A registered nurse who works in the operating room is commonly known as a perioperative nurse, a title that accurately reflects the duties before, during and immediately after surgery. A perioperative nurse might work as a scrub nurse, a circulating nurse or even an RN first assistant, a role that requires extensive additional training and allows the RN to work directly with the surgeon in a role once reserved for physicians.
A perioperative nurse may begin her education in an associate program, a baccalaureate program or a diploma program in a hospital-based school of nursing. Any of the three programs provides the necessary qualifications to take the NCLEX-RN exam, a national test that all nurses must pass to obtain an RN license. Some nurses also choose to obtain a master’s or doctoral degree. They may complete advanced education before licensure or go back to school later in their careers. Perioperative nurses may also choose to become certified in their area of expertise.
Basic expectations for all perioperative nurses include an understanding of the principles of surgical asepsis, or sterile technique. They must know how to use aseptic techniques during an operation to prevent infection. In surgery, the perioperative nurse should know what tools to use and how to handle them correctly. She must also know how to operate specialized equipment used in the operating room and how to position a patient to prevent complications, such as skin breakdown. Perioperative nurses are called on to assess patients’ physical, emotional and spiritual needs.
Scrub Nurse vs. Circulating Nurse
In surgical settings, a perioperative nurse may act as a scrub nurse or a circulating nurse. The scrub nurse works directly with the surgeon and must maintain sterility throughout the operation. The scrub nurse passes instruments, sponges or other items to the surgeon; takes them back after use; prepares sutures; and monitors the sterile field to ensure that there is no contamination. The circulating nurse works outside of the sterile field. She might bring in equipment or supplies needed during the operation; obtain medications or intravenous solutions; or communicate with family members during the surgery.
Registered Nurse First Assistant
A registered nurse first assistant, or RNFA, has an expanded role in the operating room. At one time, the surgeon’s assistant was another physician, but RNFAs have taken over that role in many areas. Each state regulates the practice of RNFAs, and exact duties may vary from state to state. Generally, an RNFA is authorized to expose a wound, dissect tissue, stop bleeding and close a wound with sutures or staples. The RNFA is not allowed to function as a scrub nurse while acting in the first assistant capacity. In addition, RNFAs are authorized to bill separately for their services.
The Bureau of Labor Statistics reports that registered nurses earned an average annual salary of $69,110 in 2011. The Association of Perioperative Nurses, or AORN, reports in its 2012 salary and compensation survey that staff nurses in the specialty of perioperative nursing earned annual salaries ranging from $65,100 to $67,800 in 2012. AORN says that RNFAs earned more, with salaries ranging from $82,800 to $83,300 annually in 2012.