Here’s a little understood fact about perioperative nursing careers: Like surgical glue, they stick.
OR nurses, for example, are known to stay in surgical center jobs for years; often their perioperative nursing careers last decades.
Although surgical center jobs aren’t for every clinician, those who do choose to work in hospital inpatient surgery departments, same-day surgery, or pre-op and PACU departments report high levels of job satisfaction. In a 2016 survey of perioperative nurses by Nurse.com, an overwhelming majority of respondents said they’d recommend the perioperative nursing specialty to other nurses. On a scale of 1 to 5, with 5 representing most satisfied, 90% of participants in the survey ranked their satisfaction on the job as a 4 or 5.
The reasons nurses remain in perioperative nursing jobs are as assorted as the types of patients they see, but veterans of the OR point to several standout features of the role:
Variety of Patients, Procedures, and Tools
There’s no shortage of variety in the patients who perioperative nurses assist before, during, and after surgery. While some seasoned perioperative nurses may have the opportunity to specialize in a distinct type of surgery depending on their setting, most RNs in surgical roles participate in a wide array of operations, from minimally invasive procedures to open surgery and from common elective procedures to emergency surgery.
Technology is likewise plentiful and varied in surgical departments. Operating theaters give perioperative nurses the opportunity to work with (and troubleshoot) hundreds of pieces of equipment, from lasers, cameras, and monitors to robotic surgical systems and ultrasound imaging, to name a few. That’s in addition to the standard fare of the surgical suite, such as forceps, lancets, drills, retractors, suction devices, and other common instruments.
Variety of Roles
Then, too, perioperative nurses can elect to practice in different roles, each with their own distinct responsibilities:
Scrub Nurse
Before surgery can begin, a scrub nurse holds the vital responsibility of preparing the operating room. A scrub RN organizes equipment and instruments; counts sponges, needles, and other tools; and ensures a sterile environment. Scrub nurses may also assist in preparing patients for procedures, including attaching patients to equipment and monitors. In some cases, they also assist surgeons with sterile gloving and gowning. During surgery, scrub nurses typically select and pass instruments to surgeons; sterilize and return instruments to their designated places in the theater after each use; and monitor both patients and the procedure to maintain a sterile field and ensure patient safety. Following a surgical procedure, scrub nurses count sponges, sharps, and other instruments to safeguard patients from retained foreign objects; remove equipment and instruments from the operating theater; assist in applying dressings to patients; document the procedure; and transport patients (or arrange for their transport) to post-anesthesia care.
Circulating Nurse
Generally working outside the sterile field, circulating nurses check and maintain the inventory of sponges and other disposable equipment, as well as sterilized tools. Circulating RNs verify the functioning of various apparatus used during surgical procedures. They also authenticate patients’ identity upon the patients’ arrival in the operating room, ensure required consent forms have been completed, and confirm the procedure type and surgical site with surgeons. Circulating RNs may also assist in positioning patients for their relevant surgery, attach patients to suctioning or other equipment, and aid anesthesiologists or certified registered nurse anesthetists (CRNAs) with intubation of patients. During surgery, they provide fluids and medications; replenish disposable supplies and instruments; and document the procedure. At the close of a procedure, circulating nurses may assist the anesthetist with tube removal, as well as help with patient transport to the PACU. Circulating RNs often help the scrub nurse clean and prepare the operating room for the next surgery.
Registered Nurse First Assistant
Working side by side with surgeons, RNFAs perform an expanded role once reserved for surgical physician residents. Upon completion of additional training, nurses in RNFA positions are afforded the opportunity to have hands-on contact with patients during surgical procedures. According to the Association of PeriOperative Registered Nurses (AORN), the functions of the RNFA role include suturing; handling and/or cutting tissue; controlling bleeding; and intervening when complications arise, such as administering necessary medications. Prior to a procedure, RNFAs meet with patients to evaluate their health status and readiness for surgery, as well as answer their questions. During surgery, RNFAs monitor patients’ vital signs and alert surgeons to complications. After surgery, they evaluate patients’ status, ensuring no complications exist, before patients are transported to post-anesthesia care. RNFAs typically begin their careers as scrub or circulating nurses.
Certified Registered Nurse Anesthetist
At a top echelon of the nursing profession, CRNAs are advanced practice RNs who have completed master’s-level education and work in collaboration with anesthesiologists to independently deliver anesthesia during surgical procedures. Like their physician counterparts, CRNAs conduct patient assessments before surgery, prepare patients for anesthesia, administer and maintain anesthesia during procedures, and ensure patient recovery from anesthesia.
PACU Nurse
In the postoperative phase, post-anesthesia care nurses perform the crucial role of monitoring and assisting patients during their recovery from surgery. PACU nurses possess expertise in managing conditions involving patients’ respiratory, cardiac, neurological, and hemodynamic functions. Upon patients’ arrival in the PACU, these specialized RNs assess patients’ status and regularly and consistently monitor their cardiac function, oximetry, CO2, blood pressure (invasive, as in the case of a patient with an arterial line, and noninvasive), temperature, sedation, and return to consciousness. PACU nurses ensure patients are stable and meet established criteria before they are discharged to another unit or, in the case of same-day procedures, the home.
Collaboration and Camaraderie
Gone are the days when surgical nurses were considered little more than instrument sterilizers. Progressive facilities like Eisenhower Medical Center cultivate collaborative work environments that promote trust and effective, respectful communication between caregivers. Ultimately, teamwork in the OR has proven to reduce error, protect patient safety, and lower risk of poor outcomes.
In the fast-paced, high-stress, high-stakes surgical department, tensions among clinicians can occasionally flare. Yet experienced perioperative nurses cite camaraderie with their colleagues — physician and non-physician alike — as a top reason for their satisfaction in their roles. Surgical departments involve tight-knit groups: Perioperative nurses will often work on their feet alongside a small group of colleagues (typically three to five team members), often for hours at a time. The precision required of clinicians during surgical procedures obliges clear understanding of, and respect for, roles and responsibilities. Nurses who work in surgical areas come to know that mutual respect fosters a level of trust between colleagues in the OR, which benefits patients and supports long, rewarding perioperative nursing careers.
Salary
As with nurses in general, perioperative nurses earn more than the average annual salary for all U.S. occupations, according to the U.S. Bureau of Labor Statistics. In its annual Salary and Compensation Survey, last published in 2015, AORN reported an average base salary of $67,900 for staff-level perioperative RNs in facilities with 10 or fewer operating rooms (small facilities) and $68,900 for perioperative nurses in facilities with more than 10 operating theaters (large facilities). RNFAs earned on average $76,100 per year in small facilities and $84,900 in large facilities.
Perioperative nurses in California, however, enjoy higher annual salaries than their counterparts in other areas of the country. In the Coachella Valley area, for example, perioperative nurses in staff roles earn salaries exceeding $72,000 per year, according to a November 2016 listing by Salary.com. What’s more, perioperative nurses can boost their earnings by being on call for procedures that occur beyond their regular shifts.
If you’re an experienced nurse interested in changing your specialty to pursue a satisfying, long-term career in perioperative nursing, we’d like to talk with you. Search our open positions and connect with us today.
Originally posted on 5/1/2017