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A Trip Down Memory Lane: From the Recovery Room to PACU
THE BACK PAGE
A Trip Down Memory Lane: From the Recovery Room to PACU Guest Editorial Cecil B. Drain, PhD, CRNA, FAAN, FASAHP IT WAS IN APRIL of 1967 when it all began. I was a senior nursing student, and it was my chance to choose a 3-month clinical rotation. It was my one and only chance to enhance my clinical practice—how neat is that! I chose the toughest and most demanding specialized clinical area in our hospital, a combined unit consisting of both the intensive care unit (ICU) and the recovery room (RR). The head nurse, Mary Shaufner, had been there for years, and always came to work in a finely starched white uniform, including the white cap with one black stripe that was worn in the military at that time. Ms. Shaufner was indeed in complete charge of that unit. Her mere presence demanded excellence, and her primary focus was the patient. In many ways, Ms. Shaufner was ahead of her time. For example, she combined the ICU and RR. Patient safety was the key. She also made the RR a unit and the ICU a separate unit within her workstation. Nurses who staffed Mary’s RR were specially trained in all aspects of postanesthesia care. She did not support pulling nurses from other units to staff her RR. She managed that unit with a demanding style and expected nursing care to be administrated according to her criteria, which was described in countless Standards of Practice Manuals in that unit. Only four senior students asked to spend their last 3 months of nursing education on Ms. Shaufner’s unit, and only two The ideas or opinions expressed in this editorial are those solely of the author and do not necessarily reflect the opinions of ASPAN, the Journal, or the Publisher. Cecil B. Drain, PhD, CRNA, FAAN, FASAHP, is the Dean of the School of Allied Health Professions, Virginia Commonwealth University, Richmond, VA. Conflict of interest: None to report. Address correspondence to Cecil B. Drain, School of Allied Health Professions, Virginia Commonwealth University, 1200 East Broad Street, Box 980233, Richmond, VA 232980233; e-mail address: [email protected]. Ó 2015 Published by Elsevier Inc. on behalf of American Society of PeriAnesthesia Nurses 1089-9472/$36.00 http://dx.doi.org/10.1016/j.jopan.2015.04.003
372
were selected by Ms. Shaufner (one of whom was myself). I was the first man to be selected by her. Those were 3 months of boot camp! Each day was an experience I will never forget. That clinical experience had a phenomenal impact on my nursing career. More importantly, it gave me a wonderful appreciation of postanesthesia care. It helped me to conclude back in 1967 that anesthesia has a three-prong clinical approach: preoperative, intraoperative, and postoperative. Each of the components has equal importance. After I finished my nurse anesthesia education and 2 years of outstanding clinical experiences at a mobile army surgical hospital and a community hospital, I was asked to speak at a seminar for RR nurses in Atlanta. In April of 1974, an anesthesiologist from Emory University and I presented to a RR seminar to over 300 nurses. The focus was on the emergence phase of anesthesia plus the required nursing care. All the attendees said there were no texts that focused on postanesthesia care. The 300-plus nurses who attended the seminar did so at their own expense, and no contact hours were given. They were there because it was an opportunity for them to enhance their knowledge base in RR nursing. They all said that they were so frustrated because there were no textbooks on RR care—the textbooks on anesthesiology did not meet their needs because the focus of those books was on intraoperative care of the patient rather than on postanesthesia care. In 1974, I also went to Tucson to attend the University of Arizona and I worked at Tucson Medical Center as a certified registered nurse anesthetist. I got to know the RR nurses, and because of their insatiable appetite to know more about the pharmacology, physiology, and special topics, we all came into work at 5:00 a.m. twice a week to meet and have inservices on many of the topics that were considered critical in their performance of delivering excellent RR care. Those presentations, plus the Atlanta
Journal of PeriAnesthesia Nursing, Vol 30, No 4 (August), 2015: pp 372-374
THE BACK PAGE
seminar notes and my countless notes taken in Dr Ivan Lytle’s graduate physiology class at the University of Arizona, became the backbone of the first edition of the book entitled The Recovery Room, commonly called the Blue Book because the cover of the book was a light blue. The nursing care chapters were handled very well by my co-author Susan Shipley, a graduate student at the University of Arizona at the time. This was my calling, to write a text that focused on the postanesthesia care. The Blue Book was focused on physiology, pharmacology, and special topics, with an integration of clinical implications throughout the entire text. The book did not have any footnotes but did have an extensive biography at the end of each chapter for those readers desiring more information on a particular subject. The book was published in 1979 by W B. Saunders. The lead nursing editor at Saunders was so focused on the need for this publication that he actually extended his retirement date by 6 months to ensure the book was published. Thank you, Bob Wright, for your loyalty