Become an Operating Room (OR) Nurse in 3 Steps

What is an OR Nurse?

An operating room nurse is a registered nurse who works closely with the surgical team in the operating theater. Their job is to care for patients before, during, and after surgery, ensuring patient safety and providing the surgical team with the necessary resources.

Becoming a perioperative nurse involves specific educational requirements. Obtaining advanced certifications beyond the basic requirements can improve job prospects in this field.

Roles of OR Nurses

There are generally two main roles for registered nurses (RNs) within the operating room.

• Circulating Nurse (Circulator): The most common role for RNs in the operating room is that of the circulator. Circulators do not scrub in for surgery, meaning they do not handle sterile items or touch the surgical site. Instead, they manage the operating room, ensuring everything is prepared, and assist with patient positioning, anesthesia, and other responsibilities.
• Scrub Nurse: A scrub nurse handles sterile instruments and assists the surgeon directly. While some hospitals train RNs to fulfill both roles, many scrub techs, who may or may not hold certifications, fulfill this position.

Some nurses with extensive OR experience may have started as scrub techs or have some scrub experience. The scrub nurse’s duties include setting up the sterile field and providing sterile instruments to the surgeon.

Examples of procedures OR nurses may be involved in include:

• Minor lumpectomies
• Meniscus repairs
• Extremity surgeries
• Robotic-assisted laparoscopic cholecystectomy
• Breast biopsies
• Arthroscopies
• Total joint replacements
• Urology procedures

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Preoperative Responsibilities

These tasks involve preparing for the surgery, including setting up the room and assessing the patient. Key actions might include:

• Setting up the OR suite: Collaborating with the scrub tech to open sterile items, counting surgical sets, and preparing medications and fluids.
• Ensuring equipment is functional.
• Configuring the OR table for patient positioning and gathering necessary aids.
• Verifying consents in the preoperative area.
• Assessing the patient preoperatively and double-checking lab results.

Intraoperative Responsibilities

These duties begin when the circulator and anesthesia provider enter the operating room:

• Assisting the patient onto the OR table.
• Supporting anesthesia during IV placement and patient intubation.
• Positioning the patient correctly to avoid injury during surgery.
• Applying surgical prep to the designated sites.
• Conducting a surgical time-out before the first incision.
• Monitoring equipment and passing medications to the surgical field.
• Keeping accurate counts of surgical instruments and items.
• Ensuring sterile technique adherence by all team members.
• Documenting the procedure.
• Communicating with the patient's family or loved ones.
• Handling specimens or surgical implants.
• Performing counts at the surgery’s conclusion and transferring the patient to PACU with anesthesia assistance.

Postoperative Responsibilities

Post-surgery duties focus on safe recovery from anesthesia and effective hand-off to PACU. These involve:

• Assisting the anesthesia provider during anesthesia recovery.
• Transferring the patient from the OR table to a stretcher.
• Providing a report to the PACU nurse.
• Collaborating with the scrub tech and support staff to prepare the room for the next procedure.

Where are OR Nurses Employed?

• Hospitals: Many OR nurses work in hospitals, where the range of surgical services and complexity can vary greatly. For example, a Level I trauma center handles complex emergency surgeries, while a Level IV trauma center focuses on lower-acuity procedures.
• Outpatient Surgery Centers: OR nurses can also work in outpatient surgery centers for procedures that do not require overnight stays. Many nurses prefer outpatient settings as they typically do not require being on-call, unlike hospital-based roles. More than half of elective surgeries in the U.S. are performed as outpatient procedures.

Common outpatient procedures may include:

• Urology procedures
• ENT procedures
• Robotic surgeries (e.g., robotic-assisted laparoscopic cholecystectomy)
• Breast biopsies
• Arthroscopies
• Total joint replacements

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Additional Roles for OR Nurses

• RN First Assistant (RNFA): The RN First Assistant is an RN with advanced surgical experience and additional training and certification. The RNFA acts as an assistant to the surgeon by scrubbing in and handling sterile instruments. Unlike scrub techs, they can dissect tissue and close surgical wounds.
• Advanced Roles: Surgeons may require extra help during complex procedures, often involving other healthcare professionals like Physician's Assistants, Nurse Practitioners, or RNFAs.

Steps to Become an OR Nurse in 3 Steps

1. Obtain a Nursing Degree:
   Educational paths include:After earning a degree, aspiring OR nurses must pass the National Council Licensure Examination (NCLEX-RN).
   • Associate Degree in Nursing (ADN): This is the minimum requirement for RN licensure but may limit OR career opportunities.
   • Bachelor of Science in Nursing (BSN): Typically completed in four years. Many employers prefer or require this degree. RN-BSN programs, often funded through tuition reimbursement, can be completed online in 12-18 months.
2. Gain Experience:
   While some employers hire new graduates directly into the OR, most prefer candidates with at least one year of acute care experience. Many hospitals offer transition programs to help experienced nurses move into the OR. Certifications like Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) may also be required.
3. Obtain Certifications:
   Many employers prefer hiring certified OR nurses. After gaining two years of full-time experience, nurses can take the Certified Perioperative Nurse (CNOR) exam.

Career Advancements for OR Nurses

After gaining experience, OR nurses can explore various career paths, such as:

• Representing companies that manufacture surgical implants or equipment
• Becoming nursing educators
• Coordinating organ recovery or transplant processes
• Taking on management or administrative roles

Salary and Job Outlook for OR Nurses

According to the Bureau of Labor Statistics (BLS), the average annual income for registered nurses is $82,750, or $39.78 hourly. Specialized nurses, like OR nurses, often earn more than general RNs. Data from GoodWork suggests OR nurses earn an average of $92,800, with variations based on experience, facility, and education.

The BLS projects a 6% job growth rate for the nursing sector from 2021 to 2031, which is a positive outlook compared to many fields.

FAQs:

• What is an OR nurse?
  An OR nurse is a registered nurse who works with the surgical team, managing patient care throughout surgical procedures.
• How much does an OR nurse earn?
  The average salary for OR nurses is $92,800 annually.

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