Presenter Lilliana Levada, Nurse Education Consultant
Lilliana Levada is an experienced clinician with over 35 years of clinical experience in perioperative nursing (instrument, circulatory, anaesthetic, PACU, educator, consultant and manager nursing roles), intensive care nursing, patient flow management, after-hours hospital management and patient safety management.
Lilliana is passionate about nursing research and patient safety and uses this to translate science into practice. In the past, this has led her to become a lead reviewer for ACORN Standards and engage in providing consultancy for healthcare management.
She firmly believes that continuous improvements in nursing practice are paramount, and loves when nurses cause 'revolution' and evolution in healthcare practice.
She is also involved in medical missions donating her time and expertise to those causes.
The Perioperative environment functions in a highly uncertain clinical and operational manner; workloads fluctuate due to daily variability in surgical cases and patients’ diverse and rapidly changing conditions. Variability challenges managers’ ability to predict and optimize nurse staffing to maintain safe and efficient care. An understaffed perioperative department may compromise patient safety, create operating room delays or surgical cancellations, and result in nurse burnout.
Conversely, an overstaffed unit creates excessive nurse idle time and associated labour costs which are not viable, given tightening economic pressures in health care.
Perioperative nurse staffing has historically been dependent on clinical judgment and intuition of experienced nurse management; moreover, surgical case changes often take place days before the procedure, thus requiring careful planning.
The arrival of patients into the PACU also changes by time of day, necessitating granularity and time-varying analysis.
Perioperative standards around the globe all agree that perioperative nurses must have scientific research-based clinical knowledge and reasoning skills so to respond to patients’ physical, psychological, and spiritual care needs and to deliver nursing care of good quality.
The authors of this article consider these perioperative standards and have found research that demonstrates a link between inadequate nurse staffing and negative patient outcomes, indicating that patient outcomes may depend on the nursing staffing.
Traditionally, nurse staffing has been expressed by calculating nurse-to-patient ratios; however, this is not possible for perioperative nurses as there is a need to adapt nursing resources with patients’ needs for nursing care, not just to the number of patients.
Likewise, the complexity or acuity of care, the severity of patient condition, nursing expertise and skill level required, and the fluctuation in patient count must also be considered.
The care left undone, evaluated by nurses themselves, may offer a checkpoint warning about understaffing because optimal staffing levels can be considered by estimating the omission of needed nursing care.