By James X. Stobinski
As I have mentioned in previous columns, the Competency and Credentialing Institute (CCI) nurses teach an introduction to the operating room course at Edgewood College in Madison Wisconsin. In a recent class, my long-time friend Stephanie Davis presented to our class on the topic of the business aspect of perioperative nursing. I was surprised to hear that the revenue from surgery is shrinking as a percentage of total hospital revenue. She stated that OR revenue is now less than 50% of total revenue where previously that ratio had been 60-70%. This decrease represents a foundational shift in health care operations and reflects changing patterns of reimbursement.
From an overall perspective, this is part of a larger transition to a value-based system of care. Payers in the American health care system are increasingly negotiating for better pricing for surgical care. Bundled payments for the entire episode of surgical care are becoming increasingly common and perioperative staff must be aggressive in controlling expenses. The net result of all these changes is that perioperative leaders must develop new skill sets. Financial management has always been prominent for perioperative leaders, but the level of financial acumen needed is increasing rapidly. CCI is aware of the nature of the work of perioperative leaders from the job analysis work done in support of our certification exams. From these studies we know that financial management, operational management and strategic management are significant portions of the work of leading in surgical services. All these areas require varying degrees of financial acumen.
The publication OR Manager conducts an annual survey of perioperative leaders to track trends. In previous years, we have heard of an impending wave of perioperative nurse leader retirements. From the 2022 survey it appears that surge is now happening. The age of the respondents and the reported years of experience has markedly shifted, generally the respondents are younger, earlier in their career and educated at a higher level. Of the 2022 respondents, 91% had baccalaureate level education or higher as their highest educational attainment and only 4% reported a diploma of nursing. The departure or retirement of experienced nurse leaders has driven down the average age, opening opportunities for nurses earlier in their career.
When I first began working in the OR in the early 1980s the route to perioperative leadership was much different. The role of perioperative nurse leaders and managers was not as well delineated. It was assumed that perioperative leaders must be OR nurses and that these nurses were required to have strong clinical skills. Job analysis findings from the CCI now demonstrate that perioperative nurse leadership is a separate and distinct role with little overlap with perioperative clinical skills. From the 2022 survey results, we also see that 23% of the perioperative leaders are not nurses. Increasingly, we are seeing non-nurses in surgery leadership roles as supply chain and financial analysis gain in importance.
I do not see these findings as a temporary aberration. We are amid long-term foundational change in the business of how surgery is done. Hospital-based ORs will concentrate on more complex cases which cannot be done in an ambulatory setting but, more importantly, the skill sets for perioperative leaders will continue to evolve. Financial expertise, the ability to work in intradisciplinary teams and higher levels of formal education and credentials will become the rule. For those aspiring to leadership roles, including nurses, there are great opportunities. Flexibility, an innovative nature and a willingness to adapt as surgical care continues to evolve will be key.
– James X. Stobinski, Ph.D., RN, CNOR, CNAMB, CSSM(E), is CEO of the Competency and Credentialing Institute (CCI).
References: Saver, S. (2022). Survey: Some improvement in satisfaction, but stagnant compensation. OR Manager, (38)10. (Pp 1, 5-9). S.
