News / Behind the red line

How Investing in Periop Education Can Save Hospitals Money 

September 14, 2023


How Investing in Periop Education Can Save Hospitals Money 

When people think of revenue-producing power in surgical services, the OR educator may not immediately come to mind. However, perioperative education—creating nurses who are prepared for their job and can be kept on the payroll well beyond a year—is an often-untapped source of cost savings. Inadequately trained staff has just as much of a negative impact as a staff shortage.  

Directors of Surgical Services Nikki Washington and Theresa Cowger, who have both worn the hats of OR educators, discuss the importance of solid perioperative education and the financial consequences when it’s neglected. Zach Parker, Manager of Whitman Partners’ Interim Department, shares trends he has noticed regarding OR educator needs across facilities.  

What is the path to becoming an OR Educator? 

Nikki Washington, MSN, MBA-HMC, RN, CNOR 

Nikki Washington

For many, it’s on-the-job training. With the imminent nursing shortage, organizations are lucky if they have someone in the educator role who can cultivate others. Many OR nurses transition into the role because they see a need; there’s a deficit, continuous breaches in practice behaviors, and a lack of training resources for newer nurses. As with any educator or teaching role, whether it be school or healthcare, it is a gift. Unfortunately, not everyone is an effective teacher. What’s missing is a structured program tailored for the success of OR educators. We—and when I say we, I mean nursing collectively—have mastered other specialty-focused curricula. However, somehow, the role of the OR educator was not fully factored in. There must be a segue to catapult OR excellence to the next level. I’m a firm believer that OR educators are the answer. 

Does every facility have an educator? 

Theresa Cowger, MSN, BSB, RN, CNOR 

Theresa Cowger

When I arrived, the hospital I just finished a contract for didn’t have an operating room (OR) educator. I was hired for the role because they needed OR nurses and had no applicants. Periop leadership decided to hire registered nurses within the organization and train them to be OR nurses. They didn’t have an educator or Periop 101 administrator/facilitator, so that’s where I was able to assist. Once the nurses graduated from the Periop 101 program and were officially OR nurses, the decision-makers decided that a periop educator wasn’t within the budget. I was shocked, and my boss was unhappy about it. It’s hard to keep educators because leadership doesn’t see the role as important until there is a problem. A reported sentinel event; the state or Joint Commission may become involved. Some regulatory agencies, such as OSHA, may want to see if training has been completed, including who did the training and how many people attended the training. Medicine, science, and practices change every single day. I don’t understand why the OR educator position is not recognized as critical since so many things can go wrong, and the OR is such a specialized area.  

What are some causes of the OR nursing shortage, and how should the industry address it? 

Nikki Washington

Many educators have retired, or some no longer wish to remain in the role. On the bright side, a lot of newer nurses desire to transition into the role but only have two years of experience. Their success would be smoother if they had a seasoned mentor to assist them. At the two-year mark, many OR nurses are just becoming acclimated to their role. Don’t get me wrong, I am not suggesting an OR nurse with two years of OR nursing cannot be an effective OR educator because they very well can be extremely effective. However, without appropriate guidance, their transition can be challenging. The industry should be proactive and attentive to the increasing number of OR educator roles that need to be filled. They would be wise to strategize methods to combat the shortage. Whether AORN partners with universities to create a certificate in OR education or other avenues, it would be highly advantageous for all stakeholders. 

Theresa Cowger

It always comes down to finances. I don’t think a lot of leadership recognizes the pockets of their organization that have needs. For instance, this one hospital is getting a daVinci robot. They just want it in place. It’s a million-dollar venture. But they haven’t focused on how we will train people to use the daVinci. How are we going to store and reprocess items? There are so many other things to think about besides just getting the robot, and it will be a hot mess unless they look at those other factors.   

How can an OR educator boost hospital profits? 

Zach Parker  

It’s not obvious that a good educator and training staff contribute to the bottom line, but if a nurse isn’t properly trained, it leads to patient safety issues. About one-third of our interims on assignment are educators right now. Many Directors of Surgical Services have contacted us and said they need an educator because they can’t keep up with the demand to train new OR nurses. So, we’ll bring in a second person to help handle the workload but also train and mentor that person.  

Theresa Cowger

The OR educator potentially prevents financial loss to an organization by providing ongoing training to staff.  For example, the safe use of LASERs, prevention of retained surgical items, safe use of electrical equipment, and safe handling of surgical specimens, to name a few. Misuse or mistakes can lead to additional patient hospitalizations, injury to the patient, or staff injury. If a patient needs to return to the OR because of a retained item or misdiagnosis because of a specimen error, that’s a potential liability for the hospital. Leadership has an obligation to be aware of what transpires behind the “red line.” Become familiar with the sterile processing department (SPD) because that is the foundation of what critically supports the OR and the clinics in the whole hospital. SPD’s primary goal is to safeguard patient safety by meticulously cleaning, disinfecting, sterilizing, and repackaging all medical instruments and devices used for surgical procedures.   

Nikki Washington

Often, the person driving initiatives in the operating room is the educator. With the assistance of leadership, they execute, follow up, and ensure there are no fallouts in the implementation. When an educator is in place, they prevent a lot of breaches in sterility because they’re actively observing the process. They can correct mistakes in real-time. They bring things back to leadership for feedback, where revisions are made, and another rollout occurs; they are right there again for real-time teachable moments. When a dedicated educator is in place, the risk of surgical site infections will be minimal. There will be fewer hospital readmissions, less non-reimbursement for Medicaid/Medicare denials, and a decrease in lengths of stay. That’s how you tie it into money. But again, organizations need to be proactive and get ahead of the deficiency. It’s like the boiling frog syndrome. At first, the water is lukewarm, so the frog is comfortable. As time progresses, the temperature starts to rise. That’s where problems start to occur, but the frog doesn’t react because the water isn’t hot enough. The frog just adapts. By the time the water is boiling, it’s too late for it to jump out. Whether nursing or anything else in life, you can’t wait until the last minute to try to dig yourself out of something. Ninety percent of the time, you’re too late.   


If your facility has an OR educator vacancy or your current educator needs training/support, contact Zach Parker for more information about our suite of interim perioperative educators ready to help you!  

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