Advanced Practice Opportunities for OR Nurses. What to do!

llg, PhD, RN · Sep 2, 2011

I am not an OR nurse -- but I am not aware of a lot of opportunities as an NP in an OR. However, OR's do need staff development specialists, clinical specialists, managers, etc. Does your DNP program encompass those types of leadership role? Or is your program limited to the NP role?

You're asking a good question -- one that indicates that you probably need to do some serious thinking and a little reserach about your career path before you make a huge investment that you might regret later. It makes little sense to become an NP if you don't want to work in an NP role. And if you really want to be an NP, then why are you not attracted to the type of role that will lead you towards an NP role?

All of those paths, roles, specialties, etc. are good ones ... but which is the right one for you? What type of work do you want to do? You should have a good answer to that before you make huge investment either way.

Good luck to you.

Cyan8181 · Sep 2, 2011

We don't have any NPs who work exclusively in our OR, nor do we have any positions that I know of that are targeted at advance practice nurses specifically. Our nurse managers and clinical leaders all have a minimum of a BSN, and our staff development/educator person has a master's in education, but none are NPs.

We do have NPs who come to the OR to assist the surgeons that they work with/for. The assisting is a very, very small percentage of their time. When they aren't assisting, they are rounding, working with patients, doing orders, etc. You can definitely spot the ones who are comfortable in the OR and the ones who aren't.

I would ask if the position in the OR would give you the opportunity to scrub. If not, I'm not sure how much of an advantage it would give you to have circulating experience with little hands on floor patient experience. Also, a lot depends on the type and size of hospital you work for whether or not their NPs spend any time in the OR to begin with. At our teaching hospital it's mostly residents and PAs with the occasional NP.

Good luck with the decision. Make it and don't look back.

luvapug · Sep 2, 2011

I also don't know of any NP's who work in the OR. If you did go the OR route however you would get to meet and work with a lot of surgeons and possibly find one that would hire you in their office when you graduated to help see patients and that sort of thing. You may get to help assist with a surgery with that dr occasionally if you have experience but usually it's a PA they have help them (or just the regular OR staff). Most NP's work in dr's offices or clinics because that's where the doctors need help-they already have people who help them do surgery in the OR. Not sure the cardiac step-down would help you any further with that career goal unless you were planning on getting hired by a cardiac surgeon because you really liked that specialty. If that's the case go with the cardiac step-down but if you don't have a preference I'd do the OR and use the networking with the doctor's you'll be working with the hopefully open a door.

SkipBeat · Sep 2, 2011

I currently work in the OR and before that I worked med-surg. I believe your long term goals are what you would need to consider. In the OR you can use a DNP to assist surgeons in surgeries, round on patients, write scripts, and do general nurse practitioner stuff. The only difference is that you're trained and familiar with the OR. Also, depending on your surgeon's specialty, you probably will only treat your patients for things related to the surgery performed, such as coumadin dosing, pain meds, antibiotics and such. At least in our facility we have a medical doctor manage a patient's normal medical conditions like, HTN, diabetes, and cholesterol. Also I've noticed that most Drs have PA's in this role and not so many NP's. There are probably more opportunities to use the DNP outside the OR in a broader scope, so it really all depends on what you want to do.

The Guy · Sep 2, 2011

Awesome feedback all, much appreciated. I didn't really specify too much but I'm not looking to take the NP role directly in surgery (not so much interested in assisting in surgery's, i'll leave that to the PA's). What I would be much more interested in would be rounding on surgical patients pre/postoperatively (inpatient or outpatient). I just wanted to make sure that the experiences in the OR wouldn't hurt me. Does anyone have any experience working with NP's who do a lot of work with surgical patients?

Anyways, thanks again for all the helpful advice

AmyCardsNP, RN, NP · Sep 3, 2011

As a nurse with experience in an inpatient area as well as a procedural area (as well as a current NP student), I would say that floor nursing will give you a better background for what your long term goals are. While working in the OR will give you a great background of surgical procedures, you will not have much experience with what happens to patients before and after surgery, which is the time you are wanting to care for your patients as a NP. Procedural (OR) nurses don't often find out what happens to patients when they are done with the surgery nor get experience with treating post-op nausea, hyper/hypotension, or surgical complications such as infection. Working on the floor, you will see these things happen and have a better idea how you, as a NP, will need to care for them.

Just my two cents on helping with your NP goals. But, there is something to be said about having passion for the job you're doing, so maybe that would lead you to choose the OR position. To me, it sounds like a decision between short term desires/interests and long term goals. Good luck!

Oh, as a side note, in my facility, the PAs who assist with surgery are the ones who round on the patients post-op (in addition to the physicians, of course)

llg, PhD, RN · Sep 3, 2011

I have worked with several NP's who have worked with surgeons. They round with them and are the liaisons between the surgeons and the nursing staff. Their background is that they were staff nurses on those inpatient units before going to grad school and becoming NP's.

They are experts in the nursing care of those patients -- who enhanced their outpatient skills while getting their NP educations. They now are the link between the inpatient and outpatient environments and between the physicians and the nursing staff.

jmokeefe · Sep 14, 2011

I am currently a floor nurse in a large hospital on the post surgical inpatient unit and we have NP's and PA's that work on our floor for the surgical line. They round on surgical patients pre/post-op, and write orders all day long for our surgical patients/support the nursing staff. I would think that the experiences in the OR would help you in the end because you would have a larger picture of the whole surgical line/process and the needs of such patients from beginning to end. This is the path that I am going to take, and I left cardiac/tele step down to go to the surgical floor I am on now. I am getting my BSN right now and intend on working in the OR soon and then hopefully returning to the floor as a NP once I graduate. We also have a RN on the floor that was an OR nurse who followed a neuro surgeon back out of the OR and she's his right hand for the past 15+ years. In my opinion the OR can open many doors...