A perioperative nurse is a nurse who works in operating rooms. These nurses are qualified to the Registered Nurse (RN) level and sometimes go by the title of Surgical Nurse. When working in an operating room, a perioperative nurse may have a specific duty, such as being the scrub nurse or a circulating nurse. Those who choose to specialize in this profession at a higher level can qualify as a Surgical Nurse Practitioner.
A scrub nurse is a nurse who is responsible for the supplies and instruments used in the operating theater, assisting the surgeon by ensuring they have access to the right tools. Circulating nurses take on a more general role, maintaining a sterile field and managing the nursing care offered in the OR.
A perioperative nurse may work with an individual who is being prepared for surgery and their loved ones, as a part of an interdisciplinary care team. They make sure the patients are ready for surgery and monitor the patient throughout the procedure as well as after, helping ensure their recovery goes as planned.
Perioperative nursing is a skilled profession that will appeal to those who want to work in operating rooms, providing acute care. The scope of practice of a perioperative nurse who is at the start of their nursing career will be more limited than the scope of practice of a Surgical Nurse Practitioner or a CNOR, but all nurses working in operating rooms have significant responsibilities.
The average salary of an operating room nurse is $72,227 per year, although salaries will vary depending on how well-qualified the nurse is. Nurses at the beginning of their career will earn closer to $50,000 per year, while nurses qualified to the Nurse Practitioner level can often earn around $100,000.
What a perioperative nurse does
Perioperative nursing is a skilled profession that involves caring for patients prior to and in the immediate period after surgery. A CNOR or perioperative nurse is a part of a skilled team of medical personnel, all of whom must work together for the operation to be a success.
A surgical team may include many other professionals, such as:
- Nurse anesthetists
- Registered nurses
What are the responsibilities of a perioperative nurse?
There are several roles that a surgical nurse can fulfill within an operating room, such as a scrub nurse, first assistant, or circulator. Each of these roles is very important and requires some training and knowledge of the surgical procedures. For example:
- Scrub nurses must know the names of each instrument, what it is used for, and the order of the procedure so they can prepare supplies ready for when the surgeon will need them
- Circulating nurses must understand the safety requirements of the OR and how to provide adequate patient care throughout the procedure
- First assistants provide more hands-on care, cauterizing bleeding, closing incisions, and otherwise directly assisting the surgeon
Safety is paramount during surgery, and there are many steps that must be followed to ensure that the correct surgery is performed and that the patient is properly cared for. Things a perioperative nurse is responsible for include:
- Confirming the correct patient is sent for surgery and that the correct surgery type is being performed
- Verifying that there is consent for the surgery
- Positioning the patient in a way that is safe for them and allows the surgeon to work properly
- Counting surgical items to ensure nothing is left inside the patient
- Troubleshooting surgical equipment if anything goes wrong during the process
Each surgery requires detailed, painstaking preparation to ensure the correct equipment is available, that the OR and all of the equipment in it is sterile, and that the patient is ready for surgery too. Attention to detail is vital for the safety of the patient, and the job can be intense and demanding because of this.
Where do perioperative nurses work?
Perioperative nurses work in operating rooms in civilian and military hospitals, trauma centers, and private clinics. While most scheduled surgeries are done during working hours on weekdays, emergency surgeries can happen at any time, which means there is a demand for nurses who are willing to work night shifts, holidays, and weekends too.
Nurses who are unable or unwilling to work odd hours may find the perioperative nursing specialization appealing to them because they can focus on clinics that do elective surgeries, thereby having more predictable working hours. These nurses will usually have a small team of other medical professionals they work with, and this creates a close-knit dynamic that nurses in other areas of the hospital may not experience, due to the more fluid nature of their work.
Once a surgeon has scrubbed in, they’ll rely on the perioperative nurse to give them supplies, instruments, and tools. Many surgeons have nurses they find they’re most comfortable working with, and vice-versa, and this working relationship is a major part of job satisfaction for some nurses.
Why are perioperative nurses important?
