Role-reversal simulation training to enhance performance and reduce stress of endovascular scrub nurses in the operating room

Simulation-based education (SBE) is increasingly implemented in vascular surgical training curricula to learn technical and non-technical skills, intending to educate competent surgeons and ensure patient safety. However, scrub nurses are rarely offered the same type of training opportunities. This study aimed to assess if skills learned by scrub nurses during SBE in endovascular aortic repair (EVAR) are transferred into a reduction in perceived and measured stress levels. Errors occurring during the procedures were also explored. Endovascular scrub nurses were invited to attend an SBE program in EVAR, which was developed for surgeons. Before and after SBE, nurses were observed during actual EVAR procedures. The impact of training was evaluated using these methods: stress level as perceived by participants determined by cognitive appraisal (CA), cardiovascular stress determined by heart rate variability (HRV), and errors observed during procedures using the Imperial College Error Capture tool. Twelve scrub nurses with a median experience of one year (IQR: 0-2) working with peripheral endovascular procedures but never EVAR were included. The median CA ratio before SBE was 1.3 (IQR: 1.3-1.7), which was reduced to 0.8 (IQR: 0.6-1.0) after SBE (p=.043). The change in HRV after SBE did not reach statistical significance, +1.2 (CI: -10.9-13.4). The mean number of errors was reduced from 13.2 (CI: 10.1-16.3) per hour before SBE to 4.7 (CI: 3.2-6.2) per hour after SBE (p<.001). The most common error types were technical and communication errors. Extending SBE programs designed for vascular surgeons to scrub nurses reduces perceived stress levels and errors during EVAR. This study highlights the possibility of adopting a surgical training program to scrub nurses with minimal modifications. There appears to be a significant, yet unrealized, opportunity in providing SBE to scrub nurses across various surgical specialties.