The Ideal OR Educator: Hiring, Best Practices, and Generating Revenue in the Post-Covid OR

5 Key Points

Don’t combine circulator and educator roles. Be committed to a full-time educator position
The ideal educator should have 7 or more years of clinical experience in the operating room, and be passionate about guiding the next generation of nurses
Educators can grow volume by opening up PM shifts with newly trained perioperative nurses providing additional opportunity for elective case volumes
Your educator should take a perioperative course through the Association of PeriOperative Registered Nurses (AORN)
Plan 3-6 months for an Interim OR Educator to bring the program on-line

Full Conversation Below

When a Chief Nursing Officer (CNO) sees a need for a perioperative educator, how do they approach the hiring process?

Initially, they promote an operating nurse from within. The goal is to be 60% circulator and 40% educator. There’s also a need to both educate existing staff and novice nurses, so in addition to being the perioperative 101educator, this person will also be in charge of general perioperative education. But after a while, they find out that this is too much. The person that they want to divide clinical time and non-clinical time isn’t able to adequately perform duties for either role. They aren’t able to devote the time they need to circulate or, as educators, they get pulled from those duties to do a case. That’s very frustrating and many just quit. Nurses want to do a job well or not do it at all. The decision is made to cut the educator role and that person goes back to full-time circulating. So, combining roles rarely work. A CNO has to be willing to relieve that person of their clinical duties so they can be a full-time educator.

In your experience, what qualities and skills are necessary to be a successful perioperative educator?

You must be an outstanding operating room (OR) nurse with at least 7 years of solid clinical experience. It’s imperative to have established yourself as an expert in the OR because if you haven’t been an OR nurse very long, you’ll have a very hard time gaining the respect of your peers and your students. You have to be intimately familiar with every case known to man so that when you’re thrown into any situation, you can keep your head above water. Having a mentor is also very important, so the CNO might consider pulling an educator from obstetrics to fill that role.

Who would find the most job satisfaction in being a perioperative educator?

Some tenured nurses don’t prefer having a student with them because it can be distracting. Research has found that you lose about 30% of your productivity with someone next to you. You work faster when you don’t have to narrate your care. But if you’re passionate about OR nursing, want to impact the next generation, and you enjoy spending the time to answer a lot of questions, repeatedly, then you’ll have a ton of job satisfaction. When I watch my girls and guys graduate, I get a sense of pride and accomplishment seeing them finish to become solo nurses. It’s extremely satisfying to me, but it’s not everyone’s cup of tea.

Due to Covid-19, many hospitals are facing extreme financial challenges, with educator positions getting cut. Is there a narrative to explain how a perioperative educator can grow volume for the OR?

There is. As an educator, I was able to open more rooms and increase staffing hours. I created block time later in the day because I now had a PM shift, which goes to new nurses. Our hospital [Robert Wood Johnson University Hospital] had 22 OR’s, but when Covid-19 hit, we stopped doing cases that weren’t emergencies. Then, we lost about 15 nurses due to getting sick from Covid-19, maternity leave, traveling nurses being let go, and retirement. That translated to losing seven OR’s. This is major because we have two rooms dedicated to cardiac, two for transplants, and one for burns. No one can book those five rooms. The group of four that I am training right now will go on the PM shift, then four nurses will go to the AM shift, and that will re-open four OR’s. That brings us up from 15 to 19 ORs. This provides hours later in the day for surgeons to do cases mid-afternoon because they have office hours earlier in the day. They’ll see patients until about 1:00 p.m., then come over and do a case. Overtime from earlier shifts are also reduced and First-case-on-time (FCOT) starts is improved by having operating rooms prepared for early morning cases.

How did being a Director of Surgical Services prepare you to be an educator?

Because I know what’s happening behind the scenes. I understand human resources, fiscal matters, position control, and how important turnover time is. For instance, I teach my nurses that we don’t open expensive tools until the doctor’s eyeballs are in that OR. We’re not going to open a $1500 package of DuraSeal, for a spinal tear, unless the doctor says specifically to open it. And then when you drop it on the floor, and you open another one, you just spent $3000. Every minute that you are late getting a patient into the room is $350. You need to get your patient into the room on time, so that there isn’t a snowball effect at the end of the day, makes our doctors late, and then they don’t want to come back. Also, the OR nurse always has to be prepared for their case to be over. I want that turnover time to be less than 20 minutes. If you leave your room messy, it’s going to take you an extra 20 minutes to clean up. But if you’re always ready for your case to end, your turnover time will be less.

What does a CNO have to keep in mind if they want to put a Director in an educator role?

The Director has to be tough and make hard, fast decisions. But an educator needs to be Switzerland. They must be neutral. Establish trust with your novice nurses, where they can say anything to you without fear of retribution or judgment. That’s who I am with my nurses; I listen to their problems at work, and sometimes a little at home because it affects how they learn.

Is there a certification to signify that you’ve passed an exam to be a perioperative educator?

There’s only a CNE (Certified Nurse Educator) that’s provided by the National League of Nurses for any nurse educator. It doesn’t prepare you to be a perioperative educator and its more educational theory. I would start with a course in perioperative education through AORN (Association of periOperative Registered Nurses).

What kinds of questions would you ask a CNO that might help guide them in their decision?

I would ask them if they’ve made up their mind, as an organization, to invest the time and financial resources into this position? Because if you haven’t, don’t go down this road. You’ll contaminate this role at your organization for a long time and no one will be willing to step up to the plate. I would also ask how big of a role is this? It can be anything from just being a staff educator, to being in charge of nursing students that come to the OR, surgical tech students that have to do their externship, perioperative 101 students, maintaining education files for commission and regulatory agencies to make sure everyone has annual competency. Do you want someone to do all of this? If so, there are people out there like me that can do that.

How long would it take you to set up this program and train transitional staff members to take over?

It takes about six months for an interim to set up the program. They’re also involved in interviewing because they know the right clinical questions to ask a candidate to make sure they have the experience and skills they say they do.

What keeps you inspired and motivated?

I love this job and have never regretted my decision to enter this specialty. It is the people, the patients, families and providers. Ultimately, it’s not about the educator, it’s all about the patient and providing them with the utmost degree of quality while they are in our care.

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Carisa Brewster

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The Ideal OR Educator: Hiring, Best Practices, and Generating Revenue in the Post-Covid OR