The role that a surgical nurse plays in the operating room is critical to the success of the operation. A successful perioperative nurse will pay attention to every last detail of their working environment and will be pro-active when it comes to performing a preoperative assessment on each patient.
These nurses perform patient care in an environment where missed details or mistakes could be incredibly costly. Surgeons, doctors, and other operating room personnel such as the Certified Registered Nurse Anesthetist rely on the skills of the perioperative nurse to help them do their jobs properly. Some people are dismissive of the role of nurses as being one of the less-skilled areas of health care but this is not the case with a perioperative nurse.
This is a job that is demanding both mentally and physically since the nurse must always be on top form and get things right when following detailed and complex procedures. Perioperative nurses may sometimes have to lift heavy trays, move large items of equipment and manipulate the patient’s body without the use of an overhead lift. Because of this, it’s common for people who have been doing the job for a long time to have back issues.
A large part of the job involves handling potentially hazardous materials, so safety protocols must be followed at all times to prevent exposure to biohazards, contaminants, radiation, or toxic materials. Not only is this important for the health of the patient, but also for the others in the operating room. Everyone in the theater depends on everyone else doing their jobs correctly to keep each other safe.
Requirements to become a perioperative nurse
To become a perioperative nurse, you will need to hold a valid nursing license at the Registered Nurse level. There are many routes into nursing, depending on your prior academic background and how quickly you want to enter the workforce. All perioperative nurses, however, must be qualified to the RN level. Licensed Practical Nurses and Licensed Vocational Nurses are not able to enter this profession without first taking the RN-level licensure exam.
How do you become a perioperative nurse?
To be able to sit the NCLEX-RN examination and call yourself a Registered Nurse, you will, first of all, need a degree in nursing. At the moment, it’s possible to take the NCLEX-RN with an associate’s degree and then get a job at a hospital or a clinic and earn some real-world experience while you work towards the next level of your education.
In the state of New York, nurses who took the NCLEX-RN after earning an ADN are required to upskill to a BSN within ten years of licensure if they wish to continue working in the nursing profession. Some other states are considering introducing similar laws in the next few years, because studies show that BSN-prepared nurses offer better patient care, resulting in lower mortality rates and shorter hospital stays for patients.
After you’ve become qualified as a Registered Nurse, you can start looking at postgraduate qualifications and work-related certifications, allowing you to specialize in a specific area of practice, such as becoming a surgical nurse.
What classes do you need to take to become a perioperative nurse?
In most cases, for someone to become a perioperative nurse, they’ll need to hold a BSN. This takes four years of full-time study through direct enrollment or via a two-year ADN then a two-year top-up course to go from ADN to BSN. There are part-time options for ADN-holders who wish to continue working while they study.
After passing your ADN, the next step is to take some practical certifications. There are several different certifications available, depending on what level you’re at in your career.
For example, the Competency and Credentialing Institute’s (CCI) CNOR certification is aimed at perioperative nurses who are still fairly early on in their careers. This qualification requires nurses to have a valid RN license, have been working as a nurse for at least two years, and have a total of 2,400 hours or more of clinical experience.
A nurse with a graduate degree could apply to become a Certified Perioperative Clinical Nurse Specialist (CNS-CP). This is another CCI certification requiring 2,400 hours of clinical experience and two years of nursing experience in addition to experience as a clinical nurse specialist.
The third option is Certified Surgical Services Manager (CSSM), which has similar baseline requirements to the CNS-CP certification, but is aimed at nurses looking to move into a management and leadership role, rather than the more hands-on areas of surgery.
How much does it cost to become a perioperative nurse?
Training to become a perioperative nurse takes at least six years and usually far longer than that. The total cost of all of the qualifications and training required will vary depending on whether you study part-time or full-time, and also where you choose to complete your studies.
The cost of a Bachelor of Science in Nursing can be between $40,000 and $100,000 for the full course. Many nurses are able to reduce the overall cost of this part of their studies through bursaries or scholarships. Another option is to apply for a Nurse Corps scholarship which offers financial assistance for those who are willing to provide a few years of service at the end of their studies.
