Ergonomics in the operating room is a safety imperative

Historically, the conversation around ergonomics in surgery has been largely focused on surgeons. Whilst important, this lens is incomplete. Poor ergonomics affects everyone in the OR: nurses, anesthesiologists, technicians, and trainees. A scrub nurse standing for hours with no anti-fatigue mat is as vulnerable as the surgeon operating with prolonged neck flexion. An anesthesiologist forced into a hunched position for intubation is as likely to suffer long-term strain as any other member of the team. Moreover, poor ergonomics doesn’t just result in discomfort. It affects communication, reaction time, and decision-making, all which affect patient safety. Increasingly, we recognize that surgical safety is not only about checklists and technique; it is also about ensuring that the people delivering care are supported, protected, and able to perform at their best.

Despite how common these issues are, talking about ergonomic pain or fatigue still carries a stigma. Many OR workers fear being seen as weak, disruptive, or “difficult” for raising concerns. But the data tell a different story: discomfort in the OR is the norm, not the exception.

Surveys show that up to 70% of surgeons, 90% of anesthesiologists and 50% of nurses report musculoskeletal pain or injuries linked to their work in the OR.2–6 These symptoms are not benign. In fact, they are known to correlate with burnout, change in practice, and early retirement.6–8 In our hospital, 1 in 2 OR workers reported using medications for ergonomic-related symptoms, 1 in 4 worrying about injuries, and 1 in 10 feeling ashamed because of them. Up to 25% also indicated having avoided coming to work due to fear of pain and injury.9

Unfortunately, because discomfort and injuries from ergonomics hazards in the OR are often insidious (cumulative, invisible, and often normalized), coordinated efforts for prevention and improvement are challenging. One of the most powerful first steps is simply to talk about it. Talking openly about back pain, numb fingers, or shoulder strain in the OR should not be taboo. It should be standard practice. When we speak up, we can help others feel less alone and we can begin to shift the culture.

Our ongoing research uses surveys, live observations, and in-depth interviews to understand ergonomic challenges faced by OR workers in their daily work and, more importantly, how they might be addressed through education and teamwork. A survey of surgeons, anesthesiologists, and OR nurses at our institution revealed widespread pain and strain, minimal awareness or application of ergonomic interventions, and a prevailing fear of judgment from colleagues.9 Live observations followed, the findings of which are reported in the British Journal of Surgery.1 Then, in 25 interviews, we asked surgeons, anesthesiologists, and OR nurses to describe their everyday work at the micro-level and asked them to identify key ergonomic moments in the OR and offer specific ergonomic practices or barriers. We explored the interaction of individual ergonomic solutions within a team environment as well as interdisciplinary learning opportunities. Analyses are still underway, but a recurring theme has emerged: individual coping to organizational problems. People rely on personal workarounds, bringing their own chairs, finding ways to stretch during breaks, and quietly reconfiguring OR setups, often without institutional or team support. They often do so silently, worried that speaking up will make them seem uncooperative. Improvement requires shifting from individual workaround to shared strategies. As part of our work, we are identifying ergonomic challenges that cut across surgical specialties and roles, with the goal of creating shared educational tools that engage the entire OR team in learning best ergonomics practices and how to help each other implement them.

We are now developing a simulation-based curriculum to teach ergonomic best practices to interprofessional OR teams.10 This curriculum is designed to reflect the real-world complexity of the OR because improving ergonomics is not just about ideal positioning but about knowing how to adapt in real-time, with sometimes limited space, time, and support. Concurrently, with a team of international surgeons, anesthesiologists, nurses and human factors researchers, we are developing a communication tool that can be integrated into safety processes, an “ergonomics time-out”.11 Just as the WHO surgical checklist has standardized discussion of critical safety steps before and at the conclusion of an operation, this tool will aim to normalize and standardize conversation about team ergonomics before, during and potentially after a procedure. It could for example include simple, high-yield checks, such as

The OR is a place where precision and safety are paramount. We have made huge strides in addressing patient safety through improved protocols, teamwork, and systems thinking. It’s time we bring that same rigor and commitment to the safety of the people performing the surgery. Ergonomics is not a luxury. It is essential infrastructure for safe, sustainable, high-quality surgical care. Let’s keep the conversation going, and let’s work together to build OR environments where wellness and safety are priorities not just for patients, but for everyone in the room.

For anyone interested in learning more about ergonomics in the OR and contributing to this movement, consider joining the Society of Surgical Ergonomics (SSE). SSE is a young, dynamic, and inclusive community of surgeons, anesthesiologists, nurses, human factors researchers, and other professionals committed to improving safety and wellness in the OR through better ergonomics.