. Perioperative RN: D.14. Standard 14: Resource Utilization D.15.1.1. Supervises peers, colleagues, The perioperative RN considers factors related to allied health personnel, and support staff safety, effectiveness, efficiency, and the environment, members as assigned and appropriate. as well as the cost in planning, delivering, and evaluat- D.15.1.2. Delegates tasks and responsibili- ing patient care. ties according to law, regulation, and accred- iting agency standards. D.15.1.3. Holds self and team members Measurement accountable to the patient, the organiza- D.14.1. Perioperative RN: tion, and other internal and external stake- D.14.1.1. Assigns tasks or delegates care holders. based on knowledge and skills of perioperative D.15.1.4. Creates and maintains a healthy team members to meet the needs of the patient work environment. D.15.1.5. Embraces lifelong learning for and keep him or her free from harm. self and others. D.14.1.2. Assists the patient and desig- D.15.1.6. Advocates for a culture of safety nated support person(s) with identifying for patients and staff members in the human and material resources that are avail- workplace. able to address perioperative patient needs. D.15.1.7. Actively has input into organiza- D.14.1.3. Advocates for technical advances tional operations. Activities include, but are in clinical care to increase efficiency or not limited to, the following: improve outcomes. • influencing policy-making to improve D.14.1.4. Promotes the use of electronic patient care; information systems to provide periopera- • advocating for issues that affect periopera- tive patient care efficiently and safely. tive care; D.14.1.5. Advocates for reusing, recy- • participating in quality improvement cling, and renewing supplies whenever activities; appropriate in the perioperative setting. • participating on committees; D.14.1.6. Conserves supplies to minimize • being a role model when new policies, waste and decrease costs without compromis- procedures, or processes are im­­­ple­­- ing safety or negatively affecting outcomes. mented; 702 STANDARDS OF PERIOPERATIVE NURSING

• supporting change while considering E. Standards of Perioperative short- and long-term organizational goals; • operationalizing the mission, vision, and Administrative Practice values of the organization; and • encouraging peers and colleagues to E.1. Standard 1: Assessment be active. The perioperative RN administrator collects compre- D.15.1.8. Participates in ongoing quality hensive data necessary to support perioperative and improvement workplace activities as appro- organizational services. priate to the individual’s position, educa- tion, and practice environment. Measurement D.15.1.9. Enhances perioperative nursing through involvement with professional E.1.1. Uses evidence-based processes to collect organizations. Activities include, but are pertinent data in a systematic and ongoing manner not limited to, the following: to support perioperative services. • taking an active role in the association; E.1.2. Sets priorities for data collection activities • encouraging peers and colleagues to be based on the needs of the department, the organiza- active; tion, and perioperative patients. • sharing information received through asso- E.1.3. Involves internal and external stakehold- ciations with team members; and ers, as appropriate, in systematic data collection. • presenting pertinent information to indi- E.1.4. Develops mechanisms to resolve missing viduals and groups of lay and professional or insufficient data, information, and knowledge audiences. resources. D.15.1.10. Participates in legislative and E.1.5. Develops, maintains, and evaluates retriev- policy-making activities that influence peri- able data management systems to support periopera- operative care. tive services.

Additional measurement E.2. Standard 2: Identifies Issues or Trends The perioperative RN administrator analyzes data to D.15.2. Advanced practice RN: develop ideas and support decisions relevant to the D.15.2.1. Uses advanced knowledge to act delivery of perioperative nursing care. at the organizational level and beyond to promote change by identifying and influ- Measurement encing variables affecting health care prac- tices and outcomes. E.2.1. Synthesizes available data to identify D.15.2.2. Promotes interdisciplinary issues, patterns, trends, and variances involving cooperation and collaboration to imple- perioperative nursing services. ment outcome-based patient care programs E.2.2. Collaborates with internal and external to meet the needs of individual patients, stakeholders when analyzing data as appropriate. designated support person(s), or patient E.2.3. Validates the issues and trends with inter- populations or local, regional, or state nal and external stakeholders as appropriate. communities. E.2.4. Reports issues or trends to internal and D.15.2.3. Uses advanced team building,­ external stakeholders as appropriate. negotiation, and conflict resolution skills to E.2.5. Documents issues and trends in a retriev- promote teamwork to build partnerships able format to facilitate outcome identification and within and across health care systems. planning. D.15.2.4. Initiates legislative and policy- making activities that influence periopera- E.3. Standard 3: Outcomes Identification tive care. The perioperative RN administrator identifies expected D.15.2.5. Collaborates to prevent and outcomes for perioperative services. reduce the incidence of surgical site infec- tions, health care-associated infections, and other adverse events related to surgical Measurement patients. E.3.1. Develops outcomes for perioperative nursing D.15.2.6. Facilitates staff member access service using assessment findings and analysis. to and compliance with current local, state, E.3.2. Develops and maintains policies and proce- and federal regulations; professional stan- dures that support the outcomes. dards; and accreditation guidelines. E.3.3. Identifies evidenced-based outcomes using D.15.2.7. Advances the profession through standardized perioperative nursing language. writing, publishing, and presenting perti- E.3.4. Supports perioperative RNs and other nent information to individuals and groups health care personnel to achieve quality patient care of lay and professional audiences. outcomes. 703 STANDARDS OF PERIOPERATIVE NURSING

