IS IT FEAR OF THE UNKNOWN? Of 140 students in my nursing school class, only 3 of us wanted to pursue a career centered around the operating room (OR), in a specialty now called perioperative nursing. Perhaps this lack of interest is because my nursing school, like many others, offered little exposure to perioperative practice in its curriculum. First, let's define what this specialty is: Perioperative nursing encompasses caring for patients during surgical or other invasive procedures in a variety of clinical settings, including hospital-based ORs, ambulatory surgery settings, and office-based practices.

In this article, I'll shed some light on this exciting specialty of nursing so you can make an informed decision about your career choice or possible career change. I'll focus on perioperative nursing in the hospital-based OR.

What does it take?

If you want to be a perioperative nurse, you need to be energetic and quick, with good critical-thinking skills. You also need to be physically strong and able to stand for long periods. Endurance is vital when you're the circulating or scrub nurse.

Before you start, you'll need at least 1 year of consistent perioperative training because you'll need to learn about the many specialty areas. One way to become a perioperative nurse is through on-the-job training in a hospital or surgery center. Many hospitals and surgery centers accept nurses into a training program in exchange for a future work commitment.

Another route is via a perioperative nursing program from the Association of periOperative Registered Nurses (AORN) called "Periop 101: A Core Curriculum." Perioperative nurse educators use this program to teach nurses new to the specialty; some of the coursework can be done online. AORN recommendations are considered the gold standard for perioperative nursing practice.

Alternatively, some colleges offer perioperative nursing as an elective in their associate's or bachelor's degree in nursing programs. Both methods of training are centered on nearly the same basic principles and will give you the groundwork you need for your career.

Crucial contributions

As a perioperative nurse, your crucial contribution will be to advocate for your patients while they're most vulnerable. Other nursing responsibilities include managing the overall nursing care of surgical patients and working closely with the surgical team to ensure the best outcomes are achieved for your patients. The surgical team includes the anesthesiologist, a nurse anesthetist, a scrub person, a primary surgeon, a second surgeon or surgical assistant, a circulating nurse, and a perioperative patient care technician. Now let's look at what the circulating nurse and the scrub person handle.What does a circulating nurse do?

Preoperative duties include the following:

* Develop a plan of care.

* Prepare the OR (review surgeon's preferences for the surgery, instrumentation, equipment, sterile supplies; assist with set-up of surgical field and pre-surgery count of instruments, sponges, sharps, and miscellaneous items with scrub person).

* Check equipment.

* Interview the patient and review the preoperative assessment with him (identify patient and discuss surgery with him, check chart for proper documentation: history and physical examination, consents, correct surgical site, laboratory test results, lab values, allergies, and NPO status).

Then, the circulating nurse's intraoperative duties are to:

* assist anesthesia provider with induction.

* assist surgeon with patient positioning.

* participate in surgical "time out" (verify correct patient, correct procedure, consent matches procedure, correct surgical site, correct position, and correct implant, when applicable).

* assess skin, then apply cautery grounding pad to appropriate site.

* connect suction, cautery, and other equipment needed.

* issue sterile fluids and medications onto the sterile field.

* monitor the sterile field, equipment, and anesthesia so you can troubleshoot quickly.

* issue sterile supplies, and additional equipment as requested, onto the sterile field.

* monitor the traffic flow through the OR suite.

* complete documentation on OR record and OR surgery charge sheet.

* perform intraoperative surgical counts of instruments, sharps, sponges, and miscellaneous items with the scrub person.

* prepare specimens for pathology.

* assist with wound and drain dressings.

Finally, the circulating nurse's postoperative duties are to:

* assist anesthesia provider with extubat and preparing patient for safe transfer to the postanesthesia care unit.

* assist scrub person with cleanup.

* provide report to postanesthesia nurse (procedure, dressings, drains, type of incision, allergies, and any additional pertinent information).

What does a scrub person do?

The scrub person, who is sometimes a nurse, has the following duties:

* Set up the sterile field.

* Perform surgical counts with circulating nurse.

* Gown and glove surgical team.

* Monitor the field for breaks in aseptic technique.

* Request additional sterile supplies and equipment per surgeon's request.

* Have a sound surgical knowledge base to anticipate the surgeon's needs (instruments, suture material, equipment, medications, irrigations, and so forth).

* Safely handle sharps.

* Prepare wound dressings.

Now that you've learned what contributions you can make, consider if this is the field for you. (See Sizing up the pros and cons of perioperative nursing.) This field offers many opportunities for professional development and advancement: you can become a certified nurse in the OR (CNOR), a certified registered nurse first assistant (CRNFA), patient care coordinator (specialty supervisor), perioperative nurse educator, patient liaison (handling communication between the OR and the family during surgery), or nurse manager or director. Master's prepared nurses work as surgical nurse practitioners or certified registered nurse anesthetists (CRNAs).

Go for a "test drive"

If your curiosity is piqued, ask to spend a day in an OR or surgery center and see for yourself how awesome perioperative nursing can be.

Sizing up the pros and cons of perioperative nursing

Pros

* Nurse/patient ratio 1:1

* Establish a rapport with patient preoperatively and act as patient advocate

* Flexible schedule

* Opportunity to work with cutting-edge technology and to develop a broad surgical knowledge base

* Continual learning opportunities

* Professional growth

Cons

* Physically demanding and fast paced

* High stress environment

* Short-term relationship with patients

* Very technically challenging

* May need to be on call