An ethnographic study of differentiated practice in an operating room

An ethnographic study was conducted to investigate implementation of the cl inical nurse III or team leader (TL) role as part of a newly executed nursi ng differentiated practice model. The six TLs studied were employed in the operating room (OR). Through participant observation, interviews, and docum ent analysis, the TL role-as well as perceptions of the role by the TLs and OR staff-were studied. Problems related to performance of the role and its evolutionary process were delineated. Data analysis involved identifying c ategories and subcategories of data and developing a coding system to ident ify themes. Salient themes were related to the culture of the OR. Because o f the OR's highly technical environment, the TLs defined their roles in rel ation to the organizational and technical needs of their surgical service. Refinement of surgeon "preference cards" and "instrument count sheets" was considered the initial priority for the TLs. Various controllable and uncon trollable factors were identified that affected implementation of the new T L role. Findings suggest that introduction of the role requires insight int o setting and an emphasis on staging and orientation of employees to the ne w role.