Surgery and Central Processing Relationships: A Survey

April 1, 2001

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Surgery and Central Processing Relationships: A Survey

By Jack Donaldson, BSN, CNOR, CSPDM and Kathy
Donaldson,
RN, CNOR, CSPDT

A survey designed to explore Central Processing Department (CPU)
staff attitudes regarding their relationship with the Operating Rooms (OR) of
their respective institutions was conducted at the annual conference of the
Golden West Central Service & Healthcare Chapter held in Reno, Nev,
September 27-29, 2000. Sixty-six conference attendees responded to a 19-question
multiple-choice survey. Of those responding, 30 also wrote short statements
addressing the one thing they would do to improve CPU-OR relations (Addendum
A
).

In general, the survey finds that the current state of CPU-OR relationships
is good. No significant themes or patterns are identified as contributory
factors to poor relationships. Some data results are cause for concern and
written comments centered around two major themes. The following will report on
the survey findings, discuss areas of concern, and share recommendations
expressed in the written comments.

Survey Results

Two survey questions asked participants to rate both their department's and
their personal relationship with the OR. Rating choices were excellent, very
good, good, fair, poor,
and very poor. For the purposes of this
survey, ratings of good to excellent were considered positive and ratings of
very poor to fair were considered negative. Forty-nine respondents (74%) rated
the current state of CPU and OR relationships as positive while 17 rated
them as negative. Thirteen respondents (20%) gave excellent
ratings while only one very poor rating was recorded. These responses
were explored for influencing factors: numbers of operating rooms, acuity of
surgical practice, hospital type, management structure, management
credentialing, intradepartmental credentialing requirements, personal status of
respondents credentials, departmental educational practices, departmental
orientation practices, physical location of the department relative to the OR,
interdepartmental communication tools, staffing design, experience levels, age,
and staffing schedules. The survey response data is presented in Table A. The
following is a review of each category response and how it may contribute to excellent
or poor ratings.

Review of Findings

CPU complexity results from two primary influences, facility size (numbers of
operating rooms) and the "CPU-Acuity" of the surgical services
practiced in the OR. CPU-Acuity is influenced by instrumentation volume and
complexity relative to requirements for decontamination, assembly, and
sterilization. Thus, a facility performing multiple total joint, spinal
fixation, and laparoscopic procedures will earn a higher CPU-Acuity score than a
similar sized institution performing large volumes of general surgery.

Staff from small facilities (1-6 Rooms) responded positively 89% of the time.
Moderate size facilities (7-11 Rooms) report a 52% positive rating. Staff from
large facilities (12-23 Rooms) responded positively 78 %of the time. Facilities
with higher acuities were rated positively 77% of the time while less acute
facilities were given positive a 55% positive rating.

A review of facility types found that outpatient surgery center staff gave a
100% positive rating. Other facilities gave the following ratings:

  • Teaching hospitals: 81% positive
  • Private hospitals: 75% positive
  • Clinics and other settings: 66% positive rating.

Management structure does not appear to influence approval ratings. Staff
under material's management gave a 72% positive rating, while those under
surgical services gave 70% positive ratings. Those classifying their management
structure as "other" gave 100% positive ratings.

Management credentialing appears to influence ratings. Nurse managers
received 80% positive ratings. Certified sterile processing technicians were
rated positive 66% of the time. Non-certified managers received a 50% positive
rating.

Departmental certification requirements and personal certification do not
appear to influence positive or negative ratings. It is important to note that
while only 43% of the departments require certification, 80% of the survey
respondents were certified.

There is no indication that the frequency of education programs influences
positive or negative relations. However, given the ongoing technological changes
challenging sterile processing professionals, it is disconcerning that 78% of
the respondents report that they have education programs monthly or less
frequently. However, it is encouraging that 74% of the respondents report that
their departments have structured orientation programs.

The responses do not show that structured orientation programs influence
positive or negative ratings.

The physical relationship of the CPU to the OR does not seem to impact
relations. Those located in the OR gave an 81% positive rating. Those
respondents most removed--on a different floor and without direct access to the
OR--gave a 77% positive rating.

Communication does not appear to influence ratings. Direct verbal
communication received a 77% positive score, while phone communication received
75%.

The relationship does not appear to be affected by staffing design,
experience, or age. It is important to note that the average experience of the
survey respondents was over six years and that the average age was 48 years.
There were no respondents under 30 years of age and only five respondents were
entry-level employees. These figures match well with current nursing data and do
not bode well for the future staffing of central processing departments. If they
are a reflection of national trends, central processing units will be facing a
shortage of experienced workers in an era of advancing technological challenge.

