Inside Samoa’s operating theatre: How empowered nurses keep patients safe

Nurses and midwives are the foundation of health systems everywhere, providing essential care across the full continuum of health, from community‑based primary health services to highly specialized care. In Samoa, this breadth of nursing practice includes perioperative nurses like Filipi Keresoma, whose work takes place in the operating theatre at Tupua Tamasese Meaole (TTM) Hospital.

Filipi is a perioperative nurse and Nurse in Charge, supporting urology and orthopaedic services in the operating theatre, where every action matters and patient safety must be protected at all times.

“Perioperative nurses care for patients before, during and after surgery,” Filipi explained. “We are responsible for ensuring patient safety for surgery, maintaining a sterile environment, assisting the surgical team intraoperatively, and ensuring safe recovery of patients afterwards.”

^{Perioperative nurse Filipi Keresoma checks the surgical safety checklist as part of routine safety procedures in the operating theatre. The patient’s face has been blurred for privacy. Photo © WHO / Faizza Tanggol}

Much of this work occurs away from public view. Patients who enter the operating theatre doors are often anxious, need reassurance, and want to feel supported.

“We advocate for our patients. In simple terms, we are the voices of our patients, especially when they can’t speak for themselves, especially when they are under anaesthesia,” said Filipi.

^{Filipi (right) assists in a surgical procedure at the operating theatre. Photo © WHO / Faizza Tanggol}

Journey to perioperative nursing

Filipi’s journey into nursing was not one he originally planned. His path into the profession was shaped by his mother, whose influence remains deeply personal and emotional.

“I didn’t select nursing,” he recalled. “From my whole life, I didn’t want to be a nurse, I wanted to be something else, but it was her wish for me to become a nurse.”

Growing up, his mother had observed his natural compassion and care for others. She had also seen nurses at work during hospital visits and believed that nursing would allow Filipi to serve people when they needed support most.

“Now I see the importance and how important my life is right now,” Filipi reflected. “How I am worthy enough as a Samoan male to serve my people, especially in operating theatre, in the difficult and vulnerable times that people have.”

Filipi’s entry into perioperative nursing was also shaped by mentorship. Early in his career, a senior colleague encouraged him to consider perioperative nursing. At the time, Filipi was one of only a few male nurses working in the operating theatre. However, his earlier experience in nursing education had already challenged gender stereotypes. When Filipi completed his nursing degree at the National University of Samoa, men and women were equally represented in his cohort. Today, Filipi hopes that his presence in the hospital and in the operating theatre shows other boys and men in Samoa that nursing is a respected and viable career path, including in advanced areas of care.

This sense of purpose now underpins his work and dedication to the profession. To deepen his expertise, Filipi completed a postgraduate diploma in perioperative nursing at Fiji National University, supported through the WHO Fellowship Programme. Spending a full year in Fiji to complete the programme was both professionally rewarding and personally challenging. Being away from his wife and children at that time placed emotional strain on his family life, but it also strengthened his resilience and commitment to growth.

“The WHO Fellowship Programme was one of the milestones of my professional development,” Filipi said. “It exposed me to international standards, best practices, and different healthcare settings.” He was awarded a postgraduate diploma in perioperative nursing and also received the ‘Clinical Excellency Award’ at graduation.

^{Filipi graduated from Fiji National University with a postgraduate diploma in perioperative nursing, supported by WHO through the WHO Fellowship Programme. Photo supplied by Filipi Keresoma.}

In addition to his postgraduate diploma, Filipi has completed specialized perioperative courses through the Australian College of Nursing alongside fellow Samoan nurses at TTM Hospital. These courses focused on patient safety, infection prevention and control, and clinical leadership. Together, these learning opportunities equipped him with the technical and leadership skills needed in the operating theatre.

Empowered nurses saving lives

Filipi believes that empowerment comes directly from education and continuous professional development. With strong training, nurses are better equipped to speak up, collaborate effectively with surgeons and anaesthetists, and advocate for patient safety when it matters most.

“Perioperative nurses are empowered to make critical clinical decision‑making related to patient safety,” he explained, referring to duties such as verifying patient identity, confirming surgical sites, ensuring sterility, and identifying risks before and during procedures.

^{Perioperative nurses assist in safely transferring a patient from the operating table following a successful surgery in the operating theatre at TTM Hospital. Photo © WHO / Faizza Tanggol}

As Nurse in Charge, Filipi also carries leadership responsibilities, working closely with the head nurse to oversee theatre operations, support other nurses, plan resources, and ensure that safety systems function effectively. His experience reflects a broader reality that empowered nurses require sustained investment in education, leadership, and supportive work environments to deliver safe care.

“The strength of any healthcare system depends on its nurses,” Filipi said. “When nurses are supported and educated, they are not just caregivers. They are critical decision-makers who directly influence patients’ outcomes. That’s why investing in nursing today is investing in safe healthcare for the future.”