Career Pathways & Education

What Does a Perioperative Nurse Do?

Blyss Splane, BSN, RN, CNOR
March 16, 2021
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It’s highly likely that you have had surgery or know someone who has had surgery, whether it was an elective or emergent procedure. Successful surgeries are dependent on operating room (OR) teams functioning together to achieve favorable outcomes for patients. 

The OR can feel very mysterious to those who have not been inside. Patients who have been in the OR were typically under the influence of medications that may have altered their memories of their experience.

So, who works in the OR? Typically, a surgical team is assigned to each OR. This is made up of a variety of healthcare professionals such as perioperative nurses, anesthesia providers, and ancillary personnel that assist the surgeon and his/her surgical team for the procedure.

So, what are perioperative nurses?

In short, perioperative nurses provide care for patients undergoing surgery. They work as part of the operative team of surgeons, anesthesiologists, and are responsible for the safety, planning, and monitoring of the patients having surgery. There are three general divisions in perioperative nursing: pre-operative, intraoperative, and post-operative care. Each area requires specialized skills, knowledge, and experience.

What are the Responsibilities of a Perioperative (OR) Nurse?

A perioperative (OR) nurse can have multiple jobs inside the OR such as a scrub nurse,  circulator, or first assistant (RNFA).

Scrub nurses prepare instruments for a procedure and assist in maintaining sterility throughout the operation, while also passing instruments to the surgeon. This role requires knowledge of the instruments’ names and functions, as well as step-by-step knowledge of the procedure in order to prepare the supplies in advance. 

Circulating nurses manage the safety and patient care aspects of the OR. Safety is the top priority. 

Key facets of safety include:

  • Correct patient for the correct surgery on the correct body site
  • Verification of surgical consent
  • Safe patient positioning that will not cause injury
  • Accurate surgical counts to prevent items left in a patient
  • Knowledge and ability to troubleshoot surgical equipment 

RNFAs have a specialized nursing role in the OR. This allows them to support the surgeon with closing incisions, cauterizing bleeding, and assisting with retractors to increase visibility. This is an advanced practice nursing (APRN) role that requires additional education.

nurses and surgeons in operating room performing a surgery perioperative nurse

Introduce your experience as a Periop Nurse

Before I went to nursing school, I already knew that I wanted to find a way into the OR. My local trauma center offered a one year perioperative nurse residency program that provided training to scrub and circulate. I fell in love with orthopedic surgery and continue to feel that way today. Every day I wonder how I get paid to do this amazing job!

If you’re a nursing new grad and are not sure where to begin your career, you can check out Trusted for New Grads for some helpful resources. Daily life as an OR nurse can feel like completing projects one at a time. There is an intense focus on preparation for each surgery to facilitate a surgical schedule with minimal delays. 

What are some of the benefits of working as a Periop RN?

Being an OR nurse is an intense, fast-paced, and highly technical specialty of nursing. The number one reason (in my opinion) to be an OR nurse is the ability to focus on only one patient at a time. This allows nurses to give their complete attention to one patient without the distractions of caring for multiple patients simultaneously. 

Also, the majority of surgery occurs during daytime hours. This can be highly beneficial to nurses who are unable to work a night shift position. Trauma centers have emergency surgeries throughout the day and also require evening and night shift nurses. Surgery schedules are typically reduced on holidays, requiring fewer staff to work.

Relationships between surgeons and OR nurses are different than other areas of the hospital. There is a dynamic team-focused relationship between surgeons and OR nurses that may not be typical in other areas of the hospital. After scrubbing in, a surgeon depends on the circulating nurse to retrieve necessary supplies, equipment, or instruments. 

OR nurses have strong competence in troubleshooting equipment issues and learning how to operate new and advanced surgical equipment. 

Overall, perioperative nurses experience the satisfaction of seeing broken bones repaired, cancer removed, arthritic joints replaced, and a trauma patient’s life stabilized for recovery. All incredible things that inspire awe when watched, and assisted, first hand! 

What are some of the not-so-great parts of working as a Periop RN?

As with any nursing job, there are some not-so-great parts of working as a perioperative nurse. The OR is a highly intense environment due to the high stress of surgeries and the expectation of preparedness for procedures. Ample specialty knowledge and continuing education is critical to maintain proficiency. 

There are also physical demands to lift heavy instrument trays, move large equipment, position patients without overhead lifts. Surgery often involves a long day of standing, which can even last an entire shift straight. Staff must wear heavy lead aprons—sometimes for several hours—to protect themselves from radiation.

There is a high risk of exposure to blood, body fluids, surgical smoke, strong smells, radiation, and harmful chemicals. Proper knowledge of safety guidelines and ongoing education protects perioperative nurses and surgical staff from these hazards. 

Share your favorite piece of advice for nursing new grads or students looking to become a Periop RN

Interested in the OR? Shadow a perioperative nurse to see the ins and outs of an OR nurse role first-hand before committing to a perioperative nurse residency program. Once in the OR, understand that it can be one to two years before a nurse feels completely comfortable in this environment (but don’t let that stop you!). What are you waiting for!?

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