The Nurse Corps Scholarship can cover most of the costs of completing a nursing program, including:
- Tuition fees
- Clinical supplies
- Other reasonable fees
After completing the BSN, there are fees for taking the NCLEX-RN (approximately $200). This entitles you to work as a registered nurse.
After two years of experience as a nurse, you can take one of the CCI examinations to become a surgical nurse. The cost of these certifications is approximately $350. There may be discounts available for people who are members of the CCI.
The average salary for a perioperative nurse
Perioperative nurses are expected to have a higher level of training than an entry-level Registered Nurse. According to the Bureau of Labor Statistics, the average salary of a Registered Nurse is $73,000. This assumes the nurse has a Bachelor’s Degree, and because there are so many different job titles under the category of Registered Nurse, actual pay can vary significantly.
Entry-level Registered Nurses can expect salaries of around $45,000 per year, with the most highly-qualified nurses, working in cities with a higher cost of living, earning $91,000 per year. CNOR nurses can expect to enjoy higher salaries than this, although their pay depends on which certification they have, how experienced they are, and whether they’re normally serving as a first assistant, scrub nurse, or filling some other operating room nurse role.
What is the average entry-level salary of a perioperative nurse?
The average salary of a perioperative nurse who is working in an entry-level role is $50,000 per year, although this will vary depending on the state they live in and whether they’re working at a private clinic or a not-for-profit hospital. Nurses who are more experienced can expect higher salaries.
For example, an Operating Room Nurse Manager earns an average of $93, 432 per year. The salaries mentioned here are base salaries, and some hospitals offer bonuses, profit sharing, or other benefits that can increase a nurse’s overall income.
Where do the highest-paid perioperative nurses work?
Nurses are very much in demand across the whole of the United States, and the average income enjoyed by any form of Registered Nurse is higher than the national median income. Salaries vary dramatically from state-to-state, however.
The states with the highest salaries for nurses who are educated to Bachelor’s Degree level are:
- California ($106,950)
- Hawaii ($98,080)
- Massachusetts ($92,140)
- Oregon ($91,080)
- Alaska ($89,310)
Even in the states that are further down the list, such as Kentucky ($63,100), the average salary for a Registered Nurse still compares favorably to the national average salary of $39,810 per year.
It’s important to note these figures are for all kinds of Registered Nurse. Someone who has specialized will usually earn more than a nurse who is at the start of their career and who has not pursued education beyond the BSN. If we look at perioperative nurse salaries specifically, two of the highest-paying cities are Los Angeles, California, where there’s an average salary of $97,148 for perioperative nurses, and New York City, where perioperative nurses earn $81,094.
Surgical Nurse Practitioners can expect even higher salaries than Registered Nurses who work in the operating room.
What is the job outlook for perioperative nurses?
Employment opportunities for nurses at the Registered Nurse level are expected to increase by 7% between 2019 and 2029. This increased demand is due to the skilled nurses currently in the workforce retiring, plus the fact the United States has an aging population.
As the average age of our population increases, so too does the number of people living with chronic health conditions who require nursing care. Perioperative nursing is demanding both physically and mentally. Nurses are expected to work long shifts and spend a lot of time on their feet, often moving heavy patients or awkward machinery.
As the currently trained batch of nurses either retire or move into administrative roles because they’re at an age where they can’t handle the physical demands of the profession, new nurses will be needed to fill the gap and help the health care service keep up with the increasing demands.
Demand for those who are educated to nurse practitioner level is even higher than that of BSN-prepared nurses and is expected to rise by 45% over the same ten-year period. This means that anyone who is willing to invest the time and effort into training to become a surgical nurse practitioner or a clinical nurse specialist with a master’s degree should find many employment opportunities open to them, whether that’s in the operating room or in some other area such as serving as a nurse educator or a surgical technologist.
Most people who opt to study this area of nursing do so because they want to play an active role in the acute care side of nursing, but in the long term, the skills they learn will serve them well, allowing them to pursue nursing-related research jobs, public health-related positions, education, or technology consulting.
