Is Being an OR Nurse Right for You?

If you’re attentive to detail and you like working with an interdisciplinary team, you might want to consider being an operating room (OR) nurse. These nurses can also be known as a perioperative nurse or circulating nurse, and they help keep patients safe during surgeries. The role of an operating room nurse requires unparalleled organization, quick thinking, and a deep understanding of surgical techniques and patient care.

An operating room is sometimes called an operating suite or surgical suite. It’s a specialized area within a hospital that’s designed for invasive surgical procedures. This meticulously controlled environment is equipped with advanced instruments, sterile supplies, specialized lighting, and state-of-the-art monitoring equipment.

Not every hospital has an operating room. On the other hand, ORs can also be free-standing surgery centers or ambulatory surgery centers. Professionals in these facilities carry out a range of surgeries. Some of the most common surgeries performed in the U.S. include:

• Cesarean sections
• Appendectomies
• Cataract surgery
• Coronary artery bypass
• Skin grafts
• Breast biopsies
• Carotid endarterectomy

To help perform these essential surgeries, ORs are staffed by an interdisciplinary team, including surgeons, DNAPs, anesthesiologists, nurses, surgical techs and CVOR techs. Each has a specific role in supporting patient care — whether it’s the anesthesiologist monitoring vitals or the surgical tech preparing instruments, each person has a specific skill set.

What Is OR Nursing?

OR nursing is a specialty that supports patients during surgical procedures. Going in for surgery is one of the most vulnerable times in someone’s life. Every surgery has risks, and many patients go in with complex health histories. These patients trust the OR team with their bodies and their lives, and that’s not something to take lightly. Nurses are advocates during surgery. They perform safety checks, ensure informed consent, keep a sterile environment, supervise patient positioning, and more.

OR vs. PACU Nursing

Perioperative nursing is not to be confused with pre-op or PACU nursing, although in some smaller hospitals nurses will cycle through each role. The pre-operating area (pre-op) and post-anesthesia care unit (PACU) help support the OR by getting patients ready for surgery and helping them recover afterwards. Compare the OR duties below to those found in ads for PACU nurse jobs.

What Does an OR Nurse Do?

An OR nurse is responsible for keeping patients safe during routine and emergent surgical procedures. This might include getting the room ready, maintaining a sterile field, monitoring a patient’s vitals, and assisting the surgeon.

OR nurses may also go by these names, which designate separate roles within the operating room:

• Scrub nurses get the OR ready for each case. They sterilize the room, make sure equipment is ready, and might pass surgeons supplies during the case.
• Circulating nurses support the OR by prepping patients and providing supplies to the team. They might answer phones or notify patients when the team is running late.
• First assistants (RNFAs) directly assist the surgeon during a case. They perform essential tasks like monitoring vitals, holding the site, controlling bleeding, and suturing.

It can be hard to imagine yourself in the operating room. For an idea of what might be asked of you, it can be helpful to look at the latest RN operating room jobs. Here’s a brief list of common OR nurse duties you might expect.

Pre-Surgery OR Nurse Duties

You and the surgical tech will get the room ready for each patient and case. You review the type of surgery that’s being performed and make sure that the right tools are sterile and ready. Sometimes you might pull medications that could be needed during a case. Then you’ll do an initial supplies count, which helps ensure that nothing is left inside the patient after closure (this is less rare than you think).

Once the room is ready, you’ll go to the pre-op area to bring a patient into the OR. You’ll do a complete handoff with the pre-op nurse and go over any medication allergies or risks the patient has for surgery. Before bringing a patient back, you verify their identity and medical record number. These checks will happen several times before surgery, and they’re an essential part of surgical protocols.

Intra-operative OR Nurse Duties

In the OR, you’ll lead a time out to ensure that every team member agrees on the patient’s identity, the surgery they’re getting, and the site of that surgery. The surgeon usually marks the site while the patient is in pre-op, but every check helps ensure patient safety.

Proper patient positioning is essential in the operating room, because patients can’t advocate for themselves if they’re uncomfortable. You help ensure that a patient is positioned in alignment, and that they have proper padding to avoid pressure injuries. You also help prepare the sterile drape once a patient is situated.

During surgery, you keep patients safe through several continuous checks. You monitor the sterile field to be sure it’s intact and count supplies again to ensure that none are left in the patient. You’ll also need to speak up if you feel that a patient is unsafe, like if an electrosurgical device burns a patient’s skin, or if there’s a communication breakdown within the team.

OR nurses also monitor vital signs and document throughout surgery; you’ll note the exact time that surgery began, as well as other timeline events in the chart. If a patient has an adverse reaction to anesthesia — such as a malignant hyperthermia — you’ll assist the team in response.

