Is Perioperative Nursing Right for You?
Are you a checklist person? Think you would enjoy working with a tightly organized team, using high-tech equipment? If you’re looking for a satisfying career where you’ll help keep patients safe and learn about complex surgical procedures, perioperative nursing might be the right role for you.
On any given day as a perioperative nurse, you might sit by a patient’s side to comfort them before they enter a serious procedure, assist with preparing a room for surgery, and help run a code blue during another procedure. While this specialty role has some benefits of routine and schedule, it’s also varied and challenging, with opportunities for professional development and career advancement.
Perioperative nurses work wherever surgeries are performed, from large medical centers to stand-alone facilities, such as:
- Hospital operating rooms and surgical suites
- Ambulatory surgery centers
- Specialty surgery clinics
- Military and veteran’s hospitals
- Academic medical centers
- Private surgical practices
- Research institutions
- Medical mission and humanitarian organizations
- Mobile surgical units
What Is Perioperative Nursing?
Periop nursing is a range of roles that help care for patients before, during, and after surgery. This specialty is also sometimes called operating room (OR) nursing or surgical nursing, but perioperative is a broader term that includes professionals in the pre-op and post-procedure areas.
Perioperative nurses can work in any of the three phases of surgery. Typically, nurses who work in pre-op and post-op (PACU) will rotate to those areas between shifts. OR nurses and other surgical clinicians remain in their roles from shift to shift. You’re probably wondering, what are the three phases of perioperative nursing, and what nursing professionals assist in each phase? Let’s break them down:
1. Preoperative Phase
A pre-op nurse prepares patients for surgery, ensuring that informed consent is completed, patients have been NPO (nothing by mouth), and that they have IV access if it is needed.
2. Intraoperative Phase
Surgery can be complex. Once a patient is prepared and has entered the surgical suite, there are several nursing professionals who may be involved in their care:
- Scrub nurse: Maintains the sterile field in the operating room, handing instruments and supplies to the surgeon during the procedure.
- Circulating nurse or nurse circulator: Manages the overall environment of the operating room, coordinating care, and ensuring patient safety by facilitating communication among the surgical team.
- RN first assistant: An RN with advanced training who assists the surgeon directly during surgery, performing tasks like suturing and tissue handling.
- Surgical nurse practitioner: An advanced practice nurse who provides comprehensive perioperative care, including preoperative assessment, intraoperative assistance, and postoperative follow-up.
- Nurse anesthetist (CRNA): A specialized nurse who administers anesthesia to patients and monitors their vital signs during surgery, ensuring a safe anesthetic experience.
3. Postoperative Phase
Once a patient’s procedure is complete, their recovery begins. Post-Anesthesia Care Unit (PACU) nurses monitor and care for patients as they recover from anesthesia immediately after surgery.
What Is It Like to Be a Perioperative Nurse?
Being a perioperative nurse is all about staying sharp, working fast, and keeping cool under pressure. The surgical suite is a high-risk area, where patient safety is the utmost priority. Whether you work in pre-op, the OR, or the PACU, you’ll have checklists and workflows of tasks that must be done timely. You’ll also need to adapt to changes in patient status, which can take a turn quickly. These factors can make periop nursing challenging — yet also rewarding.
Perioperative nursing is different from inpatient areas (such as med-surg, ICU, and cardiac nursing), because you’ll typically be completely focused on one patient at a time for a shorter period of your shift. As a floor nurse, you might be assigned five patients for your entire workday. In periop, you might see eight patients in a day, but each of their procedures might be only 30 minutes long.
Depending on the surgical area, you might have much less patient interaction than other patient-facing roles. For example, if you’re the scrub nurse, your patient might be anesthetized for the whole procedure. It’s still your duty to advocate and watch out for your patients, even if they can’t speak for themselves.
Surgical nurses work with complex technology and equipment, which aren’t seen in other areas. Advances are being made every day to improve patient safety and reduce surgery invasiveness. Some tools you might see in this area include:
- Surgical robots: Enhance precision and control during surgery with robotic arms that surgeons manipulate from a console.
- Electrosurgical units: Devices that use electrical currents to cut tissue or control bleeding during surgery.
- Laparoscopic instruments: Graspers and cameras designed to help surgeons operate through small incisions rather than creating large cuts.
- Surgical lasers: Light beams that cut, vaporize, or coagulate tissue.
Surgical nurses are part of a specialized team. You’ll work closely with surgeons, physician’s assistants, nurse practitioners, nurse anesthetists, surgical technicians, and other professionals. Communication is essential in this role, both with patients and the people you work with.
