ORNAC Notice: These guidelines are currently under review by the Education Committee and may be subject to change without notice.

RULES AND REGULATIONS MANUAL

Perioperative Programs for Registered Nurses
Program Review and Approval Process: Guidelines for Self-Assessment

• Accountability for co-ordination of the Approval Process for Perioperative Education Programs for Registered Nurses lies with the Perioperative Education Committee.
• Programs shall notify the Chair of the Perioperative Education Committee of their intent to apply for ORNAC Approval at least three months in advance. The Chair shall then arrange for the review process.
• The approval process shall be strictly confidential, and information will not be communicated regarding applications. The Committee’s reports to the ORNAC Board will indicate the number of applications, reviewers, etc. but will not divulge confidential details. If External reviewers are required they will sign a confidentiality agreement with ORNAC.
• Programs which apply for ORNAC Approval may be requested to provide individuals to participate in external reviews of other programs, subject to ORNAC confidentiality agreement. Applications will follow the format outlined in the Approval Process.

Policies

1. ORNAC’s Approval Process for Perioperative Education Programs is available only for those educational programs offering education for Registered Nurses. Programs offering the same education to other health care providers or to both Registered Nurses and others within the same program will NOT be evaluated or approved by ORNAC.
2. Approval Status

   2.1 Full Approval
   A program is granted unqualified approval by ORNAC for three (3) years. Suggestions may be included by the reviewers for consideration by the Program, but the approval status is not dependent upon implementation of these suggestions.

   2.2 Conditional Approval
   A program is granted conditional approval, based on the results of the assessment. The conditions may be removed by ORNAC, with full approval status subsequently granted, upon:

   • Implementation of the major recommendations set forth in the conditional approval; and,
   • Submission of a written report, within the time-frame specified by the reviewers, (maximum 6 months) outlining actions taken on the recommendations.

   A decision regarding the removal of conditions remains the discretion of the Committee and reviewer

   2.3 New Program Approval
   A new program may be granted either full or conditional approval, with provision for a review of approval status following the graduation of the first class.

   2.4 Approval Denied
   A program may be denied approval by ORNAC when:

   • The program has failed to present sufficient evidence that the criteria have been met.
   • The program has not taken action to address recommendations in the time-frames outlined in an award of Conditional Approval.
3. Application Format
   The same application format is used both for original applications, and for applications for renewal of approval.
4. Application and Other Fees
   A non-refundable application fee (payable to ORNAC) must accompany the application. The application fees shall be received by ORNAC prior to approval review being initiated or approval granted. The fee structure is established by the ORNAC Board.
   
   Website fees (as established by ORNAC) shall accompany each request for changes to Program information on the ORNAC website during the 3-year approval period. All requests for changes to information on the ORNAC website shall go through the Chair, Perioperative Education Committee.
5. Appeal Process
   A program may appeal the decision of the review process. Such appeals are to be made in writing to the Chair of the Perioperative Education Committee within one (1) month of receipt of the decision. The Chair has the discretion to appoint a second review of the documents as submitted.
   
   Results of the Appeal process are final.
6. Perioperative Education Programs for registered nurses that achieve "ORNAC Approved" status may indicate that status on their promotional materials only for the period covered by the approval, and only in the format as indicated by ORNAC in the letter of Approval. A certificate from ORNAC (suitable for framing) indicating approval status and time-frame for the approval will be provided to the educational provider. This is suitable for display in clinical settings, etc.
7. ORNAC will maintain a current list of approved Perioperative Education Programs for registered nurses on its website. This list shall indicate program information, the educational provider, contact information and approval status.

ORNAC Notice: These guidelines are currently under review by the Education Committee and may be subject to change without notice.

