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Perioperative Nursing Competency

By Jim Stobinski

I recently received a notification from the website ResearchGate that an article had been published which referenced a paper I had written in 2008 on perioperative nursing competency.[1] “ResearchGate is a European commercial social networking site for scientists and researchers to share papers … ”[2] and to interact and collaborate. I quickly went to the article and found that I had been cited by a group of researchers who were writing about perioperative nursing competency among Swedish nurses.[3]

After reading the article on the work being done by the Swedish researchers, I was struck by two things. First, the education and training of Swedish perioperative nurses is much different than that of American nurses. Witness this statement from the article that describes the operating theater (OT) nurse, “The professional title of OT nurse is protected by law in Sweden and may only be used by nurses registered with the Swedish National Board of Health and Welfare holding a bachelor’s degree who also have a postgraduate diploma in specialist OT nursing of 60 credits.”[3] That quote tells us much about perioperative nursing in Sweden. First, entry into practice requires baccalaureate level education. Nursing in America is still debating the issue of entry level education. We must also consider that the professional title of OT nurse, a perioperative nurse in this country, is protected by law. That title protection is not the case in this country. And a last point, the course of study to practice in the OR is a postgraduate diploma of 60 credits; the equivalent of graduate level coursework in the United States. In this country, we have yet to standardize the educational preparation to practice in perioperative nursing and there is no equivalent to the NCLEX examination to begin practice in the specialty.

Eleven years have now passed since I wrote that article for the AORN Journal. That brings me to my second thought. Upon reflection I must say that collectively, American perioperative nurses have not made substantial progress on the concept of competency assessment. Donna Scott Tilley sums up the issue clearly when she speaks on American nursing. Tilley states, “Currently, in most states, a nurse is determined to be competent when initially licensed, continuing competency is assumed thereafter unless otherwise demonstrated.”[4] Many American nurses, and their employers, operate from that paradigm.

In American nursing there has been slow, grudging progress on meaningful conversations about competency and competency assessment. Some state boards of nursing are using the terminology but there is no widespread consensus on the use of the term. There has been even less progress by certification organizations in integrating meaningful competency assessment practices into the credentialing process. In short, we have a way to go to the reach the level of practice in some other countries. Sweden, Canada and Australia are among the countries that are the most advanced on education standards and in integrating meaningful competency assessment to the licensure process. The U.S. lags the efforts of these leaders.

At CCI, we believe that certification bodies can address some of the issues outlined in the preceding paragraphs. It will not be an easy task and the solutions will be disruptive and resource intensive. We believe that the risks associated with implementing competency assessment processes and increasing the education levels of perioperative nurses are well worth taking. The Competency and Credentialing Institute will continue our work on these topics, and we welcome the collaboration of like-minded perioperative nurses in these efforts. Stay tuned, there is more to come from CCI in this area.

James X. Stobinski, PhD, RN, CNOR, CSSM (E), has in excess of 30 years experience in the operating room. He has 18 years of management experience in perioperative nursing and has published and presented extensively at the national level on perioperative management related topics. He also serves as adjunct faculty at Nova Southeastern University in Ft. Lauderdale, Florida and Wilkes University in Pennsylvania. In February 2017, he began serving as the CEO of the Competency and Credentialing Institute. He maintains an active research agenda centered on nursing workforce issues and certification.


  1. Stobinski, J. X. (2008) Perioperative nursing competency. AORN Journal (88)3. pp. 417-436.
  2. Wikipedia (2019). ResearchGate. Accessed December 18, 2019 at:
  3. Vogelsang, Ann-Christin & Swenne, Christine & Gustafsson, Birgitta & Brynhildsen, Karin. (2019). Operating theatre nurse specialist competence to ensure patient safety in the operating theatre: A discursive paper. Nursing Open. 10.1002/nop2.424.
  4. Tilley S. Competency in nursing: a concept analysis. J Contin Educ Nurs. 2008;39(2):58-64.



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