Pros and Cons of Perioperative Nursing
This unique nursing role has benefits and some potential drawbacks. Here are some of the things nurses might enjoy about working in the periop setting:
- Continuous skill development: Surgical nursing offers the chance to develop specialized technical skills, and there’s always more to learn in this area.
- Team collaboration: You’ll have the opportunity to develop strong bonds with your colleagues because you’ll work closely with a range of professionals.
- Specialization and advancement: There are several ways to advance your career in surgical nursing, such as pursuing CRNA credentials, becoming first assistant, or ascending to OR manager.
- Schedule: Many ORs don’t operate on nights, weekends, or holidays, so you may work more regular hours in this role.
There are also a few potential drawbacks of working in the perioperative setting, such as:
- Physically demanding: You might need to assist with lifting and moving patients, and standing for long periods is common in this role.
- Stress: While the OR is very organized, every surgery has risks. Patients can deteriorate quickly, and it’s up to staff to anticipate and respond to life-threatening emergencies.
- Accountability: Mistakes can be very serious in the OR. For example, if you’re the scrub nurse and you miscount supplies, a tool can be left inside a patient.
- On-call: Depending on where you work, you may be asked to take on-call hours and be available for last-minute or emergency procedures.
Perioperative Nurse Salary Expectations
The average staff nurse in the operating room makes $87,245 per year, but it varies based on your certifications, experience, education, and where you live. Earning advanced degrees and credentials can help you become a more competent surgical nurse, and help you make more income.
Location plays a big factor in your take-home pay as a nurse. Here are some of the highest-paying states for nurses
How to Become a Perioperative Nurse
Becoming a perioperative nurse can take as little as three years. You’ll need to complete a vocational program or graduate from nursing school, and OR nurse roles sometimes require experience in other areas. Here are the steps to becoming a perioperative RN:
Step 1: Attend Nursing School
First you’ll need to learn the basic skills to provide care and advocate for patients. Nursing school will help you lay a foundation of knowledge — you’ll take classes like pharmacology, pathophysiology, medical-surgical nursing, and more.
There are three different programs that will help prepare you for surgical nursing; licensed professional nurse (LPN) training, an associate degree in nursing (ADN), or a bachelor of science in nursing (BSN) degree. Becoming an LPN is the fastest route, but you’ll have a more narrow scope of practice and job opportunities. A BSN is the preferred degree and will help train you for a broader range of roles. Learn more about the types of nursing degrees and credentials.
Step 2: Become Licensed
Once you’ve graduated, you’ll need to become licensed before you can practice as a nurse. If you completed LPN training, you’ll need to pass the National Council Licensure exam for practical nurses (NCLEX-PN). If you completed an ADN or BSN degree, you’ll take the NCLEX-RN to gain your registered nurse license. Passing the NCLEX shows that you have the baseline knowledge to keep patients safe and perform the duties of a nurse. Learn more about the NCLEX exam.
Step 3: Gain Experience
It’s common for new nurses to gain experience in another area before transitioning into surgical care. Working on a med-surg floor, for example, will offer opportunities to care for patients with a broad range of issues. If you have a specific surgical specialty you’re interested in, such as cardiac or oncology, you might want to seek out experience in that area to learn more about common diagnoses, medications, and procedures in that patient population.
If you live near major medical centers, you may be able to enter perioperative nursing as a new graduate nurse. New grad residency programs help nurses transition into professional life and the responsibilities of patient care, and some facilities offer new grad jobs in the OR.
Step 4: Enter Perioperative Nursing
Entering the OR typically involves more training than other areas, because it’s a highly specialized area with specific skill requirements. You’ll likely need to complete several months of on-the-job training when you onboard into the OR. Large facilities also offer perioperative training program for nurses, where you’ll attend classes and work with a preceptor before taking your own patients.
Earning a perioperative nurse certification is a great way to deepen your confidence and potentially increase your income as a periop nurse. Getting certified involves meeting eligibility requirements, paying a fee, and passing an exam. You’ll also need to maintain your certification in order to remain active. Here are some of the leading certifications for perioperative nurses:
- Certified Perioperative Nurse (CNOR): requires an RN license with two years of experience, paying an application fee, and completing a 200-question exam.
- Certified Registered Nurse First Assistant (CRNFA): Requires an RN license with a BSN degree, 2,000 hours of experience as First Assistant, and completing a Professional Portfolio.
- Certified Post Anesthesia Nurse (CPAN): Requires an RN license, 1,200 hours of clinical experience, an application fee, and completing an exam.
- Certified Ambulatory Perianesthesia Nurse (CAPA): Requires an RN license, proof of at least 1,200 hours of direct clinical experience in preanesthesia, day of surgery/procedure, post-anesthesia phase II, and/or extended care settings in the two years before applying for initial certification. You must also pay an application fee and complete an exam.
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