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The Instrument Nurse and the Future
THE INSTRUMENT NURSE AND
THE FUTURE William W . Monafo, M.D. Some American surgeons seem to be afflicted by a peculiar blind spot that prevents them from seeing in true perspective the instrument nurse and her importance in contemporary surgery and in the surgery of the future. If we are to accept the opinions in the surgical press of the few years past, that precious species known popularly as the scrub nurse is in fact at this moment disappearing from behind a giant scotomaM that now permits only her dexterous hands to be seen. The idea now popular is, that since surgical operations are merely technical and mechanical exercises and not nursing procedures, the instrument nurse can be replaced by a technical assistant who has been given a short but intensified course in operating room technique. Nurses everywhere are in short supply, the argument goes, and they must be paid more than technicians. As nurses are not really needed in the operating room they can thus be released into the general nursing pool at no loss to the standard of surgery and with great economic saving. The instrument nurse is dying or dead-a vanishing species.’ Her requiem has been publicly s u n g 2 Too few surgeons have made a formal rebuttal to these ideas-ideas, which if accepted, will soon and without ceremony downgrade a rightly proud segment of the nursing profession into a mere trade, and represent William W. hlonafo, M.D., is chairman of the Department of Surgery at St. John’s Mercy Hospital, St. Louis, Mo. Dr. Monafo rweived his degree from Tufts University.
* Scotoma: “A spot of varying size and shape within the visual field in which there is no vision.”-Dorland’s Medical Dictionary
56
for the art and science both of surgery and of surgical nursing a great leap backward toward the ignorant and empirical Middle Ages. This subtle but rude disenfranchisement that already perceptively has begun to occur must not be allowed without a calling to arms of those surgeons, silent perhaps until now, who appreciate the importance of the professional nurse in the operating room. You nurses are, as the result of the efforts of Miss Nightingale and others, the proud inheritors of a tradition of professional nursing that is more than 100 years old. Profession is the important word in the previous sentence, for nursing is today rightly and generally recognized as a profession. Before the Crimea and Scutari Hospital, where incidentally, Florence Nightingale worked many hours as an instrument nurse-it was not. The Oxford Dictionary defines “profession” as the “occupation which we profess to be skilled in and to follow, a vocation in which a professional knowledge of some department of learning is used in its applications to the needs of others or in the practice of an art founded upon it.” A profession differs from a job or a trade because it is fundamentally oriented toward others-toward society. The profession of nursing is, of course, oriented in particular toward ill mankind. Professions by definition practice self discipline and self regulation toward loftier standards-as both the nursing and surgical professions do today. Thirteen centuries ago the surgeon Lanfranc said, “Why in God’s name, in our days, is there such a great difference between the physician and the surgeon? The physicians have abandoned operative procedures
AORN Journal
to the laity, either, as some sa). I J V C ~ ~ W they disdain to operate with the h
A proper surgical operation, which iepresents
the
crucial
moment
this is the fundamental reason why 4 ou turned ~ o w a r dthe operating room when your formal nuIsitig education was over. You can appreciate easily the comparison of a well conducted surgical operation to the performance of a major slimphony by a professional orchestra. In both instances the efforts of the group are directed by a leader toward the fullest expression of the theme. I n both there is an easily recognizable beginning, the theme is fully developed antl the conclusion is precise and inevitable. It is, of course, inconceirahle that the conductor of the symphony would permit as his first violinist any hut an individual of the highest professional qualifications. Lacking this he might well cat ice1 the performance, as cacophony instead of harmony might result should not this vital memher of the oschestra be of the highest caliber. We surgeons should refuse to accept anything hut professional, properly trained nurses as instrument nu.rses and circulating nurses. Traditionally we are exceedingly and often illappropriately vocal on matters of much less import either to us or to our patients. J f the salaries being paid are not high enough they must he raised. If there is a shortage of professional nurses, we should help i n every way we can to see to it that more nurses are trained, and see to it that the hest of the lot are encouraged to a career in operating room nursin:. The professiorlal nurse can not be adequately replaced at the operating table or in the operating suite by anyone with inferior or limited training, or hy one w h o does not possess the vocation to the care of ill mankind that is inherent in the trained nurse. Although the patient is without sensation,
