By Don Sadler

Like the iceberg that sunk the Titanic, there’s a looming threat on the horizon that could have dire consequences for perioperative nursing. We’re talking about a shortage of OR nurses.


This shortage has been attributed to two main factors: the retirement (or pending retirement) of OR nurses who are in their 50s and 60s, and the lack of specialized perioperative training for nurses during their clinical education.

“The OR nursing shortage is particularly impacted by the absence of perioperative clinical practice and curricula in most nursing programs,” says ChrysMarie Suby, RN MS, the president and CEO of the Labor Management Institute. “This reduces interest in and awareness of employment opportunities in the OR environment among new nurse graduates.”

The Aging Nurse Population

As for the aging OR nurse population, about two-thirds of perioperative nurse leaders today are over 50 years old and one-fifth are over 60. Also, 37 percent of OR nurses say they plan to retire within the next three years and 65 percent plan to retire by 2022.

“We are observing the impact of the nursing shortage on a daily basis,” says Janet Chadwick, Manager, Education and Quality, Perioperative Services at UNC Hospitals in Chapel Hill, North Carolina.

“All managers in our area are discussing the same concerns,” Chadwick adds. “And all hospitals within our health system are experiencing issues with recruitment of specialty skilled nurses, including OR nurses.”

In West Bloomfield, Michigan, Lakes Surgery Center Administrator Jennifer Butterfield, MBA, RN, CNOR, CASC, says she anticipates a significant OR nursing shortage within the next few years, especially in hospitals. The average age of OR nurses at Butterfield’s surgery center is 50 – the oldest is 64 and the youngest is 35, she says.

“The biggest challenge will be to replace the extensive knowledge and experience of retiring OR nurses,” says Butterfield. “These are the RNs who have experience as both circulators and scrub nurses and in all specialties.”

Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN, the CEO and Executive Director of the Association of periOperative Registered Nurses (AORN), concurs.

“Now that the economy has improved, the experienced nurses are beginning to retire and the ‘brain drain’ of knowledge is resulting,” says Groah. “The experienced nurses are taking 30 to  40 years of nursing knowledge with them.”

“If you have an OR nurse who is retiring, this is going to leave a gaping hole in your team,” says Butterfield. “What employers often don’t see is that the retiring nurse was the unofficial person everyone else went to with questions.”

“To replace this person, employers will have to look beyond the job description and hire someone who is willing to wear multiple hats,” Butterfield continues. “He or she must be motivated to learn the ‘why’ behind what is being performed in a surgery.”

Cyclical Shortages

Chadwick says that OR nurse shortages are cyclical in her university setting.

“This current cycle seems to be much longer and more severe than in other years, however,” she says.

According to Butterfield, another staffing challenge is that perioperative nurses are becoming highly specialized.

“This means they are really great at one or two service lines but have limited experience in other lines,” she says. “This type of specialization creates staffing challenges because nurses ready and willing to perform cases often are not able to jump into other service lines to help.

“In a multispecialty center, this means my orientation and training time is extended,” Butterfield adds. “For service lines that my ASC does not frequently see, such as urology, the experience in the room can be like ‘50 First Dates.’ ”

Groah says that one of the biggest challenges with the perioperative nurse shortage is that most student nurses do not have exposure to the operating room during their clinical training.

“Therefore, they do not know what the OR is like as a specialty,” says Groah.

“Also, many facilities will only hire experienced OR nurses since it takes from 6 to 12 months to be trained as a fully functioning perioperative nurse capable of taking call for emergency surgery,” Groah adds. 

According to Groah, the training costs for one RN can be between $65,000 and $75,000.

“However the loss of revenue for an operating room that is not staffed for one shift can be between $160,000 and $200,000,” she says.

Preparing for the Shortage

Butterfield believes that the best way to prepare for the looming OR nurse shortage is to be proactive and plan ahead.

“The worst thing an employer can do is ignore the signs,” she says.

“Employers need to review the ages of their OR nurses and listen to the needs of their perioperative team leaders,” Butterfield adds. “Also, succession planning is a must and should start at least two to three years before the time when you think it will be needed.”

“Facilities need to look at the big picture, review their current workforce and project its retirement status,” says Groah. “This way, experienced nurses can serve as mentors to new nurses prior to retiring.”

Groah also stresses the need for conversations with members of the C-suite regarding what the loss of revenues will be if ORs do not have trained nurses.

“This should include discussions about the delivery of safe patient care as well as patient and physician satisfaction,” she says.

Groah says that some facilities have started nurse residency programs to help bridge the gap between education and professional practice.

“Training programs and education resources like AORN’s Periop 101 are excellent recruitment tools for novice OR nurses,” says Groah.

Focus on Retention

Once new OR nurses are recruited and hired, attention must be turned to retaining them.

“Retention is a strong focus for all managers in our hospital,” says Chadwick.

Butterfield recommends trying to hire OR nurses who want to continuously learn.

“Once you have hired such OR nurses, continue to challenge them,” she says.

“In my experience, nurses who are engaged and involved in more than just coming to work tend to stay longer,” says Butterfield. “Thirty percent of my staff has been at the center over 10 years – all of these nurses do things outside their normal job description.”

Suby recommends creating a pipeline for getting newly hired OR nurses through orientation and building their experience as quickly as possible.

“This pipeline should take them from novice to beginner to experienced RN,” she says. “The goal is to provide new hires with experience that builds on itself to help get them comfortable as quickly as possible while also promoting patient safety.”

In addition, hospitals should create a strategic plan that works with local nursing programs to introduce nursing students to OR and perioperative nursing as a career, Suby adds.

“Offer opportunities that allow nursing students to shadow an experienced RN or Preceptor to learn about OR nursing and get excited about it as a career,” says Suby. “Also consider offering opportunities for clinical experience with these programs, and document the number of new graduates you are able to recruit into your vacant positions.”

Finally, Butterfiled stresses the importance of providing unequivocal support for new OR nurses.

“I’m sure that new OR nurses would much rather hear, ‘We’ll help you every step of the way’ from their supervisors than, ‘Sink or swim!’ ”