What Is Pediatric Operating Room Nursing? The Ultimate Guide
In the United States, 40 to 50 million major surgeries are performed annually. Approximately 3.9 million of these surgeries are performed on children aged zero to seventeen. These surgeries would not be possible without the assistance of pediatric operating room nurses.
Are you contemplating a career in pediatric surgical nursing? This ultimate guide will cover everything you need to know to help you decide if this specialty is the right career path for you.
What Does Pediatric OR Stand For?
The abbreviation OR stands for operating room. Therefore, a pediatric OR is an operating room where surgeries are performed on children using minimally invasive surgery suites and instruments specially selected for use in infants and children. In addition, pediatric ORs are staffed with healthcare professionals especially trained to operate on and care for children.
What Does Pediatric Surgery Nursing Mean in Medical Terms?
By definition, pediatric surgery is a surgical specialty dealing with diseases, trauma, and malformations in pediatric patients from the fetal period to the teenage years.
The decision to perform surgery on pediatric patients is based on careful evaluation of children’s medical histories and tests, including blood tests, X-rays, magnetic resonance imaging (MRI), computed tomography (CT) scans, electrocardiograms, and other relevant tests.
Surgeries can be divided into two major categories depending on the severity of the illness, the parts of the body affected, the complexity of the surgery, and the expected recovery time.
Major Surgeries
Major surgeries are surgeries of the head, the neck, the chest, and, in some cases, the abdomen. These surgeries have higher risks of complications, and recovery time can be long and may involve a stay in the intensive care unit (ICU) or many days in the hospital.
Major pediatric surgery may include the following:
- Removal of brain tumors
- Correction of bone malformations of the skull and face
- Repair of congenital heart disease, organ transplants, and repair of intestinal malformations
- Correction of spinal abnormalities and treatment of injuries caused by major blunt trauma
- Correction of problems in fetal development, including problems with the lungs, intestines, diaphragm, or anus
Minor Surgery
Minor surgeries are usually performed as outpatient procedures and have a short recovery time, allowing children to return to their usual activities rapidly. In fact, children can generally return home the same day since these surgeries rarely have complications. The following are examples of minor pediatric surgeries:
- Removal of skin lesions
- Biopsy of growths
- Hernia repairs
- Correction of bone fractures
- Placement of ear tubes
In addition, the following are other ways to classify pediatric surgeries:
- Elective surgeries, such as having a birthmark removed, may be helpful but are not essential.
- Required surgeries are necessary to ensure the quality of the child's life in the future, such as having a spinal fusion to correct severe curvature of the spine.
- Urgent or emergency surgeries are performed in response to an urgent medical need, such as repairing injured internal organs after an automobile accident.
What Is Pediatric Surgery Nursing?
According to the American Pediatric Surgical Nurses Association, Inc., pediatric surgical nursing follows a patient- and family-centered care approach. Pediatric surgical nursing aims to prevent illness and injury, restore health, and maximize comfort in pediatric patients by diagnosing, treating, and managing the condition that requires surgery. Pediatric surgical nurses focus on promoting, protecting, and optimizing abilities and health in children with surgical issues from the neonatal period to young adulthood.
What Is a Pediatric Operating Room Unit in a Hospital?
In general terms, a pediatric operating room (OR) is any place where surgeries on children take place, including the surgical departments of general medical surgical hospitals and the surgical departments of children’s hospitals. Pediatric surgeries may also take place in ambulatory surgery centers, outpatient centers, clinics, and physician’s offices.
The staff required to perform pediatric surgeries varies depending on the type of surgery. However, most pediatric surgical teams include the following members:
- Pediatric surgeon
- Anesthesiologist
- Certified registered nurse anesthetist (CRNA)
- Anesthesiologist assistant (AA)
- Pediatric operating room nurse
- Surgical technologists (scrub techs)
In preparation for pediatric surgery, a parent or other caregiver can usually stay with the child during the start of anesthesia. Once the child is asleep in the operating room, the caregiver will be directed to a waiting room, where they will be informed of the status and success of the surgery. After surgery, the pediatric surgeon meets with the family in the waiting room, and a nurse takes the family members to see the child in the post-anesthesia care unit (PACU).
