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universities; therefore, it is important to provide perioperative education and experience for novice perioperative nurses20,21. The evidence indicated a direct correlation between trained and experienced perioperative nurses and patient safety4 . Research recommends the implementation of undergraduate perioperative experience20 and specialist postgraduate training programs as well as on-the-job and didactic in-service education for staff3 . Furthermore, managerial support for continuing professional development is seen as a motivating factor by perioperative nurses23. Limitations A robust review of literature was undertaken which included processes to identify and examine suitability and limitations. The articles included in this review were of good standing and credibility within the nursing field. The inclusion of secondary research also strengthened the discussion. All authors cited no conflict of interest, and no biases were able to be identified throughout the literature. Current quantitative research was difficult to identify as the majority of research was qualitative or mixed methods aimed at exploring nurses’ opinions and views. This gap in literature makes it difficult to draw irrefutable conclusions regarding the effects of staffing on patient safety. A lack of counter arguments was searched for but not noted in the literature. The articles were cohesive in their discussion and all research Journal of Perioperative Nursing Volume 34 Number 1 Autumn 2021 acorn.org.au e-21 identified throughout the review was supportive. A gap in the current literature is noted in the absence of recent statistically significant data to link fatigue, staffing shortages and patient outcomes. Studies that had small sample sizes were identified as a limitation within this review. Additionally, all research contained within the review was related to perioperative nursing; however, some articles did not include only perioperative nurses as participants. This limited the relevance of these articles. Knowledge translation 1. All perioperative nurses should be aware of the signs and symptoms of fatigue and compassion fatigue, and work with their respective perioperative manager to mitigate and manage fatigue. 2. Perioperative nursing staff should be seen as assets to the perioperative department and therefore appropriate staffing levels, adhering to the ACORN Standards recommendations, should be budgeted for in the health service to allow for safe clinical care. 3. Adequate postgraduate training for perioperative nurses is a serious concern for staff and must be addressed. Also, the incorporation of perioperative nursing into undergraduate nursing core curricula for the acquisition of surgical knowledge, to promote perioperative nursing and to provide basic transferable perioperative nursing skills, is paramount to ensure future recruitment of skilled perioperative nurses. Conclusion This literature review has revealed numerous perioperative concerns that effect the safety of vulnerable patients and the quality of care across perioperative departments in Australia. The main themes identified were fatigue, nurse-topatient ratios, and nurse training and education. Qualitative, mixed methods and secondary research indicate that these themes must be managed appropriately in order to ensure patient safety. Inadequate staffing and education create a serious risk for patients undergoing invasive procedures. There was a lack of counter arguments against the assumption that education creates safer staffing within the perioperative environment. A recommendation of this review is to consider further research into the links between fatigue, adherence to staffing standards, education levels of perioperative nurses and patient outcomes. The evidence suggests the importance of non-fatigued, welleducated perioperative nurses in operating suites that are staffed in accordance with the ACORN standards to ensure a high level of perioperative patient care. Perioperative nurses and our patients deserve nothing less. Acknowledgements The author would like to acknowledge and thank the staff of the perioperative department at Bundaberg Hospital for their ongoing support throughout the author’s postgraduate studies. The author would also like to
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