1. Thompson, Elizabeth M. MSN, RN, CNOR

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William Shakespeare wrote "What's in a name? That which we call a rose by any other name would smell as sweet." In October 2010, the Institute of Medicine (IOM), in conjunction with the Robert Wood Johnson Foundation, introduced a recommendation for a nurse residency program. How does this recommendation affect the preparation of the perioperative nurse? Is the nurse residency program a "rose by any other name" or is this truly an innovative approach to transitioning new nurses into their practice?

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The IOM's residency recommendation reintroduces a recommendation made by the Joint Commission in 2002. Both agencies noted the "difficulty for nurses transitioning from school to practice."1 The IOM recommends state boards of nursing, accrediting bodies, the federal government, and healthcare organizations take actions to support nurses' completion of a transition-to-practice program (nurse residency) after completion of a prelicensure or advanced practice degree program or when transitioning into new clinical practice areas.2


Some initiatives have been taken to develop a curriculum to support this transition from education to practice. The University Health System Consortium and American Association of Colleges of Nursing (UHC/AACN) attempted to define the curriculum.3 Their recommendations were a 1-year standardized curriculum, guidance of a preceptor, and clinical experience consistent with the nurse resident's specialty area. Suggested curriculum content focused on developing leadership skills, patient safety, professional role, critical thinking, communication, and evidence-based practice.


When I investigated the topic of nurse residency programs, I was surprised by the number of healthcare organizations that have implemented curricula to support this objective. The curricula are quite varied in content, and some but not all of the programs seem to follow the UHC/AACN guidelines.


As perioperative nurses, we recognize the role we perform as unique. Orientation and training programs needed to prepare nurses for the perioperative role are separate from, and in addition to, the preparation for medical/surgical nursing. Perioperative orientation is very specialized and focused on the concepts and responsibilities needed to provide the best care for patients undergoing surgical procedures.


Our organization offers a competency-based orientation that is completed in about 6 months. We provide weekly staff development programs to provide evidence-based information in current trends, new procedural techniques, and continuous improvement initiatives. In talking with colleagues across the United States and internationally, I've found that our program isn't unique, but matches many others of comparable size and resources.


So although this curriculum meets much of the criteria recommended by the IOM, vigilant examination of the evolving perioperative nursing role should identify gaps in transitioning nurses from education to practice. Managing change in a highly technical and complex environment, promoting the leadership role in a team environment, and promoting optimal patient outcomes through enhanced communication are other areas that might benefit from more extensive and ongoing attention.


Elizabeth M. Thompson, MSN, RN, CNOR

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Editor-in-Chief Nursing Education Specialist Mayo Clinic, Rochester, Minn.




1. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. 2010. [Context Link]


2. Garner C. IOM recommendations for transforming nursing practice. 2010. [Context Link]


3. University Health Consortium. UHC/AACN Nurse Residency Program. 2007. [Context Link]