Maryann Papanier Wells

Determining the Best Length of an OR Orientation Program

The length of orientation necessary for nurses new to the OR to obtain basic perioperative skills to ensure quality patient care is a major expense for health care facilities. The length of perioperative orientation programs varies greatly from institution to institution. Some last only one month, and others last from three months to one year. Educators usually decide the length of time based on tradition or outcomes; however, this may not be the best way to determine the length of an orientation program. A standardized time frame for perioperative orientation needs to become a reality. This article reports the results of a study that examined the effect orientation length had on RN compliance rates after nurses completed two different orientation programs and discusses the implications for developing orientation programs.

Are there leaders among us

In Peter Pan, the lost boys chanted, “Follow the leader wherever he may go,” and, whereas most of us can identify a leader and follow his or her lead, it can be hard to say why the leader is successful. According to Warren Bennis, “Leadership is like the abominable snowman whose footprints are everywhere but is nowhere to be seen.” There is no uniform definition for leadership. From biblical times to the present, one can argue that leaders possess similar traits, but those traits also change to reflect the times. Leaders tend to materialize no matter what the environment. If one has the passion and ambition to lead, then one can develop into a successful leader. According to Vince Lombardi, “Leaders are made not born.” Colleagues and coworkers who have the potential to be leaders need to be mentored by current leaders. Real-life examples can be an excellent teaching method to aid individuals in becoming successful leaders. To show examples of leadership experiences, we discuss scenarios encountered by a former perioperative nurse manager with more than 25 years of experience working at a major inner city teaching hospital and a lead tax consultant with less than one year of experience working at one of the largest professional service organizations in the United States.

Total Abdominal Hysterectomy

Learning Objectives 1. The learner should be able to list indications for hysterectomy: o Abnormal bleeding o Leiomyoma/Adenomyosis/Endometriosis o Pelvic organ prolapse o Pelvic Inflammatory Disease o Chronic pelvic pain o Malignant disease 2. The learner should be able to list relative indications for and risk associated with abdominal hysterectomy: o Large leiomyoma, abnormal position of leiomyoma o Uterus >12 week size o Pelvic Inflammatory Disease, extensive adhesions/endometriosis o Cancer, extensive metastases o Increased operative time o Increased complications: fever, blood transfusion o Longer hospital stay 3. The learner should be able to demonstrate the basic steps in performing abdominal hysterectomy: o Confirm size of uterus and mobility, absence of nodularity, location of myoma o Document degree of descensus with tenaculum on cervix o Abnormalities such as cystocele and rectocele 4. The learner should be able to identify important anatomic landmarks: o The common iliac artery bifurcation = area where ureter crosses o The uterine artery is found adjacent to the uterus at the level of cervical os 5. The learner should demonstrate basic knowledge about abdominal hysterectomy: o Incidence of abdominal hysterectomy = 66% o Incidence of vaginal hysterectomy = 26% o Incidence of laparoscopic hysterectomy = 12% o Subtotal hysterectomy: reserved for rare concern over large blood loss, or anatomic distortion limiting dissection o Common site of ureter injury: at infundibulopelvic (IP) ligament, area of uterine artery ligation, bladder base