By Don Sadler
At some point in time, we’ve all said to ourselves, “If I were in charge of things around here, the first thing I would do is (fill in the blank).”
While we can’t promise anyone that you’ll ever be “in charge of things” in your work environment, we did think it would be fun to ask perioperative professionals a similar question: If you could wave a magic wand and create the perfect operating room environment, what are some of the things that would be at the top of your wish list?
We received a number of enthusiastic responses that covered virtually every facet of OR operations, including operating room layout, design, equipment, staffing, culture, nurse training and education.
OR Layout, Design and Technology
For Vangie Dennis, MSN, RN, CNOR, CMLSO, FAORN, the perfect OR balances clinical function, patient safety, efficiency, comfort and adaptability. “While the exact design depends on the type of surgery being performed, there are core elements that define an ideal OR,” she says.
For example, the perfect OR is spacious, sterile, ergonomic, technology-enhanced, data-integrated, staff-friendly and adaptable for future advances, says Dennis, “all while keeping patient safety at its core.”
Specifically, Dennis believes ORs need to be at least 600-800 square feet (or larger for specialized surgeries) and zoned properly with smooth workflow for staff and instruments. “They should have an advanced surgical table and integrated surgical lights, laminar airflow and HEPA filtration, modular design, smart displays, noise reduction and AI integration,” she says.
“Older ORs and sterile processing areas lack space for advanced equipment, which leads to clutter and ergonomic strain,” says Tracy Hoeft-Hoffman, MBA, MSN, RN, CASC, administrator at the Heartland Surgery Center. “So, my wish list includes a modern OR layout, which improves efficiency, reduces turnover time and supports multidisciplinary teams.
Hoeft-Hoffman would also like for ORs to incorporate ergonomic and staff-centered design. “This would include height-adjustable booms, monitors and tables to reduce staff fatigue, and natural light or simulated daylight with adjustable brightness and color temperature to support staff alertness.”
Karen deKay, MSN, RN, CNOR, CIC, senior perioperative practice specialist with the Association of periOperative Registered Nurses (AORN), wishes that every OR were “clean, uncluttered and well-kept, with no tape or adhesive residue, chips, peeling paint or cracks in the walls and floors. These can harbor pathogens or increase the risk of cross-transmission and falls.”
In addition, deKay would like to see walls painted in soft blue, green or other neutral tones that promote a calm and peaceful environment.
Hoeft-Hoffman believes that fragmented technology in the OR causes inefficiency, duplicate documentation and communication delays.
“My perfect OR would have fully interoperable digital systems where anesthesia, surgical, imaging and EHR platforms communicate in real time with voice-activated controls for lights, tables and imaging equipment,” she says.
“My ideal OR would have at least one wall with natural light and a documentation station on wheels so the circulating nurse can easily move it to maintain a line of sight to the sterile field,” adds Tammy Hanks, DNP, CNOR, a perioperative practice specialist with AORN.
“In the physical environment, I’d like to see communication tools built into the OR so staff have one less thing to carry or charge each day,” says Zach Swartz, MHI, BSN, RN, CNOR, a perioperative practice specialist with AORN. “Also, the sterile processing department would be located directly adjacent to the OR for quick and easy access.”
“My OR wish would be for tools that help the operative team stay continuously informed about the patients in their care,” says Kristine Little, MSN, RN, CNOR, a perioperative education specialist with AORN. “Communication boards that display pertinent patient information to the entire team would be especially valuable. Ideally, these would be electronic boards that link directly to the medical charting system and display one patient at a time.”
“My perfect OR would include live communication tools to be able to communicate with teams about what is happening in the department, along with AI assist to help predict and prompt and adjunct technology to keep our patients as safe as possible,” says Leigh Ann Bartlett, MSN, RN, CNOR.
