Operating Room

THE ULTIMATE GUIDE TO OPERATING ROOM (OR) NURSING

OR nurse prepping patient

Choosing a career path is no simple matter. We all want to feel fulfilled and energized by our jobs. We want to learn and feel useful. We want to earn good money while striving to achieve work-life balance. To make matters even more complex, there is not a one-size-fits-all answer. Each person is unique and will thrive in very different work settings. Even nurses have very diverse personality types, interests, and skills. Therefore, finding the ideal nursing career path is a very personal journey. 

Are you interested in operating room nursing? In this ultimate guide, you will find everything you need to know about operating room nursing to help you decide if this highly demanded specialty is for you. Learn about where you could work, how much you could earn, what the profession is like, and much more.  

Table of Contents

What Does OR Stand For?

The abbreviation OR stands for operating room. In turn, the definition of operating room is literally “a room in a hospital where operations are done.” Furthermore, an OR nurse assists during surgeries, and OR nursing refers to the surgical or perioperative nursing specialty.

What Does Surgical Nurse Mean in Medical Terms?

Surgical nurses specialize in perioperative care, meaning they care for patients before, during, and after surgery. Some surgical nurses sub-specialize in one of these three stages of care: pre-operative, intraoperative, or postoperative. Although often used interchangeably with the more general term surgical nurse, the term OR nurse often refers specifically to intraoperative nurses. Intraoperative or OR nurses work alongside surgeons and anesthesiologists during operations. Furthermore, OR nurses can also sub-specialize in specific areas, such as pediatrics, neurology, general surgery, urology, cardiology, or oncology.

The following are some of the most common surgeries performed in the United States with which OR nurses assist:

  • Appendectomy 
  • Breast biopsy
  • Cataract surgery
  • Cesarean section or c-section
  • Coronary artery bypass or “bypass surgery” 
  • Debridement of wound, burn, or infection 
  • Dilation and curettage (D&C) 
  • Free skin graft 
  • Hemorrhoidectomy 
  • Hysterectomy
  • Low back pain surgery 
  • Mastectomy 
  • Prostatectomy 
  • Releasing of peritoneal adhesions
  • Tonsillectomy 

Where Do Operating Room Nurses Work?

The simple answer is that OR nurses work wherever surgeries take place. Primarily, they work in hospital surgical departments, including inpatient and ambulatory operating rooms, recovery rooms, and medical-surgical care units, but they also might work in the following settings:

  • Ambulatory surgery centers
  • Outpatient centers
  • Clinics
  • Physicians’ offices

What Is a Surgical Unit in a Hospital?

OR nurse at hospital

Hospital surgical units may provide significantly different types of care. Some offer intensive care, such as surgical intensive care units (SICUs). On the other hand, others may provide non-intensive care, such as surgical units caring for pre and post-surgical patients or performing certain types of surgery, such as orthopedic joint surgery.

What Does a Surgical Nurse Do?

Surgical nurse responsibilities differ depending on the phase of surgery they assist with. Some nurses focus on caring for patients before surgery; others assist with the surgeries themselves, and others care for patients after surgery. Each of these surgical nursing roles implies different duties. 

What Is the Specific Role of an OR Nurse?

Whereas pre-op nurses help prepare patients for surgery and post-op nurses care for nurses after surgery, intra-op or OR nurses assist with the surgeries themselves. In turn, intra-op nurses may also have different roles within the OR.

  • Scrub nurses: These nurses prepare the operating room for surgery by sterilizing the room and hand instruments. They also anticipate the surgeon’s needs during surgery, being ready to pass surgeons instruments and supplies. 
  • Registered nurse first assistants (RNFAs): RNFAs assist surgeons directly during surgery by helping to control bleeding, suturing, dressing wounds, monitoring vitals, and watching for signs of complications.
  • Circulating nurses: For the most part, circulating nurses fulfill the role of pre-op nurses, helping prepare patients and family members for surgery. Nevertheless, they also play an important role during surgery because they update the family on the status of the operation. They also help out within the OR, assisting the anesthesiologist or the scrub nurse, answering phones, etc. 

“In reality we do everything to make sure the OR functions properly. Including equipment checks, supply checks, phone checks, lifting surgeons pants up (rare, but not kidding), coordinating care, etc. we do anything and everything to make the surgeons day go smoother and the patient be well taken care of.”

