OR nurses helping doctor during surgery

In 2019, operating room (OR) nurses were the sixth highest in-demand nursing specialty experiencing staffing shortages. One major factor of this shortage is that nursing schools typically focus on bedside nursing. Clinical rotations cover basic medical-surgical floors, and some specialty units teach the hands-on skills that are necessary to function as a nurse. However, many nursing schools do not offer OR clinical rotations. Some schools offer an opportunity to observe in the OR, but typically only for one day in place of a full clinical rotation.

What Are Some Essential OR Nurse Skills?

In order to perform their job competently, OR nurses need additional hands-on technical skills that are not taught in nursing school. The roles and responsibilities of an OR circulator include, but are not limited to:

  • Engaging in interdisciplinary teamwork to care for the surgical patient
  • Maintaining strong communication skills and a willingness to advocate for the patient
  • Understanding the steps of numerous surgical procedures
  • Preparing equipment and instruments needed for each surgery
  • Conducting patient assessments and verifications of surgical documents
  • Ensuring the safe positioning of the patient
  • Performing surgical counts to reduce the risk of retained foreign bodies left in a patient

Luckily, there are several different ways to gain access to ORs or to learn the necessary skills for the job.

Nursing School Clinical Rotation

If available, this opportunity allows nursing students to shadow a circulator in the OR. Depending on the school and facility rules, student nurses may be able to dispense medications to the sterile field, open sterile supplies, insert foley catheters, and gain an understanding of the circulator nursing process.

Pros:

  • Exclusively for nursing students
  • Offers an opportunity to experience the OR specialty
  • Ability to create a relationship with the OR and potentially be hired after graduation

Cons:

  • Not offered at all nursing schools
  • Only available for current nursing students

Periop 101 by AORN

The Association of periOperative Nurses (AORN) is a professional nursing organization for surgical nurses. AORN offers numerous educational programs for nurses at any stage of their education. AORN also offers courses such as Periop 101 and Introduction to Perioperative Nursing, but these programs must be completed with a specific educator in a facility group setting.

Pros:

  • A nursing school can purchase OR training programs specifically for undergraduate nurse training
  • Student nurses can petition their nursing school to utilize these training programs
  • Completion of these programs shows dedication to learning OR nursing basics from a professional nursing organization

Cons:

  • The cost of the program can be expensive and requires multiple students
  • Nursing schools are not always willing to purchase the program
  • Not a guaranteed way to secure a job in an OR, as the facility must still be willing to provide hands-on training.

On the Job Training

Surgery centers and procedural doctor's offices (ex. plastic surgery, eye procedures, ENT) are often more willing than a hospital to provide training without a formalized program. By working with a preceptor, nurses can receive on-the-job training centered around the responsibilities of the procedural nurse at that particular facility.

Pros:

  • No mandated time commitment in exchange for training
  • Shorter training period due to it being a single surgical specialty

Cons:

  • A single surgical specialty focus, which means it may not be translatable to a job in a hospital OR
  • No formalized education regarding the fundamentals of surgery, or why actions are performed a specific way

Perioperative Nurse Residency Program

A "Periop Program" is a nurse residency program offered by a hospital for nurses aiming to gain the necessary skills to become an OR Circulator. It is an introductory course on the basics of working in an OR for new graduate nurses or experienced nurses looking to change specialties. An experienced preceptor combines a strong didactic portion of education with hands-on learning.

Programs can vary in duration, lasting anywhere from six months to one year. If learning to scrub into surgery is included, the program can run even longer.

This is the ideal path to become an OR nurse, as it offers the most comprehensive experience and the greatest chance of using the skills in a future job.

Pros:

  • Detailed and specific education, focused on the fundamentals of surgery
  • Accepts nurses of all perioperative skill levels
  • Covers multiple surgical specialties (ex. general, plastics, neuro, ortho, etc.)
  • Completion of these programs offers a higher chance of obtaining an OR position

Cons:

  • May come with a time commitment to work at the facility in exchange for the education (ex. a requirement to work in that specific OR for two years after completing the program)
  • Not offered at all desired hospitals or locations

While gaining the critical skills and experience to get there is no easy task, OR nursing is a highly desirable and well-respected specialty. A perioperative nurse residency program is the best opportunity to become a well-rounded surgical nurse, as it combines thorough education and on-the-job training in multiple surgical specialties.

Bliss Splane, RN, BSN, CNOR
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