wrgical
asepticall>- draped, with his face often hidden
therapeutics, has a good deal of ail in iI antl
from view. he or she is still the avowed ob-
alnays will, no matter how many moic scien-
ject of the profession of nursing. As Kyan has said,-’ “Improvements in
tific advances are made-and
of
wondri l u l may
they be! You as instrument nurses have lev-
future patient care do not depend on at-
ognized that this is so and, in mosl initanceq,
tempting to make technically trained person-
September 1967
57
nel behave more like nurses by giving them more or longer courses or allowing them to accept responsibilities beyond their capabilities. Neither can they depend on lowering the standards of professional education for nurses by shortening their courses, eliminating practical experience from their training, or creating different grades of registered nurses. The intangibles which are represented by the process of selection of youn? women for nurse’s training, by perpetrating the concepts of vocation and professionalism in undergraduate and postgraduate nursing education, by continuing to include subjects of a broad cultural character such as sociology,
psychology, history of nursing, etc. in the undergraduate curriculum, and by encouraging the development of a greater esprit de corps among all registered professional nurses create a difference which cannot be compensated for by time spent on any amount of practical experience alone.” That the professional nurse can be substituted at no loss to the standard of patient rare is an inutterable delusion. Let us admit honestly that the fewer professional nurses there are in the operating theater the lower will he the standard of care in that pivotal and crucial area of surgical therapeutics. We owe that much to our sister profession.
REFERENCES
3. Cusliing, Harvey, “The Physician and the Sur geon,” Conserrntio Medici, Little, Brown and Co., 1929, 11. 144. 4. R ~ ~ ~ l ~J., l ‘
1. De Takats, Geza, “The Scrub Nuise-A Vanishing Species,” Surg. G y n . Obst. 112: 494-6, 1961. 2. Pickrell, K. L., “Requiem for a Sciuh hiiise,” Ann. Surg. 156: 513-4, 1962.
0
0
0
$50,000 GRANT FOR ANA The Federal government has awarded a $50,000 grant to tlie American Nurses’ Association for a nationwide program to persuade inactive nurses to return to practice. Funds are provided under the experimental and demonstration provisions of the Manpower Development and Training Act. Federal officials hope that 30,000 retired nurses will take the refresher course. The new grant agrerment calls for A N A t o 1 ) bet up a national, unified prninotion and rrcruitment program; 2) oflet. consultation and technical assistance in preliminary planning to state and local constituents which are starting or taking part in refresher courses under MDTA funding; 3 ) evaluate the programs through survey and study methods; and 4) submit appropriate progress reports at quarterly intervals and a final report with recommendations and follow-up plans. As part of the ncw agreement, ANA acknowledges that i t is the nurses’ responsi1)ility to a l work with tlie Ikpartment of Labor and state officials to survey and identify the potential pool of inactive nurses; 1)) survey and rvaluate edocational and clinical facilities for placement ~f courses and trainees; c j identify employment opportunities in the area, not only in hospitals, but also in clinics. nursing homes. and home health agencies; d ) develop the objectives of the refresher courses; e ) develop criteria and mi)dels for tlie conduct of refresher courses, including the selection of faculty and trainees, identification of teaching materials, classrooms, and clinical facilities, ancl placing of trainees. In the agreement ANA acknnwledges tlip statutory obligations of the frderal and state agencies working i o eatahlisli refresher courses and recruitment programs. The agreement says further that ANA recognizes it is essential to obtain t h e support ancl assistance of other community resources such as health agencies. medical and hospital associations. leagues of nursing, and stale Imards.
