Advanced nursing roles

The perioperative nurse educator is responsible for facilitating the professional development of all staff in perioperative areas including the operating suite, day surgery unit and pre-admission unit as well as subsidiary areas such as the central sterilising and supply unit. This may also extend to outlying areas that undertake interventional procedures; for example, the cardiac catheter laboratory and medical imaging departments.

The perioperative nurse educator is also responsible for facilitating the orientation of new staff; developing transition to practice programs in perioperative nursing; and the support, mentoring and assessment of postgraduate students. The role also includes the delivery of education, compliance with mandatory education and performance management.

It is a demanding yet incredibly rewarding role for those passionate about educating and nurturing the next generation of perioperative nurses. 

Knowledge and skills

A perioperative nurse educator will have been working in the clinical setting for some time and have postgraduate perioperative qualifications. They will have a strong understanding of evidence-based practice and the use of the ACORN Standards. They will know the principles of competency-based assessment and the application of the ACORN Professional Standards. A perioperative nurse educator will be a skilled communicator, a highly successful facilitator of learning, and experienced in giving feedback. They will be a role model and mentor to students, transition-to-practice graduates and staff. 

Education pathway

This role is suitable for registered nurses who have completed a Bachelor of Nursing degree and a postgraduate degree in perioperative nursing. Education to develop knowledge and skills in education include Certificate IV Training and Assessment as minimum qualification and, potentially, further postgraduate study in adult education. 

Nurse Practitioner (NP) is an advanced practice autonomous role endorsed by the NMBA. NPs have direct clinical contact and practise within their scope under the legislatively protected title Nurse Practitioner under national law. 

The Nurse Practitioner role is defined as a continuum along which nurses develop their professional knowledge, clinical reasoning and judgement, skills and behaviours to higher levels of capability. Nurses practising at this advanced level incorporate professional leadership, education and research into their clinically based practice. Their practice is effective and safe. They work within a generalist or specialist context and they are responsible and accountable in managing people who have complex health care requirements.

The Nurse Practitioner (Perioperative) role is an autonomous one that practices in conjunction with the multidisciplinary team to help support patients through their surgical journey. They can be responsible for undertaking preoperative assessment and postoperative care in conjunction with a surgeon. They generally work in close consultation with particular surgeons and usually in one perioperative specialty providing surgical assistance, wound care, patient education, discharge planning and post-operative follow up. 

Knowledge and skills

The nurse practitioner needs to be a highly knowledgeable and skilled perioperative nurse with excellent assessment, communication, problem solving and critical analysis skills and the ability to work autonomously and make independent clinical judgements. They have advanced knowledge of health assessment, pharmacology for prescribing, therapeutics and diagnostics and research.

Education pathway

Nurse Practitioners require a postgraduate master’s degree in nursing that is relevant clinically to the context of the advanced nursing practice for which they are seeking endorsement as a Nurse Practitioner. They also need to have completed appropriate supplementary education which may include advanced health assessment, pharmacology for prescribing, therapeutics, diagnostics and research. Applicants who have completed their study and are applying for registration as a Nurse Practitioner will need to map evidence for assessment against the Nurse Practitioner Standards for Practice.

For further information refer to the Australian College of Nurse Practitioners (ACNP) Nurse Practitioners Career Guide.

Perioperative research is an exciting and engaging career pathway which is at the coalface of shaping health policy and clinical practice. Becoming a nurse researcher is a logical next step from the role of nurse educator. Research is integral to ensuring that patients consistently receive safe, high quality care, that care is continually enhanced and that best practice of care is maintained.

A nurse researcher may follow a research question that they feel passionate about and embark on a master’s or doctoral research degree. They may then stay in the research field and become part of a research team, based in either a hospital or university.

Knowledge and skills

A researcher needs the passion, inquisitiveness and vitality to uncover best practice solutions and outcomes. They need to be persistent and unwavering in developing their research knowledge and skills.

Education pathway

There are two pathways into this role, either through a Master of Nursing by research (not by coursework) or a Doctor of Philosophy (PhD). It is possible to articulate directly into a PhD from a master’s by research. 

When embarking on a PhD, it may be challenging to locate a suitable supervisor. It is best to try to work out a few areas of interest and then approach various university lecturers to see who would be the best fit and most able to supervise a PhD. 

