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Even the United Stated of America (USA) system, for all its shortcomings, incentivises ERAS pathways. This isn’t the case in Australia. The international ERAS Society website (erassociety.org) has a wealth of information about the e-2 Journal of Perioperative Nursing Volume 33 Number 4 Summer 2020 acorn.org.au ERAS movement and evidence-based pathways for every conceivable category of surgery. On the website, you can see that many advanced health systems, such as those in Canada, the UK and USA, have their own national ERAS Society Chapter and ERAS Centres of Excellence. Australian representation in the ERAS movement is noticeably absent. I’m sure there are dedicated professionals across the country trying to implement ERAS, but we don’t appear to have a coordinated national approach. ERAS uptake in Australia is a classic example of a gap between evidence and practice. There are over 20 years of evidence, yet we still haven’t adopted it consistently into routine practice. When we try to address evidence–practice gaps, we look to identify the barriers. A systematic review reported three common barriers: 1. resistance to change from frontline clinicians 2. not enough resources allocated to implementation 3. external factors, like patient complexity or hospital location2 . I acknowledge that these barriers exist but, to me, they are a symptom of a greater problem. The fact that there is no national push to implement ERAS despite all the benefits demonstrates that surgical care is not a priority in Australia. I do not know what the solution is to this problem, but I suggest that rather than focusing on what we should do, maybe we should focus on what we should be. Let me pose this thought experiment. What would our surgical services need to be to adopt ERAS? Here are some things that come to mind: • evidence-based • patient-focused • outcomes-oriented • interdisciplinary • collaborative • integrated. If there are examples where ERAS has been implemented in facilities or across health services, then I encourage you to share your experiences here in the Journal of Perioperative Nursing. These reports can be from Australia or other countries, and they can include successful or unsuccessful implementation attempts. For my part, I have decided to write an editorial every year until we have a wide-scale adoption of ERAS in Australia. References 1. Zhang X, Yang J, Chen X, Du L, Li K, Zhou Y. Enhanced recovery after surgery on multiple clinical outcomes: Umbrella review of systematic The effects of staffing practices on safety and quality of perioperative nursing care – an integrative review Abstract Problem identification Patients undergoing invasive procedures are highly vulnerable to adverse outcomes. From 2012 to 2013, 5.5 per cent of all inpatient admissions reported an adverse event. Perioperative nurses play an important role in providing safe patient care and acting as the patient advocate. This review of literature aims to examine the effects of perioperative staffing and patient safety. Three common staffing themes that impact the safety and quality of patient care were identified; namely, nurse-to-patient ratios, staff training and staff fatigue. Literature search An integrative literature search to identify empirical data surrounding perioperative nursing staffing was conducted via the use of databases which included CINAHL, JBI, Medline and PubMed. Duplicates were removed, and the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines were followed. A total of 216 articles were identified. Data evaluation synthesis Scholarly literature including both qualitative and mixed methods primary research studies, that collected both qualitative and quantitative data, and some secondary research were identified for review. Articles were appraised for relevance by the researcher. Inductive thematic analysis and structured reporting was undertaken to synthesise the data. To ensure the rigor of articles Mixed Methods Appraisal Tool (MMAT) and Standard Quality Assessment Criteria for Evaluating Primary Research Papers (QualSyst) appraisals were undertaken. Out of the 216 articles, 15 research papers were identified as suitable for
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