A master nurse clinician for intraoperative care

The intraoperative period has long been the missing link in the chain of continuity of care for the surgical patient. An intraoperative clinical nurse specialist who is able to work with patients, families, and health care team members preoperatively, intraoperatively, and postoperatively can effectively bridge the gap in care. Nursing care given to patients in the O.R. should be no different qualitatively from nursing care given sedated and/or unconscious patients in other nursing units. The C.N.S. in the O.R. can help make such care a reality through giving care to patients and families as a role model, directing care as an expert through written care plans or physical presence, doing formal and informal teaching of patients, families, and staff, and through research. Operationalizing the role of the C.N.S. for surgical patients during the intraoperative period requires the specialist to move out of the O.R. to assess patients and families preoperatively and to evaluate the postoperative results of care. Implementation of the specialist role in the O.R. clinical nursing setting is accompanied by the same frustrations and problems met by master clinicians in other nursing specialty areas.