Choosing an Operating Room Specialty

Editorial Team / Admin · Jan 26, 2019

I take it the facility you work in segregates teams and members almost exclusively work in that specialty? I'm fortunate enough to work in a facility that while your supervisor may have been the specialty coordinator, you were pretty much assigned wherever a need was and had the opportunity to work in all specialties (except cardiac- they're separate). I'm no longer direct clinical staff, but that is still the set up.

How far into your orientation are you? Have you had the opportunity to work in each of those specialties and see the way surgeons and staff interact? The complexities that each specialty requires? What is it about each specialty you mentioned that draws you in? Trauma can involve pretty much every specialty- general may or not be involved if there are trauma specialists who will do the "general" surgeries like ex laps, vascular for vascular injuries, neuro for head/spine injuries, ortho for fracture management, dental/plastics for maxillofacial injuries, and so on.

FurBabyMom, MSN, RN · Jan 27, 2019

We have teams. That's what you normally do...but not always. Our management team has the expectation that we can do all cases except open heart, but if it were a life threatening emergency, guess what you'd be trying? In our facility, we hold the most available room for traumas or other emergencies - so you do not always only do your service. This is true on call too - you may do something different from normal.

I agree with RoseQueen - what are the staff and staff:surgeon interactions like? This is what drove my choice. I get to a little of most things all the time, but I love the service I picked because of the way people work together.

BeautyRN2017, ADN · Jan 28, 2019

I will soon (February) be starting orientation/AORN periop 101 in an OR also at a large teaching hospital! ? I am very excited and know that the program structure is very similar, as far as having several specialty areas for training.

I know that I will also need to choose areas of interest to focus after general training. Curious to hear some of the feedback from those with experience in the different OR teams/rooms! At this point I have no particular preference, but hope to have a better idea going into training!

Sassy-RN · Jan 29, 2019

Ortho is my favorite! Gerneral next...gyno and urology my least favorite...

ETCO2 · Jan 31, 2019

Typically ortho and general handle the trauma. I personally don't find trauma all that exciting from a circulating nurse perspective. Its a lot of fetching and documenting work away from the surgical field. I would recommend you choose a specialty that you think you will enjoy overall, not just based on being involved in trauma. I am Ortho myself. It is loud fun loving rooms with younger hotshot doctors from my experience. It attracts a little more party crowd type person. Ortho room radios can usually be heard bumping TUPAC and Dre from down the hall. Neuro is for detail oriented people who don't mind hours and hours of near silence. Neuro docs in my experience are all kind of odd ducks though. CV is for those who want long extensive cases with a good chance of some sort of drama or complication. General is a mixed bag in my experience. Some young docs, and some very old docs and age does not determine in any way how easy they are to work with. I personally hate urology line, but the cases are generally quick and the docs are very self sufficient. Colorectal is gross, but the docs seem to be pretty laid back. Maxillofacial/ENT docs are usually some of the nicest docs I have ever worked with. Next in terms of comfort of working environment would be plastics. They are typically not in any rush since they know their cases are going to take forever anyway. Whatever specialty you choose learn to scrub! Its a very welcome change to perpetual circulating, even if you just end up holding retractors or a camera. I started by scrubbing only ortho cases, but quickly branched out to include other service lines. It is far more interesting than circulating. But be aware that a nurse who can circulate and scrub in an environment where RN scrub is optional will almost definitely be worked hard, likely abused!

That being said im going to give you my perspective on one thing..... I went into OR after having worked ER, Cath Lab, and Vascular Access. Prior to becoming an RN I was an anesthesia tech and Paramedic. When I meet or train new grad nurses who want to do OR as their first job I caution them about the possible ramifications of choosing that path. Once in the OR for an extended period it can be difficult to leave the OR for another specialty. As an OR nurse you will generally not utilize many of the skills, and little of the knowledge, that you acquired in school. In addition you will not be truly providing direct patient care. If you don't have these skills, knowledge base, and experience well established prior to becoming an OR RN they can quickly fade into obscurity. I always recommend that new grads pursue critical care areas such as ICU and ER to get an extensive solid medical base to your practice before branching off into specialties that may severely limit your practice and skills. Most other departments will not want to pay you an experienced RN salary when they have to train or re-train you in the fundamentals of nursing practice.

Good luck with whatever path you take!

ctsurgeryscrubrn · May 25, 2019

Hi Julez!

Belated welcome to the ORNurses ‘Fra-rority’. I am a second generation O.R. Nurse - my mom was a scrub nurse in hearts at Cleveland Clinic for nearly 20 years.

I had a natural inclination to hearts after hearing so many interesting, dramatic, and exciting stories from her time at The Clinic - albeit, many did not have fairy tale endings.

Entering nursing school, I certainly noticed that perioperative nursing was not encouraged and floor experience (either med/surg or ICU) was seen as the default ‘immerse yourself in the basics’ specialty. I had to basically fight for a perioperative rotation. I was able to gain great experience that enabled me to obtain a post-graduate perioperative nursing residency out of school. The residency was a 6-month program where we got to scrub and circulate nearly all of the specialties (Hearts, Trauma, Neuro, General, ENT, Vascular, and Outpatient).

