The power of influence - President's Message

AORN Journal,  Sept, 2002  by Donna S. Watson

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In the current health care environment, decreased reimbursement fees have resulted in significant cost control changes for health care facilities and surgeons. This has led, in turn, to group purchasing agreements and some product decisions that resulted in less than optimal outcomes because they were based on cost rather than quality. Additionally, an increase in the number of freestanding ambulatory surgery centers and physician office surgical units, fewer hospitals, advanced technology, consumer demand for the newest technology, and the nursing shortage continue to change the way business is conducted in health care, and, specifically, how perioperative equipment and supplies are purchased.

THE ROLE OF THE PERIOPERATIVE NURSE IN PURCHASING

In the past, perioperative supervisors were considered key decision makers when major OR purchases were being made. A 1974 study of procedures for purchasing equipment and supplies in the OR says, "The OR supervisor is the major buying force, no matter what the size or the type of hospital." (1) A 1984 study designed to identify the role of the RN in influencing equipment and supplies purchases concludes

   Nurses, and especially OR nurse administrators, play a central role in
   deciding what is purchased for the hospital and freestanding ambulatory
   surgical centers. (2)

The role of surgical services administrators (eg, vice presidents, directors, supervisors) continues to remain an influencing factor, but a major new player in influencing product buying decisions is the perioperative staff nurse.

In the past, perioperative nurse administrators were responsible for surgical service areas (eg, surgery department, post anesthesia care unit). Today, however, most surgical services administrators are responsible for more departments, and they generally have fewer resources and less time. This has created opportunities for nursing administrators and front line managers to delegate many aspects of purchasing analysis, decisions, and recommendations to perioperative staff nurses. AORN's Congress is a prime example of this. Often a surgical service administrator will send staff nurses to research and make recommendations about products that will be considered for use in their facility.

The purchasing power of staff nurses always has been an influence; however, given the present climate in health care, it is stronger than ever before. AORN recently commissioned an independent research firm to study the purchasing influence of staff nurses. (3) The study results continue to be analyzed for a final report, but they indicate that the purchasing influence of staff nurses has increased. Staff nurse respondents were asked several questions, including

   Would you say that as a perioperative nurse your overall purchasing
   influence has increased, decreased, or stayed the same over the past three
   years?

Eighty-seven percent of the random sample of clinical staff nurses responded that their influence either increased or stayed the same.

These data are no surprise. I have first-hand experience of the influence of the staff nurse in purchasing decisions. Perioperative staff nurses offer knowledge, clinical skills, and expertise when using supplies and equipment necessary for positive patient outcomes, and they can offer their voices and views as end users of a product. It is this influence and involvement that balances product cost, quality, and patient outcomes.

USING YOUR INFLUENCE

There are number of ways we as perioperative nurses can use our influence in the choice of equipment and supplies used in our health care facilities. These include

* introducing new products (eg, equipment, supplies);

* using your knowledge about the product;

* building relationships with industry partners;

* building relationships with members of the materials management department;

* participating in product procurement; and

* creating a new position.

Introducing new products (eg, equipment, supplies). Talk to industry representatives about their products and how their products improve patient safety and quality of care. Interactions with representatives can occur in a variety of venues, but the focus should be on learning more about the products, education, patient safety, and influence on successful patient outcomes. AORN's annual Congress is the ninth largest medical trade show in the United States. (4) Congress provides a unique opportunity for perioperative RNs to talk with industry representatives about how their products make a difference in surgical units and improve patient outcomes. Inform industry representatives about your position as a staff nurse and the influence you have in the decision about which products are used in your facility.

On several occasions, I have heard from industry colleagues that some staff nurses are more interested in promotional giveaways than products being demonstrated at Congress. As perioperative nurses, if we want to continue to exercise our voice and power as decision makers, we may need to adopt the perspective that promotional items are an added bonus, but it is the information, education, and product that nurses need to influence buying decisions in their health care facilities. By obtaining as much product information as possible, we can use our knowledge and power to influence decisions about products used by the surgical team.