E.3.5. Promotes acquisition of appropriate tech- E.5.a. Standard 5a: Coordination nologies to provide patient and worker safety. The perioperative RN administrator coordinates imple- E.3.6. Identifies a physically, emotionally, and psy- mentation of the plan, using appropriate human and chologically safe work environment as a priority. capital resources. E.3.7. Identifies a time frame in which to achieve the outcomes. Measurement E.3.8. Modifies outcomes based on issues, trends, and research. E.5.a.1. Organizes implementation with consider- ation for budgetary, health care organization, and E.4. Standard 4: Planning community resources. The perioperative RN administrator develops the pro- E.5.a.2. Promotes efficient integration of services to implement the plan. cess and strategic plan to attain expected outcomes for E.5.a.3. Leads the coordination of efforts related to perioperative services. perioperative care and associated services when implementing the plan. Measurement E.4.1. Considers organizational and departmental E.5.b. Standard 5b: Health Teaching and Health structure, as well as lines of authority, when planning Promotion to meet the outcomes. The perioperative RN administrator employs strategies E.4.2. Develops a strategic plan that is consis- to promote workplace safety and health. tent with the mission, vision, and values of the organization. Measurement E.4.3. Establishes a timeline for processes and strategies to carry out the plan. E.5.b.1. Uses regulatory and evidence-based pro- E.4.4. Uses current laws, regulations, and stan- fessional guidelines to implement workplace safety dards to guide the planning process. practices. E.4.5. Bases the plan on current research and other E.5.b.2. Promotes workplace safety by applying evidence. wellness techniques. E.4.6. Assigns duties and responsibilities to carry E.5.b.3. Commits to practicing self-care and pro- out the plan with job descriptions, scope of practice, moting wellness with others. and regulatory and accrediting agencies. E.4.7. Considers the physical, psychosocial, and E.5.c. Standard 5c: Consultation economic effect of the plan. The perioperative RN administrator provides consulta- E.4.8. Modifies the strategic plan based on issues tion to communicate the identified plan. and trends in the department. E.4.9. Documents the strategic plan in a retriev- able format. Measurement E.5.c.1. Acts as a resource to internal and external E.5. Standard 5: Implementation stakeholders regarding perioperative nursing care, The perioperative RN administrator implements a stra- perioperative patient outcomes, and perioperative tegic plan within the organizational and departmental services. structure. E.5.c.2. Uses assessment data, theoretical frame- works, current research, and evidence related to perioperative nursing care when providing Measurement consultation. E.5.1. Implements the strategic plan by following E.5.c.3. Provides consultation based on experience the defined timeline with special consideration to the and knowledge of perioperative standards of care, rec- perioperative patient and workplace safety. ommended practices, laws, and regulations. E.5.2. Provides those implementing the plan with sufficient time and material, as well as intellectual, E.6. Standard 6: Evaluation human, and financial resources. The perioperative RN administrator evaluates the E.5.3. Uses health care organization and commu- effectiveness of the plan toward achieving desired nity resources to support implementation. outcomes. E.5.4. Coordinates and documents implementa- tion of the plan, including modifications. Measurement E.5.5. Communicates with internal and external stakeholders regarding implementation and E.6.1. Measures progress toward strategic planning modifications. goals at regular intervals to determine their validity. E.5.6. Encourages the development of organi­ E.6.2. Reviews the plan for compliance with zational systems and processes that support legal, regulatory, and credentialing requirements implementation. and guidelines. 704 STANDARDS OF PERIOPERATIVE NURSING

