The OR is heaven on earth

Editorial Team / Admin · Feb 5, 2017

How much involvement do scrub nurses have with surgeries?

First, are you sure the person scrubbed was actually a nurse? There's an entire profession who goes to school to learn the ins and outs of scrubbing for surgery: surgical technologists. Nurses can certainly fill this role, but many facilities (at least in my experience) tend to utilize STs because they were specifically educated (nurses need on the job training and a lot of it) and they're also a lower salary scale. The scrub person typically handles the instruments, needles, and other supplies needed for the surgery. In some facilities they may also be responsible for the cleaning and sterilization of reusable items or "picking cases" where they are responsible for collecting all supplies for the next day's surgeries. Depending on facility policies, they may be able to function in a limited assistant role. In my facility, they may hold retractors and suture skin (if they've taken a suture course and have been signed off by three different surgeons each year), but they absolutely cannot use the electrocautery or fire any staplers. Other facilities may allow more.

Is there ways to go through extra certifications to get more hands on responsibility in an OR?

There are options for this- certified first assistant (tends to be the path STs take) and registered nurse first assistant (obviously requires one to be a nurse).

Do NP's have the ability to assist with major surgeries in the OR?

They can, as can PAs. Also depends on the facility- my guess is that in a facility with surgical residents you'll see fewer NPs or PAs in the OR because the residents fulfill that role. In my facility, they are hired by a surgeon/surgeon group and must go through the credentialing process to be given privileges. They are also responsible for more than just being in the OR- they round on patients, write up H&Ps/consults and progress notes, take care of discharge paperwork (orders/prescriptions), and other duties.

Does this mean I am more cut out for pursuing med school?

That really depends on you. Do you want to be the one actually performing the surgery? You're going to need that MD or DO. Do you want to fulfill the assistant role? Then there are other paths.

stephen22 · Feb 5, 2017

To answer your first question, there was one ST, two scrub nurses (one of which was sitting on the side writing on the board and taking commands, the other was over the mayo), a PA, resident and attending.

stephen22 · Feb 5, 2017

BTW, Thank you for your long response! That was very helpful!

Editorial Team / Admin · Feb 5, 2017

To answer your first question, there was one ST, two scrub nurses (one of which was sitting on the side writing on the board and taking commands, the other was over the mayo), a PA, resident and attending.

Okay, first let's look at your terminology. Scrub means that- scrubbed. The person has done a surgical hand scrub and is wearing a sterile gown and gloves. That nurse sitting on the side isn't a scrub nurse- he or she is a circulating nurse. And it is so much more than writing on the board and taking commands.

As a circulator, I am that patient's advocate. I am counting instruments, sponges, and sharps with the scrub person at the table to ensure nothing is left behind in a patient. I am responsible for ensuring that medications are either given to the patient or on the sterile field and labeled (I can tell you a horror story involving an unlabeled med that led to a teenager's life being permanently changed). I am responsible for positioning the patient in a way that optimizes exposure of where the surgeon needs to work while also preventing skin and nerve issues. And so much more.

I get that you are interested in watching the surgery, and that's ok in this instance. However, I suggest that if you have another observation opportunity that you watch what it is the nurse is doing. It's amazing how many people think the OR is where they want to work only to have no clue what it's really about because all they saw was the surgery.

stephen22 · Feb 5, 2017

Well there you have it.. that's something I have learned in this exchange (the difference between a scrub nurse and a circulating nurse as well as their roles). I absolutely believe their job consists of more than writing on a board and taking commands but I simply chose to describe it in that way to differentiate between the two in order for your question to be answered clearly.

I agree with doing some more shadowing to see what the different roles of a nurse is within the OR. The most important part for me at this point is the fact that previous to this experience, I had ZERO interest in the OR. This has (at the very least) given me a greater perspective and ignited a ton of interest in the OR which I did not have previous to this.

