Perioperative nursing shortage threatens SDS programs

Less OR exposure in school means fewer prepared

Across the country, hospitals and other health care providers are bemoaning the shortage of nurses, but within same-day surgery programs, the shortage is felt more strongly. The shortage of perioperative nurses has been called "a shortage within a shortage."1

One reason for the shortage is the move from a three-year diploma program that gave nursing students time to work in the OR environment to two- and four-year degrees that focus more on theory and classroom learning than on hands-on clinical experience, says Lucy H. Miller, RN, PhD. Miller is an associate professor of nursing at Valdosta (GA) State University.

"Caring for patients today is technologically complex, so students do need extra time in the classroom," she says. "Requirements for licensure also mean more classroom time than in the past."

Nursing schools also don’t have the same relationships they had previously with hospitals that provided opportunities for students to work within the OR. Such opportunities allowed students to become acquainted with the facility, the nurses, and the physicians, says Louise deChesser, RN, MHA, CNOR, MHA, director of operations at the HealthSouth Surgery Center of Hartford, CT. "This lack of time in the operating room doesn’t give students, even those with a natural gift for the operating room, a chance to discover if surgery is the right place for them."

When Linda Y. Kautzman, RN, MSN, CNOR, clinical staff coordinator for South Georgia Medical Center in Valdosta, returned to school for an advanced degree, she noticed that nursing students took some elective courses, but most students chose courses outside nursing.

The electives are usually psychology or sociology courses that can be applied to patient care, but Kautzman says the elective requirement is a way to introduce students to perioperative nursing. She developed a course that is being offered at Valdosta State University. (See story on perioperative course, p. 29.)

If you don’t have a nearby school of nursing, but you want to offer classes that will help train nurses to work in your day-surgery program, the Denver-based Association of periOperative Registered Nurses (AORN) has a class that can be offered at your site. The course covers 24 topics such as patient assessment, sterilization and disinfection, scrubbing, gowning and gloving, patient position, and electrosurgery, says Eileen Ullmann, RN, MHS, CNOR, professional education specialist for AORN.

"The total course requires 80 hours of classroom and clinical time that should take about three months," she says. The cost is $1,250 for the initial licensing agreement and per-student cost for course materials. The total number of students determines the fee per student, so it differs from facility to facility. One staff member is needed to serve as a course leader. The course leader must attend a facilitator seminar offered by AORN, Ullmann adds.

While hospital-based same-day surgery programs may be most likely to present this type of course, she sees an opportunity for freestanding same-day surgery centers and small community hospitals to pool resources to present this course.

"Different facilities could work together to supply a course leader for the didactic portion of the course, and the students could complete clinical training at individual institutions," she says.

Another approach to attracting nurses to the operating room is to offer one-to-one training for RNs who are interested in moving from another area to the operating room, says Sharon C. Wolfrum, RN, CNOR, director of surgical services at Gulf Coast Medical Center in Panama City, FL.

"I didn’t plan to take on nurses with no operating room experience, but I had one nurse who expressed an interest in moving from a medical floor to the surgery program," says Wolfrum. After the nurse used her own time to observe the same-day surgery program, she asked to be hired within surgery. Wolfrum set up a training program that involved video education as well as self-study of books about surgical nursing practices. An experienced nurse within the surgery program volunteered to act as the trainee’s preceptor for six months.

Wolfrum admits that this type of training takes a full year before the nurse can work completely on her own, but she says it can be worth it. "She’s a terrific perioperative nurse because she wanted to become one." She suggests that surgery program managers who take on a single nurse to train start with the basics and pair the nurse with a strong preceptor. "Be sure you let the trainee set the pace of learning so he or she doesn’t become overwhelmed or frustrated."

Freestanding surgery centers don’t have the same resources in terms of staff, time, and money to train nurses for the operating room, so most rely upon hiring experienced nurses, says Jane Kusler-Jensen, RN, BSM, BSN, CNOR, director of surgical services for Surgicenter of Greater Milwaukee. This often results in creative strategies to lure nurses to their centers, she adds. (See story on how perks attract experience, p. 30.)

Hospital-based or freestanding same-day surgery managers need to make a commitment to work with others to increase the pool of perioperative nurses, says deChesser. "The traditionally trained nurses are growing older, and we need to make sure we have well-trained, experienced perioperative nurses in place as we approach retirement. After all, the nurses we hire and train today are the ones who will take care of us when we need it!"


1. Radziewicz K, Houck P, Moore B. Perioperative education. AORN J 1992; 55:1,071.