By The Nursezone Writing Staff
Perioperative nurses (or OR nurses
) handle more than just assistance in the operating room. “Peri-” is the Greek prefix for “around” or “surrounding,” meaning “peri-operative” nurses oversee pre- and post-operative care, as well as intra-surgery assistance. This means that the roles and responsibilities of a perioperative nurse can vary day by day and hospital by hospital.
This vast scope of knowledge is rewarded with above-average pay. In a 2018 survey done by Advance Healthcare Network, the average OR nurse salary for non-certified nurses was $83,684. Becoming a certified perioperative nurse granted a 14% boost in average annual salary, making their average pay $95,321.
To get to this point, nurses need to go through a heavy school and an advanced level of education, as well as a tough training load to prepare for one of the most demanding fields of nursing. Operating rooms involve everything from emergency, life-saving situations to simple procedures, and nurses have to be ready for both. The one component about surgery that separates it from other nursing fields is that anything can go wrong at any time.
Different Roles of an OR Nurse
Within an OR, you’ll see various specialty roles such as holding bay nurses, anesthetic nurses, scrub and instrument nurses, and post-surgery recovery nurses. Each provides his or her care symbiotically with the surgeon and other nurses.
Holding Bay Nurse
Before a patient enters the operating room, they have to be evaluated and educated about what they’re going to experience. Holding bay nurses update the patient while obtaining relevant information such as how long the patient fasted before the surgery, any allergies to medication, and pathology reports. They then relay this information to the surgical team.
Holding bay nurses also ensure that the right person is receiving surgery on the correct side on the correct body part. Mistakes in the operating room, while rare (1 in 112,000)
, are terrifying. Running through a quick checklist with the patient helps minimize these mistakes.
Once the surgery commences, the patient will be unable to advocate for him or herself. The circulating nurse acts as the mouthpiece for the patient. They observe the surgical team to confirm that all proper regulations are followed and provide the team with the necessary equipment. Part of the circulating nurse’s role will take place before the patient enters the operating room. They document patient consent forms and prepare surgical equipment to ensure appropriate instrumentation count.
Instrument and Scrub Nurse
Though in large hospitals you might find these two roles separated, they’re often done by the same nurse. They both rely on a vigilant focus in the room to anticipate any needs the surgeon might have.
The instrument nurse’s duties include sterilizing all surgical supplies and communicating any change in patient vitals.
The scrub nurse handles the equipment in the room, often anticipating the surgeon’s needs and transferring tools appropriately. Communication is key in the operating room, and scrub nurses have to be ready to respond to visual cues, hand motions, and audible commands.
Post-Surgery Recovery Nurse
Once the surgery is finished, patients are considered to be in critical condition. Post-surgery recovery nurses maintain the health of the patient, ensuring clear airways and proper vitals until the patient wakes up. The nurse then takes corrective action for any pain and nausea experienced by the patient, and they are in charge of documenting and administering any medication that the doctor ordered.
Perioperative nurses with years of experience under their belt are allowed to train and test to become an anesthetists nurse. These nurses work under the supervision of the anesthesiologist to prepare and administer anesthesia to patients and to monitor any reactions to the medication.
Certified anesthetist nurses have a higher salary than most other nurses, averaging about $144,063 per year.
Registered Nurse First Assistant
The role of the RNFA depends heavily on the type of hospital and the surgeon in charge. They are trained and equipped to handle surgical equipment, perform some operation tasks, and develop treatment plans with the surgeon.
Some tasks they are allowed to perform are suturing, cutting tissue, providing surgical site exposure, and providing homeostasis.
Their role in the operating room changes if the hospital is a teaching hospital. With surgical fellows and residents available, RNFAs will likely stay on assistant duties.
How to Become an OR Nurse
As mentioned above, education and training are imperative to working in the OR. Because perioperative nurses are assisting in high-stress situations where emergencies can occur at any moment, they must be ready. This includes proper education, certification, and adequate training.
The first step on the path to the OR is education. There are two different degrees you can obtain, both of which allow you to become a registered nurse. The first is earning an Associate Degree in Nursing (ADN). This is typically a two-year program where students focus on the primary classes needed to pass the NCLEX (the examination to become a registered nurse).
The second option is to obtain a Bachelor of Science in Nursing (BSN) from an accredited four-year institution. These programs will require you to take general education classes as well as the nursing program to complete your bachelor’s degree. Although it takes twice as long, BSNs are looked on favorably by hiring managers. Plus, the extra time studying will greatly improve your chances of passing the NCLEX.
One option many nurses consider is to obtain an ADN to become a registered nurse and then complete an RN to BSN program. This will allow you to gain work experience and job training while still studying for the preferred degree.
Once you’ve completed an ADN or BSN program, you’re eligible to take and complete the National Council Licensure Examination
(or NCLEX). This exam is offered through the NCSBN and is a six-hour examination with up to a possible 265 questions.
The NCLEX is a computer-based software that determines in real-time how well you’re performing. It could shut off as early as question 75, or it could take up to the full 265. Whether you pass or fail, you will be notified immediately before leaving the testing center.