(A.J.N.)
58
AORN Journal
THE FUTURE William W . Monafo, M.D. Some American surgeons seem to be afflicted by a peculiar blind spot that prevents them from seeing in true perspective the instrument nurse and her importance in contemporary surgery and in the surgery of the future. If we are to accept the opinions in the surgical press of the few years past, that precious species known popularly as the scrub nurse is in fact at this moment disappearing from behind a giant scotomaM that now permits only her dexterous hands to be seen. The idea now popular is, that since surgical operations are merely technical and mechanical exercises and not nursing procedures, the instrument nurse can be replaced by a technical assistant who has been given a short but intensified course in operating room technique. Nurses everywhere are in short supply, the argument goes, and they must be paid more than technicians. As nurses are not really needed in the operating room they can thus be released into the general nursing pool at no loss to the standard of surgery and with great economic saving. The instrument nurse is dying or dead-a vanishing species.’ Her requiem has been publicly s u n g 2 Too few surgeons have made a formal rebuttal to these ideas-ideas, which if accepted, will soon and without ceremony downgrade a rightly proud segment of the nursing profession into a mere trade, and represent William W. hlonafo, M.D., is chairman of the Department of Surgery at St. John’s Mercy Hospital, St. Louis, Mo. Dr. Monafo rweived his degree from Tufts University.
* Scotoma: “A spot of varying size and shape within the visual field in which there is no vision.”-Dorland’s Medical Dictionary
56
for the art and science both of surgery and of surgical nursing a great leap backward toward the ignorant and empirical Middle Ages. This subtle but rude disenfranchisement that already perceptively has begun to occur must not be allowed without a calling to arms of those surgeons, silent perhaps until now, who appreciate the importance of the professional nurse in the operating room. You nurses are, as the result of the efforts of Miss Nightingale and others, the proud inheritors of a tradition of professional nursing that is more than 100 years old. Profession is the important word in the previous sentence, for nursing is today rightly and generally recognized as a profession. Before the Crimea and Scutari Hospital, where incidentally, Florence Nightingale worked many hours as an instrument nurse-it was not. The Oxford Dictionary defines “profession” as the “occupation which we profess to be skilled in and to follow, a vocation in which a professional knowledge of some department of learning is used in its applications to the needs of others or in the practice of an art founded upon it.” A profession differs from a job or a trade because it is fundamentally oriented toward others-toward society. The profession of nursing is, of course, oriented in particular toward ill mankind. Professions by definition practice self discipline and self regulation toward loftier standards-as both the nursing and surgical professions do today. Thirteen centuries ago the surgeon Lanfranc said, “Why in God’s name, in our days, is there such a great difference between the physician and the surgeon? The physicians have abandoned operative procedures
AORN Journal
to the laity, either, as some sa). I J V C ~ ~ W they disdain to operate with the h
A proper surgical operation, which iepresents
the
crucial
moment
this is the fundamental reason why 4 ou turned ~ o w a r dthe operating room when your formal nuIsitig education was over. You can appreciate easily the comparison of a well conducted surgical operation to the performance of a major slimphony by a professional orchestra. In both instances the efforts of the group are directed by a leader toward the fullest expression of the theme. I n both there is an easily recognizable beginning, the theme is fully developed antl the conclusion is precise and inevitable. It is, of course, inconceirahle that the conductor of the symphony would permit as his first violinist any hut an individual of the highest professional qualifications. Lacking this he might well cat ice1 the performance, as cacophony instead of harmony might result should not this vital memher of the oschestra be of the highest caliber. We surgeons should refuse to accept anything hut professional, properly trained nurses as instrument nu.rses and circulating nurses. Traditionally we are exceedingly and often illappropriately vocal on matters of much less import either to us or to our patients. J f the salaries being paid are not high enough they must he raised. If there is a shortage of professional nurses, we should help i n every way we can to see to it that more nurses are trained, and see to it that the hest of the lot are encouraged to a career in operating room nursin:. The professiorlal nurse can not be adequately replaced at the operating table or in the operating suite by anyone with inferior or limited training, or hy one w h o does not possess the vocation to the care of ill mankind that is inherent in the trained nurse. Although the patient is without sensation,
