By Don Sadler

The nursing shortage in the U.S. could get worse before it gets better.

Half-a-million seasoned nurses are expected to retire by 2022, according to the Bureau of Labor Statistics. This translates into the need for 1.1 million new nurses to replace those retiring and accommodate an expansion in the delivery of health care services.

Nurse staffing challenges are especially daunting in the operating room. About half of all OR leaders say they are having problems recruiting perioperative nurses, notes ChrysMarie Suby, RN, MS, the president and CEO of the Labor Management Institute.

In addition, two out of three perioperative nurse leaders today are over 50 years old and one-fifth are over 60. About two-thirds of these nurse leaders say they plan to retire by 2022.

A Top Priority
Statistics like these should make OR nurse hiring and retention a top priority for health care organizations, says Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN, the CEO and Executive Director of the Association of periOperative Registered Nurses (AORN).

“A large number of perioperative nurse retirements are predicted in the next five years, which will cause the current nursing shortage to escalate,” says Groah. “This will result in a serious loss of the perioperative nursing knowledge and experience that are critical to safe patient care and optimal outcomes.”

Making the challenges even more difficult is the fact that very little, if any, perioperative training is provided in nursing schools today.

Groah says that while hospitals can count on recently graduated nurses to be clinically prepared to care for patients in medical surgical units, they can’t generally count on them to work in the OR.

“Recently graduated nurses are not prepared to care for patients requiring surgical intervention because nursing schools have eliminated specialty training from their curricula,” says Groah.

“Nursing school curricula is designed to prepare student nurses to pass the licensure exam, but not to work in specialty areas like the emergency department, critical care, labor and delivery unit, or perioperative areas,” she adds.

David Taylor, MSN, RN, CNOR, the President of Resolute Advisory Group LLC, agrees.

“Nursing students today don’t get clinical exposure as part of their education,” he says. “So most hospitals have to train OR nurses on the job.”

Due to this lack of training, Groah says that many recently graduated nurses are reluctant to seek out employment in specialty areas like the OR.

“This puts the responsibility on health care facilities to either develop a training program that will result in competent perioperative nurses or recruit experienced perioperative nurses,” she says.

Periop 101 From AORN
One of the most commonly used OR nurse training programs is AORN’s Periop 101: A Core Curriculum. According to AORN, this comprehensive, blended educational program is used by more than 2,500 health care organizations nationwide to recruit, educate and retain perioperative nurses.

Periop 101 is based on AORN’s latest, evidence-based Guidelines for Perioperative Practice. According to Groah, the program combines a standardized, evidence-based online curriculum and textbook readings with hands-on skills labs and a clinical practicum.

“It’s very resource-intensive and usually takes about six to seven months to complete,” says Groah. Taylor believes that health care organizations should have OR nurse training programs like Periop 101 running continuously at all times. He recommends a three-pronged approach to perioperative nurse training that encompasses didactic and clinical experience with lab work. Visit www.aorn.org/periop101_OR to find out more about AORN’s Periop 101: A Core Curriculum.

“To adequately train new OR nurses, health care organizations need to have a dedicated perioperative educator,” says Taylor. “But most don’t have someone who functions in this role on a daily basis.”

Maintaining a Work-Life Balance
To attract and retain the perioperative nurses they need to keep their ORs running smoothly, Groah recommends that health care organizations focus on the things that are most important to OR nursing candidates. At the top of the list, she says, is maintaining a healthy work-life balance.

“The results of the AORN 2017 salary survey reflect this,” she says.

However, Taylor points out that the typical scheduling practices at many hospitals aren’t designed to allow for this.

“Four nights of call a week and two weekends of call a month aren’t conductive to a healthy work-life balance,” he says.

The AORN salary survey results also indicate that facilities need to put greater focus on paid time off and that there should be incentives for established nurses to remain in their jobs, adds Groah.

The most frequently suggested motivator for retention mentioned in the survey retention bonuses. According to the survey, retention bonuses increased by just one percent last year, while incentive bonuses were up two percent and employee referral bonuses were up four percent.

Taylor stresses the importance of strong perioperative leadership in hiring and retaining OR nurses.

“Nurses often leave due to poor leadership,” he says. “Transformational leaders are better equipped to keep nurse retention levels high.”

Creating the right kind of working environment is also critical to hiring and retaining high-quality perioperative nurses.

“AORN believes that creating a professional practice environment of safety is the most successful retention practice for health care facilities,” says Groah.

A culture of safety includes effective communication and individual accountability.

“It allocates appropriate resources and provides the necessary incentives and rewards to promote a healthy patient safety culture,” says Groah.

“It also encourages the reporting of and response to errors with a focus on process improvement,” Groah adds. “A commitment to safety must be articulated at all levels of the organization and safety must be valued as a high priority – even at the expense of productivity.”

Partnering Together
Groah recommends that OR directors partner with the health care facility’s human resources department and the CFO to develop a perioperative nurse hiring and retention plan.

“The first step should be an assessment of the current staff and projected dates of retirement for senior staff members,” she says. “Using this information, OR directors should work with the CFO to develop a business case for recruiting OR nurses that includes adequate time for orientation and training.”

“The potential loss of revenue related to closing ORs due to a lack of staff should be a defining factor in assessing the return on investment of proactive staff planning,” she adds.

Taylor concurs.

“Over half of a hospital’s net revenue comes from perioperative services,” he says. “The OR is a hospital’s financial engine – the viability of many other hospital services depends on a financially healthy OR.”

Succession Planning
Included in proactive OR staff planning should be succession planning.

“The nursing profession in general does not do a good job of grooming its next generation of leaders,” says Taylor.

“There’s no question that OR managers and directors need to anticipate leadership turnover,” says Groah. “The wave of retirements that’s anticipated suggests a ‘grow from within’ approach to building a team that can withstand leadership departures.”

Taylor believes that one of the most effective ways to develop OR nurses’ leadership skills is to empower them with greater responsibility for OR processes and outcomes.

“OR leaders can’t be everywhere at all times and they shouldn’t try to be,” he says.

“Team members at all levels should be empowered to make decisions,” Taylor adds. “This helps current OR leaders identify employees who are interested in higher level leadership positions but need some grooming.”