The Nurse Who Transformed Sant Pau’s Operating Rooms

In the late 1960s, the recruitment of nurses with specialized training, the definition of their roles, and the establishment of common asepsis and sterilization standards required a profound transformation of how Sant Pau’s operating rooms were organized. Until then, nursing staff had largely worked under the authority of surgeons.

An article published in the journal Temperamentvm revisits the story of Pilar Masgrau Gomollón, who in 1968 became the first professionally trained nursing supervisor of the Central Operating Rooms at Hospital de Sant Pau. The study was conducted by Neus Buil, a researcher at the Sant Pau Research Institute (IR Sant Pau), and Dr. Paola Galbany-Estragués, a professor at the University of Barcelona’s Faculty of Nursing.

Drawing on an in-depth interview with Masgrau, the study reconstructs her professional career and examines her role in the transition from a model in which much of the work was performed by nuns, unlicensed staff, and scrub nurses personally affiliated with surgeons to a structure composed of qualified nurses with defined responsibilities and their own organizational system.

“Revisiting her career helps us understand the role that nurses such as Pilar Masgrau played in transforming operating rooms and advocating for specialized training, clearly defined responsibilities, and greater decision-making authority for the nursing profession,” explains Neus Buil.

A New Organization for the Operating Rooms

Masgrau had trained as a technical healthcare assistant at the Santa Madrona School and gained experience as a scrub nurse and supervisor at Hospital General de Asturias, one of Spain’s pioneering centers in hospital modernization.

In 1968, she arrived at Sant Pau to lead the reform of the Central Operating Rooms. After helping provide practical training for new surgical nurses, she began the gradual replacement of unlicensed staff and the reorganization of the department between 1969 and 1970.

The transformation introduced nurses specifically trained to work in operating rooms; clearer definitions of professional roles; standardized cleaning, disinfection, and sterilization procedures; and a nursing supervision structure. Masgrau also designed and established a new Central Sterilization Department.

This commitment to training remains a distinguishing feature of Sant Pau today. Nurses joining its operating rooms must demonstrate specialized training in surgical nursing. Historically, they were required to have completed the training provided by Sant Pau’s own school. Today, however, training from other institutions is also accepted because of the shortage of professionals.

This requirement is not standard throughout the healthcare system, where nurses without specialized surgical training may begin working directly in an operating room. This situation reflects the lack of implementation of the medical-surgical nursing specialty, which was approved in 2005 but has yet to be formally established.

“The change was not simply about recruiting qualified staff. It affected the entire culture of the operating room: how responsibilities were distributed, who could establish standards, and the extent to which nurses could exercise their own professional judgment,” Buil notes.

Upholding Standards in the Face of Medical Authority

The transformation encountered resistance from some surgeons, who were accustomed to working with their own scrub nurses. These nurses knew their preferences and sometimes also performed personal or administrative tasks for them.

These tensions came to a head in 1972. When the surgeon responsible for a procedure was absent and could not be reached, Masgrau and the anesthesiologist decided to cancel it, following the "Standing Instructions" approved by hospital management to regulate surgical activity.

After the surgeon complained, the hospital director initially informed Masgrau that she was being dismissed. However, after confirming that she had simply respected the established rules, he reversed the decision and congratulated her on her actions.

During the interview on which the study is based, Masgrau recalled the impact of a nurse—and a woman—deciding that challenged the surgeon’s traditional authority: “It caused an uproar. Everyone in Barcelona heard that an ordinary nurse, an ordinary woman—because they were very sexist at the time—had canceled an operation.”

Shortly afterward, Masgrau left Sant Pau and became the first director of nursing at Hospital Clínic de Barcelona, a position she held until 1982.

“Her career helps bring recognition to the role nurses played in building modern hospitals and sheds light on the long journey the profession has undertaken to achieve greater autonomy,” concludes Neus Buil.

Reference Article:

Buil N, Galbany-Estragués P. Pilar Masgrau, la primera supervisora de los Quirófanos Centrales del Hospital de Sant Pau. Temperamentvm 2026:e16219–e16219. https://doi.org/10.58807/temperamentvm20268275