Steps to become a perioperative nurse
If you’re interested in becoming a perioperative nurse, the first step is to earn your nursing license. Some people take a short diploma to become a Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN), then spend some time working at a hospital or in a clinic before they go back to study a degree-level course and prepare for the NCLEX-RN.
Those who have a good academic background and got good grades in the GED can enroll directly on an ADN or a BSN and then earn their NCLEX-RN certification. This will give them the right to call themselves a Registered Nurse and work with a wider scope of practice than an LVN or an LPN.
What degree do you need to be a perioperative nurse?
It’s possible to work as a perioperative nurse in an operating room or as a scrub nurse with a Bachelor’s Degree. You can earn the CNOR certification if you have been a registered nurse for at least two years and have at least 2,400 hours of clinical experience. This experience must include time spent in operating rooms or similar acute care settings.
If you wish to take on a more specialist role, such as working as a Nurse Anesthetist or becoming a nurse practitioner, you will need to have a Master’s Degree or a DNP, along with a significant amount of clinical experience. Many people who are considering going down the advanced practice nurse career path will spend some time on a clinical placement, working under nurses who are already qualified and learning the job of a scrub nurse or a circulating nurse while under close supervision.
The surgical team needs a significant number of people present to keep the operating room safe, clean, and organized. Nurses who are not yet fully qualified as perioperative specialists can still play a valuable role in patient care while they are working on earning the clinical practice time they need to apply for their CNOR certification.
How do you apply for a degree program to be a perioperative nurse?
It takes about six years, at a minimum, to become a perioperative nurse. Most people take longer than this, because of the clinical experience requirements put in place by the CCI for the CNOR certification.
Four of those six years are the time it takes to earn a BSN degree. Entry into Bachelor of Science in Nursing programs is quite competitive. Individual schools set their own criteria in terms of admission requirements, but most schools will want students to have a GPA of 3.0 or better, with good grades in math and science.
Students will often be asked to write a Statement of Purpose and attend a face-to-face interview if they’re studying an on-campus program. Scores on the SAT or ACT may be taken into account if someone is enrolling straight out of high school. International students who come from a country where English is not their primary language may be asked to take a language proficiency test.
Once admitted to the BSN program, it’s important to study diligently because admission onto future courses such as an MSN or DNP will be contingent on the grades achieved during the BSN.
Choosing a degree program to prepare you for becoming a perioperative nurse
Starting a BSN is a significant commitment. Most BSN programs are four years long if studied full-time, and the total cost of the course can be tens of thousands of dollars, or in some cases over $100,000. If you choose to study part-time, the course could take six years to complete.
You can study for a BSN at a traditional university or nursing school, or look for an online BSN. If you opt to take the online route, make sure the course is fully accredited. You can be a successful perioperative nurse with an online degree. You’ll still need to complete the same certifications as someone who studied at a more traditional institution.
Consider the cost of the course, the focus of any optional modules, and whether the course requires you to take a specific state’s licensing exam. Some universities require graduates to take the NCLEX-RN for their state, and if you’re planning on pursuing a job in a different state, you’ll need to take another exam before you can do that.
Continuing education for perioperative nurses
Once you’re a qualified nurse, you can start taking training courses and continuing education sessions run by organizations such as the American Association of Critical Care Nurses or the Association of Perioperative Registered Nurses. These organizations are widely recognized within the United States and provide support, training materials, and information for nurses working in this highly specialized field.
To maintain your CORN qualification, you’ll need to re-certify every five years, which means staying active as a perioperative nurse and keeping your continuing education credits up to date. The medical profession is a fast-moving one, and there are new treatment options and best-practices being discovered on a regular basis. It’s important for nurses to make an effort to keep their skills current so they can provide the best possible care for their patients.
Long-term, you may wish to update your qualifications by earning a master’s degree and becoming an advanced practice registered nurse, or even qualifying as a nurse anesthetist and moving into a different position in the operating room as the next step in your career.