So you’re a nurse or in nursing school, and you think you want to work in the operating room… or endoscopy… or the post-anesthesia care unit… or interventional radiology. But, what are the important things to know before getting into this specialized field within nursing? What do perioperative nurses do, exactly?
What do Perioperative Nurses Do?
For this post, I had the opportunity to interview an expert from AORN! Learn more about her below.
Amber Wood, MSN RN CNOR CIC FAPIC, who is a Senior Perioperative Practice Specialist for the Association of PeriOperative Nurses (AORN) and previously an operating room (OR) nurse at Children’s Medical Center in Dallas, TX.
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New Graduate Nurse Options in Perioperative Nursing
Working as a critical care nurse, I have to admit… I was a bit ignorant to all of the perioperative options. Amber informed me that the options include, not only your typical preoperative (pre-op), intraoperative (operating room, or OR nurse), and postanesthesia care unit (PACU), but also procedural areas like endoscopy, cath lab, and interventional radiology.
Nurses can further specialize in the OR. Amber noted, “You can specialize in the OR by service line. For instance, things cardiac surgery, neurosurgery, orthopedics are all specialties… all of which are are challenging in their own way.”
Naturally, your options are dictated by the size of the institution. If it’s a large hospital or a teaching facility, you’ll have more options. If you’re in a smaller rural hospital, you won’t have as many.
When thinking about OR subspecialties like cardiac surgery, orthopedics or neurosurgery, there’s more to consider than the type of population you’ll be serving. You really have to also consider the team you’ll be working with and the flow of the day. Maybe you love orthopedics, but you don’t really mesh into that group of people well… or maybe you like lots of volume and patient turnover rather than longer cases with sicker patients.
What is Most Rewarding About Perioperative Nursing?
Amber noted that, “it’s definitely being able to advocate for patients when they are most vulnerable. Their family isn’t there and they can’t advocate for themselves.”
In the perioperative world, patients are sedated for their procedure. Their family members cannot come back and hold their hand mid-procedure and ask questions. The responsibility to comfort, encourage, and advocate falls upon the nurse.
What’s the Most Challenging Aspect of Perioperative Nursing?
When discussing challenges within this specialty, Amber mentioned how different teamwork looks in the perioperative world. When I think about teamwork while providing patient care, I connect it to my experience. For me, I’m used to being on a floor or critical care unit in which I call a physician or healthcare team member as needed to discuss issues. However, this is not the case in perioperative nursing.
Teamwork is elbow-to-elbow. Instead of paging a physician with a concern and waiting for a reply, the physician is right there. While that sounds easy and wonderful, some are not used to it.
Amber stated, it’s “different from working in other areas because everyone on the team is working at the same time, rather than coming in and out. This real-time teamwork and collaboration can be challenging for some. You really have to function within that team and play your roles at the time. This means you have to know and understand everyone else’s roles as well. This can be particularly challenging if you enjoy working independently.”
A Typical Day for a Operating Room (OR) Nurse
Amber went over a typical day for an OR nurse with me. One of the first things she mentioned was that the way your day will look really depends the shift/time of day and if you’re scrubbing in or circulating.
Amber noted that, “the scrub nurse is more focused on instrumentation, planning, and coordination of that while the circulating nurse would be more focused on positioning, equipment, medications, and ensure any issues with implants, tissues, and/or specimens that are needed is addressed.” Also, depending on your facility, you may or may not be working with surgical technologists.
A Typical Shift OR Nurse
- Receive report
- Receive your assignment for the day
- Go over the surgery schedule: the charge nurse will communicate any special needs, requests, or changes to the plan that have arisen
- Begin preparing the operating room
- You typically have around 30 minutes before you must get a patient in a room
- Begin planning the day, getting special equipment ready for surgery
- Ensure rooms are cleaned and ready to go
- Check important equipment (like suction!)
- Ensure you have the appropriate instruments for the day
- Head to pre-op holding to get your patient
- Receive report from the preoperative nurse, ensure you’ve got consent, and begin building rapport with the patient – they’re about to put their life in your hands
- Transport to the operating room
- Assist as needed with anesthesia
- Begin positioning, skin prep, establishing a sterile field, and monitoring
- If everyone else is scrubbed in, you’re grabbing anything that’s needed
- If it’s a surgery requiring multiple surgeons, you’re coordinating that
- Documenting everything
- Once surgery is complete, call report to their destination
- Get them ready to go and transport
- Clean the room and get ready to start all over again!
Amber says it can sound a lot like a traffic controller because so much is going on at once – and lives are at stake!
Recommendations for Nurses Interested in Perioperative Nursing
Perioperative nursing is a highly specialized field, therefore you really want to ensure it is where you want to be.
Amber recommends getting as much clinical experience in perioperative areas as possible during nursing school. Amber, like myself, completed an externship between her junior and senior years of nursing school and spent time in the OR. She said this further solidified her interest in working in a pediatric OR.
But if you must work in another area of the hospital because you can’t get into the perioperative areas, try to stick to surgical areas within the service line you’re interested in.
FAQs About Perioperative Nursing
What does an OR nurse do?
OR (Operating Room) nurses work in surgical settings to assist surgeons during procedures. They help prepare patients for surgery, set up equipment and instruments, and monitor the patient’s vital signs during the surgery. They also help ensure that the surgical environment is sterile and assist in post-surgical care.
What is a PACU nurse?
A PACU (Post-Anesthesia Care Unit) nurse works in the recovery room after a patient has undergone surgery. They monitor the patient’s vital signs, assess for signs of complications, and manage any pain or discomfort the patient may experience. They also communicate with the surgical team to ensure a smooth transition from the operating room to the recovery room.
What does a pre-op nurse do?
A pre-op nurse works with patients prior to surgery to prepare them for the procedure. They review the patient’s medical history and medications, explain the surgical process, and address any concerns or questions the patient may have. They also ensure that the patient is properly prepared for the procedure, which may include administering medications or conducting diagnostic tests.
What are the education and licensing requirements for these roles?
To work as an OR nurse, PACU nurse, or pre-op nurse, you must be a licensed registered nurse (RN). Some employers may require specialized training or certification in these areas, such as a perioperative nursing certificate or advanced cardiac life support (ACLS) certification.
What is the job outlook for these roles?
According to the Bureau of Labor Statistics, the employment of registered nurses is projected to grow 7% from 2019 to 2029, which is faster than the average for all occupations. There is expected to be continued demand for healthcare services, which will drive the need for nurses in a variety of roles, including in surgical settings.
What types of settings can these nurses work in?
OR nurses, PACU nurses, and pre-op nurses can work in a variety of settings, including hospitals, ambulatory surgical centers, and outpatient clinics. Some may also work in private practice or as independent contractors.
What skills are important for these roles?
Excellent communication skills, attention to detail, and the ability to work well under pressure are essential for these nursing roles. Additionally, strong clinical skills and a solid understanding of surgical procedures and anesthesia protocols are important for providing safe and effective patient care in these settings.
More Resources for Perioperative Nurses
- Top Tips for New Grad Nurses in the Operating Room (OR)
- What Do CRNAs Do?
- Nursing Interview Questions: The Good, Bad and the Ugly
- Best Nursing Jobs for New Grads
- The Future of Nursing: A Deep Dive into Nursing Informatics
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