There are several ways to improve the education-to-workforce nursing pipeline, including creating perioperative electives and perioperative preceptorships. These efforts might prevent anticipated shortages caused by an aging workforce on the brink of retirement.

“The current problem faced by the perioperative workforce is twofold,” says Jessica Reuter, DNP, RN, assistant professor of clinical practice at The Ohio State University. “Perioperative positions have long been held by nurses with vast amounts of experience. In fact, a few decades ago, it would have been rare to see new graduate nurses in the perioperative setting.”

Most perioperative nurses had worked on the medical-surgical area before transferring to the perioperative area. “Now, those experienced nurses are retiring, and we are seeing many open positions in this specialty,” Reuter observes.

The solution is making it easier for nursing students to enter the workforce with the necessary skills and also to make it easier for some proportion of them to enter the ambulatory surgery world.

“We need to remove barriers to people entering the nursing profession,” says Julie Manz, PhD, RN, assistant dean of the undergraduate program for the College of Nursing at the Omaha, NE, campus of Creighton University. “How can we partner together to design the best curricula that make nursing graduates as prepared as they can be for what the employers are expecting?”

There is a national initiative among nursing college organizations to design a program that will improve the efficiency of the nursing educational pipeline.

“Clinical agencies and employers are looking for nurses who are ready to practice, grads who can hit the ground running and assimilate in nursing culture seamlessly,” Manz says. “I want to prepare them for that role so that transition time between graduate and practicing nurse is not so tumultuous.”

It is difficult to rotate students through surgery center/operating room settings, so there is a generation of nursing students who have not experienced formal education in that specialized area, 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.

For the long-term health of perioperative nursing, there are some educational techniques that could direct more student nurses toward that specialized area. Reuter, Manz, and Maneval share these suggestions:

Ask experts for answers. “In addition to extensively reviewing the literature on this topic, I have had the opportunity to hold focus groups with nurses from different backgrounds and education levels,” Reuter says. “A large majority of the nurses I spoke with mentioned that they would not have known about the specialty of perioperative nursing if there had not been an elective they happened to take while in nursing school. The nurses did not attend the same nursing schools.”

Offer nursing students a chance to see what a surgery center or hospital operating room are like in the real world. “It’s important to offer nursing students exposure to different specialties, including perioperative nursing, if we are going to fill the large amount of vacant positions due to new surgery centers opening, the growth of current healthcare systems facilities, and nurses retiring,” Reuter says.

Reuter met with nurse educators and managers who hire in the perioperative department. She found both professionals liked the elective because it could be an extended interview of nursing students.

“Administrators get to see the student orient, learn the role, and get to know more about their strengths and opportunities for growth, as well as their work ethic — before deciding to hire them,” Reuter says. “Nurse educators in the department agree that seeing the students during the course of the elective ... gives them an idea of how they will [fit] into the culture of the department and know that the students already have a solid foundation to build their orientation process around.”

Nurse leaders reported students who took a perioperative elective performed better in orientation and completed their orientation more confidently.

Provide perioperative nursing electives. Nursing schools could develop and implement clinical elective courses for perioperative nursing.1

These unique courses could provide foundational knowledge about the specialty, as well as skills in each practice arena. For instance, surgery centers could become clinical practice partners in training nursing students.

Typically, it takes a lot of time and many resources to train a nurse to become an operating room professional.

“When we focus on our practice partner, we say, ‘What if we partner together and we offer an elective course,’” Maneval says. “In our nursing program, every nursing student has to take a three-credit elective as a requirement.”

Perioperative nursing could be one of these electives. “In that elective, we have nurses and leadership from operating areas come in to present information and talk with students,” Maneval explains. “One faculty member will manage the course but the content is delivered by experts.”

An entry-level perioperative course could provide didactic education, as well as simulations developed in collaboration with surgery center practice partners.

“Another benefit of offering a perioperative elective to students is that it assists in identifying student nurses who prefer not to work in the perioperative environment,” Reuter says. “Since many students do not understand the role of the nurse in this setting, they discover that it is not the career choice for them. Therefore, they are less likely to pursue a career in the perioperative department and begin orientation only to transfer or leave their position shortly after being hired.”

This may help prevent nursing turnover, which is a main concern for the profession as a whole. Still, creating an additional course may not work for every institution.

“It takes a great collaborative effort between the hospital department and the school of nursing to offer a successful elective,” Reuter says. “However, even if an elective cannot be created, innovative ways of introducing specialty areas of nursing in the curricula so students can experience these roles is imperative.”

Provide the chance for an operative preceptorship. Surgery centers could collaborate with nursing schools to provide a preceptorship for working in operating rooms and surgery centers.

A paper addressing the perioperative nursing shortage describes how a large healthcare system partnered with a college of nursing to institute a perioperative preceptorship for baccalaureate nursing students in their final semester.

Researchers found students who completed the preceptorship reported a better understanding of perioperative nursing roles and responsibilities, as well as better time management and patient safety skills.2

“We’ve developed a perioperative simulation that every student goes through, an eight-hour module, and the interactive, high-fidelity simulation experience,” Manz says. “We’re trying to find more ways to get nursing students exposed to great opportunities that perioperative nursing offers.”

The perioperative nursing preceptorship program requires students to complete 220-240 clinical hours with a preceptor. It is offered as an option for students to fulfill their final semester clinical preceptorship requirement.2

Students work with a nurse who has earned at least a bachelor of science in nursing degree and recorded at least two years of experience. The students spend 24 to 36 hours in both the preoperative and postanesthesia care units. The rest of their time is spent in the intraoperative setting with the dedicated nurse preceptor.2

Manz says the goal is to prepare students for work in perioperative nursing after they graduate. Other schools have developed preceptorships, too.

“We work with practice partners to give every student a 135 hours preceptor experience,” Maneval says. “What if you were to provide all the students registered for a periop elective a registered nurse who works in that area to be their preceptor?”

Students could work with perioperative nurses on their shifts for 135 hours. “That’s what we did,” Maneval says. “The vice president overseeing the perioperative area across nine hospitals came on the first day of class. She was just so impressive, telling the story of what a great career it is to work in the perioperative nursing environment.”


  1. Maneval R, Hepburn M, Brooks C, et al. Enhancing the undergraduate nursing education experience with clinical elective courses. J Prof Nurs 2021;37:366-372.
  2. Manz J, Williams K, Jessen J, Kirkpatrick A. Addressing the perioperative nursing shortage via a perioperative nursing preceptorship for baccalaureate nursing students. AORN 2021;113:52-63.