to me, the book, and the profession of nursing. The Blue Book’s contribution to RR nursing was significant because it provided professional accountability to all the nurses who became members of the new organization, the American Society of Post Anesthesia Nurses (now the American Society of PeriAnesthesia Nurses [ASPAN]). The Blue Book was created because of the deep and profound respect I had for RR nurses, going all the way back to Ms. Shaufner in Fort Worth. Due to her and many others, the Blue Book enjoyed a wide popularity throughout the United States and world (the book also written in Portuguese). So many changes have occurred in RR nursing. It is now a critical care specialty in nursing. In the 1990s, the RR became known as the Post Anesthesia Care Unit (PACU)—a critical care unit staffed by nurses specially educated in PACU nursing. Rarely are nurses pulled from other work centers because the standard of care dictates only PACU nurses should staff a PACU. It is an issue of patient safety that only PACU nurses staff the level I or II PACUs. So hooray for those extremely dedicated nurses who were at that seminar in Atlanta and the nurses at TMC. Their professionalism and phenomenal quest to make postanesthesia nursing a specialty of nursing did indeed come true. Certainly, as the discipline of nursing
373
has gone through maturation, the specialty of postanesthesia nursing has followed an irregular and uneven course. Changes in the educational preparation and attitude of the practitioners have, however, facilitated an acceptance for conducting formal research, writing for publication, and developing educational models incorporating perianesthesia nursing, which became the accepted name for this specialty in the 2000s. Consequently, there are an ever-increasing number of perianesthesia nursing professionals being prepared in the method of scientific inquiry who are conducting investigations with the intention of enhancing patient outcomes. There is a need for perianesthesia nursing professionals not only to conduct research, but also to publish their findings. This will greatly extend the knowledge on which theory, practice, and education are based. Our ultimate professional goal is to establish a scientific base of knowledge fundamental to professional practice so that we may have a greater impact on improving patient care outcomes. As we have grown in our specialty of perianesthesia nursing, so therefore should our commitment to research grow. The professionals in perianesthesia nursing must make a major thrust toward research, for it is the very cornerstone on which our practice will be based. Implicit in the conduct of research is the obligation to communicate the outcome to the scientific community in an objective and unbiased fashion. The future position of the perianesthesia nurse in the health care team depends greatly on professional accountability—how effectively we communicate new developments to our colleagues, other health care professionals, government and regulatory agencies, and the public. This accountability to our own profession is based on the effectiveness and scientific quality of our communications along with a long history of practicing the art and science of perianesthesia nursing. Hence, writing for publication is an obligation arising from the principle of accountability. It is the expressed goal of perianesthesia nursing to provide the means necessary for initiating and developing the capabilities of our practitioners to communicate both within and outside their specialty to meet the responsibilities of professional accountability. In this way, perianesthesia nursing will be well-placed to make a considerable impact on the future direction of the health care
374
community to include direct and indirect patient care. I have spoken with many perianesthesia nurses over the years who have cited a particular method of care, or ‘‘tricks of the trade,’’ in their particular PACU. This is the cornerstone of growing as a profession, and that particular method should be researched and documented because we have reached that point in the evolution of the perianesthesia nurse. We have come a long way, and I thank each and every one of you for your contribution to this great specialty of nursing. Who would have thought that we could look to the future of perianesthesia nursing using words such as ‘‘research’’ in our conversation? What a ride for me! The good news is that Ms. Shaufner received the very first copy of the Blue Book, and it was my honor to present that book to her at in a long-term care facility in Fort Worth. I handed the book to her and told her how much she meant to me and to all nurses
CECIL B. DRAIN
in the RR. She was unable to speak but tears of joy streamed down her face, and I want to think they were because her dream was answered: the existence of the specialty of perianesthesia nursing. It has been my honor and pleasure to have spent time with so many wonderful nurses who specialized in the field of perianesthesia nursing. Always remember to be as diverse as possible and to allow and support other specialties of nursing to play a part in the future of perianesthesia nursing. It is so rewarding to turn over the reins of the postBlue Book generation, now entitled Drain’s PeriAnesthesia Care: A Critical Care Approach, to Jan Odom-Forren. It is you, and people like Jan, who will continue the legacy of such a great specialty of nursing. I extend my thanks to each and every one of you. With warmest regards, Cecil B. Drain