If you pass, you will officially be a registered nurse and can begin applying to hospitals.
Operating Room Experience
Before working in an operating room, most hospitals require some form of training. You might start out shadowing a holding bay nurse or post-operative nurse to understand how patients rotate in and out of the OR. From there, you might receive one-on-one training with the set-up procedure and identification of various surgical equipment. Once you understand how the process works, you’re then likely to be a spectator in the room.
Gaining this experience and preparing for the operating room can happen in one of three ways.
Many hospitals will provide on-the-job training once the registered nurse has worked for a certain number of years and has expressed interest. As mentioned above, this training happens in a step by step fashion, slowly integrating the nurse with the careful proceedings of the operating room.
The Association of Peri-Operative Registered Nurses
(or AORN) offers core curriculum courses in perioperative care. There’s coursework in anesthesia, equipment sterilization and safety practices, patient care, and surgical draping. The courses couples clinical experience with lab experience to give you the full picture of how an OR works.
One note about Periop 101. This is a course designed to help nurses with little to no experience gain insight into what being an OR nurse is. This is not a certification program (which will be discussed below).
Working in Similar Fields
Certain hospitals will also consider any experience in other high-stress fields like emergency nursing or critical care units to be sufficient for starting in an operating room. Although, keep in mind the intra-operative training is unique to the room and will require many hours of studying and training to be fully prepared.
Becoming a Certified Nurse
There are two different certifications OR nurses can receive. One option is to become CNOR certified; the other is to be a Certified Registered Nurse First Assistant (or CRNFA).
The certification programs run through the Competency and Credentialing Institute
(or CCI), and the NASC (or National Assistant at Surgery Certification
), respectively. These organizations provide credentialing to qualified perioperative nurses who have trained for many years and studied to complete a rigorous exam. The exams are unique to the individual field, and they test nurses on their ability to provide quality patient care and perform all duties at an exceptional level.
Becoming CNOR certified
means to master the vast body of knowledge related to surgery, surgical nursing, and the application of this into clinical practice. The difference between obtaining a license and a certification is that a license denotes competence, certification is for proficiency.
To be eligible for the CNOR exam, you must complete 2,400 hours of perioperative nursing experience, and 1,200 of those hours must be in the operating room. When applying for the exam, you must have an unrestricted RN license and be working full-time or part-time.
The job responsibilities of an RNFA are mentioned above. To become credentialed, nurses must complete a 180-question exam in 225 minutes. This provides a little over one minute per question, and all questions must be completed.
The areas tested will be in the following: Basic Sciences, Professional Practice, Intraoperative Techniques, Assessment Techniques, and General Skills.
Benefits of Being an OR Nurse
Besides receiving an above-average salary, there are many benefits of being an OR nurse.
Reduced Patient Load
In many nursing fields, you can be juggling up to four patients at a time. This means keeping straight four different diagnoses, charts, and medical needs. This can be overwhelming at times, especially when the patients are in critical care units like the emergency room or when you’re dealing with younger patients in pediatrics with specific needs.
In 2004, California implemented a law that’s known as the Nurse Staffing Ratio Law
. This places a limit on different nursing specialties for how many patients they can be in charge of at one time.
For perioperative nurses, that limit is one. Operating room nurses manage one patient at a time as they come in for surgery and during recovery. This eases the stress on OR nurses prior to surgery and ensures that mistakes do not happen.
For many general practitioner nurses, the results of your efforts may be a simple thank you at the end of each session. For perioperative nurses, you are dealing with life-threatening situations and scared patients. Surgery, no matter how inconsequential, comes with risks, and patients are well aware of that. Every patient that comes through your care is better off in the end—it’s an incredibly rewarding experience.
Bonding With Your Team
Because of the importance of effective communication while in the operating room, nurses develop strong bonds with their coworkers. This includes the surgeon. One role of scrub nurses is to anticipate the needs of the surgeon, and that requires a type of communication that goes beyond speaking.
Opportunities to Grow
There are few occupations as intense as working in an operating room with a life-threatening surgery in progress. Nurses have to be focused for many hours at a time, where any hesitation or second-guessing can have fatal effects for the patient. In return for this work, OR nurses are able to transfer to many different fields of nursing (without much resistance). They’re also able to continue developing their skills to reach new career opportunities with even higher salaries.
One aspect of the job that hasn’t been touched on is how not all surgeries are a success. Working close to an operating table means severe complications and even losing patients. OR nurses are emotionally resilient and can cope with the stress that comes with the territory.
Perioperative Nursing: An Overview
Working in an OR is no easy task. Surgery is one of the most stressful acts a body can endure, and it’s always reserved as a final solution. For this reason, many patients come in with anxiety and fear. As a perioperative nurse, you’re there to assuage their worries and to prepare them for what’s to come.
Inside the OR, nurses are the backbone of surgery. Surgeons rely on his or her dedicated team to monitor the patient’s vitals, exchange tools, and provide any assistance necessary while the procedure is underway.
Once the surgery is complete, perioperative nurses are in charge of monitoring their patients until they’ve recovered. In exchange for this dedicated care, OR nurse salaries are higher than the average, and they receive extensive career opportunities.