Whose names come to mind when we think about the history of surgery?
Perhaps a famous surgeon. Perhaps the inventor of an instrument, an anesthetic agent, or a new surgical technique. Medical history has preserved many of those names.
But look more closely at the development of the operating room and another story emerges.
Nurses helped change how hospitals approached cleanliness. A nurse’s damaged hands led to an innovation that eventually became standard surgical practice. Groups of operating room nurses organized to define their own specialty. Nurse educators created resources that trained generations of professionals. Others pushed for safer workplaces, stronger standards, better patient advocacy, and evidence-based care.
Some became widely known. Many did not.
Who were some of the women who helped make perioperative nursing what it is today?
Florence Nightingale: Changing the Environment Around the Patient
Florence Nightingale was not a perioperative nurse in the modern sense. The specialty did not yet exist.
Her influence on the environment in which surgical nursing would eventually develop, however, is difficult to ignore.
During the Crimean War in the 1850s, Nightingale encountered military hospitals struggling with overcrowding, poor sanitation, inadequate supplies, and widespread disease. She became a forceful advocate for cleanliness, ventilation, organization, sanitation, and trained nursing care.
The National Library of Medicine describes Nightingale’s work as extending well beyond bedside nursing. She wrote extensively about hospital administration and design and used statistics to demonstrate the scale of preventable deaths among soldiers.
Her ideas helped establish an expectation that nurses should understand the patient’s environment and actively manage factors that could influence recovery.
That principle feels remarkably familiar in a modern operating room.
Think about the responsibilities surrounding a surgical patient today. Environmental cleanliness matters. Infection prevention matters. Ventilation matters. Organization matters. Observation matters. Nurses are expected to recognize risks and act before those risks become harm.
Nightingale worked before modern germ theory was fully established, yet the broader idea she championed remains recognizable: the conditions surrounding a patient are part of patient care.
Read about Florence Nightingale in the National Library of Medicine’s historical collection
Caroline Hampton: The Nurse Behind the Surgical Glove Story
One of the most familiar objects in an operating room has an unexpectedly personal origin story.
In 1889, Caroline Hampton became the chief operating room nurse at the newly opened Johns Hopkins Hospital in Baltimore. She worked closely with surgeon William Halsted and was recognized for her skill in the operating room.
There was a problem.
The harsh chemicals used to disinfect the hands, including mercuric chloride, caused severe dermatitis on Hampton’s skin. Her reaction became serious enough that continuing the work was difficult.
Halsted approached the Goodyear Rubber Company and asked it to produce thin rubber gloves that Hampton could wear.
They worked.
Other assistants began wearing them too.
At first, the gloves were intended to protect Hampton’s hands from the disinfectants. Their importance in reducing contamination became clearer later. Research on the history of surgical gloves describes Hampton as the first medical professional at Johns Hopkins to use them in the operating room, with their adoption eventually becoming part of the development of aseptic surgical practice.
Consider the strange path of that innovation.
A nurse experienced a workplace problem. Someone responded to it. The solution spread through the surgical team. Eventually, gloves became one of the most recognizable barriers between healthcare workers, microorganisms, blood, tissue, and the surgical wound.
Hampton’s story is also a reminder that changes in healthcare do not always begin with a grand scientific plan. Sometimes progress begins because someone notices that the existing way of doing things is causing harm.
Read more about Caroline Hampton Halsted and the origin of surgical gloves
The Operating Room Nurses Who Organized a Profession
Perioperative nursing also owes a great deal to women whose individual names may be less familiar.
By the middle of the twentieth century, operating room nursing was becoming increasingly specialized. Surgical procedures were advancing, equipment was changing, and nurses working in operating rooms faced responsibilities that were different from those in many other areas of nursing.
They wanted a way to exchange knowledge and improve practice.
In 1949, operating room nurses from across the United States came together to create what would eventually become the Association of periOperative Registered Nurses, or AORN. AORN credits the New York operating room nurses’ group with helping establish the national organization. That group later became part of the charter membership of the Association of Operating Room Nurses.
Seventy-five years later, AORN described that original effort as operating room nurses joining forces to advance surgical nursing practice.
That decision mattered.
A specialty becomes stronger when its practitioners can define standards, share evidence, educate one another, conduct research, and collectively advocate for patients and professionals.
Those early nurses were doing more than creating another professional association.
They were helping perioperative nurses define their own professional identity.
Explore AORN’s history and the development of perioperative nursing
Jane C. Rothrock: Helping Generations Learn the OR
A profession also changes through the people who teach it.
Jane C. Rothrock has had a major influence on perioperative education. She served as professor and director of perioperative programs at Delaware County Community College and became closely associated with one of the specialty’s best-known educational resources, Alexander’s Care of the Patient in Surgery.
The book has existed for decades, but Rothrock’s work as an author and educator helped carry it through successive editions as perioperative practice changed.
