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"People need to ask appropriate questions and make an informed decision," Hill said.

"Advertising misleads people," said Kate Wilson, RN, a staff nurse at the ophthalmology clinic at Kaiser Permanente Redwood City in California, and selecting a surgeon on the basis of price is a bad idea. Patients should have extensive prescreening to determine if they are good candidates for the procedure-and surgery should not be performed on those who aren't.

Sharon Sjulstad, RN, CRNO, CNOR, director of operations at Barnet Dulaney Perkins Eye Center in Arizona, is comfortable with advertising, as long as patients know what they are getting. "But the patient has to dig deep to make sure they know."

Standardized vision

Concerned about the lack of standards in the field, a group of nurses helped develop a recommended-practices manual under the aegis of the American Society of Ophthalmic Registered Nurses. Katzen, Navarro and Sjulstad were members of the work group that wrote the standards.

"Lasik is not totally sterile like the OR," Hill said. "It is a combination of clean and sterile. We felt the situation needed to be researched to find the best practice of how to manage that, to ensure patients would not have adverse results from the surgery." The group expects the guidelines to be somewhat controversial, as well as to evolve in time.

"The idea was to have unified practices," Katzen said. "We made the first statement that anything that touches the eye must be sterile." As data are compiled on the effectiveness of the guidelines, evidence-based practices can ultimately be developed.

Part of the problem, though, is finding trained nurses or even nurses who are interested in the field, Sjulstad said. "Typically, technicians work up the patients in the clinic without nurses to help them through it." By providing guidance for those technicians, the standards, the authors hope, will improve patient care.

To Katzen, the ideal situation would be for nurses in ophthalmologic centers to be cross-trained, able to handle the technical aspects as well as the patient care. "Nurses have been trained in sterile procedures, where for the most part technicians have not," she said. For that to happen, the medical community must be educated about the value of a nurse in this setting.

"There's no question that it is a cost-containment issue," Navarro said. "But I think we will transcend it. Because there is a nursing shortage, we need to make sure nurses are taking care of patients and not doing routine tasks that someone else can do."

"If you have a crisis in the center-and we've had full cardiac and respiratory arrests-you need a nurse," Katzen said. "Nurses have been fully trained in CPR skills."

She encourages nurses to look into the field. "Not only is it exciting and fulfilling, but from a lifestyle standpoint, you are able to have fairly regular hours. It is mostly 9 to 5, five days a week."

Besides, as baby boomers age, the population needing eye care will grow tremendously. That means even more nurses will be needed.

Contact Melissa Gaskill at gaskill@dbcity.com