RULES AND REGULATIONS MANUAL

Perioperative Programs for Registered Nurses
Program Review and Approval Process: Recommended Core Curriculum

1. Perioperative nursing programs will include theory content from nursing, sciences and the humanities.
   The focus of the program shall be on the provision of individualized, patient-centered care.
2. The current edition of the Standards, Guidelines, and Position Statements for Perioperative Nursing Practice by ORNAC will be a required textbook.
3. The Code of Ethics of Canadian Nurses Association, Perioperative Nursing Data Set and Provincial Nursing Standards of Practice will be included in curriculum.
4. Teaching and learning methodologies will reflect principles of adult learning and may include self-instructional units, independent learning opportunities, challenge exams and research projects or presentations.
5. Clinical assignments will be designed to provide opportunities for the learner to apply theory to practice. Adequate clinical practice time will be allowed for the learner to achieve predetermined objectives.
6. Learner outcome evaluation will be ongoing and based on the achievement of program objectives. Evaluation will include objective measurements (e.g., examinations), competence to perform selected skills, and evidence of clinical decision making and critical thinking.
7. A passing grade 75% (minimum) must be achieved.
8. A plan will be developed for process evaluation, and should include: the learning climate; timing of events; levels and quality of instruction; appropriateness of teaching methods; and, the quality of supporting materials.
9. Provision will be made for records and reports to be maintained by the program.
10. Methods for the storage and retrieval of individual records will be developed.

COMPETENCIES TO BE ACHIEVED BY THE LEARNER UPON COMPLETION OF THE PROGRAM

The Perioperative Registered Nurse Practices Professionally:

1. 1. Is committed to continual improvement of knowledge and skills required to respond to the needs of the perioperative patient throughout the continuum of care; 2. Understands and applies ORNAC’s Standards, Guidelines, and Position Statements for Perioperative Nursing Practice (current edition) and the Canadian Nurses Association Code of Ethics; 3. Utilizes self-evaluation and reflective practice as a method to continually improve practice; 4. Collaborates with patient and patient’s support systems as well other providers to assist the patient in achieving optimal health status; 5. Articulates the role of the perioperative nurse using the Perioperative Nursing Data Set; 6. Has an understanding of ORNAC and the role/contribution that ORNAC makes to professional perioperative nursing; 7. Understands professional accountability for active membership in professional nursing bodies (provincial and national e.g. ORNAC); 8. Advocates for the role of perioperative registered nurse; 9. Advocates for changes to institutional policies and practices that meet evidence based practice.

The Registered Nurse Provides Patient Care in the Circulating Role:

1. 1. Reviews, identifies, and assesses the physiological and psychological status of the patient, focusing on the individual needs of each patient; 2. Uses the nursing process to develop a nursing care plan to meet the specific needs of the patient; 3. Establishes priorities of patient care specific to the patient’s needs and the surgical procedure; 4. Provides resources required for the surgical team to function efficiently; 5. Provides emotional support to each surgical patient; 6. Provides appropriate care during the surgical procedure; 7. Demonstrates knowledge and supports the role of the anesthesia care provider during both routine and emergency situations; 8. Demonstrates a surgical conscience; 9. Coordinates care requirements and liases with interprofessional team; 10. Communicates effectively with interprofessional team members contributing to positive patient outcomes; 11. Monitors patient safety throughout the experience; 12. Performs the count procedure with the scrub person according to ORNAC Standards, facility policy, and documents appropriately; 13. Maintains the integrity of the sterile field; 14. Provides focused, astute observation of the surgical team throughout the operative procedure; 15. Anticipates and meets the team’s needs with minimal delays; 16. Acts as the patient’s advocate during the surgical procedure; 17. Monitors and evaluates the physiological status of the patient throughout the operative procedure; 18. Responds appropriately to complications and unexpected events; 19. Assists with patient transfer and positioning pre, intra and postoperatively; and 20. Documents nursing and surgical activities during the perioperative period.

The Registered Nurse Provides Patient Care in the Scrub Role:

1. Sets priorities and expedites an efficient set-up for each surgical procedure;
2. Demonstrates a surgical conscience;
3. Maintains a sterile field;
4. Labels medication on the sterile field;
5. Advocates for use of smoke evacuation devices;
6. Tracks instruments throughout the surgical experience;
7. Communicates effectively with an interprofessional team contributing to positive patient outcomes;
8. Monitors patient safety throughout the care experience;
9. Applies knowledge and skills to the techniques and procedural steps of the surgical procedure;
10. Demonstrates the ability to respond appropriately to complications and unexpected events during the surgical procedure;
11. Performs the count procedure with the circulator according to ORNAC Standards and facility policy;
12. Demonstrates knowledge of instruments and equipment; and
13. Acts as the patient’s advocate throughout the surgical experience.

