Maintaining perioperative nursing competence in rural and low-volume surgical settings: A Canadian perspective
Keywords:
rural perioperative nursing, competence maintenance, low-volume surgery, simulation, Canadian nursing workforceAbstract
Background: Perioperative nurses in rural and low-volume Canadian surgical facilities face a persistent risk that infrequently practised skills may decline over time. This decline can affect technical, cognitive, and team-based performance. Infrequent procedural volumes, professional isolation, and limited access to specialist support, create conditions in which competence may be difficult to sustain. Drawing on Benner’s (1984) Novice-to-Expert framework, this paper examines competence maintenance across the perioperative nursing competence continuum.
Methods: A narrative review of published literature was conducted across CINAHL, MEDLINE, and SCOPUS (2000–2025), integrating evidence from perioperative nursing, rural health, simulation education, and Canadian health policy. Searches returned approximately 480 records; after screening titles, abstracts, and full texts against predetermined inclusion criteria, 14 sources were included in the final synthesis.
Results: Competence maintenance challenges affect preoperative assessment and preparation, scrub, circulating, post-anaesthetic care unit (PACU), and crisis-response nursing roles. Evidence supports simulation-based training, tele-mentoring, structured inter-facility rotation, cognitive aids, and contextualized continuing education, as core maintenance strategies. Sustainable competence requires coordinated investment across the individual nurse, the facility, the regional network, and the provincial or territorial health system.
Discussion: A multi-level framework is proposed, with specific actions for individual nurses, facilities, regional networks, and provincial and territorial authorities. Indigenous health equity and cultural safety are identified as integral competency domains.
Conclusion: Rural perioperative nursing competence is achievable with deliberate, multi-level investment. Provincial and territorial nursing regulators, health authorities and facilities, individual nurses, and professional associations have distinct and complementary roles. ORNAC contributes through evidence-informed guidelines, educational opportunities, and professional knowledge exchange.
References
Arriaga, A. F., Bader, A. M., Wong, J. M., Lipsitz, S. R., Berry, W. R., Ziewacz, J. E., Hepner, D. L., Boorman, D. J., Pozner, C. N., Smink, D. S., & Gawande, A. A. (2013). Simulation-based trial of surgical-crisis checklists. The New England Journal of Medicine, 368(3), 246–253. https://doi.org/10.1056/NEJMsa1204720
Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Addison-Wesley.
Canadian Institute for Health Information. (2020). CIHI portal: Hospital standardised mortality ratio and surgical volume data. https://www.cihi.ca/en/indicators/hospital-standardized-mortality-ratio
Cook, D. A., Brydges, R., Zendejas, B., Hamstra, S. J., & Hatala, R. (2013). Technology-enhanced simulation to assess health professionals: A systematic review of validity evidence, research methods, and reporting quality. Academic Medicine, 88(6), 872–883. https://doi.org/10.1097/ACM.0b013e31828ffdcf
Gillespie, B. M., Chaboyer, W., Wallis, M., Chang, H. Y., & Werder, H. (2009). Operating theatre nurses’ perceptions of competence: A focus group study. Journal of Advanced Nursing, 65(5), 1019–1028. https://doi.org/10.1111/j.1365-2648.2008.04955.x
Issenberg, S. B., McGaghie, W. C., Petrusa, E. R., Lee Gordon, D., & Scalese, R. J. (2005). Features and uses of high-fidelity medical simulations that lead to effective learning: A BEME systematic review. Medical Teacher, 27(1), 10–28. https://doi.org/10.1080/01421590500046924
Kornelsen, J., Av-Gay, G., Parajulee, A., Humber, N., Ebert, S., Skinner, T., & Stoll, K. (2025). Rural surgical and obstetric facility-level outcomes for index procedures: A retrospective cohort study (2016–2021). Canadian Journal of Surgery, 68(3), E221–E234. https://doi.org/10.1503/cjs.003423
Mitchell, L., Flin, R., Yule, S., Mitchell, J., Coutts, K., & Youngson, G. (2011). Thinking ahead of the surgeon. An interview study to identify scrub nurses’ non-technical skills. International Journal of Nursing Studies, 48(7), 818–828. https://doi.org/10.1016/j.ijnurstu.2010.11.005
Operating Room Nurses Association of Canada. (2025). ORNAC guidelines for perioperative practice in Canada (17th ed.). https://ornac.ca/standards.phtml
Parajulee, A., Stoll, K., Humber, N., Ebert, S., Williams, K., & Kornelsen, J. (2024). The motivations and experiences of specialists who provide outreach services in rural operating rooms: A survey study from British Columbia. PloS One, 19(3), e0298757. https://doi.org/10.1371/journal.pone.0298757
Riley, R., & Manias, E. (2006). Governing time in operating rooms. Journal of Clinical Nursing, 15(5), 546–553. https://doi.org/10.1111/j.1365-2702.2006.01362.x
Statistics Canada. (2022). Population and dwelling counts: Canada, provinces and territories [Table 98-10-0002-01]. https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=9810000101
Stoll, K., Treissman, J., Av-Gay, G., & Kornelsen, J. (2025). Examining changes in compassion satisfaction, burnout, secondary traumatic stress and work-related quality-of-life of rural surgical and obstetrical nurses in British Columbia during the COVID-19 pandemic. The Canadian Journal of Nursing Research, 57(2), 314–323. https://doi-org/10.1177/08445621241305194
Truth and Reconciliation Commission of Canada. (2015). Truth and Reconciliation Commission of Canada: Calls to action. https://www2.gov.bc.ca/assets/gov/british-columbians-our-governments/indigenous-people/aboriginal-peoples-documents/calls_to_action_english2.pdf
