**1. Introduction**

Shortage of specialist nurses in perioperative settings has been a commonly discussed issue during the past years and is of larger significance today; furthermore, it affects quality of patient care [1], as planned surgeries may be cancelled [2, 3]. Perioperative settings or operating departments offer unique and demanding working conditions for perioperative nurses, that is, nurse anaesthetists, operating room nurses, nurse assistants, and anaesthesiologists, due to which some of them decide to leave [4]. The pressure to work quickly is high and stressful in perioperative settings due to high patient turnover [5].

The decreasing interest in training to become specialist nurses in perioperative settings makes it even more urgent to address the issues in connection with the perioperative work environment. Studies show that colleagues and nurse managers, among others, are important in perioperative nurses' decision to stay or leave [4]. Moreover, female gender, younger age and parents with children are reasons for burnout among anaesthesiologists [6]. Studies also show that when there is a peak in demand, employees need recovery the most. This chapter provides insights into the unique challenges in the work environment faced by the perioperative staff and how the perioperative environment can be a better workplace by just implementing some simple measures. This chapter comprises three main parts presenting: a) the uniqueness of perioperative work environment, b) psychosocial and organisational work environment and c) how the work environment can be improved by simple means. In the first part, the chapter explains the work of the perioperative nurses, including their education. Moreover, it describes the work environment of nurse assistants and anaesthesiologists. In the second part, insights are given into challenges in psychosocial and organisational work environments, the nurse managers' role in perioperative nurses' satisfaction with work, and how job demand-control affects work for professionals in perioperative settings. The final part describes measures that can be taken to make the psychosocial work environment better for the employees working in the perioperative context.

#### **1.1 Methodology**

To write each part of this chapter, a literature search was conducted in the database PUBMED with different combinations of the following keywords: perioperative settings or departments, perioperative care, perioperative dialogue, work environment, air temperature in operating room, noise level in operating room, regulations, nurse anaesthetist, scrub nurse, operating room nurse, assistant nurse, formal education (Europe, Nordic and the USA), work tasks, professional responsibilities, role description, skills, non-technical skills, competences, person-centered care, anaesthesiologists, experience, burnout, work place incivility, work stress, work-life balance, psychological work environment, nurse turnover (global and perioperative), nurse shortage, leave one's workplace, stay or remain at workplace, job satisfaction/ dissatisfaction, organisational justice, nurse managers, caritative leadership, caritative caring, digitalization, job-demand-control- support model, organisational justice and relational justice. The inclusion criteria were articles about perioperative staff (nurses, nurse assistants, and anaesthesiologists) or nursing and perioperative environment. Research articles after year 2000 were used, with the exception of key references in specific areas, for example, in perioperative dialogue, where articles published before year 2000 were also included. In conclusion, this chapter reminds of an integrative review as research using multiple methodologies were utilised.
