What Do Perioperative Nurses Do? An Interview with an OR Nurse

Thank you to AORN for partnering with us for this post.

So you’re a nurse or in nursing school, and you think you want to work in the operating room… or endoscopy… or the postanesthesia 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?

I had the opportunity to interview 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. She shares what it’s really like to be a perioperative nurse.

Let’s dive in!

Options for a new graduate interested 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 that, “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’s most rewarding about perioperative nursing?

When I asked Amber about the most rewarding aspect (in her opinion) of the perioperative nursing specialty, she responded by saying, “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 most challenging about 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.”

((Cough-ICU nurses-cough-cough))

A typical day for an 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 day as an 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 people 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.

Another recommendation is to attend a professional development conference, such as the 2018 AORN annual conference.

AORN Conference

If you’re interested in perioperative nursing, I recommend checking out AORN’s Global Surgical Conference & Expo 2018 in New Orleans, LA.

At the conference, you can:

• learn the latest in best practice with over 200 continuing education units available
  • concurrent sessions
  • on-demand streaming service for sessions you couldn’t get to
  • poster presentations
  • session in the exhibit hall)
• network with perioperative nurses all over the country
• take advantage of the largest surgical trade show in the country by visiting the exhibit hall
• feel energized from all of the fun events and passionate nurses.

A special opportunity for students

AORN is excited to offer nursing students a complimentary* registration to Global Surgical Conference & Expo 2018!

Students from local nursing programs can come for the entire week, or attend AORN Student Nurses Day on Tuesday, March 27th for a special one-day student program. This conference offers nursing students a unique opportunity to learn more about perioperative nursing and take advantage of superior education developed by leading industry experts.

During AORN Student Nurses Day, AORN will offer special activities. In the morning, students will have the opportunity to practice hands-on activities (like proper hand hygiene, gowning and gloving, surgical prepping, and positioning). In the afternoon, AORN will host an exhibit floor session to explore the complexity of surgical products and equipment. Students will be able to interact with vendors, including multiple nurse recruiter booths. Plus, student nurses who attend will receive a free one-year membership.

More Resources for Perioperative Nurses:

• Top Tips for New Grad Nurses in the Operating Room (OR)
• How to Land a Nursing Job At A Hospital

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