Most pediatric surgery patients stay in the PACU for thirty minutes to two hours, depending on the surgery and the patient’s prognosis. A nurse teaches parents what they need to know to care for their child after discharge and answers any questions they may have. A nurse will also call parents the following day to check on the pediatric patient.
What Is the Role of a Pediatric Operating Room Nurse?
As is the case with adult surgery, pediatric surgery is divided into three phases: pre-operative phase, intraoperative phrase, and postoperative phase. Each stage requires different types of care, resulting in different pediatric surgery nursing roles.
- Pre-op or circulating nurse: This pediatric surgery nurse explains the risks and benefits of the procedure to the parents and cares for the pediatric patient before surgery. This nurse is the liaison between the surgeon, the child, and the patient’s family. Therefore, this nursing role requires excellent communication skills, patience, and compassion.
- Intra-op nurses: These operating room nurses are further divided into scrub nurses and registered nurse first assistants (RNFAs). Scrub nurses ensure that the OR and the hand instruments are sterile before surgery. This role requires high attention to detail to avoid cross-contamination. RNFAs help surgeons control bleeding, suture, dress wounds, and monitor vitals during surgery, among other tasks. This nursing role is likely to require specialized certification.
- Post-op nurse: This surgical nurse is also called a PACU nurse since they care for patients in the post-anesthesia care unit after surgery. During a patient’s stay in the PACU, a post-op nurse monitors the patient’s vitals and runs tests to ensure recovery. They also work with the rest of the care team to develop a care plan and communicate with the patient and their family.
What Does a Pediatric Operating Room Nurse Do?
The responsibilities of a pediatric operating room nurse vary depending on their specific role as well as the hospital or other facility where they work. That said, the following are typical duties of a pediatric operating room nurse:
- Planning, implementing, evaluating, and communicating all aspects of nursing care
- Pre-operative patient evaluation and counseling
- Facilitating orders for tests and creating surgical listings
- Patient education before and after surgery
- Coordination of multidisciplinary care, including direct patient care, patient/family education, and transitions of care
- Telephone triage of pre- and post-operative patient calls
- Overall patient management as directed by the supervising consultant
- Serving as a liaison with other sub-specialty providers, local health facilities, and primary providers to maintain continuity of care
- Providing leadership through activities such as a preceptor role, informal leadership roles, and quality improvement efforts
- Delegating patient care according to skill level, experience, patient acuity, fiscal accountability, and adequacy of resources
How to Become a Pediatric OR Nurse?
The minimum requirement to work as a pediatric OR nurse is obtaining an associate’s degree in nursing (ADN) followed by registered nurse (RN) licensure. Nevertheless, although over half of employers will accept RNs with ADNs for surgical positions, a large percentage require RNs to pursue bachelor’s of science in nursing (BSN) degrees. Furthermore, employers may also require one to five years of previous nursing work experience in areas such as pediatric or neonatal nursing.
Pediatric Operating Room Nurse Certification?
Finally, nurses interested in pursuing careers in pediatric surgical nursing should obtain at least one of the following basic nursing certifications, in addition to a Basic Life Support (BLS) certification:
- Advanced Cardiac Life Support (ACLS)
- Pediatric Emergency Assessment Recognition and Stabilization (PEARS)
- Pediatric Advanced Life Support (PALS)
- S.T.A.B.L.E.
- Neonatal Resuscitation (NRP)
In addition to these basic certifications, a pediatric operating nurse may pursue the following advanced credentials:
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)
Additionally, the CCI offers these certification options for advanced practice registered nurses (APRNs):
- Certified Perioperative CNS (CNS-CP)
- Nursing Professional Development Advanced – Board Certified (NPDA-BC)
The Association of periOperative Registered Nurses also offers the Care of the Pediatric Surgical Patient Certificate Program for experienced nurses who are new to—or who want a refresher on—pediatric perioperative care, nurses and surgical team members wanting to expand into the pediatric surgical specialty, and perioperative educators wanting to build their pediatric surgical specialty offerings.
