The COVID-19 pandemic did nothing to help the ongoing perioperative nursing shortage. Replacing perioperative nurses is especially challenging because few nursing programs offer designated curricula on this area.

  • Research suggests as many as one-third of new nurses will leave the profession within their first two years of nursing work.
  • Nursing students receive little operative nursing content and almost no opportunities to observe perioperative nursing in practice.
  • The pandemic made it more difficult for nursing colleges to provide hands-on experience for nurses.

Seven years ago, nursing leaders and researchers issued a call to action to the surgery center world, predicting that half of perioperative nurse leaders could retire by 2020.1

Then, when 2020 arrived, something unexpected happened — the COVID-19 pandemic. Nurses of every type were pressed into service and sacrificed much. More than one year since the public health emergency began, emerging reports suggest many pandemic-weary nurses plan to change careers or retire within the next 12 months.2

While data collection is ongoing, and no one can say for certain what will happen next in the nursing workforce (especially for perioperative nurses), the past and present trends are worrisome.

The rapidly aging baby boomer population has increased demand for nursing over the past decade, says Julie Manz, PhD, RN, assistant dean of the undergraduate program for the College of Nursing at the Omaha, NE, campus of Creighton University.

“There are national efforts to recruit nurses and figure out ways to transition nursing students into professional roles in a timely manner and to create pipelines for clinical partners to fill these shortages,” Manz says.

One obstacle to replacing the nurses who are retiring is retention of new nurses. Up to one-third of new nurses leave the profession within their first two years. Work-related injuries, workload, emotional strain, and the culture of nurses eating their young are among the causes.2

“This is a call to both academia and practice to figure out how to address that,” Manz says. “How can we get students interested in this area and acclimate them to our culture, align goals, and make them a good hire?”

Replacing perioperative nurses is especially challenging because of the lack of related nursing programs, says Jessica Reuter, DNP, RN, assistant professor of clinical practice at The Ohio State University.

“Nurses may not have considered this area for their career because nursing schools have removed much of the perioperative clinical experiences in favor of clinical experiences on more general medical-surgical units,” Reuter observes.

Plus, content within the curricula of many schools has decreased since the publication of The Essentials of Baccalaureate Education for Professional Nursing Practice in 2008, which encouraged the general education of nurses.3

“Many nursing colleges have removed specialty content from their curricula,” Reuter says. “The amount of content and time spent learning about this clinical area is insufficient to introduce this field to nursing students in associate and baccalaureate degree programs. Therefore, they do not apply to, or even consider, the specialty of perioperative nursing for their career choice.”

Other specialty areas are experiencing the same plight. “The nursing pipeline problem is very complex,” says Rhonda Maneval, EdD, RN, senior associate dean of the College of Health Professions and the Lienhard School of Nursing at Pace University in New York City. “One issue is the lack of prepared faculty to teach ... You can’t produce more nurses unless you have appropriate faculty to teach them, and there’s a lack of appropriate clinical sites where students can get hands-on experience in taking care of patients.”

This is especially true for the perioperative track. Nursing students are not exposed to operative nursing content, and there are no or limited opportunities to even observe perioperative nursing. “Where students have opportunities to do clinical work is where they envision themselves,” Maneval says. “When they’re not exposed to that whole area, it’s really not on their radar.”

Without exposure, recent nursing graduates might not even think about applying for perioperative nursing jobs.

Pandemic Turned Up the Heat

“COVID has placed extra strain on nursing staff,” says Crissy Hunter, DNP, RN, CHSE, CNE, clinical nursing faculty, COURSE coordinator for the nursing education track at Southern New Hampshire University in Manchester.

With longer and more intense shifts, many health systems cut back or cut out supervision of nursing students, making it more challenging for nursing schools to find clinical practice opportunities for their students.

“They wanted to bulk up and have extra staff [during the pandemic], but it also promoted burnout,” Hunter says. “Nurses worked shifts exhausted.”

This affected nursing practice faculty. “I was flabbergasted about how many nursing faculty shortages there are in each state,” Hunter shares.

Nursing faculty at colleges need to earn at least a master’s degree in nursing, and some states require such degrees for nursing supervisors at practice sites for student nurses. Some nursing colleges shifted students to alternative sites for their hands-on experience or used simulation and virtual experiences.

“Patients are so ill in the hospital right now that staff are very stressed and working very hard. Adding students into that mix contributes to the challenges of the environment,” Maneval says.

The pandemic made it even more difficult to provide perioperative nursing experience to students. “There was less opportunity to place students in those areas,” Maneval says. “There is so much that students need to learn and experience. Detailed content in terms of working in an operative environment is not a high priority in most nursing programs.”

Surgery centers and health systems can do more to fix this problem. “My suggestion for improving the pipeline of nurses who apply and work in the perioperative environment is to educate students about the opportunity more,” Reuter offers. “Currently, most students spend one, maybe two, days observing a patient during the surgery process. They generally are not placed with a preceptor.”

There also are no set learning objectives, and every student’s perioperative learning experience is different. “Some students have positive experiences, and others do not,” Reuter says. “We wonder why students are not choosing perioperative nursing.”

Nursing schools, with help from practice sites like surgery centers, must introduce nursing roles outside the customary experiences to meet the demand for nurses in the perioperative setting. Creating more preceptorships and elective coursework in perioperative nursing is a good start.

For years, surgery centers did not hire new nursing graduates. However, that should change to prevent perioperative nursing shortages as many perioperative nurses consider retirement.

“We’ve got to replace [retiring perioperative nurses], and the only way is to get students interested is to have students work in that area and develop spark and interest,” Manz says. 


  1. Sherman RO, Patterson P, Avitable T, et al. Perioperative nurse leader perspectives on succession planning: A call to action. Nursing Econ 2014;32:186-193,203.
  2. Androus AB. The (not so) great escape: Why new nurses are leaving the profession. RegisteredNursing.org. May 11, 2021.
  3. American Association of Colleges of Nursing. The Essentials of Baccalaureate Education for Professional Nursing Practice. Oct. 20, 2008.


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