By Don Sadler

The low national unemployment numbers are forcing many businesses to scramble to find well-qualified, high-quality employees.

Hospitals and health care organizations are facing employment challenges of their own – especially when it comes to hiring and retaining qualified perioperative nurses.

Shortage is Getting Serious

“The OR nursing shortage is becoming increasingly more serious as baby boomers continue to retire,” says Donna Doyle, DNP, RN, CNOR, NE-BC, senior advisor, surgical services, with OhioHealth Grant Medical Center.

This shortage is contributing to a host of problems in the OR, says Zee Barreras, BSN, RN, CNOR, surgical services clinical educator with Tucson Medical Center. “These include staff burnout, low morale, and dysfunctional and inadequate patient care,” she says.

About a quarter of the perioperative staff where Barreras works will be retiring over the next five to seven years, she notes.

Susan Becia, career center manager with the Association of periOperative Registered Nurses (AORN), runs down her own list of problems that the OR nursing shortage can lead to. “Stress, burnout, and mental and physical fatigue are all results of nursing professionals working under less-than-optimal staffing conditions,” she says.

One of the less-obvious dangers of the OR nursing shortage is the “brain drain” that occurs when experienced nurses retire, adds Becia. “They take their wealth of knowledge with them, which isn’t easily replicated when novice nurses are hired to replace them,” she explains.

“The loss of critical thinking of retiring OR nurses with more than 20 years of experience will negatively impact the quality of patient care,” adds Doyle. “Mentorship of novice nurses may be impacted as well.”

Eye-Opening Statistics

The statistics with regard to the overall nursing shortage are eye-opening. For example, the Bureau of Labor Statistics predicts a shortage of more than one million nurses in the U.S. by 2022. And more than 438,000 new RN jobs are expected to be added to the U.S. workforce between now and 2026.

But the nursing shortage is even more severe in the operating room. This is due to several factors, including the fact that perioperative nurses are older on average than nurses in other specialties.

For example, Doyle cites research indicating that the average age of perioperative nurses is between 51 and 55, while the average age of nurses in other specialties is between 42 and 47. “Many organizations are not aware of their own demographics related to the age ranges of their perioperative nurses and their plans for retirement,” she says.

The 2018 AORN Salary and Compensation Survey determined that the median percentage of vacant full-time perioperative nursing positions has more than doubled in five years. The 2018 survey determined that the median percentage of vacant full-time perioperative nursing positions is 7.1 percent, up from just 3 percent in 2013.

Also, six out of 10 (63% ) perioperative managers said they have at least one open position, and 67% said they believe the nursing shortage has had a moderate-to-crisis effect on their working environment.

The top reasons for the OR nursing shortage cited by survey participants were insufficient compensation and benefits (listed by 43 percent of respondents), employees leaving the facility or industry (42 percent), a lack of qualified and experienced perioperative nurses (41 percent), too heavy of a workload (36 percent), nurse retirements (34 percent) and job-related stress (31 percent).

In particular, Barreras has witnessed the impact of high stress levels and the demands of call on OR nurse attrition. “Most nurses can tell you about the ‘emergent tubal’ they have been called in for,” she quips.

“Hospitals have failed to be creative when it comes to staffing and many nurses are unwilling to sacrifice family time for their jobs,” she adds. “No amount of overtime can ever buy back lost time with your family.”

Perioperative Challenges

One reason why the nursing shortage is especially challenging in the perioperative environment is the time and cost required to train new OR nurses.

“Working in the OR requires lengthy additional training, regardless of the education a nurse has,” says Barreras. “The skills needed to work successfully in the OR are not taught in the typical nursing academic curriculum.”

Doyle agrees. “There’s an absence of perioperative curriculum in undergraduate nursing education,” she says. “This prevents student nurses from the imprinting that comes with exposure to the OR.

“Nursing students are unfamiliar with the importance of the perioperative nurse’s role in caring for patients who are at the most vulnerable time in their health care experience,” Doyle adds.

Barreras believes it’s crucial for hospitals to invest in and institute Periop 101, AORN’s blended educational program for perioperative nurses that’s now in use in more than 2,500 hospitals and ASCs nationwide. “This program is one of the best resources for training and retaining competent perioperative staff,” she says.

“Personally, I would like to see hospitals and schools work together in providing the Periop 101 course,” Barreras adds. “The didactics of the course could be taught in the classroom and a clinical experience provided to teach hands-on skills in the OR.”

Potential Solutions

So what are some possible solutions to the OR nursing shortage? Doyle believes that solving the problem starts with knowing the demographics at your own organization. “Based on this information, develop a plan to prevent catastrophic staff shortages that may impact your ability to meet patients’ surgical needs.

“Also work with your human resources department to make sure there is a good recruitment plan that’s specific to the OR,” Doyle adds. “And partner with academic nursing programs to develop or teach a nursing perioperative elective.”

Barreras urges hospitals not to give in to the temptation of hiring “warm bodies” to fill open perioperative positions. “This ultimately impacts the quality of patient care that’s delivered and contributes to high staff turnover,” she says.

Doyle would also like to see hospitals present information sessions to high school students who may be interested in a career in perioperative nursing. Betsy Vane, RN, MSN, CNOR, CRCST, CHL, CSPDT, a health science teacher at Health Careers High School in San Antonio, Texas, says that a half-dozen of her students have expressed interest in pursuing careers in perioperative nursing.

“Hospitals could partner with high schools and schools of nursing to provide real-life perioperative nursing experiences for students,” says Vane. “High schools could then offer off-campus rotations that specifically target perioperative nursing skills.”

Vane believes that we need to engage the next generation of health care providers by “advertising what a career in perioperative nursing can do for them. For example, let’s take the exciting opportunities that perioperative nursing offers out from ‘behind the red line’ and give students exposure to the real-life adventures they can have as perioperative nurses.”

The Role of Succession Planning

Of course, succession planning also plays a big role in meeting the challenges of the OR nursing shortage.

“Succession planning is critical to ensuring a culture of growth in the OR,” says Doyle. “The commitment to succession planning must be present throughout the organization, since it takes a certain amount of time and money.”

“A lack of succession planning increases the likelihood that someone without the necessary training, experience and leadership skills will be hired to fill open executive positions,” says Becia. “Therefore, it’s important for perioperative executives to understand the importance of succession planning and start taking steps now to plan for the future of their departments.”