By Don Sadler
The nursing shortage in the U.S. has been well-documented. The Bureau of Labor Statistics projects nearly 200,000 nurse openings annually through 2030, while one million nurses are projected to retire by this date.
Nurse staffing challenges are especially acute in operating rooms. This is because of a number of factors including the highly technical requirements of perioperative nursing and the lack of exposure to the specialty in nursing schools. All of this makes it critical for the industry to lead and inspire the next generation of perioperative nurses.
Nurse Recruiting and Retention Challenges
David Reinhart, DNP, MBA, RN, CNOR, FAAN, director of education, EHC, Perioperative Services Enterprise with Emory Healthcare in Atlanta, Georgia, teaches Periop 101, the Association of periOperative Registered Nurse’s (AORN) comprehensive training program for OR nurses.
“Undergraduate nursing programs continue to lack perioperative nursing curriculum,” says Reinhart. “Therefore, I believe that healthcare organizations will continue to have challenges recruiting and retaining nurses to work in perioperative services.”
“It’s more important now than ever to prepare the next generation of OR nurses as the surgical environment becomes more demanding and experienced nurses retire,” says Michael Rempel, DNP, RN, CNOR, pediatric trauma program manager in the trauma service at University Hospital in Newark, New Jersey. “Early exposure to the OR helps spark real interest, builds confidence and shows students what working in this specialty truly involves.”
Dawn Whiteside, DNP, MSN-Ed, RN, CNOR, NPD-BC, RNFA, director of education and professional development with the Competency and Credentialing Institute (CCI), agrees.
“The shortage of staff in the perioperative specialty is significant. There is a high number of nurses in leadership roles who will be retiring very soon, leaving a large vacancy that may not be addressed through succession planning,” she says. “To fill this gap, we must collaborate with hospitals and academia to offer exposure to our specialty during pre-licensure training.”
The nurses at CCI have collaborated with Edgewood College to offer perioperative training electives for students in their fourth or fifth semesters, says Whiteside. The courses consist of fundamental and advanced pre-licensure perioperative services training.
“By the end of the second course, the students have demonstrated levels of competency for the different perioperative standards of practice,” says Whiteside. “Right now, one hundred percent of our students who decide OR is their specialty are getting hired as soon as they graduate.”
Since 2021, when the perioperative training electives were first offered, 50 nursing students have completed the foundational course and seven have completed the advanced course.
“Eighteen students chose periop as their specialty after graduation and they were all hired to the OR of their choice,” says Whiteside.
‘A Constant Cycle of Orienting’
Amanda Heitman, BSN, RN, CNOR, perioperative educational consultant and owner of Periop Anew, believes that having enough preceptors and mentors is one of the biggest challenges to preparing the next generation of OR nurses.
“We are in a constant cycle of orienting,” she says. “It’s hard to share your knowledge day after day and then see those you have worked to develop leave because they didn’t know what to expect before they started, or they didn’t have the right foundation to sustain them.”
Heitman stresses that any nurse can serve as a mentor, regardless of their level of experience.
“You don’t have to be in the OR for 10 years or more to be a mentor,” she says. “You just need to be there when other nurses are struggling or want to share their accomplishments. Mentoring doesn’t have to be difficult – just offer to have coffee with someone and talk about their day.”
Whiteside calls mentoring “a huge responsibility that is essential to supporting the next generation of OR nurses. Mentors must be supportive and have the interpersonal skills to establish long-term relationships.”
“Experienced nurses can support new nurses and students by having a positive attitude, introducing them to the team and asking questions to understand their level of competence,” says Whiteside. “My first mentor was the director of perioperative services at my first job after nursing school. We still keep in contact, and I think of her every time the topic of mentorship comes up.”
Rempel believes that mentors are essential for preparing the next generation of OR nurses by providing guidance, support and hands-on experience that can’t always be taught in the classroom.
“However, with the growing shortage of experienced nurses, it’s crucial for hospitals to identify, train and develop nurses into mentors through structured programs. Without proper training, even the most dedicated nurses may experience burnout from the added responsibility of mentoring,” says Rempel. “By prioritizing mentor development, hospitals can strengthen their workforce, improve retention and ensure that the next generation of nurses is well-prepared.”
Rempel recommends that hospitals create structured mentoring programs and combine them with nurse residency programs that pair seasoned veterans with new nurses.
“This will build their confidence, teach them critical skills and help them adapt to the fast-paced OR environment,” he says. “Front-line nurse leaders play a key role in this process, not only guiding new nurses but also bridging the gap between nursing education and practice.”
Rempel leads the AORN perioperative academic mentoring partnership program that pairs experienced nurse mentors with new nurses to help them transition from the classroom to practical training.
“This program helps new perioperative nurses apply theoretical concepts to real-world practice,” he says.
Early in his career, Rempel mentored a new graduate RN through the AORN mentorship program.
“The AORN program provides a great structure for mentorship by allowing me to offer consistent support and advice,” he says. “We discussed everything from clinical skills to navigating the complexities of OR culture. Being part of the AORN program was a deeply fulfilling experience and reinforced how mentorship helps both the new nurse and the mentor grow.”
To become a mentor to young OR nurses, Rempel urges experienced nurses to share personal experiences that highlight the unique aspects of perioperative nursing and show their passion by discussing what makes this specialty so rewarding.
