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experienced perioperative nursing, they are unlikely to choose this as a possible career following graduation raising concerns for recruitment of future staff19–22. More recent qualitative literature shows the importance that nursing staff place on education23. In a hospital-wide study (n=220), participants stated that two important recommendations for perioperative departments were systematic professional development around new technologies and equipment, and managerial support for continuing education23. Participants also felt that further education allowed them to provide e-20 Journal of Perioperative Nursing Volume 34 Number 1 Autumn 2021 acorn.org.au higher quality and safer care to patients23. A limitation of this study was that only 35 per cent (n=75) of participants were from the perioperative environment. Replications studies have, however, been conducted using more contemporary and rigorous research methods3,24. Using a cross-sectional mixed method design, data collected from perioperative managers in the United States of America demonstrated that managers and directors (n=27) believed that on-the-job training and didactic training for new perioperative nurses improved the practitioner’s safety and efficiency3 . Fifteen of the participants provided graduate programs for new staff members to complete3 . Similar studies have also found that, in addition to increasing patient safety and quality of care, perioperative training improves staff retention rates24. Staff retention rates across 13 new graduate nurses improved from 59 per cent to 87 per cent after completing an advanced perioperative training course provided by the institution24. This mixed method research concluded that experienced perioperative nurses are paramount to surgical safety24. Staff training is also important for reducing staff shortages4 . Experienced and educated staff prevent maldistributions and allow nurses to work across multiple areas in the perioperative setting4 . This allows more nurses to be assigned to areas of high acuity, thus improving patient safety4 . Implications for perioperative nursing practice This review identified the importance of staffing levels on patient safety and quality of care, which is integral to perioperative nursing. The literature included in-depth discussions about staffing and patient safety in regard to fatigue, staffing ratios and education and training. Five articles unanimously agree with the importance of managing nursing fatigue5,7,13,15,16, four supported the provision of perioperative undergraduate experience19–22, five consistently supported further postgraduate education and training for perioperative nurses3,4,17,23,24, and three determined safe nurse-to-patient ratios within the perioperative setting14,17,18. Fatigue has been shown to be significantly detrimental to perioperative nurses’ performance which, in turn, effects their ability to perform duties safely14. Overworking, long shifts and challenging situations can cause nurses to suffer from compassion fatigue, which affects the holistic care that a nurse can provide for patients15. It is of paramount importance that fatigue is mitigated, identified and managed by health service organisations and practitioners to ensure that quality patient care can be provided in the perioperative environment. This review has also highlighted the importance of nurse-to-patient ratios within the perioperative setting as a significant factor relating to patient safety and positive outcomes. Current Australian standards recommend that 3.5 nurses are allocated per operating theatre per patient to ensure appropriate staffing for safety8 . This standard is based upon the discussed evidence that demonstrates the hazards of staffing operating theatres with fewer nurses17,18. Additionally the research shows the importance of having staff available to complete non-clinical tasks and the importance of crosstraining nurses to deal with nursing shortages4 . Finally, perioperative nurse education and training has been discussed as an important concern related to staffing in this specialty field. Perioperative nursing is not part of core undergraduate nursing programs in all Australian
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