A Trip Down Memory Lane: From the Recovery Room to PACU Guest Editorial Cecil B. Drain, PhD, CRNA, FAAN, FASAHP IT WAS IN APRIL of 1967 when it all began. I was a senior nursing student, and it was my chance to choose a 3-month clinical rotation. It was my one and only chance to enhance my clinical practice—how neat is that! I chose the toughest and most demanding specialized clinical area in our hospital, a combined unit consisting of both the intensive care unit (ICU) and the recovery room (RR). The head nurse, Mary Shaufner, had been there for years, and always came to work in a finely starched white uniform, including the white cap with one black stripe that was worn in the military at that time. Ms. Shaufner was indeed in complete charge of that unit. Her mere presence demanded excellence, and her primary focus was the patient. In many ways, Ms. Shaufner was ahead of her time. For example, she combined the ICU and RR. Patient safety was the key. She also made the RR a unit and the ICU a separate unit within her workstation. Nurses who staffed Mary’s RR were specially trained in all aspects of postanesthesia care. She did not support pulling nurses from other units to staff her RR. She managed that unit with a demanding style and expected nursing care to be administrated according to her criteria, which was described in countless Standards of Practice Manuals in that unit. Only four senior students asked to spend their last 3 months of nursing education on Ms. Shaufner’s unit, and only two The ideas or opinions expressed in this editorial are those solely of the author and do not necessarily reflect the opinions of ASPAN, the Journal, or the Publisher. Cecil B. Drain, PhD, CRNA, FAAN, FASAHP, is the Dean of the School of Allied Health Professions, Virginia Commonwealth University, Richmond, VA. Conflict of interest: None to report. Address correspondence to Cecil B. Drain, School of Allied Health Professions, Virginia Commonwealth University, 1200 East Broad Street, Box 980233, Richmond, VA 232980233; e-mail address: [email protected]. Ó 2015 Published by Elsevier Inc. on behalf of American Society of PeriAnesthesia Nurses 1089-9472/$36.00 http://dx.doi.org/10.1016/j.jopan.2015.04.003
372
were selected by Ms. Shaufner (one of whom was myself). I was the first man to be selected by her. Those were 3 months of boot camp! Each day was an experience I will never forget. That clinical experience had a phenomenal impact on my nursing career. More importantly, it gave me a wonderful appreciation of postanesthesia care. It helped me to conclude back in 1967 that anesthesia has a three-prong clinical approach: preoperative, intraoperative, and postoperative. Each of the components has equal importance. After I finished my nurse anesthesia education and 2 years of outstanding clinical experiences at a mobile army surgical hospital and a community hospital, I was asked to speak at a seminar for RR nurses in Atlanta. In April of 1974, an anesthesiologist from Emory University and I presented to a RR seminar to over 300 nurses. The focus was on the emergence phase of anesthesia plus the required nursing care. All the attendees said there were no texts that focused on postanesthesia care. The 300-plus nurses who attended the seminar did so at their own expense, and no contact hours were given. They were there because it was an opportunity for them to enhance their knowledge base in RR nursing. They all said that they were so frustrated because there were no textbooks on RR care—the textbooks on anesthesiology did not meet their needs because the focus of those books was on intraoperative care of the patient rather than on postanesthesia care. In 1974, I also went to Tucson to attend the University of Arizona and I worked at Tucson Medical Center as a certified registered nurse anesthetist. I got to know the RR nurses, and because of their insatiable appetite to know more about the pharmacology, physiology, and special topics, we all came into work at 5:00 a.m. twice a week to meet and have inservices on many of the topics that were considered critical in their performance of delivering excellent RR care. Those presentations, plus the Atlanta
Journal of PeriAnesthesia Nursing, Vol 30, No 4 (August), 2015: pp 372-374
THE BACK PAGE
seminar notes and my countless notes taken in Dr Ivan Lytle’s graduate physiology class at the University of Arizona, became the backbone of the first edition of the book entitled The Recovery Room, commonly called the Blue Book because the cover of the book was a light blue. The nursing care chapters were handled very well by my co-author Susan Shipley, a graduate student at the University of Arizona at the time. This was my calling, to write a text that focused on the postanesthesia care. The Blue Book was focused on physiology, pharmacology, and special topics, with an integration of clinical implications throughout the entire text. The book did not have any footnotes but did have an extensive biography at the end of each chapter for those readers desiring more information on a particular subject. The book was published in 1979 by W B. Saunders. The lead nursing editor at Saunders was so focused on the need for this publication that he actually extended his retirement date by 6 months to ensure the book was published. Thank you, Bob Wright, for your loyalty to me, the book, and the profession of nursing. The Blue Book’s