The ins and outs of perioperative nursing
There are many different jobs and settings nurses may find themselves working in, from home health facilities and assisted living to hospital and clinical institutions. This reality is further shaped by the variety of degrees, certifications and licensures available to nurses, which may make them more suited to specializations and other highly skilled positions. Increasingly, one such route that has grown more and more popular as a career choice is perioperative nursing.
Perioperative nursing generally refers to the care of patients during surgery, which encompasses three phases: preoperative, intraoperative and postoperative. What makes this route even more attractive to nurses is that unique skills and qualities are needed for each of these surgery-related subspecialties. Yet overall the perioperative path has proven to be an attractive one for nurses looking for a niche or for other roles and responsibilities.
Before jumping into any decision, online nursing students should first familiarize themselves with the benefits and challenges of perioperative nursing. Nurses considering perioperative nursing should consider the requirements for this specialty, expectations of this nursing role, subspecialties within the perioperative setting, specific skill sets needed for general perioperative nursing and subspecialties, and the general responsibilities of nurses in this specialty.
Here’s a starter’s guide to the field of perioperative nursing.
Introduction to the perioperative nurse
Perioperative nurses usually hold a bachelor’s or master’s in nursing, and all are registered nurses. Perioperative nurses are usually employed in acute care settings such as hospitals and surgical centers. Hospitals have the largest number of operating rooms, although ambulatory surgical centers are often used for common low risk procedures such as eye surgeries, oral surgeries, minor skin-related surgeries and cosmetic surgeries. Nurses don’t often start out with surgical responsibilities, given the experience and learned skills needed to thrive in such an environment: A 2017 survey of perioperative nurses by Nurse.com found 47 percent were 35 to 54 years old. So, it’s often recommended that nurses with an eye toward perioperative nursing apply themselves from the outset and soak up the clinical and practical knowledge.
Those who are interested should know perioperative positions will, at various times, require nurses to be responsible for:
• Patient assessment before, during and after the procedure.
• Patient family support.
• Patient advocacy.
• Supporting the surgical team as a scrub or circulating nurse.
• Control of environment.
• Efficient provision of resources.
• Patient care coordination.
• Interprofessional and interdepartmental communication and collaboration.
• Ongoing patient monitoring and therapy needs
Integral to perioperative care is the concept of patient-focused nursing rather than task-focused nursing. This supreme ideal (and the preceding list) is laid out in the “Essentials of Perioperative Nursing” from Jones & Bartlett Learning, which cites Association of Perioperative Registered Nurses (AORN) standards that define surgical nursing’s priority as preventative care, rather than identifying problems, using “knowledge, judgment and skill based on biological, physiological, behavioral, social and nursing sciences.”
A position in perioperative can be rewarding. A Healthcare Traveler article from 2015 cited an AORN survey that found perioperative staff nurses made between $65,800 and $69,100 in 2014. The organization measured annual salary growth over an 11-year period at 2.7 percent.
Many find the experience of perioperative nursing to be positive in other ways. The Nurse.com survey found that 90 percent ranked their satisfaction with the job at 4 out of 5. Respondents said they are drawn to the fast pace, the gratification of seeing patients recover and new challenges. However, detractors pointed to burnout and challenging intrateam relationships as occasional obstacles.
Desired skills and traits of perioperative nurses
The nature of perioperative work means that certain skills and traits are more in demand or valued. Surgical care requires not just a calm demeanor from the surgeon, but also one from the perioperative nurse, who must also be attentive and organized, constantly assessing the patient. But that is just one facet of perioperative care. Besides care administered during the procedure itself, nurses are needed beforehand to educate patients and their families on operations (which they must also prep). In the postoperative stage, nurses must monitor patients as they wake from anesthesia and stay alert to any symptoms of complications.
For these reasons, perioperative nursing relies as much upon a nurse’s command of core competencies and sciences as it does on their mastery of soft skills like communication, presentation and bedside manner. In a Q&A with Nurses.com, then-AORN President Patricia Seifert said nurses must be comfortable in their capacity to interact with families, and that they must also have strong personalities needed to power through quick-developing situations. She also noted physical strength and stamina as qualities that perioperative nurses need; standing for hours with little movement around an operating room can be taxing on the body.
Technical skills, specified by the “Essentials of Perioperative Nursing” include a working knowledge of: surgical equipment and instrument use, care and keeping; surgical techniques and specific operations (bypasses, orthopedic procedures, trauma); nursing diagnoses (risk of infection, knowledge level); and the competencies of perioperative care (patient safety, physiologic response, behavioral response and health team collaboration).
The many different roles of the perioperative nurse
As previously mentioned, the nuance and multiple stages of perioperative work mean diverse opportunities for nurses. Under the overall umbrella of perioperative nursing lie a number of distinct positions:
• Scrub nurse: In primary charge of surgical instrumentation and tools, responsible for passing different implements to surgeons at request. Ensuring clean operating spaces and assessing the patient are also tasks scrub nurses perform. Their detailed nature is needed when, for instance, counting supplies and tools after the procedure so that everything is accounted for.
• Circulating nurse: According to Seifert, this position “manages the overall nursing care in the OR and helps maintain a safe, comfortable environment.” The circulating nurse helps prepare patients in advance of procedures, as well as collects and verifies patient identities and consent forms.
• RN First Assistant: An advanced role responsible for direct care (like wound bleeding control and suturing), the RN First Assistant is very hands-on, especially during the surgery itself, but also afterward when they need to keep close tabs on patients for any signs of complications.
• Certified Registered Nurse Anesthetist (CRNA): Near the top of the hierarchy in perioperative nursing, CRNAs help deliver anesthesia, sometimes in collaboration with anesthesiologists, and sometimes independently. This upper class of nurse has a salary range upward of $150,000 per year.
• Post-Anesthesia Care Unit (PACU) nurse: A PACU nurse is intimately involved with the immediate recovery stage after surgery, charged with monitoring “respiratory, cardiac, neurological and hemodynamic functions,” according to Eisenhower Medical Center in California. These nurses are responsible for directly observing patient vitals and stability as they return to consciousness.
• Holding bay nurse: Another nurse who addresses the general management and care of the operating unit, a holding bay nurse may be responsible for admissions and collecting information on a patient’s medical history, drug allergies, tests and bloodwork, and other documentation.
Consider the University of Arizona for continuing education
Becoming a perioperative nurse takes time and training, as well as a disposition toward the fast pace and “no two days are the same” nature of surgical nursing. It can be a demanding job and those interested will need to prove themselves capable in a number of different disciplines and competencies.
Health-care settings may also look for nurses with advanced degrees. Those who want to engage in continuing education as a means to perioperative work can investigate the University of Arizona’s online Master of Science in Nursing online program, in which students may be able to learn more about leadership skills, applied knowledge of population health, care coordination, integrative health and business principles. To learn more about the program, contact us today.
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