This paper reports the findings of a qualitative study in which the aim was to explore nurses' perceptions of competence in the unique context of the operating room (OR). Three focus groups were conducted with 27 OR nurses from three large metropolitan hospitals in southeast Queensland. Analysis of textual data identified the category 'managing and coordinating the flow of the list'. Within this overarching category, four sub-categories - 'coordinating and negotiating competing priorities', 'leading', 'adapting and being flexible' and 'using the big picture perspective' - were important aspects of clinical competence. Findings indicated that coordinating human and material resources, and negotiating the flow of the operating list were not confined to the OR manager; rather, OR nurses at all levels of practice need to develop competence in these areas. These findings validate the importance of the role of the OR nurses who coordinate patient care within the theatre itself. Therefore, mentorship and education of less experienced OR nurses in relation to managing patient flow, problem solving, prioritising and managing intradisciplinary conflicts is essential if nurses are to develop these aspects of competence.