Hearts just felt right to me. Although I know many don’t like the repetition of cases, teams, etc., it suited me perfectly. I liked working with the same core team (surgeons, anesthesia, etc.) AND I loved the opportunity to scrub high-acuity marathon cases (our institution doesn’t have CSTs scrub hearts). It’s certainly not all ‘fun and games’ and there is more than a fair share of heartbreak, but it feels so right to me - I always say “I didn’t choose hearts; hearts chose me.” I think that’s cliche, but something we should all be on the lookout for - a specialty or niche where we feel completely in ‘our element’ even when put in high-stress, uncomfortable situations.

Feel free to PM me, and I wish you all the luck and fulfillment in your perioperative career.

shodobe · Jun 29, 2019

I guess I'm a bit confused on this subject. I retired a few years ago after 42 years as an OR nurse. I could scrub everything that walked through the door. It is a disservice to anyone that gets pidgeoned holed as a one and done type OR nurse. Everyone should learn as much about all services so they can be a bit more marketable. If all you can do is open hearts or urology or ? your pretty much useless in all other aspects or OR nursing. The worse ones were open heart nurses because that was all they could do, didn't even know the basics of general surgery or ortho. I got good at everything and was comfortable in all situations. The problem now a days is hospitals don't want to taech anyone to scrub, only circ. What's with that? I did both and felt I could walk into any hospital in the country and fit right in. So my thoughts are, learn all you can about everything and don't limit yourself to one specialty, it won't help in the long run.

shodobe · Jun 29, 2019

On 1/31/2019 at 12:51 PM, ETCO2 said:
Typically ortho and general handle the trauma. I personally don't find trauma all that exciting from a circulating nurse perspective. Its a lot of fetching and documenting work away from the surgical field. I would recommend you choose a specialty that you think you will enjoy overall, not just based on being involved in trauma. I am Ortho myself. It is loud fun loving rooms with younger hotshot doctors from my experience. It attracts a little more party crowd type person. Ortho room radios can usually be heard bumping TUPAC and Dre from down the hall. Neuro is for detail oriented people who don't mind hours and hours of near silence. Neuro docs in my experience are all kind of odd ducks though. CV is for those who want long extensive cases with a good chance of some sort of drama or complication. General is a mixed bag in my experience. Some young docs, and some very old docs and age does not determine in any way how easy they are to work with. I personally hate urology line, but the cases are generally quick and the docs are very self sufficient. Colorectal is gross, but the docs seem to be pretty laid back. Maxillofacial/ENT docs are usually some of the nicest docs I have ever worked with. Next in terms of comfort of working environment would be plastics. They are typically not in any rush since they know their cases are going to take forever anyway. Whatever specialty you choose learn to scrub! Its a very welcome change to perpetual circulating, even if you just end up holding retractors or a camera. I started by scrubbing only ortho cases, but quickly branched out to include other service lines. It is far more interesting than circulating. But be aware that a nurse who can circulate and scrub in an environment where RN scrub is optional will almost definitely be worked hard, likely abused!
That being said im going to give you my perspective on one thing..... I went into OR after having worked ER, Cath Lab, and Vascular Access. Prior to becoming an RN I was an anesthesia tech and Paramedic. When I meet or train new grad nurses who want to do OR as their first job I caution them about the possible ramifications of choosing that path. Once in the OR for an extended period it can be difficult to leave the OR for another specialty. As an OR nurse you will generally not utilize many of the skills, and little of the knowledge, that you acquired in school. In addition you will not be truly providing direct patient care. If you don't have these skills, knowledge base, and experience well established prior to becoming an OR RN they can quickly fade into obscurity. I always recommend that new grads pursue critical care areas such as ICU and ER to get an extensive solid medical base to your practice before branching off into specialties that may severely limit your practice and skills. Most other departments will not want to pay you an experienced RN salary when they have to train or re-train you in the fundamentals of nursing practice.
Good luck with whatever path you take!

Lose your skills being an OR nurse! Are you nuts or heven't done this very long

FurBabyMom, MSN, RN · Jun 30, 2019

19 hours ago, shodobe said:
Lose your skills being an OR nurse! Are you nuts or heven't done this very long

It's actually a very commonly held belief. It is incredibly prevalent in academia. I'm finishing up a MSN and oooh boy, they do not value OR nurses. The belief is common in other clinical environments - ED, ICUs, stepdown and floor. They all think that OR nurses sit around and do nothing all day.

One of my MSN classmates who has become a dear friend listened when I responded in a group activity in one of our first classes - s/he actually said s/he was amazed we did have to know things in the OR.

There is some truth in that we do not necessarily use the same skills as floor/ICU nurses in the OR. On the other hand, we have some skills they don't necessarily have.

monicarelic · Sep 9, 2019

I am starting my job in the OR in two weeks! I am super excited. My background is in ER and Plastics (where I started my love affair with the OR as a surgical assistant) and I was worried I would lose my clinical skills too. Although, this belief seems to be unfounded and baseless I guess somewhere along the line I got this destructive message too. I asked to Circulate and Scrub on the job and my manager is very supportive. Also, I will be finishing my RNFA while there as well. I am hoping to circulate all types of cases and will advocate for my own career progression. ORJulez, please tell us what specialty you chose and update us on your progress. Wishing you well!

Divine-LPN,BSN · Sep 15, 2019

Hello, I am glad that you asked that question. I was wondering about that a few years ago. A colleague of mine informed me that I could work in the OR with a certification as a Transplant Coordinator or that I could work alongside cardiologists performing heart surgery if I became certified as a Registered Cardiovascular Invasive Specialist. I hope this helps!

Kindly,

Divine-LPN, BSN