How to Prevent Common Periop Nursing Injuries and Stay Healthy

Self-Care Advice for Periop Nurses

4 Tips to Keep You Safe and Healthy

A nurse’s health can be lost in the high-stress, high-stakes pace of providing surgical care. Especially in an organization without a strong culture of safety. Use our expert tips to stay safe and healthy in your workplace.

Respite activities like yoga, sleep, and healthy eating are helping more nurses avoid burnout. But self-care needs to extend into the OR, too. That's according to AORN perioperative practice specialists Emily Jones, MSN, RN, CNOR, NPD-BC, and Zach Swartz, MHI, RN, CNOR.

Think about it. Have you worked without smoke evacuation? Have you felt like you didn’t have enough time to ask for additional help when positioning a patient? Maybe your team didn't want to use a neutral zone for passing contaminated sharps? These potentially hazardous exposures could cause life-threatening illnesses and chronic injuries. Exposures that cannot be prevented by personal protective equipment or sheer nursing passion alone.

A Self-Care Mindset Can Keep You Safe and Healthy in the OR

“Don’t let your health get lost in the shuffle,” Jones and Swartz advised.

Here they break down self-care strategies to avoid common periop nursing injuries.  Use these tips to care for yourself and be at your best for patients.

Injury #1: Back and Neck Strain, Tears and Chronic Pain

Lifting while bending or twisting are two of the most common behaviors that put perioperative nurses at risk of musculoskeletal injuries, Swartz shared. These injuries can cause pain you notice right away, like a twinge or ache. Or barely be noticed until you develop chronic conditions like arthritis and spine damage.

Self-care strategies: Know the facts about weight limits and required team members needed to safely position patients. Especially for lateral or prone positioning, Jones cautioned. Look to ergonomic tools cited in the AORN guideline for Safe Patient Handling and Movement. Your organization should provide assistive technology to shoulder the weight of the patient and help position them safely.

Plan ahead for what positioning support (people and devices) you will need for a specific patient, Jones suggested. If those supports are not available, speak up and ask for them. These should be part of your organization’s Safe Patient Handling and Mobility Program.

Injury #2: Respiratory Illness, Cellular Disease, and Hearing Damage

Hazardous chemicals and toxins are released in surgical smoke. These are known to cause respiratory symptoms and illness. Radiation in x-ray devices, including the c-arm, can emit harmful radiation to those in the room. And loud equipment, alarms, music, and conversation can increase noise in the room to dangerous decibels.

Self-care strategies: Hospitals are required by OSHA to provide a safe work environment. Staff members can mitigate hazards through a framework from NIOSH called the Hierarchy of Controls. It provides a ranking of actions to protect employees from the hazard. Such as the engineering control of smoke evacuation.

Understanding this hierarchy can help nurses make decisions about protections from exposure in the correct order. “PPE is at the bottom of the hierarchy as the last line of defense,” Jones stressed. “Too often nurses and even healthcare facilities lean on PPE as a first defense. But PPE alone is not enough to entirely protect nurses from these hazards.”

Also, don’t underestimate the dangers of excessive noise in the OR. It can even increase stress levels, according to Swartz. “Ask to turn down music or limit unnecessary conversation. This should be permitted and even expected during critical portions of an operative procedure. Especially in a facility with a strong culture of safety that welcomes speaking up.”

Injury #3: Contracting Bloodborne Diseases

It only takes one stick with a needle or scalpel contaminated with a bloodborne pathogen to give a nurse a lifelong disease such as hepatitis or HIV.

Self-care strategies: Use a neutral zone to safely transfer sharps that could be contaminated with bloodborne pathogens. This is an established approach that scrubbed team members should be comfortable using, according to Jones. It’s discussed in the AORN guideline for sharps safety. “The research shows that many sharps injuries occur when sharps are passed from one person to another.”

Another self-care strategy is using the correct PPE. Ideally use double gloving with an indicator system. This can help identify inadvertent perforations and increase safety.

Injury #4: Stress and Burnout

Mental health in nursing has become more recognized. But it doesn’t change the high stress nature of working in perioperative care, Swartz cautioned. “Periop nurses spend their days in a heightened state of “fight or flight.” This can increase stress response and even impact physical health. As a certified yoga instructor, Swartz advocates time outside of the OR to engage in calming activities that balance a high-stress workday. But he also believes nurses can embrace yoga practice at work.

He’s trained nurses to practice what he calls “Sterile Yoga.” Here are a few moves to try during surgery without disrupting the procedure or the sterile field:

• When you are standing at the sterile field: Hold on to the mayo stand and step one foot backwards 8-10 inches. Begin to straighten through your back leg by contracting your quadricep muscle. You should feel a stretch in the back of your lower leg. Then step your back foot forward and extend your foot by pointing your toes and lifting your heel off the floor. You should feel a stretch in the front of your lower leg. Repeat this process several times for each leg.

• When your neck has been in a static position: Lower your right ear to your right shoulder. Return to center. Then lower your left ear to your left shoulder. Return to center. Continue to the left and then the right again, making slow and deliberate movements like a metronome.

Advocate for Collaboration and a Culture of Safety

“When a nurse faces preventable occupational hazards, they are not practicing sound self-care. Instead, they are risking their health and their ability to care for their patients,” Jones stressed.

Health care organizations should advocate self-care through a dedicated safety culture that welcomes and even expects speaking up for personal safety. And “nurses have an equal responsibility to harness their own safety culture mindset,” Swartz encouraged.

Interested to learn more? Jones and Swartz recommend these evidence-based practice resources to help nurses build self-care knowledge on the job.

AORN Position Statement on a Healthy Perioperative Practice Environment

AORN Position Statement on Managing Distractions and Noise During Perioperative Patient Care

If you or your facility have access to AORN eGuidelines Plus, you can visit the following links for guidance from AORN:

• AORN Guideline for a Safe Environment of Care
• AORN Guideline for Surgical Smoke Safety
• AORN Guideline for Sharps Safety
• AORN Guideline for Safe Patient Handling and Movement

Compendium of Key Resources for Improving Clinician Well-Being - National Academy of Medicine (nam.edu)

Healthy Nurse, Healthy Nation | American Nurses Association (nursingworld.org)