Roadmap Project

Roadmap to national recognition for ACORN’s Standards for Perioperative Nursing in Australia

Over 2020 the ACORN Roadmap Project (RMP) has progressed under the governance of the National Leadership Group (NLG). COVID-19 delayed progress; however, the combined efforts of ACORN member volunteers and academic, clinical and professional perioperative and health care sector leaders have enabled the RMP to gain momentum. The RMP timeline has been extended with ACORN expecting a final NLG RMP report including findings and recommendations by November 2021.

Update December 2020

Over the past few weeks ACORN has received several queries from perioperative nurses that relate to issues beyond the scope of the ACORN Standards. These questions have prompted ACORN to again try to clarify the role of the ACORN Standards and how they can best serve Australia's perioperative nurses. ACORN also considers it time to reiterate the authority of not only the ACORN Standards but also other documents that guide perioperative practice. 

In the 16th edition, published in May 2020, eagle-eyed readers may have noticed the inclusion in every standard of the following words: ‘National and jurisdictional statutory requirements must be followed and take precedence over all recommendations contained within this standard. This standard should be used in conjunction with other current, relevant ACORN standards, and national and jurisdictional statutory requirements, standards and guidelines’.

The words above signify ACORN's deliberate action to position the ACORN Standards as being an adjunct to, not an alternative for, higher order directives including any relevant legislative instruments, national mandates and state or territory guidelines and policy. Each of those alternative directives take priority over the ACORN Standards in terms of the perioperative nurse's rights, obligations and responsibilities. Critical examples include the relevant Nursing and Midwifery Board of Australia (NMBA) professional standards and the mandatory Australian Commission on Safety and Quality in Health Care (ACSQHC) National Safety and Quality Health Service Standards (NSQHS Standards) that enshrine certain Standards Australia standards. There are other examples including various laws governing medications, medical devices and clinical practice. The list is exhaustive and beyond the scope of this brief discussion.

In view of the above hierarchy a perioperative nurse could reasonably ask what, then, is the role of the ACORN standards? Do they cover every aspect of perioperative nursing and do they have any authority? The role of the ACORN Standards is an important one and is described well in the final statement on the Acknowledgment page of the 16th edition of the ACORN Standards, as reproduced below.

No government or other agency requires compliance with the ACORN Standards; however, compliance is the key to organisations and individuals ensuring perioperative care is consistently safe and of high quality. As such, it is ACORN’s goal that ACORN standards for practice are accessed, interrogated and applied in every Australian health service organisation that performs surgical procedures. Perioperative staff should use the ACORN Standards in conjunction with other national and jurisdictional legislation, guidelines and requirements including, specifically, the National Safety and Quality Health Service Standards (NSQHS Standards). It is hoped that the ACORN Standards continues to represent the minimum expected, by the profession and its stakeholders, of all perioperative staff.

Frequent users of the ACORN Standards will note ACORN's silence on some specific aspects of perioperative nursing practice and perhaps wonder why that is the case. The primary reason ACORN remains silent on specific issues is that their resolution is dependent on a higher order directive, as detailed above. In those cases, there is no need for ACORN to offer a view as the necessary advice and instruction is already available. In fact, it could be confusing for perioperative nurses and has the potential to fuel local debate and disagreement if ACORN were to suggest an alternative view or unnecessary direction. For some matters there may be a specific national, state or organisational obligation or directive and that is what must be followed. Two examples of such matters that ACORN has recently dealt with are staffing and scope of practice for enrolled nurses. 

Other examples where the ACORN Standards are silent include where set-up should take place, whether or not multiple patients' notes should be in one operating room and how blood loss should be recorded. With no higher order directives nationally and within most jurisdictions, why are these issues not addressed? These issues are important but, alone, none are of such importance that they require a specific, individual standard. Rather, each is more likely to fall under the scope of higher order directives such as the NSQHS Clinical governance standard, Preventing and controlling healthcare-associated infection standard and Blood management standard.

As members are aware, ACORN's Roadmap Project (RMP) is currently considering the future direction and content of the ACORN Standards. Future ACORN practice standards will be brief, succinct and clear. Their structure will be as described in the November RMP update.


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Development of the Roadmap project

ACORN has been setting standards for perioperative nursing practice since 1980. These standards have gone through many incarnations and are currently published as Standards for Perioperative Nursing in Australia (the ACORN Standards) 2020 16th edition. We believe the ACORN Standards contribute to safe and quality perioperative care in public and private hospitals across Australia. Unfortunately, not all hospitals use them.

The ACORN Roadmap Project (RMP) is an ambitious multi-year project that seeks to promote the ACORN Standards nationally and broaden their reach and adoption in hospitals across Australia. The project team will engage with individuals, hospitals, universities, private sector businesses and government bodies to promote the adoption of the ACORN Standards and also seek to actively involve ACORN members in the task of raising awareness and increasing the uptake of the ACORN Standards.

In February 2019, the ACORN Board of Directors engaged an external consultant to assist with the development of the RMP.