contribution to RR nursing was significant because it provided professional accountability to all the nurses who became members of the new organization, the American Society of Post Anesthesia Nurses (now the American Society of PeriAnesthesia Nurses [ASPAN]). The Blue Book was created because of the deep and profound respect I had for RR nurses, going all the way back to Ms. Shaufner in Fort Worth. Due to her and many others, the Blue Book enjoyed a wide popularity throughout the United States and world (the book also written in Portuguese). So many changes have occurred in RR nursing. It is now a critical care specialty in nursing. In the 1990s, the RR became known as the Post Anesthesia Care Unit (PACU)—a critical care unit staffed by nurses specially educated in PACU nursing. Rarely are nurses pulled from other work centers because the standard of care dictates only PACU nurses should staff a PACU. It is an issue of patient safety that only PACU nurses staff the level I or II PACUs. So hooray for those extremely dedicated nurses who were at that seminar in Atlanta and the nurses at TMC. Their professionalism and phenomenal quest to make postanesthesia nursing a specialty of nursing did indeed come true. Certainly, as the discipline of nursing
373
has gone through maturation, the specialty of postanesthesia nursing has followed an irregular and uneven course. Changes in the educational preparation and attitude of the practitioners have, however, facilitated an acceptance for conducting formal research, writing for publication, and developing educational models incorporating perianesthesia nursing, which became the accepted name for this specialty in the 2000s. Consequently, there are an ever-increasing number of perianesthesia nursing professionals being prepared in the method of scientific inquiry who are conducting investigations with the intention of enhancing patient outcomes. There is a need for perianesthesia nursing professionals not only to conduct research, but also to publish their findings. This will greatly extend the knowledge on which theory, practice, and education are based. Our ultimate professional goal is to establish a scientific base of knowledge fundamental to professional practice so that we may have a greater impact on improving patient care outcomes. As we have grown in our specialty of perianesthesia nursing, so therefore should our commitment to research grow. The professionals in perianesthesia nursing must make a major thrust toward research, for it is the very cornerstone on which our practice will be based. Implicit in the conduct of research is the obligation to communicate the outcome to the scientific community in an objective and unbiased fashion. The future position of the perianesthesia nurse in the health care team depends greatly on professional accountability—how effectively we communicate new developments to our colleagues, other health care professionals, government and regulatory agencies, and the public. This accountability to our own profession is based on the effectiveness and scientific quality of our communications along with a long history of practicing the art and science of perianesthesia nursing. Hence, writing for publication is an obligation arising from the principle of accountability. It is the expressed goal of perianesthesia nursing to provide the means necessary for initiating and developing the capabilities of our practitioners to communicate both within and outside their specialty to meet the responsibilities of professional accountability. In this way, perianesthesia nursing will be well-placed to make a considerable impact on the future direction of the health care
374
community to include direct and indirect patient care. I have spoken with many perianesthesia nurses over the years who have cited a particular method of care, or ‘‘tricks of the trade,’’ in their particular PACU. This is the cornerstone of growing as a profession, and that particular method should be researched and documented because we have reached that point in the evolution of the perianesthesia nurse. We have come a long way, and I thank each and every one of you for your contribution to this great specialty of nursing. Who would have thought that we could look to the future of perianesthesia nursing using words such as ‘‘research’’ in our conversation? What a ride for me! The good news is that Ms. Shaufner received the very first copy of the Blue Book, and it was my honor to present that book to her at in a long-term care facility in Fort Worth. I handed the book to her and told her how much she meant to me and to all nurses
CECIL B. DRAIN
in the RR. She was unable to speak but tears of joy streamed down her face, and I want to think they were because her dream was answered: the existence of the specialty of perianesthesia nursing. It has been my honor and pleasure to have spent time with so many wonderful nurses who specialized in the field of perianesthesia nursing. Always remember to be as diverse as possible and to allow and support other specialties of nursing to play a part in the future of perianesthesia nursing. It is so rewarding to turn over the reins of the postBlue Book generation, now entitled Drain’s PeriAnesthesia Care: A Critical Care Approach, to Jan Odom-Forren. It is you, and people like Jan, who will continue the legacy of such a great specialty of nursing. I extend my thanks to each and every one of you. With warmest regards, Cecil B. Drain