Perioperative Nursing

My Specialty

Perioperative Nursing

By Keith Carlson, RN, BSN
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Marcela Crowley, RN, CNOR
Clinical Coordinator of Robotics and Urology
Huntington Hospital, Pasadena, CA

What are your responsibilities as clinical coordinator?
As coordinator, I’m clinically based in the operating room (OR) giving direct patient care. That is what I like best about my role. Two days each week I’m in the office and on the other days in the OR doing cases. I’m responsible for training staff, maintaining equipment, ordering special supplies — anything that involves the service provided by the OR. I need to anticipate problems before they actually happen. As long as everything is going smoothly, that’s great. If anything goes wrong, it’s my responsibility. I was given the opportunity to set up the robotics program, so I was involved in training the team, and doing the first cases to make certain the room ran smoothly.

Briefly describe your career history as a nurse.

I have been working in the OR for 36 years since finishing school. I did a clinical rotation while studying at Pasadena City College. It was an accelerated program that produced RNs faster back in the early 70s. I chose the OR as my six-week clinical and they offered me a job before
I graduated.  I could not believe I was going to get paid to do what these people did! I loved the teamwork and the environment in the OR. They seemed to really love what they were doing.

What do you like about your work?
Huntington has given me so many opportunities. There is always something new to learn, technology is always changing. Work is never boring.
Patients come to us in a very vulnerable state because they are undergoing a procedure, and they are completely trusting us to keep them safe. They expect to leave us better than when they arrived. We have a short time to create a relationship while the patient is awake, so we need to make the most of the time we have. It is quite a responsibility and that we all take very seriously.

What do you find most challenging about your work?
Creating change. There is a process you have to go through. I am the chairperson of our Unit Based Council, and we have a group of RNs from our department that comes together to represent all of the staff. It’s an avenue where I can work to bring about positive change rather than simply complain .

What special certification or training is needed?
Training programs vary widely, some facilities offer some sort of program that pairs you with a preceptor for at least a year. You do not need to be certified to work as an OR nurse. In fact, you cannot even sit for the CNOR exam until you have worked in the OR for 2 years.  

Do you have any advice for nurses who might want to explore perioperative nursing as a career track?

I would suggest volunteering in the OR by answering phones, doing paperwork and experiencing the environment. You can apply to a program or school that offers special training or fellowships for OR nurses. If you are interested, attend hospital job fairs and apply for a training program. We have surgical techs in our department who completed school to become RNs and are training to work in the OR. Even if you’re not working in the operating room, you can go to the annual AORN conference to learn about the specialty and meet perioperative nurses who can share their experience and expertise with you. >>

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Emerita F. Santibanez, RN, BSN
Perioperative Nurse
California Hospital Medical Center, Los Angeles

 
Briefly describe your career history as a nurse.
I graduated from Trinity College of Nursing in the Philippines in 1982.  As soon as I graduated, I volunteered in the operating room for eight months, and I worked full time in the OR for four years. When an opportunity to work in the United States came my way, I worked on an orthopedic floor in Paris, Texas for 2 years. Later, after several years on the medical-surgical floor of the California Hospital Medical Center (CHMC) in Los Angeles, I was given the opportunity to work in the OR once again.

What do you love about perioperative nursing? What keeps you coming back to work?
I enjoy every aspect of working in the operating room. The challenges we face during surgery only result in a greater sense of satisfaction when the patient pulls through. I feel elated and excited every day I come to work. 

Work is like my second home and the people I work with are my second family. Each day brings a new learning experience, a new opportunity that keeps nursing exciting. I especially love the fact that California Hospital is a trauma hospital. This continuous opportunity to gain new knowledge from various experiences keeps me coming back to work every day.

What do you find most challenging about your work?
The OR is like a large puzzle, and each piece must be in the correct position for the operation to run smoothly. Sometimes keeping the OR in order can be challenging, but this challenge is what keeps the OR an interesting and exciting place to work.

