Background: The integration of medical technology in the operating room has revolutionized surgical workflows and team dynamics. However, this progress coincides with a critical global shortage of nurses and a high turnover rate within the existing nursing workforce, impacting patient care quality, nurses' well-being, and hospital finances Aim: This study investigates the impact of technological complexity on the workload and job satisfaction of intra-operative nurses, focusing on open surgery, minimally invasive surgery, and robotic-assisted surgery within the gynecology department of a Dutch academic hospital. Method: The study design follows a mixed-methods approach, combining qualitative and quantitative methods to assess nursing experiences across three surgical modalities. Specifically, we conducted 5 interviews, distributed 28 validated questionnaires, performed automated video analysis on 35 recorded surgeries, and analyzed hospital datasets encompassing 411 cases. Data collection took place in 2022 and 2023. Results: Findings show that intra-operative nurses experience varying levels of workload and job satisfaction depending on the level of technology. Open procedures showed the highest job satisfaction, characterized by continuous engagement and manageable workloads. Minimally invasive surgery procedures, while less physically demanding, were associated with reduced involvement and lower satisfaction. Robotic-assisted procedures presented the most significant challenges, with increased workload, reduced involvement, and heightened stress stemming from surgery preparation, technological complexity, and altered team dynamics. Conclusions: Advancements in medical technology improve outcomes and efficiency but often neglect their impact on intra-operative nurses. Communication issues, equipment challenges, and limited technical training contribute to burnout and turnover. This study underscores the need for supportive operating room environments that prioritize nurses’ well-being. By examining the link between technology, workload, and satisfaction, it offers strategies to retain and empower nursing staff. It also shows how automated video analysis can objectively assess nursing roles, highlighting the importance of balancing technology with human-centered care in the operating room.

Literature proposes numerous initiatives for optimization of the Operating Room (OR). Despite multiple suggested strategies for the optimization of workflow on the OR, its patients and (medical) staff, no uniform description of ‘optimization’ has been adopted. This makes it difficult to evaluate the proposed optimization strategies. In particular, the metrics used to quantify OR performance are diverse so that assessing the impact of suggested approaches is complex or even impossible. To secure a higher implementation success rate of optimisation strategies in practice we believe OR optimisation and its quantification should be further investigated. We aim to provide an inventory of the metrics and methods used to optimise the OR by the means of a structured literature study. We observe that several aspects of OR performance are unaddressed in literature, and no studies account for possible interactions between metrics of quality and efficiency. We conclude that a systems approach is needed to align metrics across different elements of OR performance, and that the wellbeing of healthcare professionals is underrepresented in current optimisation approaches.