E.6.3. Includes internal and external stakehold- E.8.5. Upholds local, state, federal, legislative, and ers when evaluating progress toward or achieve- regulatory activities affecting perioperative nursing ment of outcomes. services. E.6.4. Takes action based on the results of the E.8.6. Recognizes professional standards, recom- evaluation to modify processes or structures. mended practices, and guidelines pertinent to peri- E.6.5. Reports evaluation results to internal and operative nursing services. external stakeholders. E.8.7. Maintains professional records to docu- E.6.6. Documents results of progress toward ment ongoing competence. attaining outcomes. E.9. Standard 9: Professional Practice Evaluation E.7. Standard 7: Quality of Practice The perioperative RN administrator follows regulatory, The perioperative RN administrator guides im­prove- accrediting, and professional guidelines and regula- ment of care delivery using key indicators. tions to evaluate professional practice of self and mem- bers of the department. Measurement Measurement E.7.1. Coordinates efforts and assigns personnel to systematically collect and record data in a retriev- E.9.1. Engages in self-evaluation of perioperative able format related to quality indicators. practice on a regular basis, identifying areas of E.7.2. Tracks data to develop performance strength as well as opportunities for professional im­provement initiatives that support the delivery development. of high-quality patient care. E.9.2. Validates competency of self and others at E.7.3. Develops written plans to monitor organi- regular intervals. zational or departmental outcomes at regular E.9.3. Participates in a systematic peer review of intervals. self and others. E.7.4. Uses data to initiate organizational or E.9.4. Provides a rationale for practice beliefs, departmental changes to provide high-quality patient decisions, and actions as part of the informal and care. formal evaluation processes. E.7.5. Identifies pertinent evidence to establish E.9.5. Respects diversity in all interactions. appropriate benchmarks. E.9.6. Ensures ongoing departmental compliance E.7.6. Compares benchmark data to challenge cur- with local, state, national, and professional legisla- rent practice and organizational or departmental tive and regulations. outcomes. E.9.7. Conducts formal performance reviews at E.7.7. Incorporates research and current evidence regular intervals based on patient and departmental to enhance quality and improve delivery of care. outcomes. E.7.8. Analyzes data to identify trends, variances, E.9.8. Solicits informal and formal feedback and patterns that affect perioperative nursing regarding departmental performance from appropri- services. ate internal and external stakeholders. E.7.9. Uses analysis to develop and enact new pol- icies and procedures to improve perioperative nurs- E.10. Standard 10: Collegiality ing services. The perioperative RN administrator promotes the pro- E.7.10. Validates privileges, credentials, or certifi- fessional development of others. cations to schedule procedures appropriately. E.7.11. Reports quality outcomes to internal and external stakeholders in compliance with state and Measurement federal requirements. E.10.1. Serves as a professional role model and mentor to motivate, develop, recruit, and retain E.8. Standard 8: Education perioperative RNs and colleagues. The perioperative RN administrator has advanced edu- E.10.2. Establishes a learning environment that is cational preparation and management experience to open and respectful to others. direct perioperative services. E.10.3. Shares expertise to advance the mission, vision, and values of the organization and promote Measurement positive perioperative outcomes. E.10.4. Provides opportunities and support for E.8.1. Achieves advanced education in nursing or continuing education, professional development, a related field. and formal education. E.8.2. Demonstrates management and leadership E.10.5. Promotes specialty certification. skills. E.10.6. Promotes active membership and partici- E.8.3. Validates experience in perioperative nursing. pation in professional organizations. E.8.4. Participates in ongoing educational activi- E.10.7. Encourages staff member participation on ties related to leadership, management, and perioper- multidisciplinary teams that improve perioperative ative nursing. nursing practice. 705 STANDARDS OF PERIOPERATIVE NURSING