“Recognize their accomplishments and provide ongoing encouragement and constructive feedback while also acknowledging the challenges new nurses face and reflecting on what they need to continue to build on,” he says.
Entering the Restricted Zone
At Hartford HealthCare in Hartford, Connecticut, perioperative nursing students are placed in OR rotations, capstones and observation days.
“The OR educator plays a key role in ensuring that students are prepared for their time in the operating room and OR personnel are supportive when hosting students of differing skill levels,” says Nurse Scientist and OR Educator Jennifer Hehl, Ph.D., RN, CNOR, ONC.
Heitman agrees.
“Whether it is a self-developed course or a program like Periop 101, one key to success is having a dedicated perioperative nurse educator who can guide new OR nurses and support them in every stage of their development,” Heitman says. “To add value to these structured programs, it’s important to allow nurses to experience all the roles within the perioperative setting.”
“For example, I have found that when you allow nurses to learn the scrub role, they find that it helps them be a better circulator because they are aware of what is happening at the field,” adds Heitman.
Hehl calls the OR “the restricted zone.”
“Back in 1996, my nursing school did not support a clinician in the OR,” says Hehl. “Fast forward to my first job in the OR and I was in a foreign world with some nice people, but many more were unfriendly. I have always wanted to make the OR more accessible to students and friendlier to new RNs.”
“Practice in the perioperative area is unique and unfamiliar for nursing students compared with floor nursing practice,” says Fusae Ogino, MSN, BS, RN, CNOR, RN III, Bone and Joint Institute, Hartford Hospital. “The OR is very limited access, which makes it a mysterious area for nursing students who wonder how nurses practice in the OR.”
As a med-surg clinical instructor, Ogino brings students into the OR for observation.
“They’re always excited to witness surgeries that they learned about in textbooks,” he says. “This is a great experience for understanding different interdisciplinary roles, collaboration, teamwork and different nursing practices from floor nursing.”
“It’s also an excellent opportunity to introduce different nursing specialties to students as career paths they can choose from,” says Ogino. “In fact, some of my students have transferred to OR nursing from med-surg floors due to the observation experience during their clinicals.”
Hehl points to several benefits of mentoring students and permitting them in the OR.
“By mentoring students, you realize how much you’re capable of. It also improves teamwork by making precepting a team effort. And having an open, welcoming unit culture is more pleasant for all staff, which improves recruitment and retention,” Hehl says.
Implementing a program that allows students in the OR requires leaders who are willing to host observations and clinical placements.
“You also need to provide regular feedback to the team to build confidence in good outcomes,” says Hehl. “It helps to have involved nurse educators or experienced preceptors to organize and run the program. AORN Toolkits are available to help.”
“The OR is a restricted zone – but it shouldn’t be a mystery.”
– Fusae Ogino, MSN, BS, RN, CNOR
From Classroom Theory to Real-World Practice
Rempel believes that teaching young nurses and students how to apply what they learn in the classroom to real-world situations is essential.
“This is especially true in the OR,” he says. “While theory provides the foundation, it’s the hands-on experience that truly helps nurses understand how to put that knowledge into practice.”
To bridge the gap, hospitals and ASCs can partner with local universities to offer courses that help young nurses transition from theory to practice. “Universities provide the theoretical knowledge, while hospitals give students hands-on experience in the OR,” says Rempel.
Rempel recommends establishing a Dedicated Education Unit (DEU) program in which students work directly with experienced OR nurses in a real clinical setting. “With a strong DEU program, nursing students can receive targeted training and support to help ensure that they are well-prepared to succeed in the OR when they graduate,” he says.
Another way to translate classroom theory to real-world practice is to allow nursing students to work in both the circulator and scrub roles.
“Understanding both roles helps nursing students see the bigger picture and become more adaptable in the OR,” says Rempel.
According to Whiteside, implementation of theory isn’t always tangible in the early stages of training.
“In the program we offer, we make sure to include case studies and build upon them each week,” she says. “Our process is to assign reading related to different theories, provide guidance on this during their clinical day and then create an assignment that will demonstrate key understanding of the theory in application.”
“New theories consistently gravitate around the nursing process and different schools of nursing teach around different theories,” says Reinhart. “Once new nurses are hired, it’s important to train them in strong work ethics that always put patients first and emphasize being an advocate for patients.”
Create an Atmosphere of Acceptance
Whiteside believes it’s critical that current OR nurses are welcoming and encourage new nurses as they learn the perioperative specialty. “New hires can demonstrate an immense amount of excitement and energy,” she says. “But nothing will deflate those feelings like staff that lacks empathy and kindness toward them.”
“The atmosphere must be one of acceptance, education, training and learning to promote mentorship for new nurses coming into our specialty,” says Whiteside.
Heitman stresses the importance of veteran OR nurses unselfishly sharing their knowledge and experience with younger nurses.
“We need to remove the old mindset of ‘eating our young’ and keeping information to ourselves because Dr. Smith can’t do surgery without me,” she says. “The only way to do this is by fostering an atmosphere of continuous learning.”
Continued growth of perioperative nursing will require active recruiting, says Heitman. “The OR is hidden behind the scenes so we need to allow others to observe our environment and what we do – whether this is college, high school or even middle school students or nurses from other areas.”
“Allow them to see a different side of nursing and the amazing opportunities in the perioperative world,” Heitman adds.