Redditu/WonderlustHeart

How to Become an Operating Room Nurse

Nurses need to become licensed registered nurses (RNs) to work in an OR. To become RNs, potential nurses can opt for the associate of nursing degree (ADN) route, or they can pursue bachelors of science in nursing (BSNs). Rasmussen University analyzed 62,000 OR nurse job postings and found that 61% accepted candidates with ADNs, but 37% required candidates to have BSNs. Therefore, although many RNs with associate’s degrees can find work in ORs, obtaining BSNs opens more job opportunities for nurses.  

Surgical Nurse Certification

OR certification

In addition to becoming a licensed RN, any nurse should obtain a Basic Life Support (BLS) certification. This one-day course trains nurses and other participants to recognize life-threatening emergencies quickly, give high-quality chest compressions, deliver appropriate ventilations, and provide early use of an automated external defibrillator (AED). 

In addition, surgical nurses must also have an Advanced Cardiovascular Life Support (ACLS) certification. This course builds on the foundation of BLS skills, emphasizing the importance of continuous, high-quality cardiopulmonary resuscitation (CPR). The ACLS is important for healthcare professionals, such as OR nurses, participating in the management of cardiopulmonary arrest or other cardiac emergencies and for emergency response staff.

Besides these basic required certifications, surgical nurses may pursue other credentials in this nursing specialty. The Competency and Credentialing Institute (CCI) offers the following surgical certification options for RNs:

  • Certified Perioperative Nurse (CNOR)
  • Certified Surgical Services Manager (CSSM)
  • Certified Ambulatory Surgery Nurse (CNAMB)
  • Certified Foundational Perioperative Nurse (CFPN)

The CCI also offers these certification options for advanced practice registered nurses (APRNs):

  • Certified Perioperative CNS (CNS-CP)
  • Nursing Professional Development Advanced – Board Certified (NPDA-BC)

How Long Does It Take to Become an Operating Room Nurse?

RNs who complete ADNs could find themselves working in a surgical unit after just two years of training, whereas completing a BSN takes approximately four years. If nurses want to certify as surgical nurses, they must contemplate another approximately two years of work experience after graduation before obtaining a surgical nurse credential. Furthermore, pursuing a master’s in nursing takes an additional two to three years of training in addition to the often required one to two years of previous work experience.

How Much Do OR Nurses Make?

OR nurses’ salaries depend on multiple factors, including education, years of experience, city of residence, and even the specific facilities where they work. In general, RNs can expect to make approximately $82,750 per year. To give nurses a more precise idea of the salary they can aspire to, here are the average RN salaries in different settings where OR nurses can work: 

  • Outpatient care centers: $93,070
  • General medical and surgical hospitals: $85,020
  • Specialty hospitals except for psychiatric and substance abuse hospitals: $84,800
  • Offices of physicians: $73,860

Nurses who have completed graduate or post-graduate studies in nursing, or APRNs, earn on average $118,040 per year. However, this amount can also vary significantly depending on the facilities where they work. The following are average salaries for APRNs in different types of facilities where surgical nurses can work:

  • Outpatient care centers: $129,190
  • General medical and surgical hospitals: $122,960
  • Offices of physicians: $114,870
  • Offices of other health practitioners: $108,890

What Is Operating Room Nursing Like?

There is no better way to learn about surgical nursing than hearing about this specialty from OR nurses themselves: the good, the challenging, and everything in between.

“I love it. It definitely can get tense depending on your specialty. While you do concentrate on just one patient at a time, it’s not a lot of one-on-one with the patient. They’re asleep during most of your interaction. You take care of them by taking care of the surgical staff and their needs. And just a head’s up- OR staffs tend to be one of the crazier groups in every hospital I’ve ever been in. Makes things interesting as well as entertaining!”

Redditu/Puppa26

“OR nursing is different than “traditional” nursing and everything you learn in school. I love my job! I learn something new every day. It is definitely a learning curve and you do deal with some strong personalities and grumpy surgeons here and there, but I love the team dynamic and I find surgery so interesting. I think that nursing schools should focus more on teaching about OR nursing because I feel like a lot of students don’t know enough about our role and how awesome it can be. I will never go back to the floors ever again… my worst day in the OR is better than my best day at my previous jobs.”

Redditu/Ravehein

Is Surgical Nursing Hard?

