2 Perianesthesia nursing as A specialty

Perianesthesia nursing is a diverse field that encompasses patient care in a variety of settings. Recognition of perianesthesia nursing as a critical care specialty is well established. The main goal of the perianesthesia nurse is to provide competent, efficient care to patients and their families who are experiencing an anesthetic event. This care can be given in a traditional care setting, such as the hospital setting, or in a nontraditional care environment, such as a physician’s office. Where there is an opportunity for a patient to experience anesthesia—from moderate sedation to general anesthesia—there is an opportunity for a perianesthesia nurse to provide care.

Recent history has been witness to a number of significant factors that have influenced the practice of perianesthesia nursing. Among these factors are the emphasis on cost containment in health care; declining reimbursement for medical services; the aging and increased acuity level of the population; advances in technology; advances in pharmaceutical therapy; and fast-tracking of patients through the postanesthesia recovery process.

The American Society of PeriAnesthesia Nurses (ASPAN) is the professional organization that represents the professional interests of perianesthesia nurses and sets the clinical standards of care in this specialty in the United States and its territories. In an effort to define the role of the perianesthesia nurse, ASPAN has published a formal Scope of Practice document (Box 2-1) that addresses the core, dimensions, boundaries, and intersections of perianesthesia nursing practice.¹ The members and governing bodies partner to establish practice standards, guidelines, and evidenced-based practices to promote safe patient care. These standards encourage competent practice through their use, as vetted through peer review processes and member representation. The guidelines define practice issues such as evaluation of patient condition, practice statements for staffing patterns, use of unlicensed care personnel, and overflow of intensive care patients. ASPAN also partners with other nursing professional organizations to establish professional nursing standards advocating for safe conditions for both the patient and the caregiver.¹

Perianesthesia nursing is practiced in multiple modalities, both inpatient and outpatient, within the hospital setting and in free-standing practice settings (Box 2-2). The continued emphasis on cost containment has stimulated the regionalization of health care and the development of tertiary care centers in major cities, while primary care has increasingly moved to ambulatory settings.² As a consequence, perianesthesia nursing is practiced in a variety of traditional and nontraditional settings, from the physician’s office to recovery care centers to highly specialized postanesthesia care units (PACUs) in dedicated medical centers, such as eye institutes and surgical hospitals as well as practice sites that include dental clinics, ambulatory surgery centers, office-based procedure areas, endoscopy suites, and pain management centers.

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