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Meeting the Perioperative Leadership Challenge

By Don Sadler

The field of perioperative nursing is going through a profound transition when it comes to the workforce. By 2020, more than half of all perioperative nurses will be Millennials born between 1980 and 1996.

Members of this generation tend to look for different things in their work than other generations did. In particular, they seek a career development path and continuous professional growth. When they don’t receive these, they are likely to look for another employer, which has contributed to the high turnover rate seen among perioperative nurses.

All of this points to the need for strong perioperative leadership, says Rose O. Sherman, EdD, RN, NEA-BC, FAAN, Professor Emeritus at the Christine E. Lynn College of Nursing at Florida Atlantic University.

“Nurses don’t leave organizations – they leave managers,” says Sherman. “So, strong leadership really matters today.”

A Challenging Spot

According to David A. Wyatt, PhD, RN, NEA-BC, CNOR, vice president, perioperative enterprise, Vanderbilt University Hospital, perioperative leadership has been in a challenging spot for several years.

“The challenge lies in having enough clinical perioperative nurses who aspire to leadership,” says Wyatt. “Many younger nurses aren’t sure they’re willing to make the commitment required. Perioperative leadership isn’t a clock-in, clock-out job – it’s a 24/7/365 job.

“The stress sometimes gives young nurses pause … and rightfully so,” Wyatt adds.

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

“Young OR nurses sometimes see the OR director working 10- or 12-hour days and not being given the opportunity to be innovative or transformational with developing new models of care,” says Groah. “And they quickly make the assumption that ‘perioperative leadership is not for me.’ ”

Groah stresses that there are “pockets of excellence” in facilities where the OR director’s skill and knowledge in managing perioperative services are seen as a valuable asset to the C-suite.

“In this situation, the attitude of young perioperative nurses regarding leadership positions thrives and is rewarded,” she says.

According to Wyatt, another challenge in developing perioperative leaders is the fact that most organizations now require advanced degrees for leadership roles.

“I’m absolutely supportive of this,” says Wyatt. “But there just aren’t as many people today with advanced perioperative nursing degrees as there are in other specialties, though this is changing.”

Why Perioperative Leadership is Critical

Wyatt notes that the perioperative nursing environment is “an interdisciplinary model all the way through. This necessitates strong leadership – otherwise, the voice of perioperative nursing is non-existent.”

Meanwhile, Groah points out that perioperative services are frequently the highest revenue producer in the hospital, representing up to 70% of total revenue. And in the ASC, perioperative services are the only revenue producer, she notes.

“It’s critical that the nurse manager, as a strong leader, be able to provide the incentives and rewards to promote a healthy patient and worker safety culture,” says Groah. “A commitment to safety must be articulated at all levels of the organization and safety must be valued as a high priority, even at the expense of productivity.”

To be most effective, Groah believes that OR directors and managers must be in the C-suite.

“This is where discussions occur regarding the management of perioperative services,” she says. “These discussions include things like ensuring quality surgical care and meeting the challenges nurses face in managing a safe OR.”

Wyatt stresses the need for health care organizations to “wake up and be more intentional about developing and growing perioperative leaders. We’re past the time of just waiting for this to happen organically.”

“Perioperative leaders should be developed from both an academic and experiential standpoint,” Wyatt adds. “I’m not sure we’ve done a good job of this in the past across our specialty.”

The Leadership Challenge Model

Sherman believes that health care organizations can adopt components of The Leadership Challenge Model in their efforts to strengthen perioperative leadership.

“This is an evidence-based framework developed from over 30 years of research with thousands of leaders in a wide range of industries throughout the world,” Sherman explains. The model was developed by researchers James Kouzes and Barry Posner.

“A key finding of the research is that followers want their leaders to be honest, forward-looking, competent and inspiring,” says Sherman. Based on the research, Kouzes and Posner have identified five key practices of exemplary leadership:

1. Model the way. According to Sherman, this is a fundamental practice because it’s how leaders earn, sustain and build credibility. “Effective leaders do what they say they will do,” she says.

2. Inspire a shared vision. The best leaders are always looking toward the future with optimism and hope, notes Sherman. “They are able to imagine the possibilities in any change and get others involved and inspired by asking questions like ‘What’s next?’ and ‘How can we contribute to this future direction?’ ” she says.

3. Challenge the process. Sherman believes that perioperative leaders should actively look for ways to make things better while innovating and growing the organization. “This often means you will need to challenge the status quo to bring new methods, ideas and solutions into use,” she says.

4. Enable others to act. “Leaders who enable others to act are able to foster collaboration and build trust on their teams,” says Sherman. “They also make it possible for others to do their best work by maximizing their strengths versus focusing on their weaknesses.”

5. Encourage the heart. Sherman believes this might be the most important leadership component in the perioperative environment. “Leaders who encourage the heart bring others to life by recognizing their unique contributions and who they are as individuals,” she says.

Sherman adds: “These five practices are especially relevant in the perioperative environment where patient outcomes are dependent on excellent communication, strong teamwork and patient engagement.”

Groah says she had an opportunity to hear James Kouzes present a one-day workshop on “Encourage the Heart” when she worked as a perioperative leader at a major health care organization in the 1990s.

“I have not found another leadership model that fits the perioperative nursing environment better than this one,” says Groah. “I strive to incorporate these five practices into my leadership every day.”

When asked about her leadership style, Groah describes it is a “contingency style. I respond to each situation according to the needs of the individual or the situation, but my North Star is always the five practices that Kouzes’ and Posner’s research identified.”

Helpful Leadership Resources

According to Groah, AORN offers resources that can help health care organizations grow and develop perioperative leaders.

“For example, the Nurse Executive Leadership Seminars give OR directors and supervisors the opportunity to concentrate on management issues and hot topics focused on leading in the complex perioperative environment,” she says.

Nurse Executive Leadership Seminars are held in 10 cities nationwide in the spring and fall. In addition, AORN launched a Leader Membership Package this year that Groah says is designed for perioperative nurse leaders in search of solutions beyond clinical challenges, such as staffing and budgeting.

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