I am an RN and have worked in the perioperative setting for some 16 years as a point-of-care clinician, educator, and nurse unit manager. Then I did an honor’s program and got my doctoral degree. I currently work between the Gold Coast University Hospital and Griffith University as a professor of patient safety. I work with other researchers and clinicians in the perioperative setting and throughout the hospital.

Back when I was a clinician, I would get a bit frustrated because it was difficult to see the evidence behind many of our perioperative practices. My primary role now is to build an evidence-based culture in perioperative nursing and beyond. I bridge the gap between clinical practice and research.

Thinking about the value of clinical care, we want to make sure that we are providing evidence-based care. Generally speaking, as clinicians, we have not always provided evidence-based care, and sometimes, the care provided can lead to harm. We need to provide evidence-based care that is safe. That is my job. When I am on committees, that is the first line of questioning I bring up because we need to examine the evidence before we implement something new in practice.

My leadership is as a researcher in perioperative and acute care practice. I have been very fortunate to work with people in North America, Asia, Europe, and obviously in Australia. And this may be obvious, but it still surprises me: we all have the same issues. It does not matter what country we are in. The issues that I have seen in my visits to colleagues in different countries are very similar.

What is important is understanding these universal issues before tackling them locally. At the heart of it, people are similar wherever you go. The challenges that you see in practice, in leadership, and in developing people are universal, and we need to learn from each other.

In terms of having an interdisciplinary focus, it is not just about the nursing team; it is also about the surgical team and the anesthetic team. It is being able to balance the clinical work with the different disciplines to get the best out of people in those disciplines.

How do you get the best out of surgeons you’re working with, for instance? You get to know them. The key thing is communication. A lot of my work has shown that communication is very important. It is vital, actually, if we are going to have a successful team and a team-driven environment.

Knowing what people’s strengths and weaknesses are is extremely important. We do not know that unless we are communicating with our teams on a regular basis and allowing them to play to their strengths. You will not know that unless you communicate and build a relationship with them.

It is about doing that environmental scan; understanding your team and where people sit. Unfortunately, there is a hierarchy. We sometimes can’t get away from that in the OR. A lot of my earlier work was looking at and trying to understand where the hierarchy was. I found it is important to know people’s strengths and weaknesses and identify who the key players are, even if that feels exclusionary at times.

People need to have the freedom to voice their concerns. We know that different ORs have different cultures. I have worked in ORs that have a very open culture and a very flat hierarchy; whereas, in other places, the hierarchy is just that, a hierarchy. You need to study the culture and identify the key players.

We know the only constant in healthcare is change. The political landscape changes, as well. People come and people go. Nurses should understand the landscape, especially if they are novice nurses coming into the OR. It is really important that you are mentored and you are given those insights because you do not always know the political landscape. You may not know what the manager is like. You might not know exactly who is in charge.

Nurses have to develop that understanding and conduct an environmental scan. That comes with communication, finding a good mentor, and looking to your leadership to see how they are managing the politics and how they are communicating with their staff.

When I was a nurse unit manager, I was often the “meat in the sandwich” between the executive staff and point-of-care clinicians. I tried hard to make sure that my staff knew exactly what was going on. If they do not know, how can you bring them with you?

Learn to communicate what is going on and why, so staff have a better understanding of the dynamics you are seeing in your operations. That way they are more likely to come with you in whatever direction you take them.

I would actively seek out mentors when I was a clinician, then later when I was a manager, and still do so now as a researcher. I have sought out people who I click with, who I work well with, and who I like. That is the first thing.

Good mentors show a real desire to develop others, but you also have to exhibit a desire to develop yourself. That is not just applicable to leaders. You need to know yourself and invest in your emotional intelligence. Build up a social awareness of other people and know how you will respond in a given situation. Be open to learning from others because accepting feedback is an opportunity for personal growth.

We know implicitly, as nurses, how nurses think. But when there are other disciplines in the mix, we need to know how to communicate on a different level. And the OR is many disciplines coming together. We must have that social awareness of how other people communicate and an understanding of our own strengths and weaknesses.

In terms of education, I always encourage my colleagues to go off and do a master’s or an honor’s program. That higher level of education is going to broaden their landscape as well as the options available to them in the future.

It comes down to people’s willingness to learn from others and invest in themselves.

Having to make tough decisions and resolve conflicts. Part of that is giving feedback. Not just any feedback, but giving feedback that is honest and constructive. Unfortunately, the feedback that is hardest for you to give is probably going to be the most helpful for your staff and their development. Learning how to give useful feedback to others is a skill, and it takes time to develop that skill.

Learning to accept feedback and respond to that feedback is really important for a leader. It is also really hard for a leader, but they can’t afford to neglect to ask for feedback or respond to feedback from others. It is sometimes hard to hear criticism from the people you mentor, but it is important. Leaders, especially women in leadership, need to learn when to speak up and when to contribute. A leader who does not speak up will not have a lot of impact.

