Get to OR as nurse or PA?

pinkiepie_RN · Aug 9, 2009

I don't think I've ever heard of a PA working in the OR, but I have heard of CRNAs (advanced practice nurses), scrub techs, and registered nurses in the OR.

RN4NICU, LPN, LVN · Aug 9, 2009

What do you want to do in the OR? You can work in the OR as a nurse, a PA, a nurse practitioner, a surgical technologist, a CRNA. They all have different roles, so the best path for you to take depends on what you want your role to be.

RN4NICU, LPN, LVN · Aug 9, 2009

I don't think I've ever heard of a PA working in the OR, but I have heard of CRNAs (advanced practice nurses), scrub techs, and registered nurses in the OR.

PAs and NPs that work with a surgical group will sometimes first assist in surgery, close the wound, harvest the vein for bypass, assist with joint replacements, etc.

SandraCVRN · Aug 10, 2009

If you want to be "hands on during the surgery" then I would say PA. Some nurses scrub but all circulators (in the US) have to be RN's.

It also depends on what kind of salary you require. Scrub techs almost all work in surgery, but the pay is lower............

Good luck in whatever you decide. Also, right now jobs in many places are hard to come by........

pinkiepie_RN · Aug 10, 2009

PAs and NPs that work with a surgical group will sometimes first assist in surgery, close the wound, harvest the vein for bypass, assist with joint replacements, etc.

Interesting! Thanks for filling me in.

shep1960 · Aug 10, 2009

Laird215

Some of my colleagues have provided information and others needed more specifics since your question was rather open ended. As an active duty Navy perioperative nurse allow me to fill in a few gaps.

As a perioperative nurse you will either circulate or scrub the surgical procedures. Not all hospitals use registered nurses to scrub because it costs less to hire a surgical technologist than another RN. You will need to investigate how your local hospitals run their ORs. I would also talk to the OR nurses at your local hospitals. They can be a wealth of information. Once you begin working in the OR and wish to expand your skills then you can become certified through the Association of Operating Room Nurses (AORN). This association also has a program in which you can become a RNFA, Register Nurse First Assistant allowing you to scrub into surgical cases and work directly with the surgeon.

As a Physician Assistant, this will require a longer period of education in comparison to a registered nurse. Surgical PAs are out there but you might find yourself doing more paperwork for your surgeon and less time in the OR. Once again I would talk to the OR nurses in your local hospitals. If there are surgical PAs out there they will be the first to know and they might be able to provide you a name and phone number. Our military surgical PA in the Navy are primarily utilized in Orthopedics and even then they do not see as much surgery as you might think. In the civilian sector a PA makes more money than a nurse, but I assure you between the education required to be a PA and the very long hours working with a surgeon you will earn every penny of it.

I wish you luck

netglow, ASN, RN · Aug 10, 2009

To be clear, you should understand that if you want to actually be participating in the surgical procedure, eg get your hands bloody, the PA route is the way to go. Cardio and ortho are where I've seen PAs participating tight with surgeons. Closest to being a team. You will definitely be "workin for the man/woman". Doing the cool stuff as well as being a grunt depending on your surgeon's personality! I do know one nurse first assistant.

Sorry if I'm repeating... Trying to post off my new iTouch! :yeah:

core0 · Aug 10, 2009

I am 47 and have worked in business for 25 years. For the past 12 years I've lived exactly one mile from a major teaching hospital. There is an outstanding medical college, a great nursing college and a top-ranked PA program located around this hospital. I've gotten to know a lot of medical professionals, including PAs, nurses, surgeons, and anesthesiologists. I've wanted to make a change from my business career and am interested in finding out more about working in an OR. I'll be asking the people I know questions, of course, and have good shadowing opportunities.
In your opinion, would my best option to eventually work in surgery be to pursue a nursing program or physician assistant program?
Btw, I feel 30, live clean, exercise, treat people right, and don't do recreation well. So my expectation is that I would enjoy working far into my 70s.
Please accept my gratitude for your thoughtful reply !!

Approximately 1/3 of PAs work in surgery. If you want to work in the OR there are plenty of opportunities. The jobs range from medical management of surgical patients to PAs who only first assist and do not work outside the OR. There are two surgical specific PA programs and a number of post graduate PA programs if you are sure you want to concentrate.

Not to rain on your parade but getting into PA school (or nursing school for that matter) is more than simply applying. Most PA schools are very competitive with upwards of 20 applications per seat at some programs. In addition you are going to need at the very least recent A&P and chemistry as well as other potential classes such as O-chem, biochem, statistics and genetics depending on the program. Finally 2/3 of medical programs require or recommend medical experience. The average in 2007 was 3-4 years of direct health care experience. I'm not saying that its impossible. PA programs are full of second career students. There are a number of programs that will welcome somone with a business background. Just be aware that applying to only one program puts you at a disadvantage. Also be aware of the specific requirements for that program.

I currently work in a surgical position which is mostly medical management with occasional four AM forays into the OR. It suits me perfectly now. Thats the nice thing about the profession, if I want to do something different tomorrow (more surgery or a different medical specialty) then I can.

The nurses in the OR here are absolutely critical to what we do. However, as others have discussed they rarely get to scrub anymore.

