I remember the moment it became clear that our surgical recovery process was no longer serving patients or staff the way it should.

A postanesthesia care unit (PACU) nurse with more than 20 years of experience pulled me aside after a difficult shift and said quietly, “I feel like we’re all doing our best, but nothing is connected. Every patient’s recovery feels like starting over.”

She was right. As surgical volume increased and patient acuity intensified, the consequences of fragmented recovery practices became impossible to ignore. One surgeon followed protocols closely, while another relied on long-standing habits. Some nurses promoted early ambulation aggressively; others hesitated. Patients received different instructions depending on who was providing their education. Staff voiced uncertainty, fatigue, and growing concern about patient safety.

The evidence for supporting enhanced recovery after surgery (ERAS) programs is extensive and well established across multiple surgical populations, with consistent findings demonstrating reductions in complications, length of stay, and improved patient outcomes (Ljungqvist et al., 2017; Nelson et al., 2016; Nicholson et al., 2014). Despite this strong evidence base, translating ERAS principles into reliable daily practice felt overwhelming.

I realized quickly that ERAS implementation was not an education problem, but a partnership problem. This determination emerged through a structured assessment process aligned with Standard 1: Assessment within the Nursing Professional Development Scope and Standards of Practice (Harper & Maloney, 2022). Through informal workflow observations, interdisciplinary discussions, and review of perioperative performance data, it became clear that the primary gaps were not in knowledge, but in communication, role clarity, and consistency across teams. Variation in practice patterns, fragmented handoffs, and differing expectations among disciplines revealed a lack of shared understanding and coordination. So, we started with people.

We brought together nurses, nursing professional development (NPD) practitioners, certified registered nurse anesthetists (CRNAs), anesthesiologists, surgeons, schedulers, and quality leaders into one room. Not to present solutions, but to listen. Nurses described where workflows broke down and where communication failed at the bedside. CRNAs explained where pain management plans became inconsistent. Surgeons identified barriers they were seeing in recovery metrics. NPD specialists translated this data into learning strategies grounded in the Scope and Standards of Practice (Harper & Maloney, 2022).

That collaboration changed everything.

Instead of siloed education, we co-developed ERAS education and embedded it into onboarding, annual competencies, service line orientation, and leadership development across key interdisciplinary collaborators, including nursing, CRNAs, surgeons, and operational leaders. We shifted the conversation from “what the protocol says” to “why this matters for the patient in front of you,” grounding practice in evidence-based principles (Melnyk & Fineout-Overholt, 2019). Nurses began to see how their actions in the preoperative area, in the operating room, in PACU, and on the inpatient unit were connected across the entire recovery journey.

Competency development became a shared responsibility, with NPD practitioners leading this work through the design, implementation, and evaluation of competency-based education and validation processes across the perioperative continuum. Together, we built standardized ERAS tools, cognitive aids, preoperative education scripts, and postoperative care pathways. During early implementation, clinical leaders and NPD practitioners rounded side by side, coaching in real time, reinforcing expectations, and addressing variation at the bedside. I remember one nurse saying, “For the first time, I actually understand how my piece fits into the whole picture.”

Just as important as the technical work was the environment we created.

Change creates uncertainty, and uncertainty erodes confidence, particularly in complex healthcare environments (Edmondson, 2023). So, we focused intentionally on psychological safety. Nurses were encouraged to raise concerns, question workflows, and suggest improvements without fear of blame. That openness built trust, improved engagement, and strengthened learning across teams (Harper & Maloney, 2022; Melnyk & Fineout-Overholt, 2019). Over time, staff stopped waiting for permission to improve care and began actively shaping the ERAS model themselves.

Within the first year, the results were unmistakable. Postoperative length of stay declined by approximately 15 percent to 25 percent, and patient satisfaction scores improved by 8–12 percentile points. Pain management practices became more consistent, reflected in a 20 percent to 30 percent reduction in opioid utilization and improved alignment with multimodal analgesia protocols. Staff confidence increased, as demonstrated through increased engagement in ERAS workflows and decreased variation in care delivery, and communication across disciplines strengthened, evidenced by improved compliance with standardized handoff and recovery protocols. Most powerful of all, nurses began taking ownership of the ERAS model itself, identifying opportunities for refinement and innovation that no committee could have predicted.

What I learned through this process is simple but profound: implementation of initiatives do not succeed because of protocols. They succeed because of partnerships. NPD practitioners and clinical leaders are uniquely positioned to drive meaningful change when new care models are introduced (Harper & Maloney, 2022). But real transformation requires more than policies, checklists, or isolated training sessions. It requires people across disciplines working together with shared purpose and shared accountability, reflecting Standard 11: Collaboration within the Nursing Professional Development Scope and Standards of Practice (Harper & Maloney, 2022).

Programs like this touch every phase of the surgical journey. Without strong collaboration between nurse leaders and NPD practitioners, they become fragmented, inconsistent, and unsustainable. When partnerships are built intentionally, diverse expertise strengthens program design, resistance to change decreases, engagement grows, and transformation becomes real and lasting (Harper & Maloney, 2022; Melnyk & Fineout-Overholt, 2019).

The future of patient care will not be shaped by guidelines alone. It will be shaped by the people who choose to work together to bring those guidelines to life.

And when nurses are supported through that process, patients heal better, teams grow stronger, and systems become more resilient.

References

Edmondson, A. C. (2023). Psychological safety: The history, renaissance, and future of an interpersonal construct. Annual Review of Organizational Psychology and Organizational Behavior, 10, 23–43. https://doi.org/10.1146/annurev-orgpsych-120920-055217

Harper, M. G., & Maloney, P. (2022). Nursing professional development: Scope and standards of practice (4th ed.). Association for Nursing Professional Development.

Ljungqvist, O., Scott, M., & Fearon, K. C. (2017). Enhanced recovery after surgery: A review. JAMA Surgery, 152(3), 292–298. https://doi.org/10.1001/jamasurg.2016.4952

Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.

Nelson, G., Altman, A. D., Nick, A., et al. (2016). Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. Gynecologic Oncology, 140(2), 323–332. https://doi.org/10.1016/j.ygyno.2015.12.019

Nicholson, A., Lowe, M. C., Parker, J., Lewis, S. R., Alderson, P., & Smith, A. F. (2014). Systematic review and meta-analysis of enhanced recovery programmes in surgical patients. British Journal of Surgery, 101(3), 172–188. https://doi.org/10.1002/bjs.9394