How do you find candidates who aren't even looking?

Most of the directors we place aren't looking. We know who they are because we've been talking to them for years. When your seat opens, we don't post it on a job board and hope — we pick up the phone and call the three or four people who fit, and see who's ready to move.

What credentials should I expect from the candidates you send?

It depends on the seat. A Director of Surgical Services typically holds a BSN with CNOR behind their name. OR Managers and PACU leaders carry CNOR or CPAN. Surgical Techs hold CST. We also look at what they've actually done — robotic programs they've stood up, turnover minutes they've cut, satisfaction numbers they've moved. The credential gets them in the room. The track record is what we ask about.

Why not just use our internal HR team or a generalist agency?

Your internal team recruits for surgical leadership once every few years and starts from scratch each time. A generalist recruiter is juggling IT, finance, and nursing roles in the same week — they can't tell you the difference between a CNOR and a CST. We run six to twelve surgical searches at any given time. That's all we do, so we know the market, the going rates, and who's open to a move.

How fast can you actually get someone in front of us?

The Director of Surgery market is one of the most competitive in healthcare right now — strong leaders are rarely sitting idle, and the ones who are open to a move get picked up fast. We don't promise a specific timeline because every search is different, but we don't start from zero. We already know who fits your OR volume, trauma level, and case mix, so Day 1 is spent reaching out, not building a list. From there, how quickly someone lands in front of you depends on the market, the candidate's situation, and how fast your team can move on interviews.

Do candidates pay anything to work with you?

No. The hiring hospital or health system covers the fee. Candidates submit a resume and book a confidential call at no cost. We represent the candidate to the employer — they never pay us.

What's the difference between permanent and interim placement?

Permanent placement is a direct-hire search for a long-term leadership role — your next Director of Surgical Services. Interim is a short-term fix: an experienced leader who steps in for a leave, a gap, or while you run a permanent search. We handle both, for hospital ORs and ambulatory surgery centers.

Who leads Surgical Nurse Recruiter?

Surgical Nurse Recruiter is led by Chris Monroe, Founder & CEO. The firm is a division of The Clinical Recruiter, based in Franklin, Tennessee, serving hospitals, health systems, and ambulatory surgery centers across the United States.

OR Operations

Chris Monroe 2026-02-02

Optimizing OR Throughput to Reduce Case Cancellations and Delays

The Clinical Recruiter

I talk to hospital CFOs every week, and the conversation always circles back to the same number: first-case on-time start rate. When a hospital is running below 85 percent on first-case starts, the problem is not the surgeons. The problem is the workflow. Specifically, the problem is what happens — or does not happen — in the hour before the first incision.

Effective OR throughput starts with pre-op accuracy. That means completing pre-admission testing, anesthesia clearance, and consent verification days in advance so the patient is truly ready when the room is. Inpatient versus outpatient status, NPO confirmation, and site marking are not morning judgment calls. They are structured determinations that, when done correctly, eliminate the vast majority of same-day cancellation risk.

The second piece is turnover discipline. When a case ends, the clock starts. Parallel processing — where EVS, the circulating nurse, and sterile processing move simultaneously — is what separates a 20-minute turnover from a 45-minute one. The leader's job is to make that parallel workflow the default, not the exception, and to track wheels-out to wheels-in as a real metric, not a vibe.

Finally, preference card accuracy. I see too many surgical programs tolerating outdated preference cards that waste single-use supplies, delay case prep, and frustrate surgeons. A preference card above 95 percent accuracy means the right instruments are staged, the right implants are available, and the room turns over without scrambling. Until you audit those cards regularly, you are losing time and money to preventable friction.

When we talk with perioperative leaders for our hospital clients, we look for people who can walk into a department, audit the current workflow, identify where the first-case start is breaking down, and redesign the process. That is the leader who turns a 70 percent on-time rate into a 90 percent on-time rate. That is the leader worth fighting for.

Chris Monroe

The Clinical Recruiter

Former hospital CEO with 23 years of healthcare leadership experience, from food service worker to the executive suite. Chris founded The Clinical Recruiter to connect hospitals with surgical and perioperative leaders who understand the financial weight of every OR turn-time.

From Circulating Nurse to Director of Surgical Services: The Leadership Journey OR Utilization and Block Management: Every Unused Minute Has a Price Tag

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