For example, keeping the patient satisfied and happy can be a challenge, as they are experiencing difficult health issues. At times, the surgeon, anesthesiologist and the surgical tech may not always be in agreement with what is to be done.         It’s my job to make sure that things run smoothly and that the patient's surgery is a success. The fact that I have this role in a person’s life, that I‘m a factor in the survival of the patient makes me love my job all the more.

What special certification or training is needed?
Being an OR nurse entails continuous training. We are encouraged to attend intraoperative courses to be a certified nurse in the OR (CNOR). 
But foremost we need a keen sense of observation and anticipation.

Bearing in mind HIPAA regulations, is there a story or anecdote about a patient you would like to share?
When we became a designated level 2 trauma hospital, everyone was excited and nervous. Then came a call that we would be receiving a female patient who was a victim of a terrible vehicular accident. She was brought to the OR unconscious, with life-threatening injuries to the liver and other major organs.

Working with the trauma team to save her life made this experience memorable. Seeing this patient walking and sharing her experience on the first anniversary of her trauma was truly emotional and fulfilling.

Do you have any advice for nurses interested in this specialty?
I would advise them to take on the challenge because it is worth it! The operating room does bring stress and pressure, but the experiences that one can gain are most valuable.

I honestly have no regrets and I would not want to change anything about my career as an OR nurse. 

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Did you know? PERIOPERATIVE NURSING

EMPLOYMENT OPTIONS
Perioperative nurses, also referred to as operating room (OR) nurses, assist patients in having the best possible outcome in a surgical situation, and can be closely involved in the preoperative, perioperative, and postoperative phases of the surgical process. Perioperative nurses work closely with surgeons, surgical patients, family members, anesthesiologists, and other members of the healthcare team.

SUB-SPECIALTIES
Perioperative nurses may work in ambulatory surgery units, physician offices, clinics, major surgical centers, community hospitals, and large teaching and research facilities. In the operating room, perioperative nurses can serve in various capacities:

Scrub nurse: selects and handles instruments and supplies needed in the surgical area, and works directly within the sterile field.
Circulating nurse: manages nursing care in the OR and assists in maintaining the overall surgical environment.
Operating room director: manages and controls the broad functions of the OR, including supplies, staffing and scheduling.
Patient educator: works directly with patients and families to provide information and education vis-à-vis all aspects of the surgical experience.
Registered nurse first assistant:
assists the surgeon in suturing, controlling bleeding, and manipulating and cutting tissue in the course of surgery. This role requires additional training and specialization.

 
CAREER PATH

Many nurses seek positions in facilities that provide on-the-job perioperative training for qualified candidates. Critical care and emergency department nursing provide excellent prior experience for those wishing to work in the OR. While finding a perioperative position directly out of school may be a challenge, some nursing school graduates are able to land fellowships or other programs.

After gaining several years of experience, most perioperative nurses sit for the CNOR exam, a certification that demonstrates advanced expertise and professional knowledge specific to this highly-technical nursing specialty.

SALARY & DEMAND
The average salary for a perioperative nurse in the United States appears to fall between $57,000 and $68,000 at this time, according to several sources. 


RESOURCES
   
Association of periOperative Registered Nurses (AORN): www.aorn.org

AORN Journal:  www.aorn.org/AORNJournal

Competency and Credentialing Institute (CCI): www.cc-institute.org

Journal of PeriAnesthesia Nursing: www.jopan.org

The Operating Room Nursing Council of California: www.orncc.org

Perioperative Nursing Clinics: www.periopnursing.theclinics.com   

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Keith Carlson is a registered nurse, writer and blogger. He writes for a variety of nursing and health websites, and has been included in several nonfiction nursing books by Kaplan Publishing. He is editorial contributor to BlackDoctor.org. His own blog can be found at digitaldoorway.blogspot.com

This article is from workingnurse.com.

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