Perioperative Nurse

Perioperative nurses provide care before, during, and after to patients requiring surgery. Nurses who work in the operating room (OR) and the recovery room, also called PACU (Post-Anesthesia Care Unit), are also perioperative nurses. They are all part of the operative team along with surgeons, anesthesiologists, and nurse anesthetists.

Perioperative nurses keep the operating room functioning like a smooth-running machine. They are in charge of maintaining safety and cleanliness. Perioperative nurses ensure that patients are adequately prepared, pre-operative medication is given, and paperwork is accurately completed. In addition, perioperative nurses actively help the physician perform the surgery by readying the room before and handing the surgeon tools during the procedure.

The PACU nurses receive the patient after surgery. They closely monitor and give pain medication as needed while anesthesia wears off. They report any significant changes to the physician, and when the patient is ready to be released, they will inform and coordinate instructions with the family.

Perioperative nurses often receive advanced training to improve their skills. Some perioperative nurses specialize and only work with physicians who perform a specific type of surgery, such as plastic surgery, pediatrics, or oncology, or they train to become an RN first assistant (RNFA) to actively participate in the surgeries. Others become advanced practice registered nurses (APRNs) either as surgical nurse practitioners or clinical nurse specialists (CNSs).

Scrub nurses

• Scrubs in to assist during surgery
• Works inside the sterile field, setting up the area with sterile tools and equipment
• Hands the surgeon tools during surgery and performs other duties inside the surgical suite

Circulating Nurse

• Greets patients prior to surgery, performs pre-operative assessments, and reviews pre-op paperwork for completeness
• Works outside the sterile field to make sure all equipment is set up before the surgery and arranges for other needed supplies
• Contacts others as needed during surgery
• Keeps family informed as appropriate

RN first assistant (RNFA)

• ‍‍Assists surgeon in performing the surgical procedure by controlling bleeding and monitoring for complications
• Sutures after surgery is completed and applies dressings
• Performs any task needed during the surgery

Recovery room (PACU) nurse

• Monitors vital signs and assists patients as they come out of anesthesia
• Prepares patients for transfer back to the ward or discharge if same-day surgery
• Communicates to family and patient regarding their status and discharge instructions
• Reviews discharge medications, especially pain medication

Perioperative nurses must be detail-oriented and be excellent communicators. The operating room requires these nurses to be physically strong and have mental agility. Shifts in the OR require long hours of standing, lifting unconscious patients, and moving heavy equipment.

Perioperative nurses must maintain lengthy focus during the surgery but also be flexible. For example, they may start with one surgery and instead be sent to an emergency case instead. Strong communication skills are imperative since there is little time for mistakes. Errors prolong the time the patient is under anesthesia, increasing their risk.

Overall, perioperative nurses must use critical thinking skills and work well with the entire operative team. They must be organized, find medications or tools quickly, and be extremely accurate so that nothing is left inside the patient.

Perioperative nurses work in a variety of settings such as hospital surgical departments, ambulatory surgery centers, and offices that perform procedures on-site.

Perioperative nurses see a variety of surgeries. Sometimes they specialize in one surgical nursing area such as pediatrics, cardiac, orthopedics, or gynecology.

Competency & Credentialing Institute (CCI)

• Certified Perioperative Nurse (CNOR)
• Certified Surgical Services Manager (CSSM)
• Clinical Nurse Specialist (CNS-CP)

Perioperative nurses must be BCLS, and often are ACLS/PALS certified. It is highly encouraged that they become CNOR certified after gaining experience.

To gain CNOR certification, perioperative nurses need to be currently employed either part-time or full-time for a minimum of 2 years and have 2,400 hours of experience in perioperative nursing, with a minimum of 1,200 hours in the intraoperative setting.

Perioperative nurses who want to become a Certified Registered Nurse First Assistant (CRNFA) obtain special training then obtain their CNOR. When they pass their CRNFA additional certification, the two are merged. The AORN delineates requirements to obtain training, resources, and requirements.

Complete an Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) degree: takes two-to-four-years based on the program

1. Pass the NCLEX-RN exam and apply for your RN license after graduation
2. Usually, nurses need at least one year of experience from another nursing discipline such as Med-Surg or critical care. There are some residency programs for those without OR experience.
3. Become certified as a CNOR after meeting the prerequisites and gaining work experience.

You can advance your career by getting an MSN or doctoral degree with a surgical care focus. Alternatively, you can become a Surgical Nurse practitioner (SNP) or a Clinical Nurse Specialist (CNS) and earn certification as a Clinical Nurse Specialist Perioperative (CNS-CP).

Perioperative nurses typically make between $65,429 - $97,809, with a median salary of $81,411, according to Salary.com.

The May 2021 Bureau of Labor and Statistics report shows which states have the highest and lowest wages for nurses. They do not list by nurse specialty, but perioperative nurse salaries would likely follow suit. The highest-paid states are California, Hawaii, and Oregon. The lowest-paid states are South Dakota, Alabama, and Mississippi.

Association of periOperative Registered Nurses