5 Proven Strategies to Build a People-First Culture in the OR

Building a strong culture within the operating room is critical for both attracting nurses and retaining nurses. For perioperative nurses and other OR staff, a positive work environment can be the deciding factor in career longevity. When faced with recruitment challenges, even alongside the resources of a major medical center, cultivating a people-first culture becomes essential. 

So when Laura Gayton, MHCA, BSN, RN, CNOR, CSSM, stepped into her new role as Outpatient Surgery Director, she expected the affiliation with a major academic medical center just a mile away would boost recruitment. But potential candidates weren’t being routed to her site—and a history of unstable leadership only added to the challenge.

Gayton addressed both issues with one powerful shift: she set out to build a people-first culture.

Putting people first has always been her guiding principle as a leader—one rooted in creating an environment where staff feel heard, supported, and empowered.

“My ultimate goal is to make my staff feel like they have the power to positively influence their workplace and be an active part of shaping the facility they want to work in,” she says.

Here are the five strategies Gayton uses to instill a people-first culture—one where her team feels valued, motivated, and connected:

Hire for Engagement: Interviewing Nurses for Culture Fit

Hiring for culture starts in the interview. Gayton uses behavioral questions to identify candidates who are not only clinically strong, but also eager to engage and contribute. One question Gayton asks: If you had to take an ad out in a newspaper and had to describe yourself in 3 words what would those words be and why?

Level Set Expectations to Improve Communication in the OR

Level-setting is the process of ensuring that everyone involved in a conversation or project has a common understanding of the key facts, goals, and objectives. This can involve clarifying terminology, outlining the purpose and scope of a project, reviewing data, and sharing need-to-know information and context.  

Promote Inclusive Communication for a Stronger Surgical Team

The leader's role in creating an inclusive environment starts with modeling effective communication skills and advocating for inclusive behaviors. This can help staff develop a sense of belonging and feel valued for their unique perspectives, contributions, and experiences. Her four go-to strategies:

• Listening and responding with empathy.
• Asking for help and encouraging involvement.
• Sharing thoughts, feelings, and rationale to build trust.
• Providing support without removing responsibility.

Empower OR Nurses Through Leadership and Learning

Empowerment isn’t just about delegating—it’s about giving staff the tools, confidence, and space to grow. Gayton encourages autonomy, leadership opportunities, and continuous learning. She also emphasizes psychological safety. Staff are invited to share feedback, voice concerns, and take initiative—without fear of judgment. And when they go above and beyond, their efforts are recognized and rewarded.

Build Trust in the OR with Competence, Character, and Connection

Trust is the foundation of any strong team. Gayton builds it using the “Three Cs” of leadership: 

Leadership Tip for Sustaining a People-First Culture: Lead but also follow

To foster people-first as a cultural norm, leaders need to be vulnerable and yet bold at times, Gayton says. “Always seek to improve and include ALL in discussions, especially when barriers arise.” 

One challenge Gayton’s team is currently navigating involves compensation adjustments tied to union approval whenever an employee steps into a leadership role. Rather than shy away from the issue, she chose to bring it to the team.

“Engaging in open dialogue with my team about this barrier has created opportunities to solicit feedback and address it as a team,” she says. “That’s a powerful way to show my team they are my priority.”

Creating a people-first culture in the OR starts with intentional leadership strategies that prioritize communication, empowerment, and trust. When perioperative nurses feel supported and engaged, teams thrive—and patient care improves.