Nurse Staffing in the Operating Rooms – No Longer Behind Closed Doors

Abstract

Background: There is no agreement in the literature on what is considered to be safe nurse staffing in the operating rooms (ORs). There is no research exploring decision-making on nurse staffing resources in Aotearoa New Zealand (AoNZ) ORs, no published data on models of care used to staff AoNZ ORs and limited information available on what factors are being used to support nurse staffing decision-making. Aim and Questions: To identify key factors senior perioperative nurses consider when making decisions about nurse staffing and skill-mix. The primary research question was ‘What are the factors influencing nurse staffing decisions in AoNZ ORs?’. Secondary research questions were ‘How do nurses provide safe patient care in the OR?’, ‘How is nurse staffing and skill-mix determined for safe patient care in the OR?’ and ‘What are the resources and processes used to make staffing decisions?’ Design: A qualitative descriptive approach. The setting was ORs in a single District Health Board in AoNZ. Data sources: Seven (7) semi-structured interviews of senior OR nurses who make decisions about OR nurse staffing. Method: Braun and Clarke’s thematic analysis process was used to analyse the data, generate themes and ensure rigor. Results: Four themes were generated from the data. ‘Safety: Team-Based, Person-Centred Care’ defined nurses’ provision of individualised safe patient care. ‘The Importance of Skill-Mix’ demonstrated that one of the highest priorities when deciding how best to allocate nurses was ensuring appropriate skill-mix to secure provision of safe patient care. ‘Safe Staffing: Not Just About the Numbers’ identified that safe staffing is not purely about how many nurses are in the OR. ‘The Complexities of Staffing Decisions’ described other factors senior nurses consider when making OR nurse staffing decisions. Conclusions: Results generated indicate that ‘safety’ encompasses every aspect of the individualised care that perioperative nurses provide. Decision-making for OR safe nurse staffing has been identified as complex, with safe patient care linked to appropriate nurse staffing allocations. This calls into question the traditional ‘numbers’ approach to OR nurse staffing. A ‘Model for Person-Centred, Safe Nurse Staffing in the OR’ is proposed for guiding future work in this area.