Exploring the world of nursing in the OR

By Bernadette Thomas, RN, CNOR, BSN

The operating room is world apart, and it offers some out-of-this world
advantages if you crave excitement, teamwork, and one-on-one
nursing care.

Is it Fear of the Unknown? Of 140 students in my nursing school

class, only 3 of us wanted to pursue a career centered around the
operating room, in a specialty now called perioperative nursing.
Perhaps this lack of interest is because my nursing school, like many
others, offered little exposure to perioperative practice in its
curriculum. First let’s define what this specialty is: Perioperative
nursing encompasses caring for patients during surgical or other
invasive procedures in a variety of clinical settings, including hospital-
based OR’s, ambulatory surgery settings, and office-based practices.
In this article, I’ll shed some light on this exciting specialty of
nursing so you can make an informed decision about your career
choice or possible career change. I’ll focus on perioperative nursing in
the hospital-based OR.

What does it take?

If you want to be a perioperative nurse, you need to be energetic
and quick, with good critical-thinking skills. You also need to be
physically strong and able to stand for long periods. Endurance is vital
when you’re circulating or scrub nurse.
Before you start, you’ll need atleast 1 year of consistent
perioperative training because you’ll need to learn about the many
specialty areas. One way to become a perioperative nurse is through
on the job training in a hospital or surgery center. Many hospitals and
surgery centers accept nurses into a training program in exchange for
a future work commitment.
Another route is via perioperative nursing program from the
Association of Perioperative Registered Nurses (AORN) called “Periop
101: A Core Curriculum.” Perioperative nurse educators use this
program to teach nurses new to the specialty; some of the coursework
can be done online. AORN recommendations are considered the gold
standard for perioperative nursing practice.
Alternatively, some colleges offer perioperative nursing as an
elective in their associatie’s or bachelor’s degree in nursing programs.
Both methods of training are centered nearly the same basic principles
and will give you the groundwork you need for your career.
Crucial contributions?
As a perioperative nurse, your crucial contribution will be to
advocate for your patients while they’re most vulnerable. Other
nursing responsibilities include managing the overall nursing care of
surgical patients and working closely with the surgical team to ensure
the best outcomes are achieved for your patients. The surgical team
includes the anesthesiologist, a nurse anesthetist, a scrub nurse, a
primary surgeon, a second surgeon or surgical assistant, a circulating
nurse, and a perioperative patient care technician now let’s look at
what the circulating nurse and the scrub nurse handle.
Preoperative duties include the following:
• Develop a plan of care.
• Prepare the OR (review surgeon’s preferences for the surgery,
instrumentation, equipment, sterile supplies; assist with set-up of
surgical field and pre-surgery count of instruments, sponges,
sharps, and miscellaneous items with scrub person.)
• Check equipment.
• Interview the patient and review the perioperative assessment
with him (identify patient and discuss surgery with him, check
chart for proper documentation: history and physical
examination, consents, correct surgical site, laboratory test
results, lab values, allergies and NPO status).
Then the circulating nurse’s intraoperative duties are to:
• Assist anesthesia provider with induction.
• Assist surgeon with patient positioning.
• Participate in surgical “time out” (verify correct patient, correct
procedure, consent matches procedure, correct surgical site,
correct position and correct implant when applicable).
• Assess skin, then apply cautery grounding pad to appropriate
site.
• Connect suction cautery and other equipment needed.
• Issue sterile fluids and medications onto the sterile field.
• Monitor the sterile field, equipment, and anesthesia so you can
troubleshoot quickly.
• Issue sterile supplies, and additional equipment as requested
onto the sterile field.
• Monitor traffic flow through the OR suite.
• Complete documentation on OR record and OR surgery charge
sheet.
• Perform intraoperative surgical counts of instruments, sharps,
sponges, and miscellaneous items with the scrub nurse.
 • Prepare specimens for pathology.
• Assist with wound and drain dressings.
Finally the circulating nurse’s postoperative duties are to:
• Assist anesthesia provider with extubat and preparing patient for
safe transfer to the post anesthesia care unit.
• Assist scrub person with clean up.
• Provide report to pos anesthesia nurse (procedure, dressings and
any additional pertinent information).
What does a scrub person do?
• Set up the sterile field.
• Perform surgical counts with circulating nurse.
• Gown and glove surgical team.
• Monitor the field for breaks in aseptic technique.
• Request additional sterile supplies and equipment per surgeon’s
request.
• Have a sound surgical knowledge base to anticipate the
surgeon’s need (instrument, suture material, equipment,
medications, irrigations and so forth).
• Safely handle sharps.
• Prepare wound dressings.
Now that you’ve learned what contributions you can make consider if
this is the field for you. This field offers many opportunities for
professional development and advancement: you can become certified
nurse in the OR (CNOR), a certified registered nurse first assistant
(CRNFA), patient care coordinator (specialty supervisor), perioperative
nurse educator, patient liaison (handling communication between the
OR and the family during surgery), or nurse manager or director.
Master’s prepared nurses work as surgical nurse practitioners or
certified registered nurse anesthesia (CRNAs).

Go for a “test drive”

If your curiosity is piqued, ask to spend a day in an OR or surgery
center and see for yourself how awesome perioperative nursing can
be.

Bernadette Thomas is a perioperative nurse at A.I. DuPont hospital for

children in Wilmington, Del., and a perioperative nurse at Christiana
Care Health Services in Newark, Del.