I always knew I wanted to become a perioperative nurse. I wanted to travel overseas and do nursing work at the Fred Hollows Foundation or on the Mercy Ships — that’s what really drove me into the operating theatre.
But when I was studying, perioperative nursing wasn’t really mentioned much. In our second year, we talked about speedy recovery and how to put a pair of gloves on — but it was literally one page.
So students don’t always know how broad the perioperative continuum is. There are admission, pre-anaesthetic, pre-surgery and post-rehabilitation clinics; in theatre post-anesthetic care unit or recovery, high-dependency unit — the list goes on.
In theatre, we only have a small snippet of time to build those relationships — so those few minutes we have with them are so important.
I chose perioperative for my final nine-week clinical placement, which was my first exposure to the operating theatre environment. And I loved it — the fast-paced environment, the different surgeries and the team work.
I ended up getting a job there straight after graduating seven years ago. I was lucky I’d had the nine weeks of experience, but it would have been good to have had more education about the perioperative environment. For example, the legal and ethical aspects of patient consent, preparation — no eating or drinking, how to best recover a patient, what pain management looks like. And what nurses actually do in the operating theatre — why we’re so important!
Perioperative nurses give exceptional patient care, but so much of nursing is about the therapeutic relationship with your patient.
On the wards, students and nurses often have longer-term patients, so we are talking to them throughout the day, changing their wound dressings and things like that. But in theatre, we only have a small snippet of time to build those relationships — so those few minutes we have with them are so important. They’re nervous, they’re anxious, they’re scared about what’s going to happen — and we nurses are there to support and reassure them.
A brief history of NZNO theatre nurses
In 1969, a group of Wellington theatre nurses started meeting to discuss their specialty. In 1971, it became part of the NZ Nurses Association (which merged with the Nurses’ Union in 1993 to become NZNO), and was joined by other theatre nurses around the country. In 1974, the group launched its first edition of The Dissector and by 1975 had formally become the association’s theatre nurses section.
In 1977, the section was renamed the “perioperative nurses association of NZNO” to recognise the extension of operating theatre nurses into pre-operative and post-operative roles. In 2001, the section attained college status, and became the perioperative nurses college.
— Source: NZNO library, perioperative nurses college website and long-time college member Karen Hall, who presented on the college history at its 2024 conference. Her presentation ‘Our History‘ was published in the latest Dissector edition.
So it would be great — for us and for the patient — to be better prepared for quickly building those connections.
One of my goals as chair is to raise the profile of perioperative nursing in nursing education. We’re going to reach out to the heads of nursing schools in June and also hope to have a kōrero with the Nursing Council about whether it might be possible to bring a bit more about perioperative nursing into the nursing curriculum at our 20 nursing schools, whether polytechnic or university.
We think it should be more widely available as a placement and there should be at least three exposure days in theatre for all nursing students during their degree.
‘Exciting’ space to work in
Hospital ward nursing and community mental health are a big focus of undergraduate nurse education. But a huge chunk of nursing is also related to surgery, directly or indirectly. Illness and trauma can both lead to surgery, there is elective surgery, as well as urgent and emergency, so it would be good to see this specialty reflected more in our training.
We are a really fun college to be part of and it’s an incredibly supportive network professionally.
A lot of people I’ve talked to say they took a gamble choosing perioperative nursing, as they didn’t know much about it. But, like me, they went into theatre on their graduate NETP (nurse-entry-to-practice) placements and loved it.
In theatre, every day is different — especially in elective orthopaedics, where I work. There are different parts of the body we operate on, so one day we’re working on hands, the next day it’s feet, then spines or joints the next. So it’s always changing, a great team environment and you’re always there for the patient. It’s an exciting space to be in — I love it!
The technology gets better and better every year, too.
We get surgical plume (vapor with human cellular byproduct) when we’re using the diathermy pen with its electric currents to make incisions and cauterise bleeding during surgery. But there are now pens with suction that vacuum up the plume — which is obviously much better for health.
There is a real push in the United States to make these mandatory, for smoke-free theatres, which would be great for us workers.
Perioperative college – join us!
We’ve had a real growth spurt over the past year and now have about 500 members. The visibility we gained through our conference last October was really helpful.
With about 3200 perioperative nurses nationwide, according to the Nursing Council’s workforce data, that’s not bad, but we would love to see more, especially on the committee. Currently I’m chair, treasurer and secretary, so it’s a bit hectic!
We are a really fun college to be part of and it’s an incredibly supportive network professionally.
A lot of people I’ve talked to say they took a gamble choosing perioperative nursing, as they didn’t know much about it.
I got involved as a new graduate, because my preceptor was heavily involved and I started going along to meetings then became Christchurch representative on the national committee.
Being in the college gives you access to lots of specialised education and expertise. We do regular webinars every six weeks, there are heaps of resources for members on our website and there is a wide network of specialist nurses available to advise.
Someone might ask on WhatsApp about hand hygiene, as it’s so different in theatre than on the ward, and there are 20 people with deep knowledge who reply in two heartbeats: “This is what we do up in Auckland” or “This is what we do in Dunedin”. So having those contacts is really great.
International opportunities
It’s such a rewarding space to be in, surrounded by all these people who are equally passionate about perioperative nursing.
As for becoming chair, when [former chair] Cassandra Raj resigned late last year, I said I’d do it for a year if there wasn’t anyone else. So, here I am — at least until October when Lucy Middleton is going to take over.
Our committee meets three times a year, in Auckland, Wellington or Christchurch. As chair, there are also international responsibilities. I sit on the board for the International Federation of Perioperative Nurses (IFPN) and the college is also part of the US-based Association of Perioperative Registered Nurses (AORN).
This year, with funding from the PNC, I was able to go to the AORN conference in Boston in April to maintain those relationships, see what’s happening in the world and then bring new and exciting ideas back to the college and New Zealand perioperative nursing.
There were hundreds of perioperative nurse-led research projects on display as well as the latest technology, with a huge focus on artificial intelligence (AI) and how it can help with rostering and health policy analysis.
As a college, we are busy updating our knowledge and skills framework, after the change in scope for RNs and ENs last year; as well as our RN anaesthetic assistant role — another theatre nursing role.
Our quarterly professional journal, The Dissector, is now available online as we seek to reach more nurses.
Overall, we are just really keen to get our voice out there to shape the future of perioperative care and keep growing our membership.
- Emma Ladley is chair of the perioperative nurses college and a Christchurch perioperative nurse.