Skytron Blog

The staffing conversation in the perioperative space has been running on the same track for years, and the proposed fixes tend to follow the same playbook — better pay, more flexibility, stronger onboarding, improved leadership. All of it matters. None of it is wrong.

But there is a variable that rarely makes it into that conversation. One that was settled long before your current team arrived, before your last round of turnover, before anyone handed you a vacancy report.

It was settled when the room was built.
 

The Body Keeps the Score

Every person who works a surgical case — the scrub tech, the circulator, the anesthesiologist, the surgeon — spends hours in positions that the room either supports or works against. That distinction accumulates across a shift, across a career.

Research published in BMC Musculoskeletal Disorders found that among perioperative team members, lower back pain affects 62%, knee pain 47%, shoulder pain 44%, and neck pain 39%. These are not incidental findings. They reflect what happens when a body repeatedly adapts to a space that wasn’t designed around how work actually gets done.

For scrub technicians specifically, the risk is measurable and role-specific. A 2019 study in the International Journal of Environmental Research and Public Health found that nearly half of OR nurses in the scrub role reported upper limb musculoskeletal disorders, with those working 120 or more hours per month facing more than three times the risk. The physical demands of holding a position, maintaining the sterile field, and managing instrumentation during a long case are cumulative and compound.

Surgeons are not exempt. A 2021 analysis found that nearly 70% of surgeons report work-related pain, with close to half indicating it affects their performance in the room and nearly 60% reporting impact on their life outside of it. A separate study on surgical posture found that when equipment placement and table height are not optimized, posture deteriorates — not because of poor technique, but because the body compensates for what the room doesn’t provide.

What Disruption Actually Looks Like

Physical strain is only part of the equation. The room shapes the case too.

A study published in BMJ Quality and Safety observed 2,504 flow disruptions across 28 surgical cases. Twenty-six percent were classified as major, meaning they interrupted the task being performed. Nearly 80% occurred in the anesthesia zone, transitional pathways within the room, and the surgical table zone — precisely the areas where equipment placement, boom positioning, and room configuration directly influence how the team moves, communicates, and accesses what they need.

These aren’t dramatic failures. They are the kind of friction that doesn’t appear in an incident report. A reach that shouldn’t have been necessary. A position held longer than it should have been. A communication that got lost in a room that wasn’t set up to support it. Individually, they are minor. Across a case, across a day, across a career, they are not.

The Circular Problem

Here is where the staffing connection becomes difficult to ignore.

Surgical services RN turnover reached 15.4% in 2024, up from 13.7% the prior year, according to the 2025 NSI National Health Care Retention and RN Staffing Report. The five-year cumulative turnover rate for surgical services sits at 77.1%. Each departure costs an estimated $61,110 to replace.

Research on OR nurse turnover intention found that 60% report moderate intent to leave and 10% report high intent, and that a better safety climate directly reduces that intention.

Perioperative environments have been identified among the least favorable nursing work environments, with poor physical conditions among the contributing factors.

The circular nature of this problem is what makes it so difficult to break. Short-staffed rooms create conditions where ergonomic safety measures don’t get followed consistently. Injury accelerates attrition. Attrition produces short-staffed rooms.

The cycle continues, and the room, its layout, its infrastructure, the decisions made about it years earlier sit at the center of it.
 

What Gets Decided Early

AORN’s 2024 updated Guideline for Safe Patient Handling and Movement made something explicit that often goes unsaid in capital planning conversations. The guideline notes that overhead-mounted lift systems require less force to operate and are associated with fewer work-related injuries than floor-based alternatives. It states that permanently installed lift equipment can reduce injury risk related to patient handling tasks, and that equipment should be stored where it is readily accessible, because inaccessibility is a documented barrier to safe practice.

These are infrastructure decisions. They are made during design and construction, often long before clinical teams have meaningful input into how the room will actually function during a case. Boom placement. Ceiling configuration. Equipment positioning. The physical architecture that every member of the surgical team works around, compensates for, or benefits from was determined before the first case was ever performed.

The sequencing rarely allows for the depth of clinical input that would make a material difference. By the time workflow conversations happen, structural decisions are already fixed.

The Longer Timeline

Retaining an experienced surgical team requires more than competitive compensation and strong leadership — both of which remain essential. It requires an honest accounting of what the physical environment asks of the people working inside it every day.

The room is not a neutral backdrop to the staffing problem. It is part of it. And unlike culture, schedules, or compensation, it is one of the few variables that can be addressed at the planning stage — before the cost shows up in a turnover report.

Skytron’s clinical solutions are designed around the people who use them every day.
 

 
References
1. BMC Musculoskeletal Disorders. Prevalence of musculoskeletal disorders among perioperative nurses. 2021.
2. International Journal of Environmental Research and Public Health. Upper limb work-related musculoskeletal disorders in operating room nurses. 2019.
3. PubMed Central. Risk of ergonomic injury across surgical specialties. 2021.
4. Laryngoscope Investigative Otolaryngology. Surgical ergonomics posture study. 2022.
5. BMJ Quality & Safety. Minor flow disruptions, traffic-related factors and their effect on major flow disruptions in the operating room. 2019.
6. NSI Nursing Solutions. 2025 NSI National Health Care Retention and RN Staffing Report.
7. PubMed Central. OR nurse turnover intention and safety climate. 2021.
8. PubMed Central. Work environment and intent to quit. 2020.
9. AORN. 2024 Guideline for Safe Patient Handling and Movement.