Changes in the OR

Shortage of perioperative nurses is a concern

“Fun” isn’t the first word that comes to mind when you think about surgery, but that’s how Pam Sale describes her role as a perioperative nurse.

A nurse since 1976, Sale has spent all but three years of her career caring for patients before, during and after surgery.

“It’s the most fun I’ve ever had,” said Sale, RN, CNOR, coordinator of WellStar Kennestone Hospital’s Outpatient Surgery Center. “There’s not a day that I’ve worked that I have not liked my job. I can’t imagine myself doing anything else.

“I get the greatest satisfaction from knowing that I’m playing a very important part in someone’s life. For me, surgery is routine — like going to the store — but for the patient, it might be a once-in-a-lifetime event.”

Surgery also could be a life-or-death event, and that carries plenty of responsibility and requires specialized training and skills. Sale, like many of her fellow OR nurses, is concerned about the shortage of perioperative nurses. With retirement looming for baby boomers, not enough nurses are choosing this role.

Sale’s exposure to the specialty came during a three-month rotation when she was in nursing school. Students today might get only a few days of exposure to OR nursing, due to lack of clinical faculty, sites and time.

“Some hospitals have established perioperative training programs for nurses interested in the specialty, but there need to be more of those,” she said.

In 1999, the Association of periOperative  Registered Nurses (AORN) developed a curriculum called Perioperative Nursing 101 to help hospitals address the shortage. The effort has helped some nurses learn the specialized skills required to get into the operating room pipeline.

“You need two years of nursing experience before becoming a [surgical] circulating nurse and then you need to be skilled in computer documentation, ordering labs and technology,” Sale said.

The ability to set priorities is a must for perioperative nurses, and multitasking is beneficial.

“You’re working and supporting the nurse anesthetist, physicians and other members of the team and [you] need to decide whose needs to meet first,” she added. “A good circulator has to be alert and on point throughout surgery. She must pick up subtle cues from an oxygenation monitor or notice that the nurse anesthetist is shuffling through things on her cart.”

Above all, the nurse in the operating room is the patient’s advocate.

“You always treat them like it was your Mama on the bed,” Sale said. “And you have to be prepared to stand up to surgeons [when you see risks]. That takes years of practice.”

While other professionals are concentrating on their specific surgical duties, perioperative nurses focus on patients, said Patricia Moody, RN, CNOR, operating room staff nurse at Piedmont Mountainside Hospital in Jasper.

“By employing critical thinking, assessment, diagnosing, outcome identification, planning and evaluation skills, the RN circulator directs nursing care and coordinates activities of the surgical team for the benefit of the patient,” Moody said.

An OB nurse manager at Canton Hospital (now Northside Hospital-Cherokee) in the early 1980s, Moody was asked to manage the operating rooms, as well, and ultimately switched to perioperative nursing.

“I was lucky to get involved when I did,” she said.

Moody remembers the days when gall bladder surgery was performed with a tray of instruments. The advent of laparoscopic and orthoscopic techniques and robotic surgery has transformed the OR.

“Now, we have cameras, monitors and lasers. There are about 30 pieces of equipment that you need to stay competent on. Surgery is a lot more technical and requires ongoing in-service training,” she said.

To avoid errors, circulating nurses make sure that all members of the team participate in the “time out” and other surgery safety procedures advocated by the World Health Organization.

“Surgery is a fast-paced environment that is always evolving,” Moody said. “We constantly strive to do things better, so that patients can heal faster and go home, and every day is different.
“Even when you are doing the same surgery, every case is different because the patient is different. I enjoy that variety.”

Moody and Sale both belong to the Georgia Northwestern chapter of the Association of periOperative Registered Nurses. Moody is on the board and serves as legislative chair of Georgia for the national organization.

“It’s important to keep your knowledge up, to ask questions of other professionals and to recharge your batteries,” Moody said. “I come away from meetings remembering why I’m doing this.

“I think things happen for a reason. I loved my time as an OB nurse, but perioperative is where I’m supposed to be.”

Nurses can learn more about this role during Periop Nurse Week (Nov. 5-11) or by visiting

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