wrgical
asepticall>- draped, with his face often hidden
therapeutics, has a good deal of ail in iI antl
from view. he or she is still the avowed ob-
alnays will, no matter how many moic scien-
ject of the profession of nursing. As Kyan has said,-’ “Improvements in
tific advances are made-and
of
wondri l u l may
they be! You as instrument nurses have lev-
future patient care do not depend on at-
ognized that this is so and, in mosl initanceq,
tempting to make technically trained person-
September 1967
57
nel behave more like nurses by giving them more or longer courses or allowing them to accept responsibilities beyond their capabilities. Neither can they depend on lowering the standards of professional education for nurses by shortening their courses, eliminating practical experience from their training, or creating different grades of registered nurses. The intangibles which are represented by the process of selection of youn? women for nurse’s training, by perpetrating the concepts of vocation and professionalism in undergraduate and postgraduate nursing education, by continuing to include subjects of a broad cultural character such as sociology,
psychology, history of nursing, etc. in the undergraduate curriculum, and by encouraging the development of a greater esprit de corps among all registered professional nurses create a difference which cannot be compensated for by time spent on any amount of practical experience alone.” That the professional nurse can be substituted at no loss to the standard of patient rare is an inutterable delusion. Let us admit honestly that the fewer professional nurses there are in the operating theater the lower will he the standard of care in that pivotal and crucial area of surgical therapeutics. We owe that much to our sister profession.
REFERENCES
3. Cusliing, Harvey, “The Physician and the Sur geon,” Conserrntio Medici, Little, Brown and Co., 1929, 11. 144. 4. R ~ ~ ~ l ~J., l ‘
1. De Takats, Geza, “The Scrub Nuise-A Vanishing Species,” Surg. G y n . Obst. 112: 494-6, 1961. 2. Pickrell, K. L., “Requiem for a Sciuh hiiise,” Ann. Surg. 156: 513-4, 1962.
0
0
0
$50,000 GRANT FOR ANA The Federal government has awarded a $50,000 grant to tlie American Nurses’ Association for a nationwide program to persuade inactive nurses to return to practice. Funds are provided under the experimental and demonstration provisions of the Manpower Development and Training Act. Federal officials hope that 30,000 retired nurses will take the refresher course. The new grant agrerment calls for A N A t o 1 ) bet up a national, unified prninotion and rrcruitment program; 2) oflet. consultation and technical assistance in preliminary planning to state and local constituents which are starting or taking part in refresher courses under MDTA funding; 3 ) evaluate the programs through survey and study methods; and 4) submit appropriate progress reports at quarterly intervals and a final report with recommendations and follow-up plans. As part of the ncw agreement, ANA acknowledges that i t is the nurses’ responsi1)ility to a l work with tlie Ikpartment of Labor and state officials to survey and identify the potential pool of inactive nurses; 1)) survey and rvaluate edocational and clinical facilities for placement ~f courses and trainees; c j identify employment opportunities in the area, not only in hospitals, but also in clinics. nursing homes. and home health agencies; d ) develop the objectives of the refresher courses; e ) develop criteria and mi)dels for tlie conduct of refresher courses, including the selection of faculty and trainees, identification of teaching materials, classrooms, and clinical facilities, ancl placing of trainees. In the agreement ANA acknnwledges tlip statutory obligations of the frderal and state agencies working i o eatahlisli refresher courses and recruitment programs. The agreement says further that ANA recognizes it is essential to obtain t h e support ancl assistance of other community resources such as health agencies. medical and hospital associations. leagues of nursing, and stale Imards.
(A.J.N.)
58
AORN Journal