Perioperative Nursing: 2021 Practice Updates & Trends

As more hospitals resume elective surgeries, operating room nurses play a critical role in ensuring patients receive stellar care.

”Perioperative nursing is truly one of the most rewarding professions in all of health care,” said Erin Kyle, DNP, RN, CNOR, NEA-BC, editor-in-chief of “Guidelines for Perioperative Practice,” at the Association of periOperative Registered Nurses (AORN). “For a person who enjoys a challenge, learning new things, functioning as an interdisciplinary team leader, and seeing immediate results – there is no better place to be than as a nurse in the OR.”

Cheryl Geary, BSN, RN, CNOR, OR clinical coordinator at Mercy Medical Center in Baltimore, reported being busy, even with the pandemic, caring for patients with a variety of different conditions.

“Perioperative nursing is very rewarding because we are the eyes and ears for the patient while they are under anesthesia,” Geary said. “Our job is extremely important in ensuring that protocols are followed and that the patient’s wishes are being followed.”

AMN Healthcare recently talked about the latest trends and practice updates for OR nurses with Geary, Kyle and two other leaders in perioperative nursing: Kathy Bieler, BSN, RN, clinical director of the short stay unit, PACU and prep, and Mandi Brady, MSN, RN, CNOR, clinical OR director at Luminis Health Anne Arundel Medical Center in Annapolis, Maryland. Highlights of their answers and insights are included below.

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Q&A: Perioperative Nursing and OR Trends in 2021

What Practice Updates Are Available for OR Nurses?

Geary: Guidelines are changed when it is noted that the way things have always been done may not be working any longer due to changes to equipment or increased knowledge. We are always looking to the evidence and research to see what needs to change.

Safety is always an important trend in perioperative nursing for patients and staff, she added.

AORN updated its “Guidelines for Perioperative Practice” earlier this year. A print book with the guidelines will be available next year.

Kyle: Each guideline is built upon a systematic review of the literature, and practice recommendations reflect the most recent, high-quality evidence. 

AORN modified its recommendations for handling specimens, particularly highly infectious specimens, cleaning and caring for instruments, prevention of unintentionally retained items, surgical smoke, and caring for patients receiving local-only anesthesia or moderate sedation. Several of AORN’s six updated guidelines are related to safety. They include laser safety, electrosurgical safety, radiation and pneumatic tourniquet safety.

What OR Nursing Trends are Making an Impact?

Geary: Technology is an ever-changing dynamic in the OR, which operating room nurses must understand and stay on top of.

We are seeing more outpatient surgeries, including total joint surgeries for specific patient populations. It’s exciting to see people have a life-changing surgery and be able to leave the hospital on the same day.

Kyle: Another trend is the importance of a supportive work environment as it relates to well-being and resilience among perioperative team members. This focus, coupled with the interdisciplinary teamwork that is found in every aspect of the perioperative work environment, really makes perioperative nursing a good match for nurses from all generations.

Bieler and Brady: We are challenged with keeping our team members trained to manage the multiple different service lines, new technology and new surgeons that onboard with us.

We continue to see a shift to ambulatory surgery centers for cases that were previously done in the hospital and, as a consequence, we are seeing more complex cases being done in the hospital. 

One of the best things about this specialty is how strongly one develops relationships with your team. … Whether you are working in pre-op, the operating room or in a PACU, the teamwork and collaboration required between nurses, physicians, technicians and others is great, but the satisfaction of being a part of these teams is also very satisfying.

How Are Perioperative Nursing Work Environments?

Kyle: Today’s work environment has been vividly colored by the pandemic experience and climate change. Our collective experience is sure to invite us all, as it has in the past almost two years, to consider what is important, and how we can do our best to provide the best care possible in the face of challenges.

Bieler and Brady: Collaboration, flexibility and teamwork are the key to the success of surgery. … Being part of a well-run team is also something that keeps team members in the OR. We trust and depend on each other to support and assist during difficult times, but we also have fun being together.

Geary: Mercy has taken steps to ensure a positive work environment. We try to promote a culture that is inclusive and like family. We are very fortunate to have a good working relationship with our surgeons, so it does make it easier to work longer hours or change shifts when necessary to meet the needs of our patients.

Mercy offers a Caring Cart, which visits different units with relaxation items such as aromatherapy; Mindful Moments emails that share inspirational quotes and passages, giving time for reflection and mediation; and leadership virtual town halls to assist staff in finding balance. Monthly culture activities, such as an ice cream social, promote teamwork.

The COVID-19 pandemic has shown the resilience of healthcare and how we can overcome a lot of adversity. We want to do good work every day, so there are always challenges that come from high expectations. We will continue to strive to do better for every patient that walks through our doors.

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