E.10.8. Enhances own professional perioperative E.13.3. Promotes dissemination of knowledge nursing practice and role performance through gained from evidence-based activities via presenta- interactions with peers and colleagues. tions, publications, and consultation. E.13.4. Ensures that departmental research priori- E.11. Standard 11: Collaboration ties align with the mission, vision, values, and strate- gic plan of the organization. The perioperative RN administrator collaborates with E.13.5. Aligns departmental research priorities with internal and external stakeholders to improve periop- those set by professional nursing organizations, regu- erative services. latory agencies, and accrediting bodies. E.13.6. Incorporates evidence-based practice to Measurement improve perioperative patient outcomes. E.13.7. Incorporates evidence-based practice to E.11.1. Participates on system-wide committees as improve and support a positive work environment. a perioperative resource to influence organizational E.13.8. Supports research activities that contribute decisions, policies, and procedures. to perioperative nursing knowledge. E.11.2. Oversees departmental activities, provid- ing expert input regarding perioperative and organi- zational interests. E.14. Standard 14: Resource Utilization E.11.3. Interacts with health care providers to pro- The perioperative RN administrator uses human and material resources to deliver safe, high-quality, and mote positive perioperative outcomes. cost-effective perioperative services. E.11.4. Partners with internal and external stake- holders to influence health care policy decisions affecting perioperative services and outcomes. Measurement E.11.5. Documents collaborative efforts toward E.14.1. Considers safety and effectiveness when improving perioperative services, including plan- analyzing the cost-benefit ratios that affect perioper- ning, implementation, and effectiveness. ative services. E.14.2. Allocates resources to promote quality E.12. Standard 12: Ethics patient outcomes. The perioperative RN administrator ensures that ethi- E.14.3. Allocates fiscal resources to support the cal processes are used to deliver perioperative services. perioperative services strategic plan. E.14.4. Advocates for human and material resources by using patient acuity and nursing work- Measurement load guidelines to deliver safe patient care. E.12.1. Establishes an environment where periop- E.14.5. Advocates for human and material resources erative team members engage in competent, ethical, to support a safe work environment. and legal practices. E.14.6. Identifies strategies for cost-effective and E.12.2. Ensures the protection of human rights for efficient practices without compromising periopera- all individuals in the perioperative setting. tive patient safety or outcomes. E.12.3. Maintains privacy and confidentiality of E.14.7. Promotes creative thinking among staff individuals and health information within the peri- members, peers, and colleagues to develop new and innovative devices, practices, and strategies operative setting. to advance and improve perioperative nursing E.12.4. Fosters a nondiscriminatory climate within services. the perioperative setting. E.14.8. Advocates for environmental consciousness E.12.5. Maintains sensitivity to diversity within when using and managing resources in the periopera- the perioperative setting. tive setting. E.12.6. Uses resources within the organization to E.14.9. Provides documentation for internal and address ethical issues. external stakeholders to demonstrate costs, risks, and benefits that support decisions for perioperative E.13. Standard 13: Research practices. The perioperative RN administrator supports and inte- grates current research and other available evidence E.15. Standard 15: Leadership into perioperative services. The perioperative RN administrator provides leader- ship within the organization and the profession. Measurement E.13.1. Evaluates and updates practice decisions Measurement based on available evidence and current research E.15.1. Maintains membership in relevant profes- findings. sional organizations related to leadership and periop- E.13.2. Creates a supportive environment with suf- erative nursing. ficient resources for nurses to investigate research E.15.2. Strives to achieve relevant professional spe- findings and initiate evidence-based best practices. cialty certification(s). 706 STANDARDS OF PERIOPERATIVE NURSING

