OR’s Sustainable Staffing

OR’s Sustainable Staffing

Nurse Internship Combines Mentoring and Professional Development

by Rebecca Proch

For new nurses drawn to the high-intensity pace of the operating room (OR), learning the specialty can be an exhilarating but intimidating challenge. There’s little to no OR-specific training in most nursing school programs, yet the work requires learning a dizzying number of new skills and procedures. It’s unlike other nursing specialties, and it’s difficult to get hired without experience. Those who do are often learning on the job. At Johns Hopkins Bayview Medical Center, the Operating Room Nurse Internship builds a bridge between education and employment by offering nurses a seven-month blended work-study program that combines the support of mentorship with the practicality of hands-on experience.

It’s been over a decade now since the program started, and the vast majority of Bayview’s OR nursing staff are themselves graduates of the program. Lenora Twesigye, RN, OR Internship Nurse Educator, who runs the program and who is also a former intern—puts the estimate at 80%. Says Kathleen Owens, RN, Nursing Director for Perioperative Services, “It’s good for the hospital because it’s difficult to recruit OR nurses, and especially to find experienced OR nurses. We rely on the residency program to cultivate our own nurses and meet our staffing needs.” Within Owens’s four-year tenure, the internship has trained and retained enough nurses to eliminate completely the need to staff with agency nurses.

With so many intern alumni on the staff, the mentorship aspects of the program take on an added depth. After the initial orientation and classroom training, which includes a five-day consortium with other nurse interns from 27 participating facilities in the Baltimore region, the four to six residents circulate for three weeks, each in seven different services, working one-on-one with a preceptor who provides guidance and support as well as training. “It’s wonderful to see nurses who came through the program become the mentors and teachers,” says Twesigye. “They know what the interns are going through. There’s so much understanding in the support they give.”

Nurse Educator Lenora Twesigye, RN, CNOR (left), mentors OR nurse interns Greg Howard, Tanika Johnson, and Ben Salah.

Jeanne Sedgwick, MS, RN, CNOR and Perioperative Clinical Nurse Specialist who works closely with the program, points to peer sharing as another key benefit to the interns. “As a group, there is strength in numbers,” she says. “It’s an uphill battle taken together which builds  a cohesiveness between them.” Although the program participants are separated for their service rotations, they are still regularly brought together to share experiences and reflect. They turn to one another for empathy and advice as much as to their instructors and mentors, and camaraderie grows.

The program relies on the contributions of staff throughout the unit, acting as preceptors, trainers, and instructors. A representative from IT teaches the residents to use the OR management information system (ORMIS) that all Bayview OR nurses need to know. Owens teaches a class on professionalism in nursing that includes information on certifications and paths to career advancement in the OR specialty at Johns Hopkins Bayview.

“It builds interdepartmental relations,” says Sedgwick, noting that the interprofessional collaboration extends to the 27-member training consortium, where directors, managers, and educators are pooling resources to create a more well-rounded experience for the participants. “The consortium gets stories, perspectives and best practices from many facilities,” she says. “There is a wealth of knowledge that is shared, different practice issues that get addressed and resolved, so ultimately there is a benefit to the patient.”

At its core, that’s what the program is about—patient safety and maintaining the highest quality of care. “Our program involves evidence-based practice, where we’re always looking for quality improvement opportunities,” says Twesigye.
“We are fostering the habit of questioning in new learners so they will bring that  into their careers. Questioning everything is the best practice for keeping our patients safe.”

Adds Sedgwick, “It’s not easy to get behind the mask. We are in a very assertive environment where the nurse is the main patient advocate. For some nurses, when they’re new, it’s hard to stand your ground for the patient. So hearing them develop that voice, to call out or stop things when needed, is an essential part of the program. For the hospital, it’s a winning situation all around. It saves money to hire competent, effective nurses with OR experience, but having well-trained, well-oriented nurses means having safer practitioners for the patient.”

At the end of the program, the interns receive certificates of completion at a ceremony attended by their mentors, peers, and nursing leadership. Every time, Sedgwick observes the professional pride of nurses coming into their own. “Seeing the shine in their eyes when they truly get it, watching them really grow into a professional, that’s when you know it’s been a worthwhile adventure for all of us.”

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