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There is much advice available about the development of risk management strategies within the NHS. There are booklets and magazines and there are many management consultancies willing to give advice on the development of strategies. NATN is also working on the development of advice on risk management within the operating theatre department and a document should be available at Congress this year. It was felt, however, that it may be useful to hear a little about the specific experience of the development of a strategy within one operating theatre area and Andrea Simpson, Directorate Nurse Manager for Clinical Services, West Lothian NHS Trust has recorded the development within the directorate. There has been some additional comment from the Director of Nursing and Quality within the Trust, Libby Campbell, who is responsible for risk management there.
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The present climate in health care, including a tendency toward more managed care and capitation systems, has caused hospital administrators and perioperative managers to reexamine traditional work systems and their associated costs. Some decisions around work redesign may be financially driven or based on the decreased availability of qualified professionals in the job market. The use of an increased number of unlicensed assistive personnel (UAP) in hospital settings has become a common redesign strategy to address both issues. In the perioperative setting, some traditional roles are well established for UAP. Today, changes associated with downsizing, cost containment, and increasing technology have opened up new opportunities to explore ways to integrate UAP roles into the perioperative setting.
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This qualitative study uses a grounded theory approach to explore the motivational factors which affect nurses' career choice, by focusing on the responses of post registration nurses undertaking a course in operating room nursing. In all, 15 nurses were interviewed. Examination of the data, using a constant comparative method, revealed five conceptual categories which were used to explain factors which affected their career decisions. The descriptive analysis of each section serves to illuminate individual motivational factors which brought these respondents into nursing and the initial socialization process: early experiences of theatre nursing; aspects of work which provide job satisfaction; how nurses use nursing skills in theatre and recruitment of future theatre nurses. For these respondents, theatre nursing provided a clear task identity which is seen as significant in terms of patient outcomes, it provides interesting and challenging work within a good team structure, which was viewed as important for job satisfaction and motivation.
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