David Carpenter, PA-C

ERGirl83 · Aug 10, 2009

This depends on what you want to actually do in the OR. My husband in an orthopedic sales rep, and in my quest to decide between nursing, PA, and medical school, I've observed quite a few cases with him, shadowed and spoken to several of the surgeons, PA's, and RN's.

Here's my take, and this may be a regional thing, so you might want to investigate your hospital's specific practices. Here, the hospital does not utilize RNFA's (RN First Assists). The only RN's involved in the actual OR are the circulators, who in my opinion (and I hope I do not offend anyone here, this is referring to my own interests only) have quite possibly the most boring job in the OR. They basically just chart throughout the case, and because they are not scrubbed in, act like a gopher, when the surgeon need something from center core, or elsewhere in the room/hospital. There are also the pre-op/holding nurses, and then the PACU/recovery room nurses, but they don't really function in the actual OR during the case.

If you are hoping to scrub in, and actually assist in performing the surgery, I would HIGHLY suggest going the PA route. The two options for first assists here, are scrub techs (officially surgical technologists) who have developed a rapport with the surgeon, and know their stuff. It typically takes them several years to progress from passing instruments, to actually assisting with cases. The vast majority of the surgeons (again my experience is exclusively in the orthopedics field) have their own first assists in the form of PA's who see patients in the office, round on patients in the hospital, and assist in the actual surgeries. My brother-in-law is a PA, first-assist, and is VERY talented. In fact, I observed a case in which an older surgeon told him he may not be "official" but in his mind, he was one of the best trauma surgeons in the area.

For me, I'm planning on going the PA route, because I have always wanted to be a surgeon, but I have young children at home, and the rigors of medical school and residency just don't work with the kind of mother I hope to be.

Anyway, I hope I have helped you, and that I haven't offended any of the fantastic circulating nurses out there, they perform as a very important part of the OR team, it just isn't something I'm personally interested in, as not being scrubbed in, and able to get my hands dirty would drive me NUTS! Heck, just some of the cases I observed with some less than competent scrub techs, I wanted to jump in and take over for them!

Laird215 · Aug 10, 2009

THANKS SO MUCH. I am just astounded by all you who take time to provide this helpful input.

I'm lucky to be located close to the major med center. It looks like I can work it so I can, over time, get the prereqs and experience I need to be a competitive applicant. If I don't get in, I'll have enjoyed the process.

Thanks !!

DoGoodThenGo · Aug 10, 2009

Circulating nurses are not mere "gophers" nor do they just sit and make "boring" charting.

A circulating nurse is the patient's advocate first and foremost preoperative, interoperative and postoperative.

From interviewing a patient pre-op to starting pre-op antibiotics (or any other ordered meds), assisting with induction, insuring the room is set up properly for the type of operation performed, bringing in the proper equipment,making sure the sterile field is respected, and so forth. During the operation what you describe as "boring" is charting everything that goes on (meds, time in, time out, incision time,....) in her role as patient advocate. Remember whilst a person is under they are unable to communicate and at one of the most if not the most vunerable times during their hospital stay. As a circulating nurse you are there for the patient, just as you would be on the floors or units.

There is a reason why basically anyone after completing a course can become a scrub tech, but a only a nurse circulates. Indeed in the early history of scrub technicians, medics and PA's it was the other way around, with nurses scrubbing and "anyone" circulating, but that changed.

My copies of AORN's "Perioperative Nursing Practice" books are old, but you can go here for more recent information: http://www.aorn.org/

This depends on what you want to actually do in the OR. My husband in an orthopedic sales rep, and in my quest to decide between nursing, PA, and medical school, I've observed quite a few cases with him, shadowed and spoken to several of the surgeons, PA's, and RN's.
Here's my take, and this may be a regional thing, so you might want to investigate your hospital's specific practices. Here, the hospital does not utilize RNFA's (RN First Assists). The only RN's involved in the actual OR are the circulators, who in my opinion (and I hope I do not offend anyone here, this is referring to my own interests only) have quite possibly the most boring job in the OR. They basically just chart throughout the case, and because they are not scrubbed in, act like a gopher, when the surgeon need something from center core, or elsewhere in the room/hospital. There are also the pre-op/holding nurses, and then the PACU/recovery room nurses, but they don't really function in the actual OR during the case.
If you are hoping to scrub in, and actually assist in performing the surgery, I would HIGHLY suggest going the PA route. The two options for first assists here, are scrub techs (officially surgical technologists) who have developed a rapport with the surgeon, and know their stuff. It typically takes them several years to progress from passing instruments, to actually assisting with cases. The vast majority of the surgeons (again my experience is exclusively in the orthopedics field) have their own first assists in the form of PA's who see patients in the office, round on patients in the hospital, and assist in the actual surgeries. My brother-in-law is a PA, first-assist, and is VERY talented. In fact, I observed a case in which an older surgeon told him he may not be "official" but in his mind, he was one of the best trauma surgeons in the area.
For me, I'm planning on going the PA route, because I have always wanted to be a surgeon, but I have young children at home, and the rigors of medical school and residency just don't work with the kind of mother I hope to be.
Anyway, I hope I have helped you, and that I haven't offended any of the fantastic circulating nurses out there, they perform as a very important part of the OR team, it just isn't something I'm personally interested in, as not being scrubbed in, and able to get my hands dirty would drive me NUTS! Heck, just some of the cases I observed with some less than competent scrub techs, I wanted to jump in and take over for them!