OR Nurse Duties After Surgery

You do a final supplies count, and the surgeon will close the surgical site. You help remove the sterile drape, move the patient onto a mobile bed, and get them covered up. Then, you’ll help wheel them out of the OR and into the PACU.

With the PACU nurse, you’ll do a detailed handoff of the patient’s history and how the surgery went. If any complications happened, the PACU nurse will need to know. Depending on the anesthesia, patients may take a little while to wake up after surgery. Sometimes patients are discharged home from the PACU, and sometimes they’ll remain in the hospital to recover.

This gives you an idea of what perioperative nursing responsibilities may include during a typical case, but remember that every patient and surgery is different. Some OR nurses might work in a more specialized setting, such as orthopedics or plastic surgery.

OR Nurse Salary

The average OR nurse salary is around $87,100 per year in the U.S. The range for a perioperative nurse salary depends on location, experience, and certifications. To find out what you might earn in your location, check out the latest OR nurse jobs on IntelyCare.

The Pros and Cons of Being an Operating Room Nurse

Every nursing specialty has benefits and drawbacks. The OR is very different from other acute care areas. You won’t find yourself passing morning medications, and most of your patients won’t be able to talk to you. What you like or dislike about being a nurse in the OR will depend on your personality and which parts of patient care you enjoy.

Here’s a list of things that make the OR an attractive specialty for many nurses:

• Focus: You only have to worry about one patient at a time. There are typically fewer tasks to juggle in the OR because everyone is focused on the case at hand.
• No visitors: There’s no family in the OR. Some OR nurses rotate out to pre-op or PACU, so they might see some visitors, but compared to floor nursing there’s much less family interaction.
• Documentation: Charting in the OR is different from the floor. They use a focused documentation approach to contribute to surgical records.
• Camaraderie: Since OR nurses work closely with an interdisciplinary team, group rapport and mutual respect are essential. It’s not uncommon to get to know anesthesiologists, surgeons, X-ray and surgical techs.
• Support: There’s less uncertainty in the OR because if a patient codes, the anesthesiologist is already there.
• Variation: Every case is different, so you’ll get the chance to see interesting surgeries and procedures.
• Scheduling: Most ORs don’t run on weekends, evenings, or holidays. Staff might be on call for an emergency case, but you’ll mostly work on weekdays.
• Early leave: If your cases are done early, you can go home. There’s usually no hanging around for shift change in the OR.

On the other hand, here are a few reasons why the OR might not be for you:

• On-call shifts: While it’s less common to work evenings, weekends, or holidays, OR nurses often rotate on-call shifts. If an emergency happens, you need to be ready to come into work to assist.
• Standing: Some cases can go for hours, but you’ll need to remain attentive. If you have trouble standing for long periods of time, you might have difficulty in the OR.
• Temperature: ORs are often kept cold because surgeons wear several layers of sterile gowns. While this practice has come under criticism, it still persists in some surgical suites.
• Less interaction: While it’s actually good to speak to patients during surgery, you likely won’t get a response.
• Intimidation: Anesthesiologists and surgeons can be known for their egos. When safety events do happen, it can be hard to speak up in the OR. You’ll need to be confident in your own skill set to succeed in this field.
• Adjustment: The OR is very different from floor nursing, and it can take a while to get used to it.

How to Become an OR Nurse

Every RN needs an associate degree (ADN) or bachelor’s degree in nursing (BSN). Increasingly, BSN credentials are being required in the OR. After that, you’ll need to pass the NCLEX exam to become a registered nurse. Once you can practice, you can update your operating room nurse resume. Keep in mind that there are specific OR nurse requirements you’ll need to complete.

Specialty training may include:

• Operating room nurse residency: If you’re a new grad interested in specializing in the OR, you might be able to jump right in. New grad nurse residency programs in the OR are becoming increasingly common.
• Operating room training: If you already have nursing experience, training programs in the OR typically run for 6 to 12 months.
• Advanced cardiac life support (ACLS): Most nursing jobs require a Basic Life Support (BLS) certification, and increasingly, nurses are asked to get their ACLS certification as well.

You can pursuing additional OR nurse certification through the perioperative Competency and Credentialing Institute:

• Certified Foundational Perioperative Nurse (CFPN)
• Certified Perioperative Nurse (CNOR)
• Certified Ambulatory Surgical Nurse (CNAMB)

Perioperative nurses also have the opportunity to expand their scope of nursing practice with first assistant education. This is an advanced practice (APRN) role, similar to a nurse practitioner or a nurse anesthetist.

Find Great Critical Care Positions on IntelyCare

An OR nurse has specialized education, clinical experience, and a commitment to patient safety. Want to know where your skills could be put to use? Find out how IntelyCare can match you with the latest nursing jobs in your specialty.