Become an Operating Room (OR) Nurse in 3 Steps

Nurse Types / OR Nurse

The nursing field is one of the most diverse subsets within healthcare. There are numerous specialties for a nurse to choose from. The operating room is an excellent option for RNs that may not want to work as a traditional “bedside nurse” on an acute care unit.

In this article we will explore:

• What is an OR nurse?
• What do OR nurses do?
• Where do OR nurses work?
• What are the types of OR nurses?
• How do you become an OR nurse in 3 steps?
• What are some career opportunities of OR nurses?
• What are the salary and job outlooks for OR nurses?

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What is an OR nurse?

An OR nurse is an RN that works as a part of the surgical team in the operating room. They take care of patients prior to, during, and immediately after surgical procedures. The OR nurse is in charge of all aspects of patient safety and ensures that the members of the surgical team have what they need in order to perform their duties.

Requirements to operate as a perioperative nurse vary after receiving a nursing degree. Going above the bare minimum and pursuing further certification increases your value. It also helps your chances of securing quality employment as an OR nurse.

What do OR nurses do?

There are two main roles for the RN in the OR.

First, and most common today, is the circulating nurse or “circulator.” The circulator does not “scrub in” for the surgery, meaning that they are not handling sterile items or touching the surgical site during the procedure. The remainder of this article will focus on the role of the circulator, as this is the role that most RNs in the OR will fill.

The second role is the scrub nurse. Some hospitals will cross-train RNs to both circulate and scrub, but the majority will have a scrub tech/surgical tech in this role. A scrub tech will sometimes obtain certification if the hospital requires it. However, they are not licensed like an RN.

Many RNs who have worked in the OR for the majority of their careers have some scrub experience, or possibly even started as a scrub tech. The scrub nurse sets up the sterile field and hands sterile instruments to the surgeon.

• Minor lumpectomy
• Meniscus repair
• Procedures that involve extremities.
• Robotic surgeries such as robotic-assisted laparoscopic cholecystectomy
• Breast biopsies
• Arthroscopies (looking into a joint with a camera),
• Total joint replacements (example: some total knee replacements can be done as an outpatient procedure), 
• Urology procedures

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Preoperative duties

These are the duties carried out by the nurses before the surgery starts.  Generally, these duties involve room preparation and patient assessment. Some of these activities include:

• Preparing the OR suite for surgery. This includes assisting the scrub tech in opening sterile items, counting all surgical sets, soft goods and sharps (to prevent retained surgical items), and preparing medications and fluids.
• Ensuring that all necessary equipment is present and functioning.
• Ensuring that the OR table is in the proper configuration for the desired. positioning of the patient; gathering any positioning aids that will be needed.
• Checking consents in the pre-op area.
• Performing an assessment of the patient in the pre-op area, double-checking labs.

Intraoperative duties

These are the duties carried out by the OR nurse as soon as the circulator and anesthesia provider enter the operating room. These duties include:

• Helping the patient move to the OR table.
• Assisting anesthesia during IV placement, anesthesia induction, and intubation, potential arterial line placement.
• Positioning the patient in the appropriate position for the surgery, using any positioning aids as necessary to avoid patient injury during the procedure.
• Applying a surgical prep to the surgical site(s).
• Performing a surgical “time out” prior to the first incision/beginning of the procedure.
• Monitoring all equipment.
• Passing medication to the surgical field.
• Maintaining an accurate count of all countable soft and sharp items, all surgical instruments.
• Ensuring that all surgical team members adhere to sterile technique.
• Documentation of the procedure.
• Updating patient’s family/loved ones.
• Handling of any specimens or surgical implants.
• Performing a count at the end of the surgery with the scrub tech.
• Transferring the patient to PACU with the anesthesia provider and providing a hand-off report to the PACU nurse.

Postoperative duties

Postoperative duties center around appropriate emergence from anesthesia and safe hand-off to PACU. These include:

• Assisting the anesthesia provider during the emergence of anesthesia.
• Helping transfer the patient from the OR table to the stretcher.
• Providing the hand-off report to the PACU nurse.
• Assisting the scrub tech and other unlicensed assistive personnel with room turnover for the next case to follow.

Where do OR nurses work?

