Increasingly, hospital administrators and ASC leaders are finding it challenging to hire qualified operating room nurses.

“Whether there’s a nursing shortage or not varies by region,” says Linda Plank, PhD, RN, NEA-BC, associate dean for academic affairs at Baylor University’s Louise Herrington School of Nursing. “Some places have a surplus of RNs, but more places have a shortage of RNs. It’s not very consistent, and it only takes three people to retire or resign and you have a major staffing issue.”

Plank says ASCs are at an advantage over hospital ORs when it comes to hiring nurses. For instance, the work hours in an ambulatory OR are more desirable. Still, both hospital and ASC OR settings will continue to see increasing shortages of nurses. ASCs will experience this problem because of their increasing case volume and rise in OR nursing demand.

“As more surgical cases go to the ASC or are affected by a surgical procedure, we need more good nurses in the operating room,” Plank says.

Operating rooms function under conditions that can make the nursing shortage more severe than the general nurse shortage because of the length of time it takes to orient someone in an OR, Plank says.

“You need six months to orient a nurse in an operating room, but only a few weeks or a few months in other settings.”

Also, ORs traditionally drew most of their nursing staff from graduates with associate degrees in nursing (ADNs). Now, there are fewer schools training two-year ADN nurses as more students desire four-year degrees, Plank says.

“Two-year programs have closed or become four-year programs,” Plank notes.

A third reason for the decline in available OR nurses is that the average age of an operating room nurse is four to five years older than nurses working in other areas. The Association of periOperative Registered Nurses (AORN) surveys OR nurses regularly, finding in every questionnaire that OR nurses are older and nearer to retirement.

“That’s the main reason we see a bigger shortage in the operating room than in other parts of the hospital,” Plank adds.

Colleges and universities are graduating increasing numbers of new nurses, but ORs are not benefiting from the new additions to the nursing workforce because the students lack exposure to OR nursing. Nursing schools give students exposure to med-surg units, obstetrics, pediatrics, and oncology, but not operating rooms. “The operating room stopped being a clinical site for nursing students decades ago,” Plank laments. “If students are not exposed to the OR, they can’t make a good decision of whether or not this is a good place for them to work.”

The OR was taken out of the nursing student rotation schedule because of a lack of faculty comfortable in the OR and because the OR carries greater risk to students and patients, Plank says.

“A lot of hospitals felt it was too dangerous to have students in the OR; who would be watching them?” she explains. “[These students are] either unsupervised or they’re a burden for the OR nurse. It’s risky and burdensome.”

In a recent study, Plank suggested a solution: Operating rooms, including those in ASCs, can collaborate with academic institutions to bring nursing students into the OR.1

“Since we started the perioperative elective [at Baylor’s nursing school] in 2010, we’ve had nurses that chose to work in the OR and were offered jobs there after graduation,” Plank says. “From the nursing school standpoint, we feel that’s a win-win. The clinical time in the OR benefited the student, and the hospital ended up with [an] employee they wanted.”

Although Plank has not tracked the long-term impact, she notes that some nurses who participated in the perioperative elective program are still working in operating rooms.

An academic practice partnership entails a commitment between a nursing school and a hospital or ASC to work together to give OR experience to nursing students.

Any ASC that experiences continual nursing staff shortages should contact the local nursing school and discuss forming a partnership, Plank suggests.

“It’s better for everyone if nursing students are exposed to the OR long enough to make a decision and apply for a position, if it is a good fit.”

Such a partnership could provide one day a week of experience in a med-surg rotation in an ASC or hospital OR. The student should have the opportunity to follow the patient from a first interview to meeting the anesthesiologist all the way through viewing the procedure in the OR and watching the patient start recovery, Plank suggests.

OR nursing salaries should be attractive to nursing students, too. According to AORN’s 2017 data, staff perioperative nurses earn an average annual salary of $70,300, and perioperative nursing leaders earn an average salary of $117,000.2 AORN notes that these salaries represent increases of $1,200 and $3,400, respectively, above what those jobs paid in 2016.

Asking ASC staffers to spend a little extra time with a nursing student is a better use of resources than paying for temporary nurses or overtime during a low staffing period, Plank argues. “If you don’t want to have your staff work overtime or to hire contract nurses, there may be no other options,” she says. “Contact your closest nursing school, and bring students into the OR.”


  1. Plank L. Academic-practice partnerships to reduce the shortage of operating room nurses. Nurse Educ 2018;43:325-329.
  2. Association of periOperative Registered Nurses. What Are You Worth? 2017 Salary Survey Top Takeaways. Published Dec. 13, 2017. Available at: Accessed Nov. 19, 2018.