OR Nurse Overview

  • What You Will Do: As a Operating Room (OR) Nurse / Perioperative Nurse, you will provide nursing care for the patient being prepared for surgery, work with the family, and as a member of the interdisciplinary surgical team.
  • Where Will You Work: OR nurses work in a variety of healthcare settings, such as hospitals, outpatient surgery facilities or physician’s offices.
  • Employment Projections: Nursing is expected to be the fastest-growing professions, with growth projected at 16% – 26%; similarly, the employment outlook for OR nurses is on an upward trend, expected to increase by 19%.
  • How Much Will I Earn: The median annual salary for OR nurses ranges from $61,500 to $124,000, with an average annual salary of $88,894.
  • Requirements to Become One: Become a Registered Nurse (RN) by completing an accredited nursing program earning an Associate’s Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN), then passing the NCLEX-RN examination to obtain licensure.

Steps to Become an OR Nurse / Perioperative Nurse

  1. Earn Your RN: You must earn an RN degree from an accredited nursing program, earning an Associate’s Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN). Note that many employers prefer to hire BSN-prepared nurses, or may require an applicant to complete the BSN degree within a certain timeframe.
  2. Pass the NCLEX-RN Exam: All RNs must pass the NCLEX-RN exam to obtain licensure to practice nursing.
  3. Gain Clinical Experience as a Professional Registered Nurse: It is important to gain clinical experience as a professional nurse, in preparation for moving into a specialty role.
  4. Seek Employment in a OR Nursing Role. You must have a minimum of 2 years’ experience to be eligible for specialty certification.
  5. Obtain Perioperative Nursing Certification: Obtain this certification from the Competency and Credentialing Institute.
Become a Perioperative - OR Nurse Overview

What is an OR Nurse?

OR nursing is an umbrella term, related to differing nursing roles within a surgical department:

  • Pre-Op RN – performs duties related to preparing the patient for surgery, such as collecting vital signs, reviewing the health history, head-to-toe assessment, intravenous catheterization, confirming consents and other paperwork, providing emotional support and teaching for patient and family.
  • Intra-Op RN –
    • Instrument or scrub nurse – works with the surgeon, in the sterile field, selecting and passing the various instruments, sponges, and other supplies used during the procedure
    • Circulating nurse – manages patient care throughout the procedure form outside the sterile field, making sure that all supplies and personnel are at hand, ensuring a controlled environment and that anyone entering the OR is needed and documenting their presence.
    • RN first assistant – reviews the patient’s case before the procedure, positioning and draping the patient, and during the surgery assist with exposure, retraction, closure of the incision and other technical duties.
  • Post-Op or PACU RN – receives the patient in the recovery room immediately following surgery, monitoring the patient for complication as the patient is waking from anesthesia.

Specific duties related to OR nursing include:

  • Coordinate use of supplies, instrumentation and equipment for operative care
  • Ensure equipment is functioning correctly
  • Maintain patient safety standards
  • Monitor, and record patient’s condition and needs, and communicate with the interdisciplinary team
  • Manage overall care of the patient before, during and after the surgical procedure
  • Advocate on behalf of the patient
  • Document preoperative and intraoperative care to be delivered in accordance with the surgeon, hospital, and regulatory agencies
  • Evaluate, remediate and document the surgical environment
  • Provide patient care with an understanding of age, culture-specific needs
  • Address the biological, emotional, developmental, psychosocial and educational status of the patient and family, and address concerns
  • Coordinate professional development within their practice

    Performs core job functions with minimal supervision

How Do I Become an OR Nurse / Perioperative Nurse?

The first step toward becoming an OR nurse is to become a Registered Nurse, earning at minimum an Associate’s Degree in Nursing (ADN) or a Bachelor of Science in Nursing degree (BSN) from an accredited nursing program. Note that many employers prefer to hire BSN-prepared nurse for this role, or may require an applicant to complete the BSN degree within a certain timeframe. After graduation, you must obtain RN licensure by taking the NCLEX-RN examination in your state. Once you have achieved licensure, you will need to gain clinical experience as an RN. Following gaining this experience, then seek employment in a perioperative nursing role, in order to progress toward the CNOR credential. CNOR is unique in that it is not an acronym, but a definition – “the documented validation of the professional achievement of identified standards of practice by an individual registered nurse providing care for patients before, during and after surgery.”

The CNOR credential is awarded by the Competency and Credentialing Institute (CCI). Eligibility requirements are:

  • Current, unrestricted professional nursing licensure
  • Have completed a minimum of 2 years and 2,400 hours of experience in perioperative nursing, with a minimum of 50% (1,200 hours) in the intraoperative setting.
  • Be currently working full-time or part-time in perioperative nursing in the area of nursing education, administration, research, medical-surgical nursing or clinical practice.

Certification is valid for 5 years, after which it must be renewed by meeting the renewal requirements in place at the time of renewal, such as specialty-related professional development and clinical practice activities. If this is not possible, the certification exam must be retaken.

CCI also provides the Certified Surgical Services Manager Credential, for those in a management role. Eligibility requirements are:

  • Current, unrestricted professional nursing licensure
  • Hold a Bachelor’s degree
  • Be currently employed (either full-time or part-time) and have a minimum of two years’ experience in a surgical services management role if CNOR certified, or four years’ experience for a non-CNOR certified RN.
  • Have completed a minimum of 30 or 50 continuing education contact hours depending on CNOR certification status in the two years prior to application.

