What I Learned From Perioperative Leaders

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Last week, I had the honor of spending time with the over 700 nurse leaders who attended the OR Nurse Manager conference. It was the first time in three years that the meeting had been live. I first participated in this conference almost a decade ago and presented research on succession planning for the perioperative nursing workforce. It was interesting to look back on those research findings today. Perioperative nurse leaders who participated in the study were eerily prescient about the future of perioperative nursing.

The challenges today for perioperative nursing are similar to leaders in other areas, but there are also unique differences. Perioperative departments are and have always been the economic engines for health systems. Any disruption to perioperative services is high on the radar screen of executive leaders. These nurse leaders are under intense pressure to maintain their volumes at a time when staffing is a critical concern. Some of the challenges we discussed included the following:

The pandemic accelerated the retirements of many seasoned OR nurses – they are being replaced by nurses without perioperative experience who require extensive training.
Perioperative directors usually manage multiple areas and have larger spans of control than nurse leaders in other areas.
As in other specialties, a significant percentage of perioperative leaders have less than three years of experience and worry about failing in the role.
Finding seasoned preceptors for new perioperative nurses is extremely difficult.
Very few new graduates are exposed to perioperative nursing while in school, and faculty biases about working in the OR continue to exist.
Many experienced perioperative nurses and surgical techs have left permanent employment positions to travel.
Use of travel nurses and travel surgical techs is widespread in perioperative departments to meet core staffing needs.
Supply chain issues with drugs, equipment and other supplies continue to plague perioperative departments and impact the ability to do some surgical procedures.
The orientation of a new graduate to perioperative nursing is extensive, yet many recent graduates now leave within the first two years.
Core teams in perioperative areas have been massively disrupted, making teamwork much more challenging.
New perioperative nurses don’t want to take call or work weekends.
The increased patient volumes and lengths of stay makes it challenging to schedule surgeries for patients who need hospitalization.
More and more procedures are being shifted from hospitals to Ambulatory Surgical Centers.
A culture of incivility and bullying in perioperative areas continues to exist.
The merger of hospitals into mega systems has led to slower decision-making and less inclusion of local perioperative nurse leaders in strategic planning.

As I spoke with nurse leaders during this conference, many told me that they were so glad they had attended. Perioperative leaders often work in isolation and think that their challenges are unique. It is comforting to see that the problems they have are universal among their colleagues. Sharing ideas and getting support from other leaders is so critical at this time. I was happy to see so many health systems invest in their leaders by enabling them to attend. It was a wise investment.

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