E.15.3. Acts as a leader on administrative teams E.16.3. Endorses regulatory measures that provide participating in decision making that affects perioper- for safe patient care and workplace safety. ative services. E.16.4. Incorporates safe perioperative care into E.15.4. Participates in activities to influence legis- the design, implementation, and evaluation of poli- lative or regulatory decisions that affect periopera- cies, programs, services, and systems. tive services and perioperative nursing practice. E.16.5. Allocates resources to support advocacy E.15.5. Leads committees, task forces, councils, and activities related to perioperative services and the teams to make decisions that positively influence nursing profession. perioperative services, perioperative nursing practice, E.16.6. Supports the perioperative patient’s right or perioperative patient outcomes. to access personal health data and information E.15.6. Supervises perioperative personnel and related to privacy, security, and confidentiality. supports their roles in promoting positive patient E.16.7. Promotes a philosophy of advocacy in the outcomes. perioperative environment. E.15.7. Promotes lifelong learning among personnel involved with perioperative services. References E.15.8. Inspires loyalty, teamwork, respect, and pro- 1. Nursing: Scope and Standards of Practice. Washington, fessionalism among personnel involved with periop- DC: American Nurses Association; 2004. erative services. 2. Scope and Standards for Nurse Administrators. E.15.9. Promotes an environment that fosters inde- Washington, DC: American Nurses Association; 2009. pendent and creative critical thinking. 3. Petersen C, ed. Perioperative Nursing Data Set. 2nd E.15.10. Acts as a leader and change agent, sup- ed rev. Denver, CO: AORN, Inc; 2007. porting evidence-based practices in the periopera- 4. Nursing’s Social Policy Statement. 2nd ed. Washington, tive setting. DC: American Nurses Association; 2003. E.15.11. Advances knowledge of perioperative ser- vices and perioperative nursing by communicating Publication History pertinent information through publishing and pre- Compiled from previous editions for publication in senting for professional and lay audiences. Perioperative Standards and Recommended Practices (Denver, CO: AORN, Inc; 2009). E.16. Standard 16: Advocacy Revised October 2009 for online publication in Periop- erative Standards and Recommended Practices. The perioperative RN administrator advocates for indi- Reformatted September 2012 for publication in Peri- viduals and groups related to perioperative health and operative Standards and Recommended Practices, safety. 2013 edition. Minor editing revisions made in November 2014 for Measurement publication in Guidelines for Perioperative Practice, E.16.1. Advocates for one perioperative RN circula- 2015 edition. tor per patient in the intraoperative phase of care. E.16.2. Supports perioperative patients’ health care rights by involving individuals in their own care.

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AORN gratefully acknowledges the work of the 2007–2008, 2008–2009, and 2009–2010 Nursing Practice Committees

2007–2008, 2009–2010 Chair, Denise M. Jackson, MSN, RN, CNS, CRNFA 2008–2009 Advisor (2009–2010) RN First Assistant Antonia Hughes, MA, BSN, RN, CNOR Shannon Medical Center Perioperative Education Specialist San Angelo, Texas Baltimore Washington Medical Center Glen Burnie, Maryland Ellice M. Mellinger, MS, RN, CNOR (2008–2010) Clinical Educator 2008–2009 Chair, 2007–2010 Member University Medical Center Sharon L. Chappy, PhD, RN, CNOR Tucson, Arizona Associate Professor Barbara A. Ricker, MSN, RN, CNOR (2007–2009) University of Wisconsin Oshkosh RN Clinical Development Professional Oshkosh, Wisconsin Banner Health Phoenix, Arizona Members Linda P. Voyles, BSN, RN, CNOR (2009–2010) Beth A. Beilein, MSM, BSN, RN, CNOR (2009–2010) Perioperative Educator Director of Clinical Operations Banner Estrella Naples Day Surgery, South Phoenix, Arizona Naples, Florida Dawn M. Yost, BSN, RN, RDH, CNOR (2008–2010) James (Jay) Bowers, BSN, RN, CNOR (2007–2008) Manager of Nursing Operations and Sterile Clinical Nurse Preceptor Processing West Virginia University Hospitals West Virginia University Hospitals Morgantown, West Virginia Morgantown, West Virginia Judith L. Clayton, RN, CNOR (2007–2009) Perioperative Clinical Educator 2009–2010 Board Liaison Gwinnett Medical Center Peter Graves, BSN, RN, CNOR Duluth, Georgia Consultant Nikki A. Collier, RN, CNOR, CRNFA (2008–2010) Corinth, Texas RN First Assistant St Joseph Hospital 2007–2009 Board Liaison Eureka, California Jane Kusler-Jensen, MBA, BSN, RN, CNOR Director of Perioperative Services Joy Crouse, MS, RN, CNOR (2007–2008) Ozaukee and River Woods Campuses, Clinical Supervisor Columbia-St Mary’s St Josephs Hospital and Medical Center Milwaukee, Wisconsin Phoenix, Arizona Jim D’Alfonso, MSN, RN, CNOR (2007–2009) 2007–2010 Staff Consultant Associate Vice President Bonnie G. Denholm, MS, BSN, RN, CNOR Scottsdale Healthcare Shea Perioperative Nursing Specialist Mesa, Arizona AORN Center for Nursing Practice Vicki Dreger, MSN, RN, CNOR (2007–2009) Denver, Colorado Staff Nurse Advocate Christ Medical Center 2007–2010 Administrative Support Oak Lawn, Illinois Bonnie Kibbe Elizabeth Gasson, MSN, RN, CNOR (2009–2010) Clinical Director River Oaks Hospital Jackson, Mississippi

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