Its subjects show just how wide the modern perioperative nurse’s knowledge has become: patient safety, infection prevention, anesthesia, positioning, instrumentation, wound care, robotic surgery, trauma, pediatric and geriatric care, and hundreds of surgical procedures.
The current seventeenth edition continues to present the text as a major resource for nurses and surgical technologists preparing to work in the operating room.
Rothrock also contributed to work intended to describe and document perioperative nursing practice more clearly, including development of a perioperative patient-focused model.
Her career points to another form of influence.
A nurse does not have to invent a surgical device to change the operating room. Teaching thousands of other nurses how to think, assess, prepare, question, and care can influence countless patients whom that educator will never meet.
View Alexander’s Care of the Patient in Surgery and Jane C. Rothrock’s work
Kay Ball: Asking What Surgery Does to the People in the Room
Patient safety has always occupied a central place in perioperative nursing, but the safety of surgical personnel matters too.
Kay Ball, PhD, RN, CNOR, CMLSO, FAORN, FAAN, has spent much of her career drawing attention to workplace risks associated with surgical technology.
AORN recognizes Ball internationally for her work on surgical smoke evacuation and laser technology. Her research, publications, books, and education have helped increase awareness of hazards faced by professionals working around these technologies.
Surgical smoke is a useful example of how perioperative safety continues to evolve.
New technology may improve a procedure while introducing a different type of occupational exposure. Someone then has to ask new questions.
What are staff members breathing?
How should the hazard be controlled?
What equipment is appropriate?
Should a practice that has become routine continue simply because teams have become accustomed to it?
Those questions are part of progress too.
Read AORN’s profile of Kay Ball
Linda Groah: Moving Standards Toward Evidence
More recent perioperative nursing has also been shaped by women working at the intersection of clinical care, leadership, education, and policy.
Linda Groah, MSN, RN, CNOR, NEA-BC, FAAN, spent decades in perioperative nursing and healthcare leadership and later served for more than 17 years as AORN’s CEO and executive director.
During her tenure, AORN moved from issuing “recommended practices” toward guidelines based more explicitly on research and evidence. Groah also participated in the World Health Organization’s 2009 international work surrounding a comprehensive surgical safety checklist, advocated for the registered nurse circulator as a patient advocate in the operating room, supported efforts to reduce surgical smoke exposure, and promoted programs introducing nursing students to perioperative practice.
That collection of work shows how broad perioperative leadership has become.
The specialty now extends beyond the individual operating room. It reaches regulation, professional standards, workforce development, workplace safety, research, education, and global surgical safety.
Read AORN’s overview of Linda Groah’s perioperative nursing career
Progress Rarely Has Only One Name
There is a danger in telling history entirely through famous individuals.
No single woman created perioperative nursing.
Thousands of nurses contributed to its development.
Some introduced new practices. Some challenged unsafe ones. Some wrote standards. Some taught students. Some conducted research. Some mentored new nurses through their first terrifying weeks in the operating room. Some spoke when something on the sterile field did not look right. Some served on committees whose decisions changed practice without their names ever appearing in a history book.
AORN’s history reflects that collective effort. From operating room nurses organizing in 1949 to today’s specialists working in clinical practice, research, education, and leadership, the profession has continually defined and redefined what safe surgical nursing requires.
That may be one of the most important lessons for the next generation.
History is still being made.
The nurse questioning an outdated procedure today may influence tomorrow’s guideline.
The educator developing a better orientation program may change how hundreds of future nurses practice.
The researcher investigating a workplace hazard may discover that something accepted for years can be made safer.
And the perioperative nurse protecting one unconscious patient during one ordinary case is continuing a responsibility carried by generations of nurses before them.
The operating room may look radically different from the rooms Florence Nightingale, Caroline Hampton, or the early AORN nurses would have recognized.
Their influence, however, can still be found in its priorities: cleanliness, preparation, education, observation, professional standards, continual improvement, and protection of the patient.
The women who helped shape perioperative nursing did more than respond to the changes happening around them.
They helped decide what should change next.
References
National Library of Medicine. “Nightingale: Lady and Legend.”
Read the National Library of Medicine article
National Library of Medicine. “The Lady Who Became a Nurse.”
Read the historical profile of Florence Nightingale
Johns Hopkins Medicine / National Institutes of Health archival literature. “Caroline Hampton Halsted: The First to Use Rubber Gloves in the Operating Room.”
Read the article on PMC
Association of periOperative Registered Nurses. “Celebrating 75 Years of Excellence: AORN and Perioperative Nursing.”
Explore AORN’s history
Elsevier. Rothrock, Jane C. Alexander’s Care of the Patient in Surgery, 17th Edition.
View the perioperative nursing resource
Association of periOperative Registered Nurses. “Kay Ball, PhD, RN, CNOR, CMLSO, FAORN, FAAN.”
Read Kay Ball’s AORN profile
Association of periOperative Registered Nurses. “AORN CEO to Retire.”
Read about Linda Groah’s contributions to perioperative nursing