Hospitals

Many OR nurses work in acute care hospitals. The service lines offered and the complexity of the surgeries very greatly. For example, a Level IV trauma center might primarily focus on low-acuity patients undergoing planned/elective surgical procedures in just a few specialties. A Level I trauma center will have far more specialties as well as perform emergency surgery on patients who have been injured in accidents.

Outpatient Centers

An OR nurse can also work in an outpatient surgery center. These facilities are for surgeries that do not require an overnight admission to the hospital for round-the-clock nursing care. More than half of the elective surgeries in the United States are performed as outpatient surgeries.

Many nurses prefer working in outpatient surgery centers because you do not need to be “on call” like you will be required to be in the hospital.

Some common outpatient procedures include:

• Urology procedures.
• ENT procedures.
• Robotic surgeries (example: robotic assisted laparoscopic cholecystectomy)
• Breast biopsies
• Arthroscopies (looking into a joint with a camera)
• Total joint replacements (example: some total knee replacements can be done as an outpatient procedure)

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What are other types of OR nurses?

RN first assistant

The RN First Assistant (RNFA) is an RN that has extensive experience scrubbing in. She has also obtained additional training and certification.

The RNFA functions as an extension of the surgeon during the procedure by scrubbing in and handling sterile instruments.

The RNFA differs from the scrub tech in a few ways. For example, they can dissect tissue and then close a surgical wound (suture the wound shut) while the scrub tech cannot.

Many surgeons require additional support during complex surgeries and so will have an assistant present. This can be another surgeon, a Physician’s Assistant (PA), a Nurse Practitioner (NP), an RNFA, or even a “First Assist” (a scrub tech that has completed additional training). Any supportive personnel besides another surgeon is practicing under the primary surgeon’s supervision. This means that in general, they cannot dissect while the surgeon is not present.

How do you become an OR nurse in 3 steps?

If you think the field of OR nursing fits your career goals, you can become an OR nurse by following these three steps.

Step 1: Become a registered nurse

First, you must earn a nursing degree. There a few different options for you to choose from.

Associate Degree in Nursing

Obtaining a two-year Associate Degree in Nursing (ADN) is the minimum requirement to be licensed as a registered nurse.  It is possible to become an OR nurse with an ADN alone but some employers prefer additional education.

Bachelor of Science in Nursing (BSN)

A BSN generally takes about four years to complete. More employers are requiring that new hires have a BSN degree or commit to starting an RN-BSN program within a determined time frame.

Typically, an RN-BSN program can be paid for by your employer through a tuition reimbursement agreement. Depending on how many courses you take at a time, an RN-BSN program can be completed in as little as 12-18 months. Many RNs elect to enroll in fully online programs.

Get an RN license

After completing a degree, aspiring OR nurses must pass the National Council Licensure Examination (NCLEX-RN) exam to become a registered nurse. This allows the nurse to start practicing legally in the state where they sat for the exam.

Step 2: Gain experience

Although some facilities may accept new graduate nurses directly into the OR, it is more common for managers to require at least one year of acute care experience prior to making the transition. Many hospitals offer fellowship or transition programs to help experienced nurses make this specialty change.  Basic Life Support is required, and Advanced Cardiac Life Support is usually either strongly recommended/preferred, or required as well.

Step 3: Earn certifications

Many employers prefer that newly hired, experienced OR nurses are already certified. Generally, after 2 years of full time employment, a nurse can take an exam to become a Certified Perioperative Nurse Credential (CNOR) .

What are additional career opportunities for OR nurses?

After training in the OR and gaining experience, there are numerous career paths available to nurses. These include:

• Becoming a representative for a company that makes implants or surgical equipment
• Becoming a nurse educator
• Becoming an organ recovery or transplant coordinator
• Taking management or administrative positions

What are the salary and job outlooks for OR nurses?

The Bureau of Labor Statistics (BLS) estimates that the average yearly earnings of registered nurses in America are $82,750 per year or $39.78 per hour. It is most likely that specialized nurses, such as OR nurses, are expected to earn higher than regular nurses.

According to data from Incredible Health, the average salary for OR nurses is $92,800. The earnings of an OR nurse are dependent on various factors, including experience, medical facility, and level of study or specialization. 

According to the BLS, the career outlook for nursing in general, even before specialization, is positive – employment in the nursing sector is likely to grow by 6% between 2021 and 2031 which is higher than most other fields of work.

FAQs

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