How Long Does It Take to Become a Pediatric OR Nurse?
Becoming an RN takes two to four years, depending on whether nurses complete ADNs or BSNs respectively. Therefore, in addition to a minimum of one year of nursing work experience, becoming a pediatric OR nurse takes at least three to five years.
That said, nurses wishing to become certified as surgical nurses must contemplate a minimum of two years of work experience. Finally, nurses who wish to become advanced practice registered nurses (APRNs) must invest another two to three years to complete master’s of science in nursing (MSN) degrees.
How Much Does a Pediatric Operating Room Nurse Make?
The average salary of a pediatric OR nurse varies significantly depending on various factors, such as level of education, years of work experience, residence, and the specific place of employment. That said, the average RN salary is $82,750 annually, and the following are average salaries for RNs in different settings that employ pediatric OR nurses:
- 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
For nurses who have completed graduate studies, the average salary is $118,040 per year. However, this salary also varies significantly depending on a nurse’s work setting. The following are the average salaries for nurse practitioners in settings where pediatric surgical nurses are employed:
- Outpatient care centers: $129,190
- General medical and surgical hospitals: $122,960
- Offices of physicians: $114,870
Why Choose Pediatric Operating Room Nursing?
Besides wanting to know hard facts and figures, any nurse considering this career move will want to know what pediatric operating room nursing is like, if it is hard, and what led other nurses to make this career move and stay. With this in mind, let’s take a look at some testimonials pediatric OR nurses shared on a related thread on Reddit:
“I love that even when facing something scary like open heart surgery kids are just kids—pure and fun and innocent.”
“I am in peds because they're easy to actually care about. No matter who they are, how much they need, how "compliant" they are, or if they fight/ kick/ bite me. I forgive them and care for them. It's easy to do with kids. They have the best attitudes, they're super distractable, they bounce-back so well compared to adults, they don't tend to stink too bad, they usually have 1-2 or more people there that actually care about them, etc.. Now, the parents themselves…”
What Makes a Good Pediatric OR Nurse: Tips for New Nurses?
Becoming an excellent pediatric OR nurse takes more than completing a nursing program and obtaining work experience and certifications. The following are certain qualities and skills that pediatric surgical nurses should strive to develop:
- Excellent interpersonal and communication skills
- Dedication to patient education
- Strong critical thinking skills
- Organizational skills
- Ability to multi-task
- Being self-driven
- Enjoying working with patients and families in complex medical and social situations
Aside from developing these skills and qualities, new nurses may benefit from the following tips shared by experienced pediatric OR nurses:
“The biggest thing I found that helped to alleviate a kids pre-surgery anxiety was by encouraging them to ask questions, and answering them without sugar coating them (obviously tailored to their age mind you). When the uncertainty was gone, they would relax, which in turn helped the parents relax. It's a feedback loop of anxiety between the parents and the child, so by helping one chill out, the other will too…when taking vitals, tell them what you're doing. Don't just go at them with a BP cuff or thermometer because it's terrifying to have a stranger come at you with strange tools. Show them how it works first on Mom/Dad/Teddy/yourself before doing it to them.” – Reddit user silkwearingbuttercup
“Learn to not react emotionally to what happens around you. I find children in particular react to the emotions they see in the faces of those around them. Also be the logical rock the parents need and don't react to them over reacting. Peds surgical oncology burned me out, but outside of that, kids are a lot of fun and recover insanely fast compared to adults.” – Reddit user redrunner7
Final Thoughts on Pediatric Operating Room Nursing
We all wish children didn’t have to undergo surgery. However, since many pediatric surgeries are necessary to save children’s lives or significantly improve their quality of life, the best thing parents can hope for besides successful surgeries is getting a great pediatric surgical nurse. A qualified, compassionate, and patient surgical nurse can make a world of difference in a child’s and their family’s experience with surgery.
Do you think this nursing specialty is for you? If so, this guide provides all the information you need to pursue this career path. If not, don’t feel discouraged! There are many nursing specialties to choose from. The perfect one for you is out there, so don’t give up until you find it!
