Maintaining perioperative nursing competence in rural and low-volume surgical settings: A Canadian perspective
Mots-clés :
rural perioperative nursing, competence maintenance, low-volume surgery, simulation, Canadian nursing workforceRésumé
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.
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