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By: AORN Staff
Published: 11/6/2024
“We failed her miserably. She left OR nursing altogether,” recalls Cynthia L. Garza, DNP, RN, CNOR reflecting on an attempt to implement an in-house onboarding program for perioperative nurses at her previous facility. At the time, Cynthia was the Director of Surgical and Endoscopy Services in a brand new 59-bed hospital with 3 ORs, 2 endoscopy suites, and a cath lab.
It was December 2020, in the thick of the COVID pandemic, when the hospital opened its doors. By February 2021, elective surgeries were shut down entirely, and experienced periop nurses were floated to other units—an experience that left many burned out and looking for better opportunities. Many were recruited by travel nursing agencies, which were offering extremely high salaries at the time. By April 2021, surgery re-opened, and they had lost 60% of their nursing staff. Recruitment for full-time periop RN positions began, but no experienced nurses were applying.
Cynthia realized that she had to build her own team and train them well.
She hired a nurse with no prior OR experience, determined to train her using internal resources. But without a structured training framework, the attempt failed. Ultimately, the nurse left the perioperative nursing profession. Cynthia knew she needed a better solution to prevent this from happening again and her facility from contributing to the alarming nationwide nurse retention statistics.
Nurse retention is the rate at which nurses remain employed by a healthcare facility within a given period of time. Reportedly, 13%-75% of perioperative nurses leave their healthcare organization within the first three years in the specialty (this refers to the turnover rate).1 Difficulties in nurse retention is a serious problem facing organizations today, as it directly affects a facility's ability to reduce costs, provide consistent quality care, and promote lengthy and stable employment for their nurses.
Determined not to repeat the same mistakes, Cynthia's nurse recruitment and retention strategies included implementing Periop 101: A Core Curriculum™.
“Periop 101 was just very easy for us to use, very user friendly, and a very plug-and-play type of a system," said Cynthia.
To get the program agreement approved in her facility, she had to dive into a return on investment (ROI) assessment to support her case. She quantified the benefits of implementing a standardized onboarding program by looking at costs related to nurse turnover and patient safety events. Referencing published studies, she estimated:
She then compared the cost of implementing Periop 101 at her facility against the potential savings from reduced nurse turnover and improved patient safety. Cynthia factored in the cost of seat fees, educator time (she needed to hire a contractor for this position), and administrative efforts. This allowed her to calculate a cost-benefit per RN, showing that the program’s financial impact could far exceed the initial investment.
Cynthia concluded that an assessment of Periop 101's financial impact on her facility showed that implementing the program results in a 300% cost-benefit per RN at her facility.
"This means the benefits the program brings are three times greater than the overall costs of implementation when we factor in RN turnover and the average cost of a patient safety event,” she said.
In addition, the long-term cost savings of approximately $155,000 per nurse annually for employing a trained perioperative nurse versus securing an agency nurse, would greatly render financial benefits for the facility as it focused on increasing surgical volume.
Cynthia presented her assessment to her Chief Nursing Officer first, who supported her proposal. This was followed by a presentation to the Executive team, which was well received. Part of her action plan was to collaborate with the surgeons to get their buy in. Her strong relationship with the surgical team helped her already strong analysis, and they happily jumped on board with her plan.
Now a director of Clinical Operations at a different facility, Cynthia said the first two RNs who completed the program two years ago when she first launched it are still at that facility.
When asked about lessons learned since the first RN who she felt like she “failed,” before implementing Periop 101, Cynthia said she focused on the applicants who, despite being a new perioperative nurse, had previous OR experience in other roles – like those with a background of a scrub technologist and anesthesia technologist. She also realized that she wanted to, “take med surg nurses who were burnt out and train them to help save the OR nursing profession by injecting more staff into it.”
Cynthia’s experience is clearly a lesson that learning from your mistakes, a relentless pursuit of a solution, and a collaborative approach can make a significant impact on a facility, your team, and your patients. Implementing an efficient, turnkey periop onboarding program doesn’t hurt either.
Learn more about Periop 101: A Core Curriculum.
Fayoke Fatade, a perioperative nurse leader at Stanford Health, balances patient care, team leadership, and the challenges of healthcare. Raised in Nigeria by nurse parents, Fayoke shifted from dreams of surgery to nursing, driven by meaningful patient connections.
In a recent Leader Exchange webinar session, our panel of experienced perioperative leaders shared valuable insights and lessons on attracting and cultivating the next generation of leaders.
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