A Focused Ethnography: Nurses Transitioning to a Nursing Specialty

Transitioning to a new area of practice whether it is as a recent graduate nurse or a nurse transitioning to a different specialty area in nursing, there occurs many feelings associated with the adjustments in learning a new area of practice.  As there is a projected nursing shortage in the next five to ten years, the need for experience nurses to prepare and educate nurses as they transition to new areas of nursing is essential to maintain a safe and productive nursing workforce.   As hospitals educate their own OR nurses, retention following orientation becomes a priority.                                                                                                                                                 

The purpose of this study was to explore nurses’ experiences as they transition to a new area of nursing practice, the operating room.  A qualitative focused ethnography was conducted using Leininger’s ethnonursing research method.  Fourteen RNs transitioning to the OR agreed to participate in this study.  The OR was a first time experience for the RNs.  The setting was a large teaching hospital located in an urban area.  Observations and interviews were conducted with the RNs to explore their experiences as they transitioned in the OR.

The RNs’ transition included learning the didactics of OR nursing through the web-based AORN Nursing 101 online computer course, practicing skills learned in a simulation laboratory, and rotating through surgical specialty areas under the supervision of an RN preceptor.  Influences that facilitated the RNs transition to the OR were the positive learning experience, perception of belonging and acceptance into the OR culture, stimulating environment, supportive personnel, collegiality among peers, and presence of nursing in the OR.  Influences that hindered the RNs’ transition to the OR were inconsistency in precepting, being in a hostile environment, limited exposure to the OR prior to the RNs’ transition, and an overwhelming environment.  Meleis’ Transition model emerged in the RNs’ experiences of transitioning to the OR.                                                                                   

The need to educate nurses in the operating room is essential to assure safety and positive outcomes for the surgical patient.  Structured perioperative courses implemented by hospitals or with partnerships with nursing programs can enhance the education, transition, and retention of nurses new to the OR.   The importance of a nurse educator having an advanced degree with experience in the OR specialty was essential in coordinating and mentoring nurses transitioning to this new practice area.  RNs who are prepared to precept were vital in the education and retention of these RNs.  The need for consistent preceptors was recognized as an essential factor to the RNs’ successful transition. The findings contribute to evidence-base practice for the design and implementation of perioperative programs for new nurses.