The Registered Nurse Provides Supportive Care to Patients and Their Families

1. Remains attentive to the needs of the patient throughout the perioperative period;
2. Provides explanations when providing care;
3. Demonstrates caring behavior;
4. Provides a safe environment for the patient;
5. Offers information and support to patients and families;
6. Acts as a patient advocate; and
7. Provides culturally sensitive care to patients.

The Registered Nurse Provides Support to Team Members

1. Contributes to and encourages collaborative working relationships;
2. Shares knowledge and skills, including teaching other staff members;
3. Manages stressful situations in a focused and calm positive manner;
4. Communicates effectively both verbally and in writing;
5. Demonstrates effective conflict resolution;
6. Functions as an effective member of the multidisciplinary team; and
7. Is aware of and actively works to stop horizontal violence in the workplace.

The Registered Nurse Provides a Safe Environment

1. Practices effective aseptic technique, routine precautions and other infection control practices;
2. Provides timely, appropriate corrective action when injury or contamination occurs to self or team members;
3. Verifies sterility of all equipment;
4. Demonstrates a surgical conscience;
5. Identifies and safely manages hazardous materials and equipment;
6. Complies with Workplace Hazardous Materials Information System (WHMIS) regulations;
7. Practices according to CSA standards when radiation or laser devices are being used;
8. Adheres to policy when handling or recording controlled drugs;
9. Labels all medications on the sterile field;
10. Demonstrates knowledge of Safer Healthcare Now! Initiatives;
11. Provides interventions to assist with normothermia;
12. Ensures that equipment and instruments are in safe working condition;
13. Manages surgical specimens according to policy;
14. Conducts surgical counts according to ORNAC Standards and policy;
15. Demonstrates safe management of electrosurgical units, and pneumatic tourniquets;
16. Provides a latex-free environment for the patient when necessary;
17. Demonstrates the use of the Surgical Safety Checklist and participates in the completion of this checklist; and
18. Utilizes waste management practices in accordance with government legislation and organizational policy.

The Registered Nurse Responds to Emergency Situations

1. Demonstrates the ability to recognize and respond effectively to urgent and emergency situations; and
2. Anticipates, sets priorities, and prepares for the management of urgent and emergent situations.

The Registered Nurse Manages Resources

1. Plans, organizes and priorizes resources to meet the needs of the patient;
2. Assembles, prepares for use, and disassembles equipment for each surgical procedure;
3. Reduces waste, is cost effective, and respects environmental concerns;
4. Organizes patient care with team members to maximize efficient use of resources, energy and time;
5. Evaluates the process of activities, delegated duties, and patient outcomes; and,
6. Participates in evaluations of products and equipment.

PROGRAM CONTENT
to include but not limited to the following:

1. Introduction to Perioperative Nursing Practice
   1. Patient-centered care in the perioperative setting
   2. Perioperative nursing roles
   3. Standards of perioperative nursing practice
   4. Perioperative Nursing Data Set
2. Legal and Ethical Issues in Perioperative Nursing
   1. Ethical decision making
   2. Confidentiality
   3. Informed consent
   4. Documentation
   5. Organ retrieval and transplants
   6. Do Not Resuscitate orders & advanced directives
   7. Dealing with death in the OR
3. Preoperative Nursing Care
   1. Patient preparation
   2. Patient assessment and admission to the OR
   3. Age specific care: geriatric, pediatric
   4. Caring for patients with specific needs: pregnancy, latex allergy, high BMI, diabetes, etc.
   5. Culturally sensitive care in the OR
4. Anaesthesia
   1. Types of anaesthesia: general, regional, local, etc
   2. Perioperative nursing responsibilities related to the provision of anaesthesia, including during induction and emergence
   3. Pharmacological agents
   4. Anaesthetic emergencies:
      • cardiac arrest
      • malignant hyperthermia
      • hypovolemic shock
      • latex allergy
   5. Use of blood, blood products and alternatives
   6. Monitoring the patient receiving procedural sedation and/or local anesthesia.
5. Environmental Safety Issues
   1. Surgical Safety Checklist
   2. Fire safety protocols and procedures
   3. Use of lasers and electrosurgery devices
   4. General safety in the OR; and
      • OR table basics and safety
      • transferring patients
      • waste management and
   5. Surgical smoke evacuation
6. Immediate Postoperative Nursing Practice
   1. Preparation and transfer of patient to post anaesthesia care unit, or other nursing unit for post operative care
   2. Perioperative nursing care documentation