OR Manager - February 2019 - 22

Funds earmarked to enable nurse-led research
Leadership
he United States is amid a conversion
to a value-based system
of healthcare. Although this new
delivery model has contributed to the
closure of some hospitals and the realignment
of others into larger health
systems, the primacy of the OR as a
source of revenue for hospitals has remained
constant. The OR is the economic
engine of the hospital.
The growing importance of the revT
enue
generated by the OR, combined
with the disruptive change inherent in
the transition to a value-based system
of care, has markedly increased the
performance pressure on perioperative
nurse leaders.
The need for financial acumen in OR
leadership is apparent and has contributed
to the emergence of multidisciplinary
teams that include business
managers and supply chain management
specialists.
As unsettling as these changes are
for perioperative nurse leaders, they
also present opportunities for those
who can adapt to the changes.
As the chief executive officer of the
Competency and Credentialing Institute
(CCI), the organization that develops,
maintains, and administers the accredited
CNOR and CSSM (Certified Surgical
Services Manager) credentials, I have
insight into how perioperative nurse
leaders can establish their value in a
rapidly changing American healthcare
system. I believe perioperative nursing
can solidify its value, in part, through
research activity.
I also think that organizations
such as CCI have a role in
facilitating that research.
Although this will not be easy and
there are some formidable obstacles,
I believe perioperative nurse leaders
have a rare opportunity to better understand
and direct their profession during
these challenging times.
In this article I speak to these obstacles
and discuss how CCI is actively
working to support perioperative nurse
leaders who wish to pursue research
opportunities.
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The economics of surgical care and the
role of perioperative nurse leaders in
these processes and models is a research
topic that has the potential to
provide immediate, actionable results.
Perioperative nurse leaders are increasingly
tasked with quantifying the value
of surgical care within the larger context
of healthcare expenditures. Here is one
example of how nurses might contribute
in this area.
Research opportunities for
perioperative nurses
In a 2017 article, Peter Nichol, MD,
addressed the markups typically found
in surgical supplies. As a pediatric
laparoscopic surgeon, Dr Nichol asked
pointed questions about the connection
between quality of care and costs of
care linked to choices in surgical supplies.
The
entities providing payment for
surgical care are raising questions
about costs and altering payment methods,
which cut into the margins long
seen in surgical services. Facilities providing
surgical care are being forced to
increase efficiency and demonstrate
value. Therefore, research on these topics
is warranted.
In addition to economic considerations
in the OR, perioperative nurse
leaders must stay abreast of the evolving
skills and knowledge needed to
function effectively in this changing
landscape. Routes to acquiring these
skills and the results of their implementation
in the OR are additional attractive
research topics.
Patient outcomes research has almost
limitless potential for application
in the perioperative setting. The correlation
of nursing education levels,
certification status, and the variety of
specialty training programs for nurses
entering the profession are all factors
that might affect patient outcomes, but
these relationships have not been extensively
studied.
Financial management skills are requisite
for perioperative nurse leaders,
but the intricacy of American healthcare
presents an opportunity for more
advanced skills in this area. It may not
be possible to acquire certain complex
skills with workplace training alone.
Financial analysis methods such as
cost effectiveness analysis (CEA) and
comparative effectiveness research
(CER) could be applied to the types of
questions posed by Dr Nichol regarding
value and effectiveness, but additional
education is needed for nurse leaders
to conduct such analyses.
Longitudinal data gleaned from the
annual OR Manager salary surveys indicate
that graduate-level education is
becoming commonplace for perioperative
leaders. But performing complex
analyses such as CEA and CER, working
in multidisciplinary teams with physician
colleagues, analyzing large data
sets, and generating new knowledge all
speak to the need for at least a small
group of nurse researchers prepared at
the doctoral level.
To better understand the current
state of perioperative nursing research,
CCI conducted a search of Internetbased
resources. That search revealed
a paucity of resources for perioperativespecific
nursing research.
The search, performed by Carole
Martell of the ShyParade marketing
firm, revealed that research foundations
often focus on diseases such as cancer
and diabetes versus the practice of
nursing specialties such as perioperative
nursing.
A review of publications often read
by perioperative nurses, such as OR
Manager and the AORN Journal, reveals
some original research done by nonnursing
researchers. Nursing research
is not the focus of either publication,
but both contain some research by multidisciplinary
teams that lack nurse researchers.
Thus, it appears that there
is ample opportunity for additional research
and for greater participation
from perioperative nurse researchers.
Continued on page 22
OR Manager | February 2019 21
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OR Manager - February 2019

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