“At the top of my wish list for the perfect OR would be smart, intuitive technology that actually supports nursing workflow instead of complicating it,” says Ashley Bartholomew, BSN, RN, CNOR, ONC, OR circulator, OrthoVirginia. Examples she lists include integrated digital preference cards, real-time inventory tracking and simplified documentation systems.
“Due to budget constraints, newer OR equipment is not always high on the list of priorities,” says Karen Elliott, MSN, RN, CNOR, CSPDT, professional development specialist, Regional One Health. “That’s why having adequate equipment, supplies and instrumentation is at the top of my wish list.”
Elliott would also love for there to be a smoke-free environment in every OR.
“I am happy to report that here at Regional One Health in Memphis, we are working on achieving a smoke-free environment and earning the AORN Go Clear award.”
Beverly Kirchner, MSN, RN, CNOR, CASC, CNAMB, agrees.
“I want to work in an operating room that is free from surgical smoke, reducing the risk of cancer and other occupational diseases,” she says.
Staffing and Nurse Turnover
If Justin Fontenot, DNP, RN, NEA-BC, FAADN, could have one OR wish, it would be to have safe staffing legislation in every state to ensure that patients receive safe care. “This goes beyond just institutional staffing policies,” he says. “It must be addressed at the political and lawmaking levels.”
Fontenot points out that the nursing profession continues to experience high turnover rates, particularly among new graduates. A 2025 report from Nursing Solutions indicates that approximately one-quarter of new nursing school graduates leave their jobs within the first year and roughly half leave within the second year.
“While not all of this is related to staffing, it is a factor that must be addressed nationwide,” says Fontenot. “Implementing staffing ratios across all states could improve turnover, effectively fixing the problem of short staffing and safeguarding patients.”
Bartholomew would like to see intentional staffing and scheduling models “that prioritize consistency, adequate prep time and the ability for teams to stay together long enough to develop synergy.”
Consistent Point-of-Use Treatment
Natalie Lind, CRCST, CHL, FHSPA, director of education for the Healthcare Sterile Processing Association (HSPA), would love for OR staff to consistently practice effective point-of-use treatment of instruments. “This is one of the most essential tasks that sterile processing professionals wish were performed consistently by their colleagues in the OR,” she says.
Point-of-use treatment, which is recommended in AORN guidelines and ANSI/AAMI standards, is the process of removing gross soil from instruments to prevent blood and bioburden from drying and hardening on device surfaces, Lind explains.
“This is performed by wiping the gross soil with a water-moistened sponge and flushing lumens and channels with sterile water, not saline, which can corrode and pit devices,” says Lind. “From there, it’s vital to keep used instruments moist by using enzymatic products or covering the instruments with a water-moistened towel and ensuring the devices are transported promptly to the sterile processing department for thorough decontamination and processing.”
When soil hardens on and inside devices, this can jeopardize patient safety through microbial contamination and infection risks, as well as contribute to extended processing times, procedural delays and costly device repairs and premature replacement.
“If the steps of point-of-use treatment are not well understood, those in the OR should work closely with their teammates in the sterile processing department and review the latest standards and guidelines for assistance,” says Lind.
A Culture of Trust, Safety and Respect
“At the top of my wish list is an operating room environment that fosters a culture of trust and encourages a diverse range of generational perspectives,” says Ruth Plotkin Shumaker, MS, BSN, RN, CNOR. “Creating this means understanding that each person is unique and not a statistic, and that different people need different things to thrive.”
Kirchner agrees.
“My top priority is always keeping the patient safe throughout the procedure,” she says. “Staying current with the latest best practices, reading surgical magazines and reviewing clinical journals are all essential to maintaining high standards of care.”
Shumaker believes that establishing trust among OR team members requires cooperation, collaboration and mutual respect.
“Regrettably, nurses don’t always feel safe sharing their opinions,” she says. “To build trust, team members must feel safe voicing their opinions without fear of retaliation or criticism, knowing their thoughts will be valued and respected.”
