Learn About Solutions To Address the OR Nursing Shortage

Recruiting operating room nurses is difficult, and experts point to myriad reasons why an OR nursing shortage exists in some areas.

One reason could be many universities and colleges have eliminated OR nursing rotations, so nurses don’t get exposed to the operating room, said Nancy E. Holecek, MAS, BSN, RN, senior vice president and CNO, Northern Region, RWJBarnabas Health in New Jersey.

Holecek isn’t the only nurse leader who has experienced challenges that have led to exploring OR nurse recruitment solutions.

The shortage of nurses in this specialty is real, according to Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN, CEO and executive director of the Association of periOperative Registered Nurses.

“There are some states that are projected to have higher shortages than others,” Groah said.

OR nursing
Linda Groah, RN

According to Groah, states projected to have the highest vacancies in the next 10 years in general for nursing are consistent with what perioperative nurse members are reporting to AORN. They are California, Texas, New Jersey and South Carolina.

“The shortage is regional, however, 50% of perioperative services’ VPs indicate they are having difficulty recruiting perioperative nurses,” Groah said.

Nursing schools play role in OR nursing shortage

AORN doesn’t have information on a state-by-state basis showing which nursing schools no longer offer OR rotations, but it can confirm too few nursing schools nationwide currently are offering perioperative nursing.

As a result, there are fewer nurses who are knowledgeable about perioperative practice and fewer are choosing careers in OR nursing.

To ease the shortage and expose more nursing students to the OR, nursing schools can offer perioperative nursing as an elective or capstone project or offer AORN’s Fundamentals of Perioperative Nursing, according to Groah.

“One of the most commonly used OR nurse training programs is AORN’s Periop 101: A Core Curriculum,” Groah said. “This comprehensive, blended educational program is used by more than 2,500 healthcare organizations to recruit, educate and retain perioperative nurses. The program combines a standardized, evidence-based online curriculum and textbook readings with hands-on skills labs and a clinical practicum. It takes six to seven months to complete.”

Nurse leadership should assess their staff and estimate when OR staff will be retiring. Based on that estimate, leadership should develop a plan to back fill the vacancies one to two years prior to OR nurses’ departure dates, according to Groah.

“In addition, facilities should have a dedicated perioperative educator,” Groah said.

How one organization addresses the OR shortage

RWJBarnabas Health took matters into its own hands and created a program to fuel its pipeline of OR nurses.

OR nursing
Nancy E. Holecek, RN

Leaders there saw the writing on the wall in the late 1990s after a significant nursing shortage and nurses’ average age was nearing 50, Holecek said.

“We started to think about our workforce and how to maintain that workforce going into the future,” Holecek said. “As we were putting strategies together, we also were aware that our nursing schools stopped their clinical rotation of nursing in the operating room. We started to have a challenge in maintaining the pipeline of nurses who were interested in going into the operating room. Since it’s such a highly sub-specialized area and one that most people are not introduced to unless we would purposely do so, we were getting concerned.”

Holecek and Mary Beth Russell, PhD, MA, RN-BC, NEA-BC, vice president of The Center for Professional Development Innovation and Research at RWJBarnabas, Northern Region, started the system’s own perioperative residency to prepare new nurses or interested experienced nurses who had been in other specialties to practice in the operating room setting.

“We started in 1999 with six new hires, and to date we have prepared 429 OR nurses,” Holecek said. “We currently have a class of nine who started in October, and we have a new class starting up in November.”

The retention rate of nurses completing the program is 93%, from April 2017 to October 2018, she said.

Russell explains once nurses are hired into the OR program, they start with a basic orientation and general overview.

Then they attend the foundational program, which is three days a week for a five-week period. That’s the core curriculum, which is live didactic classroom training, lectures, case studies, presentations and some work in skills labs and simulation.

Nurses in the program also learn online, taking the AORN’s Periop 101 training.

OR nursing
Mary Beth Russell, RN-BC

Basically, nurses learn online, in the classroom and by case studies before building skills in the simulation and skills labs.

During the days that they’re not in class, nurses are attending module presentations in which our OR educators present to them.

They’re also spending time in the OR with a preceptor, so they can see some of those concepts in action that they have learned during the class, Russell said.

“The real goal of the entire program is to transition these folks from students to staff or from a general or specialty nurse in another area to a specialty nurse in the OR,” Russell said.

The program is a minimum of about six months, but nurses can take longer if they need to, according to Russell.

Holecek said the system’s nurse recruiters work closely with nurse managers and CNOs to identify future needs.

“We do workforce analysis on a quarterly basis to see the average ages of our nurses by specialty, so it’s not 100% but it allows us to keep track of nurses who may be of retirement age,” Holecek said. “We want to be ahead of the curve. We are pretty assertive in recruiting for this course.”

What’s being done on a national scale?

AORN representatives go to National Student Nurses’ Association meetings and participate in panel meetings about perioperative nursing as a specialty, Groah said.

AORN also invites students to attend local monthly AORN chapter meetings in their areas.

“Several chapters host a social hour with student nurses to discuss perioperative as a specialty, and we have a $20 student fee to join AORN,” Groah said. “We also are releasing a course for schools of nursing and junior colleges called ‘Introduction to Perioperative Nursing.’ Some cities have pooled their resources and formed a consortium, hired an instructor to teach the didactic portion of Periop 101 and then have staff at individual facilities to serve as preceptors for the clinical portion.”