How do I get into Surgical Nursing

classicdame, MSN, EdD · Jun 8, 2012

you go to RN school. Techs have limited scope of practice (and pay!). RN first assistant is RN who has had additional, advanced training. That could be a great goal once you have some experience. Good OR RN's are hard to come by in my area. Never worked where there were too many.

Editorial Team / Admin · Jun 8, 2012

A surgical technologist functions as a scrub person only, as part of the sterile field handling instruments and occasionally acting as a second assistant (holding retractors, cutting suture). They are limited in what they can do as they do not have a license. Most programs are an associates or diploma program. As far as I know (and I could be wrong) the bachelors programs are geared toward a CFA (certified first assistant). Where I work, the pay scale for STs is capped right around where the nurses' pay scale starts.

A perioperative nurse works in either the preop area, OR, or PACU (aka recovery room).

A preop nurse is responsible for getting the patient ready for surgery: IV, all consents/orders/H&P/lab results/etc are on the chart or available in the computer, any preop prepping ordered (such as clipping hair at the surgical site, performing a skin prep with antimicrobial soap), starting antibiotics if appropriate, giving any preop sedation if ordered (not anything major like anesthetics, these would be for anxiety), and other activities that get the patient ready for transport to the OR.

The OR nurse can function in either the scrub role, doing the same job as an ST, or in the circulating role. In the scrub role they fulfill the same functions as the ST. In the circulating role, they are responsible for any number of things, including but not limited to: documentation, giving medications (IV or to the sterile field), positioning, prepping, monitoring the sterile field, contacting other departments as necessary (such as radiology for x-rays in OR or cardiology for TEEs), inserting foleys, assisting anesthesia as needed, and (not my favorite by a long stretch) responding to the surgeon's pages if the pager is allowed in the OR- they are at mine but not at others. Some states mandate that the circulator must be a registered nurse. Some hospitals do not utilize RNs in the scrub role, leaving that exclusively to the cheaper STs. Others are staffed as RNs only and every nurse fulfills both roles. Others may have a staff comprised of both, and both are able to fulfill the scrub role. There are several good posts in the OR forum that go into a more detailed description of the RN circulator. You can find more information at Home: Association of periOperative Registered Nurses.

A PACU nurse is responsible for the patient's immediate post-op care while fully waking up from anesthesia. Most patients "wake up" in the OR, i.e., able to maintain an airway and rousable and able to follow commands such as open your eyes but will still be quite sleepy. Other patients who are more critical or may need longer to emerge from the anesthetics may come to PACU requiring a ventilator. Some hospitals require critical experience such as ICU before allowing a nurse to work in the PACU setting.

An RNFA is a nurse with additional training and is qualified to function as the surgeon's first assistant. You can find information about becoming a CRNFA at CCI, Competency and Credentialing Institute.

Since you are already accepted to nursing school, I would go ahead with that route. It allows you to work in more areas. As a ST, you'd be limited to the OR or L&D doing c-sections. We have many many STs who have gone on to nursing school and the vast majority of them choose to leave the OR. Out of about 15 STs who have graduated nursing school in the last 2 years, only 1 has stayed in the OR. That person is now pursuing training as an RNFA. I would also recommend shadowing nurses in the OR if that is what you are interested in. Something I say about all shadowers in the OR: pay attention to what the nurse is doing. Most are only interested in watching the surgery, and then are shocked by what the job is really like when they begin working in the OR.

Hope that helps!

manskette · Jun 9, 2012

Thank you so much for the detailed answer to my question. I am an outsider to the medical field (former teacher) and i really appreciate you taking the time to share your knowledge (and also putting it in terms I understand being medically uneducated). I am looking forward to nursing school....I think it will be fun to learn the ins and outs of nursing!