PaulBaxter · Feb 5, 2017

If you'd like to know something about the path to becoming a surgeon, there are some good books about that. I recommend Hot Lights, Cold Steel, by Michael J Collins (which is also the most entertaining book I've read by a doctor), or When The Air Hits Your Brain, by Frank Vertosick. Both of those talk about what it's like going through a surgical residency.

If you'd prefer to be an OR nurse, just find your way into nursing school. Once you get near the end, apply to programs for OR training for new nurses. If you'd like to be a scrub tech, you'll have to hunt around for a program for that. Not quite as many schools available for that, but there might be one near you.

catsmeow1972, BSN, RN · Feb 6, 2017

On the scrub tech end, check out your local county technical center. Most of them have Surgical technology programs. Some community colleges also do, but mostly the tech centers. A good program will be about 15 moths or so and have you do clinicals in a couple of different hospitals. I would avoid the private/for profit schools like the plague. They will tend to charge you an obscene amount of money for a program that will get you a job that starts around 15-17 dollars and hour in most decently sized facilities. Speaking of the job, go for a large teaching or non-profit place. You will see (and participate in) a much wider variety of procedures. While it may pay less than welding (I am not certain what one makes as a welder) it is a fantastic experience and a great entry method into nursing school. Not only do you learn lots of stuff that helps support your learning experience in nursing school, it looks great when you go to apply, not to mention while working for a hospital, you have access to means to help pay for nursing school.

Though I would recommend some time on the med/surg or comparable floor prior to OR nursing (good way to learn to handle 27 things at once) if you are already an employee, breaking into OR nursing is a lot easier. I started as a tech and transitioned right into OR circulating. I am now on the floor (several reasons. i am happy, but part of me misses the OR) and I feel like a baby nurse all over again.

I got the OR bug the same way...got to observe some and was hooked. Go for it, it's been a awesome career and I wouldn't trade it for anything.

NurseBeans, BSN, RN, EMT-B · Feb 7, 2017

Sounds like me after my first OR observation. I was hooked after one bowel resection...ahh, the memories.

Anyway, check around in your area as to what the norm is; where I am RNFA's can still get good work. They are OR nurses who go to school (believe it's about two post-BSN semesters) specifically to assist in surgeries. Oddly enough, Medicare will not pay for NP's to assist but will pay for a PA. Last time I checked, that is. Absolutely destroyed my dreams but that's a whole other thread.

A good internship at a hospital OR will teach RN's to scrub first, then circulate. They are usually about 6-9 month programs. It's what I did immediately after nursing school. I really felt like a better circulator when I knew how to scrub a particular case vs when I had never scrubbed that procedure.

Or, you could check into surg tech schools. An option after a few years is STFA, which is a tech who does a school (again, about two college semesters worth) to be the assist in surgery.

If the OR got you going like that, do it, any way you can. It's still my first love and I miss it every day.

rbs105, ADN, MSN, RN · Feb 7, 2017

I also recommend the book 'Introduction to the Operating Room' (its on Amazon). Different viewpoints from the medical students, surgeons, residents, nurses, etc.

Consider how much time/money you have to dedicate to your schooling. You are looking at 8-12 years of med school, residency, fellowship (if you choose) vs. a few years of working in ICU as a nurse and 2 years of CRNA school vs a few years of ST school. Don't underestimate the roles of the ST-they are the surgeons right hand man/woman. That will be the quickest route to get you the closest to the surgery (all of this depends on your location/schools, etc). PA's and NP's do operate, but not all of them do so you would have to get in with a surgeon who does that. Our vascular, transplant, and CT PA's and NP's operate but for every 2 that operate, there are 200 that don't-again, depends on your area.

Glad to see you are passionate about it. Keep up the love-we need more of us!

Wolf at the Door, BSN · Feb 11, 2017

OP go do pre med. If for some reason you are unsuccessful nursing will always be there to do as an accelerated program 11-18 months worst case scenario 24 months. You are 22 no 42 and realize surgery is your thing. Go do medicine. I am 32 and realize I probably should be a coroner.