OR Nurse/Scrub Nurse/ Perioperative Nurse - all the same thing?

Pediatric Critical Care Columnist · Nov 3, 2009

Let's start with "perioperative nurse"... "peri" means around, and perioperative nursing revolves around surgery. There are different responsibilities that come under the heading, including nurses working in the pre-anaesthesia/same-day admission clinic, pre-operative holding area nurses, scrub nurses, circulating nurses and post-anaesthesia/recovery room nurses. These nurses all have contact with patients who are having surgery on the day of the surgery.

Pre-anaesthesia/same-day admission nurses admit the patient and get the chart going if there hasn't been a lot of pre-op paperwork done already. They weigh and measure the patient, get an admission set of vital signs, maybe put in an IV, pull up lab reports to ensure the patient's status is known, send off labs if necessary, and get the patient ready for the OR. These nurses may also care for the patient after they're out of recovery if they're going to be discharged the same day.

The circulating nurse is the gopher. S/he gathers supplies and equipment for the surgical team, handles the paperwork and specimens collected, runs for blood products, helps the scrub nurse with setting up the sterile field, prepping the operative site and the instrument counts, answers the phone and a million other tasks that cannot be done by someone trying to maintain surgical asepsis. ("Sterility".)

The scrub nurse is the one who maintains the sterility of the instuments, helps the surgeon by passing instruments and supplies onto and off of the surgical field, collects the specimens and passes them off to the circulating nurse, and again, a lot of other tasks that are important to the surgery.

The post-anesthesia/recovery room nurse receives the patient into care once the surgery is over. The patient may still have a breathing tube in place and have not yet regained consciousness. There may also be monitoring devices in place. S/he is responsible for the safety of the patient as they recover from the anesthetic, administering antibiotics or other drugs needed, monitoring their vital signs, fluid intake and output for complications, sometimes extubating (removing the breathing tube), and then transferring the patient to the next level of care, either the same-day surgery area, the surgical ward or the ICU.

Physician's assistants are paramedical personnel. They typically don't work in the OR in Canada.

If you want to work in the OR, go there right after graduation if you're offered the chance. Med-surg is quite different from working in the OR. That's not to say you wouldn't learn a lot of valuable skills but it is different. Changing out of the OR won't be impossibly difficult if you later on decide to try something else. There will be a learning curve in terms of organizing and prioritizing the needs of multiple patients as opposed to one at a time, learning different medications and such, but it's not a huge jump. If you go into post-anaesthesia care for example, it's an easy jump to the ICU and vice versa. Room for advancement in the perioperative field is pretty decent; as your skills grow you'll be offered more and more complex surgeries and the opportunity to climb the clinical ladder. At our hospital the nurses with the highest level of skills and the most respected are those who work in the pediatric neurosurgery and pediatric cardiovascular surgery programs.

Best wishes!

RN_waitlister · Nov 3, 2009

Wow, thanks for all that info! That's exactly what I wanted to know. :nurse:

A Scrub Nurse sounds like what I'm most interested in (for now). I'd like to be in the OR and apart of the surgery, it would be so interesting! I assume though that you'd learn all the different roles (pre, circ, scrub, post) in training not just one particular role?

Pediatric Critical Care Columnist · Nov 3, 2009

If you choose to go to the OR, you'd be trained as circulating/scrub. The pre-op and post-anaesthesia areas are staffed separately; their positions are posted as strictly their own. All the departments may have a single manager though. This is a current posting for a surgical suite position at a community hospital, which is a little different from the hospital where I work:

Duties:

Under the direction of the Patient Care Manager or designate, the Registered Nurse, as a professional, bears the primary responsibility and accountability to assess needs, plan for, implement and evaluate nursing care for assigned patients.

Qualifications:

The successful candidate must be a graduate of an approved school of nursing and eligible for registration with CARNA. Current certification in ACLS is preferred. Critical Care background an asset. Certification CPR, Extubations and Initiation PCA/Epidural protocol in pain management. Previous operating room experience including scrub and circulating functions as well as a minimum of 3 years recent Surgical Suite experience. (PARR) is an asset. Recent perioperative nursing experience an asset with experience in General Surgery, Orthopedics, OB/Gyn. The ability to cope and effectively perform in stressful and/or emergency situations is essential. The incumbent must possess leadership and decision making ability and be able to exercise sound judgment and use initiative. Good interpersonal and public relations skills as well as good communication skills, oral and written are essential. Good organization and coordination skills are required.

Responsible to provide proof of active registration with the College & Association of Registered Nurses of Alberta (CARNA) and to maintain registration throughout the duration of employment.

At this hospital there would be a possibility of also covering the post-anaesthesia/recovery room nurse role but generally they're a completely separate entity.

RN_waitlister · Nov 3, 2009

Thanks again for the great info! :clphnds:

psso · Nov 3, 2009

just out of curiosity, kalokiari, what program are you going into? i'm also interested in becoming a scrub nurse and am curious to know what the "approved" schools of nursing are for this. great info janfrn! :)

RN_waitlister · Nov 3, 2009

The program I'm going into is a normal 4-year bachelor program to become an RN through Camosun College and UVic. It's not especially to become a Scrub Nurse. I've just heard that some grads of the program have been trained right after to work in the OR because they really needed people.

Pediatric Critical Care Columnist · Nov 3, 2009

There are post-basic perioperative nursing programs at many of the colleges across the country. You'll receive some exposure to the OR and surgery in your university nursing program but it'll be pretty sketchy. Some hospitals will provide on-the-job training but they will often prefer a certificate course through a community college. Here in Alberta there are courses offered at Grant MacEwan College (http://www.hcs.macewan.ca/health/periooperativeRN/Program.cfm), Grande Priarie Regional College (http://www.gprc.ab.ca/programs/details.html?ID=53) and Lethbridge College (http://www.gprc.ab.ca/programs/details.html?ID=53). I'm sure that whatever province you're in there will be similar programs.

psso · Nov 4, 2009

thank you both for the info. i'm actually on the wait list for that program too. :)

RN_waitlister · Nov 4, 2009

"psso" - you're on the waitlist for Camosun? If so, when do you think you'll get in? I'm most likely in the Fall 2011 intake. I hate waiting so looooong!!

psso · Nov 4, 2009

they said most likely for fall 2010 but i've been on the list for quite a while... had to finish a bunch of pre-requisites and did some of my electives for the program already. good luck, and yea it's a long wait!

718077 · Jul 22, 2012

hi! can you recommend which perioperative nursing program is great?

I'm choosing between macewan from alberta or SIAST from saskatchewan..

thanks!