Sharon McNamara, RN, BSN, MS, CNOR, wishes that each patient could experience a surgical procedure where the professional surgical care team functions in a true safety culture.
“I mean a culture in which there is a flattened hierarchy where each individual practitioner has full responsibility for the safety of their patients and fellow practitioners,” says McNamara. “And where each practitioner is fully engaged and confident that if there are any concerns, they can speak up and be listened to and acknowledged.”
McNamara believes that a true culture of patient safety is one of the greatest needs in the perioperative environment.
“The literature and research demonstrate that in many error cases, someone in the room was uncomfortable but not confident that their concern would be considered,” she says. “There remain administrators who put case volume, efficiency and money before holding disruptors accountable for the negative culture that puts patients and staff at risk.”
Renae Battié, MN, RN, CNOR, FAAN, vice president of nursing for AORN, agrees.
“My wish list is that every OR is a safe culture where team members feel comfortable asking for support on a difficult day, such as when a personal loss or hardship is affecting them,” she says.
“From a cultural perspective, there would be a strong culture of safety and professionalism that encourages team members to ask difficult questions, give praise without hesitation and stay curious in advancing professional development,” says Swartz. “Strong communication and transparency between perioperative team members and leaders would help build and maintain trust.”
Amber Wood, MSN, RN, CNOR, CIC, FAPIC, a senior perioperative practice specialist with AORN, wishes there were fewer disparities among different OR environments.
“Sometimes, even within the same organization, culture can vary so much that you see highly functional and highly dysfunctional teams working side by side,” she says.
“There are also disparities between facilities, with limited access to resources and quality care in rural settings,” says Wood. “My wish would be for every OR to be elevated in the pursuit of excellence – not some at the expense of others.”
Meanwhile, Bartholomew refers to “a culture of psychological safety and respect where every team member’s voice is heard and speaking up about safety concerns or workflow issues is encouraged without fear of judgment.”
“Unfortunately, disrespectful behavior such as yelling, threatening or belittling still occurs in some ORs,” says Kirchner. “No one should be subjected to yelling or belittlement in the OR. I hope to see a time when senior leadership prioritizes respectful behavior as much as financial outcomes. Eliminating fear of retribution or humiliation helps create a positive, collaborative environment that ultimately enhances patient outcomes.”
Getting Back to the Basics
When she started out in perioperative nursing nearly 50 years ago, Pat Thornton, MS, RN, CNOR, recalls that her director pushed all new nurses to be active in AORN.
“I went to AORN more than I did to Sunday school,” she says. “But many in surgical leadership today are not involved in AORN and they don’t encourage their staff to attend AORN events.”
Thornton’s wish is that ORs get back to the basics.
“Education will be the key to success,” she says. “My wish is that all surgical centers teach and implement AORN Recommended Practices by having a competency-based program. AORN has evidence-based recommendations for safe patient care, which teaches the ‘why.’ ”
Based on her observations, Thornton says it’s obvious that many nurses don’t know a lot of the perioperative basics like what a surgical “timeout” is or how to position and prep patients. “I’d like for older and more experienced perioperative staff to share their knowledge and experience to help younger nurses meet the demands of this complex specialty.”
“I encourage all perioperative nurses to value membership in AORN and adhere to the AORN guidelines,” adds Shumaker. “AORN provides an integral resource in promoting best practices so AORN membership should be encouraged and promoted by perioperative leaders.”
Dawn Whiteside, DNP, MSN-Ed, RN, CNOR, NPD-BC, RNFA, director of education and professional development for the Competency & Credentialing Institute (CCI), believes that including a standardized preceptor training program with competency assessments would help.
“Also, in the perfect OR environment, we would have nurses scrub again,” she says.
Shumaker also wishes that OR nurses would identify themselves as perioperative nurses.
“Perioperative nurses provide care in various settings that are not limited to the operating room,” she says. “The perioperative role will never be understood by others until we identify and articulate the full scope and reach of our practice.”