CPU staff who work days, are required to take calls, and work weekends gave
the highest cluster of "Excellent" ratings of any related category in
the survey.

The more negatively a staff member perceived their personal relationship with
the OR, the more negatively they rated their department's relationship with the
OR. However:

  • 8% of the respondents who rated their personal relationship as excellent
    gave negative ratings to their department's relationship with the OR.
  • 16% of those with very good personal relationships rated their
    department's relationship as negative.
  • 40% of those with good personal relationships considered their
    department's relationship as negative.
  • 66% of those with fair personal relationships with the OR gave their
    department negative marks.

Personal Comments

Survey participants were asked to suggest the one thing they would do to
improve OR and CPU relations. Their comments focused on two themes:
inter-department cross-training/cross-orientation and improved communication.
The orientation of new nursing staff in the OR to the functions of the CPU is
highly recommended by CPU staff. It is viewed as a means of providing the OR
staff with knowledge that will assist them to appreciate the workings of the CPU
and how to best work with the CPU staff to achieve their needs. Conversely,
comments strongly recommend rotation of CPU staff into the OR to provide for
enhanced understanding of OR functions and how the CPU may be better able to
improve services. Other comments addressed the need for more intradepartmental
education.

Discussion

One person surveyed found that "the weak or negligible influences on the
quality of worklife of OR nurses are: organizational structure, leadership, and
organizational learning." He states that the "things that matter to OR
Nurses and that influence their quality of worklife are: collaborative
decision-making, multiskilled workers, change, organizational culture, focus of
control: and the most important influence of all- Teamwork."1
These same influences seem apparent in this survey. The survey did not find any
major institutional influences on the quality of worklife. However, in their
personal comments CPU staff consistently called for collaboration in training,
education, and team building. Efforts in this direction are supported by
Wurstner and Koch, who found that a staffing patterns redesign process employed
to create multiskilled worker roles within self-managed perioperative specialty
teams resulted in "reduced potential interdepartmental barriers and
instilled a spirit of support and cooperation."2 A surveyed
woman recommends bi-monthly staff meetings combining CPU staff and OR licensed
staff to prevent the "we--they" scenario."3 Comments
recommending interdepartmental cross orientation are supported by Schultz, who
states: "Reality orientation might be facilitated by having CS workers
float to the OR, perhaps to staff the central core, and, conversely, OR staff
need to spend a couple of shifts in CS, including at least one in Decontam. In
today's stressed economic environment, this may be difficult to accomplish for
many healthcare institutions. But action speaks so much louder than words and
learning will occur faster with hands-on experience than with talk alone."4

The aging of the CPU workforce identified in this survey poses a need for
further investigation. Downsizing, increasing technology, and the natural
physical deterioration that comes with aging presents a complex problem for CPU
managers in the future. For example, a complex revision of a total joint knee
surgery may require as many as 25 trays of instruments averaging 20 pounds for
each tray. Assume that each tray is handled once for assembly, autoclave loading
and unloading, storage, case picking, and following the case washer-sterilizer
loading and unloading. A downsized and older CPU staff will handle a total of
3,500 pounds of instruments for one total joint surgery. Add to that the pushing
and pulling of loaded autoclave carts, case carts, washer-sterilizer carts, and
incidental handling of the trays to organize work and the figure can easily
exceed 5,000 pounds for one case.

Conclusion

The survey did not identify any aspect of institutional design that
significantly (positively or negatively) influences interdepartmental relations
between the OR and CPU. Survey data suggests that CPUs may be facing the same
staffing issues as nursing units--an experienced, educated, and aging workforce
facing diminishing membership. The data suggests that younger workers are not
entering the field and that institutional commitment to the educational needs of
CPU staff needs to be enhanced.

Lastly, personal comments recommending actions that would enhance OR-CPU
relations centered around two themes, interdepartmental cross training, and
improved communication. These comments are supported in literature as positive
change agents to improved relations.

  Jack Donaldson, BNS, CNOR, CSPDM is the Nurse Manger for Sterile
Processing at Sutter Medical Center in Sacramento, Calif. He is also the editor
of the Interned Nursing Education Site, nurseceu.com. Kathy Donaldson, RN,
CNOR,CSPDT is the Clinical Nurse Educator, Surgery at the University of
California Medical Center, Davis (Sacramento, Calif.).

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