A PhD normally takes three to four years of full-time study to complete and means engaging with vibrant and inspiring people who are passionate about improving health care. Once completed it is expected that the PhD findings will be published and a network of contacts generated to assist in obtaining employment as, for example, a research fellow.

The Perioperative Nurse Surgeon's Assistant (PNSA) is a nurse who has undertaken additional education and mentoring to learn skills to be an assistant to the surgeon. This role provides a high level of autonomy and a high level of job satisfaction. In the intra-operative phase the PNSA provides support to both the patient and the perioperative team. The role may also involve preoperative patient assessment and post-operative patient follow-up. Working in close consultant with a specific surgeon, the PNSA:

• meets and assesses patients prior to surgery
• provides support and patient education
• ensures that preoperative screening and relevant testing has been completed
• ensures a smooth admission for the upcoming procedure.

Knowledge and skills

The PNSA needs to be a highly knowledgeable and skilled perioperative nurse with excellent assessment, communication, problem solving and critical analysis skills. A PNSA practices under the supervision of the surgeon for all intra-operative practice.

Education pathway 

This role is suitable for registered nurses who have completed a Bachelor of Nursing degree and a postgraduate degree in perioperative nursing. 

PNSA education is offered as part of a master’s degree as well as specialist PNSA single subjects for those who have previously completed a master’s degree. PNSA students require the engagement of a surgeon mentor and supervisor. 

Perioperative management offers the chance for nurses to develop both their leadership and managerial skills. Nurses may follow a progression from a senior clinical position (for example, clinical nurse specialist, clinical nurse consultant) to a nurse unit manager (NUM) role that leads to higher management positions such as a perioperative service manager.

Note: management positions are called different names in different states and territories.

Emerging managers:

• demonstrate a high level of clinical decision making, problem solving, analysis and interpretation of clinical data
• maintain and improve clinical standards
• support and contribute to quality improvement and research projects within the unit
• act as a role model, resource person, mentor and preceptor to less experienced nurses
• demonstrate a commitment to their own and others’ professional development
• belong to a perioperative nursing association.

In providing clinical leadership to staff, nurse managers ensure that patient care is planned, implemented, evaluated and maintained at a high standard. Nurse managers demonstrate advanced clinical knowledge and skills while assuming a management focus in the unit. They direct and coordinate patient care at the unit level and ensure that the practice of perioperative nursing is safe and efficient while maintaining standards of care.

Nurse managers lead and coordinate the perioperative nursing team and manage the business and management processes of the unit. In larger units the management role is usually divided into the specialities of the anaesthetics and post-anaesthetic care team, the instrument and circulating team, the day surgery unit and the pre-admission clinic team.

Management roles focus on rostering and allocation of staff for the perioperative unit using the principles of delegation and supervision. As well as ensuring staff are managed with fairness, compassion and understanding, nurse managers also have a degree of assertiveness to achieve best practice and a positive culture.

The perioperative services manager is the link between the clinical area and the hospital executive. They will manage several departments such as the operating suite, day surgery unit, pre-admission unit and central sterilising and supply department. This is an administrative role that requires skills in financial management, planning, communication, decision making, delegation, problem solving and motivating others. It is also important for managers to display confidence and have respect for staff. 

Knowledge and skills

A perioperative nurse manager should:

• have broad perioperative experience and knowledge
• keep patients as the central focus of service delivery
• have professional integrity, demonstrate ethical conduct and be accountable
• be an advocate, enable others, cultivate collaborative relationships and effective teamwork
• be committed to advancing the perioperative profession and provision of care
• demonstrate openness to change.

Three basic types of management skills include

1. human or interpersonal skills, i.e. the ability to work with and relate to people effectively
2. conceptual skills, i.e. the ability to think in the abstract and formulate ideas, analyse and diagnose problems and find creative solutions
3. technical skills, i.e. the ability to use a variety of techniques to achieve objectives. 

Education pathway

Nurses pursuing a management pathway need to develop their leadership skills and their management knowledge. Management knowledge can be acquired through postgraduate degrees with a health administration focus. Leadership attributes are developed throughout a nurse’s career by listening to and learning from leaders in the profession, reading about and reflecting on other nurses’ experiences and undertaking further study. Leadership is a process of becoming, and develops through a progression of self-growth and learning. The Australian College of Nursing (ACN) offers leadership programs for all level of nurses.