Entry to Perioperative Nursing: An Explanatory Mixed Methods Study

Perioperative nursing is essential to safe surgical systems, yet remains marginal in nursing education and policy, contributing to workforce shortages and inconsistent entry pathways. This study examined how entry to perioperative nursing is represented in Australian policy and experienced by nurses entering the specialty. It focused on how policy, education and organisational conditions shape access, learning and support. An explanatory concurrent mixed methods design, underpinned by a critical realist framework, integrated policy analysis and survey data from 226 perioperative nurses. Findings revealed that relational and structural constraints shaped support, opportunity and recognition in entry to perioperative nursing. Policy analysis showed entry is treated as a local organisational matter rather than a structured specialty transition. Factor analysis identified two constructs: Legitimate Learners and Useful Bodies. Thematic analysis highlighted barriers limiting specialty exposure, access and post-entry support. Across data sources, power asymmetry emerged as a shared mechanism producing ontological insecurity. Structural reform is needed to position perioperative nursing as a supported specialty transition rather than a staffing solution.