Another challenge is to effectively delegate. Learning to delegate appropriately is one of the harder skills to learn. It involves elements of some other skills, particularly understanding the capacities and the limitations of others. Leaders need to delegate responsibilities that their teams can handle but not overload them. This goes back to what I said before about social awareness and having a good understanding of your team members, their skills, their strengths, and their limitations.

I am on the Pressure Injury Prevention Committee. Because I have a dual appointment between the hospital and the university, I have a supervisor at the hospital who is the executive director of nursing services.

Several years ago, she came to the Pressure Injury Prevention Committee meeting and brought a foam boarder dressing. She said, “This is a good dressing to prevent pressure injuries from developing in patients who are immobile in bed.”

I happened to be familiar with the literature on this issue because my research group was planning to undertake a full scale randomized controlled trial in this area. I said to her, “At this time, there are two or three studies, and they are very small studies that were not very well done. A couple of them were randomized controlled trials.”

I presented the evidence on the use of these types of dressings and said, “I think that we as clinicians really want to do what we can to help our patients. But we really don’t know whether this dressing is the panacea to avoiding pressure injuries from developing in patients who are immobile and bedridden.”

I said, “We need more evidence, and we need to test it to see if it actually works.” I think because I had already done a lot of research in that area, the committee listened to what I said because they were considering implementing these dressings. Currently, we are about halfway through a large multisite randomized controlled trial to see if the dressing does indeed reduce the incidence of pressure injuries.

Because I had research-backed authority in that particular area, my colleagues listened to me and valued my opinion. This information was probably not what members of the committee wanted to hear, but it needed to be said. As clinicians, we often feel a bit helpless if we can’t prevent something from happening, but unfortunately, we can’t just rush towards action.

My argument was based on ensuring that this type of intervention was appropriate for all patients. We did not know if it worked. I think that swayed them, and aside from my usual contributions on this committee, they took what I said seriously.

My role is to bridge, or sometimes build, a nexus between clinical practice and research. That is key to my role, to try and demystify research and make it fun. I think sometimes perioperative nurses are a bit scared of research because the language is a bit esoteric. There are things that you only say as a researcher. You do not use that sort of vernacular in other conversations you have.

What I do with my clinician colleagues is I bring them onto teams. I do not expect them to do the research. But—and this is impactful—they sometimes can enable the research in some way, and they often contribute to explaining the results in a way that other clinicians understand and value.

I have been fortunate because I have worked with several clinicians who have gone on to get masters and PhDs. Sometimes it takes a while, but it is important to build those skills because you never know where they might lead.

The biggest myth is that the surgeon is the team leader. The dynamics should be distributed leadership. The OR needs different experts at different times based on the progression of the procedure.

At some point, the leader might be the orderly who is positioning the patient. At that point in time, they oversee that activity. When the case is underway and the surgeon is operating, there might an issue the surgeon encounters. That might be when the anesthetist steps in. With intubation and extubation, we often say the anesthetist is the most important person in the room.

More often than not, the nurse in charge of the room is more the leader and the coordinator. They are coordinating activities and making sure that the team is adhering to standards of asepsis, etc.

Everyone has a role. The nurses, the surgeons, the anesthetist, and the technicians all bring their own skill sets. At different times, each one of them may be leading some activity. That is the notion of distributed leadership and shared accountability.

Everyone in the OR should be aware of what is happening at all times and adhere to surgical safety checklists. We still have a long way to go because some ORs still exhibit that surgeon hierarchy.

Like I said, I think it is important to communicate with staff, and when you can, promote them. If there is some development course that you can send them to and they are interested, do it. Develop and invest in them so they have a more well-rounded perspective.

Beyond the individual level and on a more macro level, identify the goals that the department wants to meet, and communicate to them those goals you are trying to achieve. If you want to develop a center of excellence in orthopedic surgery, for instance, what do you need to do to get there? What are the skill sets needed for that? Who needs to be involved? Communicate those questions so everyone can work together to find the answers. Sharing information and building on the team’s understanding of what is going on is key to engaging and aligning staff efforts and performance with the organization’s objectives.

Also, recognizing achievement and providing feedback. The team members need to know on an ongoing basis when they have done a good job and when you would expect better or different results. The more immediate the feedback, the more effective it is.

You must be an authentic leader. You must be true to yourself. You must stand for something. If you do not stand for something, you fall for anything. You will not be as impactful or effective. People know when a leader is not genuine.

We in perioperative nursing are behind the “eight ball” when it comes to undertaking research in our specialty. My colleagues in critical care and the emergency department have a much more prolific research profile than we currently have in perioperative nursing.

As nurse researchers, we are constantly trying to bring others along and develop others in these research roles because we need researchers on the ground in the clinical area. That presence helps to inform practice.

I am pleased that OR Manager is featuring the researcher lens because this perspective needs to be part of the conversation. Every time I talk to my clinician colleagues, I turn the conversation back to the evidence and how it is informing their practice. It is crucial that we understand what evidence informs our practices and processes.

You do not have to understand the technical aspects, but you do need to know if it is good evidence. Are there biases in the information? Would you follow that practice? If not, why? Is it because you are not sure that it won’t cause a patient harm? Every clinician should be constantly asking these questions and seeking to back their practice with evidence.