CCI also provides the Clinical Nurse Specialist Perioperative Certification credential (CNS-CP) for advanced practice registered nurses who have completed graduate preparation (Master’s or Doctorate). 

Certification as a Registered Nurse First Assistant, for registered nurses working in an expanded role as a first assistant, is offered by the National Assistant at Surgery Certification (NASC). Eligibility requirements include:

  • Current unrestricted professional nursing licensure
  • Minimum education – bachelor’s degree
  • Current CNOR credential

Or

  • Master’s, doctoral, or post-master’s certificate in an advanced practice program and certification as an Advanced Practice Registered Nurse (APRN) by an accredited certification program.
  • Currently working full time or part time as an RNFA.
  • A minimum of 2,000 documented hours of practice as an RNFA
  • Completion of an acceptable formal RNFA program that meets the AORN standards for RN first assistant education programs.

Certification is valid for 5 years, and must be renewed by completion of the method of recertification in effect at the time recertification is due and meeting recertification eligibility requirements.

Where Do OR Nurses Typically Work?

OR nurses work within a variety of health care settings;

  • Hospital/medical centers
  • Outpatient/Ambulatory Surgery facilities
  • Physician’s Offices

How Much Do OR Nurses Earn?

Nursing, in general, is identified as one of the fastest growing professions in the US in terms of salary, with a projected growth of 16% +, much higher than the national average. Specialty certification can increase earnings significantly; the median annual salary for perioperative/OR nurses ranges from $61,500 to $124,000, with an average annual salary of $88,894. This is dependent on the specific job and employer, and the geographical area. Salaries are generally higher in urban areas, however, the cost of living is typically higher, as well. In addition, bachelor’s prepared nurses tend to earn higher salaries than nurses with associate degrees. According to the Bureau of Labor Statistics the top five states for general nursing salaries are (range $96,470 – $102,700);

  • California
  • Hawaii
  • Alaska
  • Oregon
  • Massachusetts

OR Nuring Programs

At the undergraduate level, specialty-related education consists of continuing education activities, such as conferences or online CEU providers. For example, the Association of perioperative Registered Nurses (AORN) offers continuing education activities for OR nurses. Examples of related topics include:

  • Emergency preparedness
  • Aseptic practice
  • Sterile technique
  • Perianesthesia nursing
  • Endoscopic and minimally invasive surgery
  • Safe administration of moderate sedation
  • Preoperative skin antisepsis
  • Perioperative assessment
  • Perioperative safety
  • Perioperative health care information management
  • Positioning the patient
  • Laser safety certification
  • Equipment and product safety
  • Cleaning, disinfection and sterilization
  • Barriers and personal protective equipment

At the graduate level, programs may offer a perioperative/OR nurse specialty as a primary track, or as a sub-specialty related to adult health or family health nursing. Examples of graduate programs offering perioperative-related nurse tracks include:

Typically, perioperative nursing is offered as a sub-specialty within an adult health or family health nursing track. Such a program must include advanced pharmacology, pathophysiology, and physical assessment, with role-specific content and classes, and a 500-hour clinical practicum with an approved preceptor

Another related advanced practice option is that of Certified Registered Nurse Anesthetist (CRNA). Examples of Certified Registered Nurse Anesthetist programs include;

What is a Typical OR Nurse Curriculum?

Programs offering specialty or sub-specialty tracks for perioperative nursing must include advanced pharmacology, pathophysiology, physical assessment with role-related content embedded, as well as role-specific courses, and a 500-hour clinical practicum with an approved preceptor.  Specialty course topics include:

  • Surgical techniques
  • Advanced perioperative nursing
  • Anesthesia care/pain management
  • Advanced technology
  • Hemodynamic monitoring
  • Emergency scenarios
  • AORN standards, practices and guidelines
  • Patient positioning and draping
  • Exposure techniques/wound classifications
  • Suture selection/surgical dressings
  • Radiation safety
  • Wound classifications

Certified Registered Nurse Anesthetist programs will include courses such as:

  • Anesthesia Pharmacology
  • Advanced Pathophysiology for Nurse Anesthetists
  • Advanced Health Assessment for Nurse Anesthetists
  • Advanced Principles of Anesthesia
  • Anesthesia Specialty Techniques
  • Professional Aspects of Nurse Anesthesia Practice

The Role of the OR Nurse in the Healthcare Provider Shortage

The Bureau of Labor Statistics cites that employment for nurses will increase at a rate of 16% – %20 by 2024. There is a national shortage of nurses in general related to the Baby Boomer population entering retirement, and the increased health needs of the growing aging population. It is projected that the South and West will be hardest hit by the nursing shortage. The 12 states expected to have the most acute shortages are: Florida, Georgia, Texas, Virginia, Alaska, Arizona, California, Hawaii, Idaho, Montana, Nevada and New Mexico.

Although there is a current emphasis on preventative care, OR nurses will be in continued demand, as their knowledge and expert skills are increasingly needed regardless of the potential setting. Even with a focus on reducing inpatient care, millions of inpatient surgical procedures are performed annually; in addition, similar numbers of outpatient surgical procedures are performed in ambulatory surgery facilities or as physician office-based procedures.

OR Nursing Resources

References