What are the priorities of the perioperative nurse?

Perioperative nurses provide care for patients before, during and after they undergo surgery or interventional procedures. A Perioperative nurse will assist in helping patients feel less anxious before the operation, provide assistance to the surgical team during the operation, and assist the patient after surgery to provide the best care to ensure that patient needs are met both pre and post surgery.

Table of Contents Show

What are the Responsibilities of a Perioperative (OR) Nurse?
Introduce your experience as a Periop Nurse
What are some of the benefits of working as a Periop RN?
What are some of the not-so-great parts of working as a Periop RN?
Share your favorite piece of advice for nursing new grads or students looking to become a Periop RN
Looking for a New Perioperative Nurse Job?

As a Perioperative Nurse, your duties encompass a range of roles, including but not limited to:

Pre-operative patient assessment and education nurse
Anaesthetic nurse
Circulating nurse
Instrument nurse
Post Anaesthesia Care Unit nurse
Perioperative Nurse Surgeon’s Assistant
Nurse practitioners

Watch the series of interviews below, filmed by Deakin University (2018) to learn more about the different perioperative nursing roles.

The role of the Instrument nurse

The role of the Circulating nurse

The role of the Post Anaesthetic Care Unit (PACU) nurse

The role of the Anaesthetic nurse

For a detailed explanation of each role, visit the Australian College of Perioperative Nurses (ACORN) webpage ‘Perioperative Careers’

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These nurses work in day surgery units and pre-admission departments. Admissions departments are both challenging and busy, as all types of surgery from minor to major can be admitted on day of surgery. Pre-admission activities occur prior to surgery where nurses work collaboratively with doctors to assess patients’ health care needs for the planned procedure or operation.

This nursing role has one of the highest levels of patient contact in the perioperative nursing field and involves a mix of teamwork and autonomy that many find appealing and rewarding.

Pre-admission nurses:

are the first point of contact when the patient is preparing for surgery and when the patient arrives on the day of their surgery
ensure patients are fully informed and have completed an informed consent form
ensure patients are prepared for surgery and that it is safe to proceed with surgery
are responsible for assessing patients presenting for surgery and ensuring they have made the necessary preparations
substantiate data relevant to the patient's readiness for surgery
communicate pertinent information to the surgical team.

Knowledge, skills and attributes

Pre-admission and day surgery nurses require:

compassion and empathy to help allay any anxiety the patient or their family may be feeling
attention to detail
good communication skills
good assessment skills
critical thinking ability
the ability to identify potential problems and communicate these to the perioperative team to ensure safe, positive patient outcomes.

Education pathway

This role is suitable for both registered and enrolled nurses and requires the completion of, respectively, a Bachelor of Nursing or Diploma of Nursing that includes medication administration.

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It’s highly likely that you have had surgery or know someone who has had surgery, whether it was an elective or emergent procedure. Successful surgeries are dependent on operating room (OR) teams functioning together to achieve favorable outcomes for patients.

The OR can feel very mysterious to those who have not been inside. Patients who have been in the OR were typically under the influence of medications that may have altered their memories of their experience.

So, who works in the OR? Typically, a surgical team is assigned to each OR. This is made up of a variety of healthcare professionals such as perioperative nurses, anesthesia providers, and ancillary personnel that assist the surgeon and his/her surgical team for the procedure.
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So, what are perioperative nurses?

In short, 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.‍

What are the Responsibilities of a Perioperative (OR) Nurse?

A perioperative (OR) nurse can have multiple jobs inside the OR such as a scrub nurse, circulator, or first assistant (RNFA).

Scrub nurses prepare instruments for a procedure and assist in maintaining sterility throughout the operation, while also passing instruments to the surgeon. This role requires knowledge of the instruments’ names and functions, as well as step-by-step knowledge of the procedure in order to prepare the supplies in advance.

Circulating nurses manage the safety and patient care aspects of the OR. Safety is the top priority. ‍
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Key facets of safety include:

Correct patient for the correct surgery on the correct body site
Verification of surgical consent
Safe patient positioning that will not cause injury
Accurate surgical counts to prevent items left in a patient
Knowledge and ability to troubleshoot surgical equipment ‍

RNFAs have a specialized nursing role in the OR. This allows them to support the surgeon with closing incisions, cauterizing bleeding, and assisting with retractors to increase visibility. This is an advanced practice nursing (APRN) role that requires additional education.
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Introduce your experience as a Periop Nurse

Before I went to nursing school, I already knew that I wanted to find a way into the OR. My local trauma center offered a one year perioperative nurse residency program that provided training to scrub and circulate. I fell in love with orthopedic surgery and continue to feel that way today. Every day I wonder how I get paid to do this amazing job!

If you’re a nursing new grad and are not sure where to begin your career, you can check out Trusted for New Grads for some helpful resources. Daily life as an OR nurse can feel like completing projects one at a time. There is an intense focus on preparation for each surgery to facilitate a surgical schedule with minimal delays. ‍

What are some of the benefits of working as a Periop RN?

Being an OR nurse is an intense, fast-paced, and highly technical specialty of nursing. The number one reason (in my opinion) to be an OR nurse is the ability to focus on only one patient at a time. This allows nurses to give their complete attention to one patient without the distractions of caring for multiple patients simultaneously.

Also, the majority of surgery occurs during daytime hours. This can be highly beneficial to nurses who are unable to work a night shift position. Trauma centers have emergency surgeries throughout the day and also require evening and night shift nurses. Surgery schedules are typically reduced on holidays, requiring fewer staff to work.

Relationships between surgeons and OR nurses are different than other areas of the hospital. There is a dynamic team-focused relationship between surgeons and OR nurses that may not be typical in other areas of the hospital. After scrubbing in, a surgeon depends on the circulating nurse to retrieve necessary supplies, equipment, or instruments.

OR nurses have strong competence in troubleshooting equipment issues and learning how to operate new and advanced surgical equipment.

Overall, perioperative nurses experience the satisfaction of seeing broken bones repaired, cancer removed, arthritic joints replaced, and a trauma patient’s life stabilized for recovery. All incredible things that inspire awe when watched, and assisted, first hand!
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What are some of the not-so-great parts of working as a Periop RN?

As with any nursing job, there are some not-so-great parts of working as a perioperative nurse. The OR is a highly intense environment due to the high stress of surgeries and the expectation of preparedness for procedures. Ample specialty knowledge and continuing education is critical to maintain proficiency.

There are also physical demands to lift heavy instrument trays, move large equipment, position patients without overhead lifts. Surgery often involves a long day of standing, which can even last an entire shift straight. Staff must wear heavy lead aprons—sometimes for several hours—to protect themselves from radiation.

There is a high risk of exposure to blood, body fluids, surgical smoke, strong smells, radiation, and harmful chemicals. Proper knowledge of safety guidelines and ongoing education protects perioperative nurses and surgical staff from these hazards. ‍

Interested in the OR? Shadow a perioperative nurse to see the ins and outs of an OR nurse role first-hand before committing to a perioperative nurse residency program. Once in the OR, understand that it can be one to two years before a nurse feels completely comfortable in this environment (but don’t let that stop you!). What are you waiting for!?
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