OR nursing is difficult

Although many nurses love working in the OR and wouldn’t change their jobs for any other, certain challenges seem to come hand-in-hand with the job. According to OR nurses, these are the greatest challenges of working in the surgical specialty:

“Cons: dealing with surgeons and even techs. Most of the surgeons and scrub techs I work with are great, however, many of them have been very belittling to me and it gets really frustrating.”

Redditu/_greentea

“…the OR is a lot like the military. Know your rank. You’re a recruit, so shut up and be able to take direction well, and know when to speak up. It’s a fine line. That’s the personality aspect of it- that’s the hardest part.”

Redditu/hfh96

“The personalities though…yeah, very strong personalities.”

Redditu/groovySondergaard

“A lot of my struggle has been speaking up, learning to be assertive, etc. In high school I was varsity captain of a national volleyball league, top of my class, very outspoken and competitive type. The hospital is just a different game to me- everything is done in very specific ways…you need to know when to keep your mouth shut and when to speak up.”

Redditu/hfh96

Why Choose Operating Room Nursing

Operating room nurse

Despite challenges, working in the OR certainly has its perks. Here is what OR nurses love about their jobs:

“It’s nice to have the chance to focus on one patient at a time as opposed to several all at once.”

Redditu/Bigwill1976

“I like it because you have one patient at a time, it feels less “task-rabbity” than being on a floor, and I find surgery fascinating.”

Redditu/salemboop7

“OR hours also tend to be pretty nice, with a lot of places having your standard shift being Monday-Friday, holidays off, and a weekend every scheduling period.”

Redditu/salemboop7

What Makes a Good Surgical Nurse?

According to the Association of periOperative Registered Nurses’s Guidelines for Perioperative Practice, these are the traits that make for an excellent perioperative nurse:

  • Patience
  • Flexibility
  • Sense of humor
  • Ability to work in a team
  • Communication skills
  • Staying calm under pressure
  • Integrity
  • Ability to multitask

In addition to these traits, surgical nurses should strive to have the following qualities as well:

  • Detail-oriented: OR nurses must be meticulous with hygiene when preparing the operating room and the surgical instruments. They must also be alert to patients’ vitals during surgery and take detailed notes. 
  • Critical thinking: Surgeries are complex, fast-paced situations. Nurses must be able to act quickly and even anticipate surgeons’ needs. 
  • Emotional intelligence: Patients and family members are often scared before, during, and even after surgeries. As the healthcare workers that spend the most time with patients, nurses must know how to explain procedures in simple terms, assuage patients’ fears, be compassionate, and have the emotional stamina to interact calmly with anxious family members. 

Tips for New OR Nurses

For seasoned OR nurses, effective communication, teamwork, and organizational skills are second nature, and these are three skills that new surgical nurses must strive to develop. 

Effective Communication

A review of 16,000 hospital deaths due to error found that communication errors were the primary culprits, causing twice as many deaths as clinical inadequacy. Since nurses act as liaisons between physicians, patients, and family members, excellent communication skills are indispensable for these healthcare professionals.

Teamwork

OR nurse is team player

Surgeons and anesthesiologists depend on nurses to perform successful surgeries. Furthermore, nurses depend on each other as well. For example, once a nurse is scrubbed in, they depend on circulating nurses to get additional supplies from outside the OR. Surgical teams may develop this skill to such an extent that surgical team members often won’t even need to voice requests. For instance, a nurse may have an instrument ready before the surgeon asks for it. Therefore, as a new nurse, try to anticipate your team members’ needs and don’t be afraid to ask for help as well.

Organization

Working in the emergency room (ER) or an ICU may be chaotic, but the environment in an OR is highly controlled. Everyone in the OR has a specific role, and every object has a specified place. Even when complications arise, there is an established plan or protocol. Due to the nature and requirements of operating rooms, OR nurses must strive to be highly organized and detail-oriented.

Are You Cut Out for the OR?

How did you feel as you learned about operating room nursing? What was your gut reaction when you read OR nurses’ testimonials? Do you think this nursing specialty might be for you?

If OR nursing has caught your interest, the next best step would be for you to pick up some per diem shifts in surgical units to get a better feel for this nursing specialty. On the other hand, if you are pretty sure that working in an OR is not for you, then continue exploring different nursing specialties. There is a perfect specialty for every nurse, so don’t give up until you find it!

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