Enhanced recovery after surgery: the nursing elements
- Fundamental
Enhanced recovery is a bundle of proven steps before, during and after surgery that helps patients recover faster with fewer complications.
What it is
Enhanced recovery after surgery (ERAS) programmes replace traditional habits (long fasting, routine tubes and drains, bed rest) with a coordinated set of evidence-based elements. The ERAS Society publishes guidelines by type of surgery; most share common themes: patient education, prehabilitation and stopping smoking and alcohol, short fasting, prevention of nausea and vomiting, keeping a normal temperature and fluid balance, opioid-sparing multimodal analgesia, avoiding or removing tubes and drains early, early nutrition, early mobilisation, thromboprophylaxis and audit of compliance. Many of these elements are carried out or checked by nurses, which makes nursing central to the programme.
Key points
- ERAS is a team pathway: surgery, anaesthesia, nursing, nutrition and physiotherapy work from the same plan.
- Routine nasogastric tubes are not recommended after colorectal surgery.
- Routine urinary catheters should be avoided or removed as soon as the patient can void, in the hip and knee consensus ideally within 24 hours.
- The recommendations differ by type of surgery; each institution adapts the guideline that applies.
Components
- Preoperative: counselling and education, nutrition screening, prehabilitation, smoking and alcohol cessation, short fasting.
- Intraoperative: nausea and vomiting prophylaxis, normothermia, balanced fluids, regional and multimodal analgesia.
- Postoperative: early oral intake, early mobilisation, early removal of tubes and drains, VTE prophylaxis, criteria-based discharge.
- Organisation: a multidisciplinary team, a written pathway and audit.
What it is for
- To reduce the body's stress response to surgery.
- To lower complications such as infection, ileus, pneumonia and thromboembolism.
- To shorten the hospital stay without raising readmissions.
- To give the patient an active role in their own recovery.
In nursing practice
- Nurses teach the plan before surgery, so the patient knows they will be asked to drink, eat and walk early.
- Nurses record daily mobility, intake, pain and nausea, which are the measures audited.
- Nurses encourage the patient out of bed on the day of surgery or the next day, as the pathway allows.
- Nurses check the discharge criteria (pain controlled, eating, walking, voiding) and give the discharge teaching.
Common mistakes
- Fasting the patient from midnight by habit, against the pathway.
- Keeping catheters and drains «until tomorrow» without an indication.
- Treating ERAS as a list of tasks without explaining it to the patient.
- Not recording the elements, so compliance cannot be audited.
Test yourself
Think of the answer, then tap the question to see it.
Which ERAS elements do nurses carry out or check after surgery?
Early mobilisation, early eating and drinking, early removal of urinary catheters and drains, nausea and pain control, and checking discharge criteria.
What do ERAS guidelines say about urinary catheters?
Routine catheters should be avoided or removed as soon as the patient can void; the hip and knee consensus suggests ideally within 24 hours.
Why are ERAS elements audited?
Because higher compliance with the pathway is linked to shorter hospital stays and fewer complications, and audit shows where the team can improve.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Enhanced recovery after surgery: overarching themes of the ERAS Society guidelines and consensus statements for adult specialty surgery (Perioperative Medicine, open access (PMC), 2025); Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations (Acta Orthopaedica, open access (Europe PMC), 2020); Global guidelines for the prevention of surgical site infection, second edition (World Health Organization (WHO), 2018).
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Representative model, for educational purposes only.