By James X. Stobinski, Ph.D., RN, CNOR, CSSM(E), CNAMB(E)
This month I would like to highlight the findings of a recent literature review article by Ada Xie, Jed Duff and Judy Munday on the topic of perioperative nursing shortages.1 An integrative review of the literature gives us, “… a broader summary of the literature and includes findings from a range of research designs” to develop “… a holistic understanding of the topic, present the state of the science …” on a given topic.2 This article is particularly impressive in the breadth of its findings as it sought, “… to explore contributors to the international perioperative nursing shortage.”1 This is not a quick and easy read, but perioperative nurse leaders and managers will find this article informative and worthwhile.
The article covers 84 recent studies and gives a broad overview of recent studies of perioperative nursing shortages on an international level. The authors also summarize approaches to addressing these shortages and the impact of these scarcities on the work of surgery. It is noteworthy that issues facing American perioperative nurses are also found in other countries. Most nursing students have little or no knowledge of the perioperative or paranesthesia specialties as these specialties are not part of their pre-licensure coursework. On an international level, the education and training for entry into perioperative nursing varies widely with some countries requiring specialized post-graduate training. The lack of familiarity with perioperative nursing, the extensive training requirement and the demanding nature of the role deters many potential candidates and worsens shortages.
Staff shortages, as many operating rooms are experiencing, can compromise patient care. In the OR staff shortages play out in mandatory overtime, increased call responsibility and seemingly endless orientation of new staff members. This produces a spiraling effect of burnout and job dissatisfaction which then further fuels scarcities. Ultimately nursing shortages contribute to, “… workforce instability, marked by higher turnover rates …” which increase recruiting and training expenses.1
Xie, Duff and Munday do great service for the specialty in giving the detail of what is known in the current literature. This article confirms there is little research on perioperative specific attrition issues and no clear consensus on mitigation strategies. One shortfall for this outstanding study is that it did not address the grey literature. The authors did make extensive use of the annual salary survey published in the AORN Journal but the findings from the OR Manager Career & Salary Survey were excluded as this is not a peer-reviewed source.
Three viable strategies do emerge from these findings. First, we must address the nature of the perioperative nursing work environment. Staff perception of managerial support for perioperative nursing is a vital concern. Second, academic partnerships can familiarize pre-licensure students with perioperative nursing. A secondary gain would be opening sorely needed clinical sites for pre-licensure students. Perioperative nurses could also serve as adjunct faculty meliorating clinical faculty shortages and the paucity of instructors with perioperative and perianesthesia nursing experience. And finally, more research is needed on attrition issues specific to perioperative nursing.
Perioperative nurses, especially leaders and managers, would be well-served in reading this comprehensive, well-written article. The rigorous methodology of this study lays out the breadth and complexity of worldwide perioperative nursing shortages and gives us the current state of research on the topic. The lack of research lays out fertile ground for future scholarly inquiry in perioperative nursing related topics. This study sets a high bar for scholarly work but also shows the potential for future study by qualified researchers.
– James X. Stobinski, Ph.D., RN, CNOR, CSSM(E), CNAMB(E), is a faculty member at Central Michigan University and is the director of hospital and ASC surgical education relationships with National Institute of First Assisting (NIFA).
References
- Xie, A., Duff, J., & Munday, J. (2024). Perioperative Nursing Shortages: An Integrative Review of Their Impact, Causal Factors, and Mitigation Strategies. Journal of Nursing Management, 2024, 2983251. https://doi.org/10.1155/2024/2983251
- Adelphi University (2025). LibGuides: Systematic Reviews/Evidence Synthesis: Integrative Reviews. https://libguides.adelphi.edu/Systematic_Reviews/integrative-review
