Nursing Specialties

Perioperative Nurse

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What is a 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).  

What does a Perioperative Nurse Do?

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 Nurse

What skills does a Perioperative Nurse need?

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.

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What skills does a Perioperative Nurse need?

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.

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Perioperative Nurses

Work settings for Perioperative Nurses

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

Common Cases Perioperative Nurses Encounter

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

How to Become A Perioperative Nurse

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.

How to Advance Your Career As A Perioperative Nurse

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).

Education Requirements & Helpful Certification

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.

Average Salary For Perioperative Nurses

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. 

Specialty Organizations & Communities

Ideal Personality Traits

  • Calm, patient, and flexible
  • Enjoys working in a team
  • Able to multitask and prioritize 
  • Interest in a variety of surgical treatments

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Perioperative Nurse

Perioperative nurses provide care for patients undergoing surgery. They work as part of the operative team of surgeons, anesthesiologists, and are responsible for the safety, planning, and monitoring of the patients having surgery. There are three general divisions in perioperative nursing: pre-operative, intraoperative, and post-operative care. Each area requires specialized skills, knowledge, and experience.

Education Requirements

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.

How to advance/career pathway

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).

RESPONSIBILITIES

  • Pre-operative nurses ready the patient for surgery, provide patient care, education, and check that paperwork is complete.  
  • Intraoperative care 

* The scrub nurse organizes and hands the doctor surgical tools and helps monitor the patient during surgical procedures.

* The circulating nurse ensures all supplies are immediately available, maintains safety and sterility in the surgical suite, and documents surgical information. 

* First assistants directly assist the surgeon by using tools to improve the surgical area’s exposure and suturing at the end of the surgery. 

  • Post-operative care is performed by the recovery room nurses who monitor patients after surgery until they are ready to leave.

MOST COMMON CASES

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

How to become a

Perioperative Nurse

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.

Specialty Groups and Communities

The Pros

  • Care for one patient at a time. 
  • Care for patients of all ages and conditions
  • Fast paced and can learn about many interesting cases 
  • Satisfaction in reducing patient anxiety and providing initial and post-surgical teaching

The Cons

  • Only interact with the patient before and after surgery, limited teaching
  • Need to be available on call any day or hour
  • Work indoors in non-windowed operative/recovery suites
  • Can be stressful due to the need for strict timeliness
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Personality Traits

  • Calm, patient, and flexible
  • Enjoys working in a team
  • Able to multitask and prioritize 
  • Interest in a variety of surgical treatments
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Average Salary

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. 

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Certifications

Competency & Credentialing Institute (CCI)

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

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