In June  2019 the consultant  conducted a qualitative action research study composed of in-depth interviews with a range of internal and external stakeholders and compiled a report for the Board. The findings of the study showed that there is demonstrated need and sufficient scope for a project of this nature. ACORN officially launched the RMP at the inaugural Perioperative Leadership Summit in Canberra in September 2019. A design workshop with nearly 40 internal and external stakeholders was held in October 2019, in Sydney, to draft a National Action Plan to guide the project.

Leadership of the project

ACORN  recruited a group of six talented individuals to form the National Leadership Group (NLG) which will provide leadership, governance and oversight for the project. ACORN is honoured that Adjunct Professor Deb Thoms, former Commonwealth Chief Nursing and Midwifery Officer, has accepted the role of chair of the NLG. Other members include: Kathy Baker AM, Nurse Advisor, National Safety and Quality in Health Care (NSQHC); Allan Chapman, New South Wales State Manager, Royal Australian College of Surgeons (RACS); Associate Professor Christine Dennis, College of Business, Government and Law, Flinders University; Peter Roessler, Director of Professional Affairs, Australian New Zealand College of Anaesthetists (ANZCA); Ruth Melville, former president, International Federation of Perioperative Nurses (IFPN) and ACORN, CNC Patient Safety and Quality – Perioperative & SCHHS Laser Radiation Safety Officer, Surgical Services, Sunshine Coast Hospital and Health Service, and Patricia Flood, ACORN 2020-22 President, ACORN. Rebecca East, ACORN's CEO, will represent ACORN staff  and provide strategic insight.  The NLG will operate in parallel to the ACORN board. The ACORN President and CEO will provide strong links back to the organisation. In February 2020 ACORN appointed Cath Murphy, ACORN Standards Manager as Project Manager to the RMP.

The NLG will oversee the work of four workstream teams (WSTs). Each WST will focus on specific issues relevant to promoting the ACORN Standards as reflected in their name. The WSTs include the Clinical Standards and Standard Setting WST, the Professional Standards and Training WST, the Research WST and the Business Model  WST. The WSTs will work over the course of 15 months to July 2021. WST Chairs and members are detailed on their respective web pages.

Objectives of the project

The Roadmap project is an important part of ACORN's 2019-2022 strategic plan. The project's objectives are to:

  • increase demand for standardised perioperative nursing care by boosting awareness of the ACORN Standards among perioperative nurses, surgeons, anaesthetists, hospital administrators, health care companies and insurers, government and the community
  • encourage the adoption of the ACORN Standards by fortifying the evidence base which underpins them
  • remove barriers to the adoption of the ACORN Standards by reviewing and refining the Standards and the process used to set them
  • establish ACORN’s Professional Standards as the minimum level of qualification for perioperative nursing by aligning them with the ACORN Standards
  • create opportunities to develop the next generation of perioperative nursing leaders
  • engage and grow the ACORN membership by demonstrating effective national leadership of the perioperative nursing profession.

The Roadmap to National Recognition for ACORN’s Standards for Perioperative Nursing in Australia is an exciting project that will push the ACORN Standards to the forefront of the minds of health care decision-makers nationally. We ask you as ACORN members to actively engage with the project and to consider what you can do to promote awareness of the Standards among your perioperative colleagues and encourage hospital management and decision-makers to adopt the Standards.

Project timeline

February 2019

The ACORN Board of Directors engaged a consultant, Randall Pearce from THINK: Insight and Advice, to assist with the development of a project that aims to deliver national recognition and uptake of Standards for Perioperative Nursing in Australia (the ACORN Standards).

June 2019

THINK: Insight and Advice conducted a qualitative action research study composed of 36 one-on-one, in-depth interviews with a range of internal and external stakeholders.

August 2019

The ACORN board reviewed the Roadmap Project Stakeholder Consultation Report and approved the budget for the project.

September 2019

ACORN formed the National Leadership Group to oversee the work of four workstream teams (WSTs).

ACORN launched the project on 5 September 2019 at the Perioperative Leadership Summit in Canberra.

October 2019

ACORN recruited representatives from all stakeholder groups. Representatives participated in a 

Design Workshop with National Leadership Group and future WST members held on 25 October 2019 in Sydney.

November 2019 - February 2020

The  2018-20 ACORN Board and NLG approve the RMP Action Plan.

February 2020

Inaugural meeting of the NLG. 

Feb - May 2020 ACORN prioriatises COVID-19, support and collaborations.
May 2020

ACORN releases new 16th edition of the ACORN Standards for Perioperative Nursing in Australia.

ACORN 2020-2022 President and Board of Directors commence terms of office.

Invited members of WSTs 1-3 recruited.

June - Aug 2020

The inaugural meetings of the WSTs are held. The teams meet no more frequently than every four to six weeks until September 2021.

Sept 2020 ACORN Board extend the RMP by at least 3 months.
Oct 2020 ACORN calls for expressions of interest to assist the RMP

April 2021

Evaluation of the project is carried out between 5 and 23 April 2021.

Nov 2021

The final evaluation report is delivered to the ACORN Board.

May 2022 ACORN Board and NLG present findings and recommendations at the 2022 ACORN Conference