As surgical care continues to advance, so does the field/scope of nurses’ responsibilities. Operating Room nurses (Scrub Nurses or Perioperative Registered Nurses (PRN)) are now known as to more precisely show their functions/duties immediately before surgery, during surgery, and after surgery. Perioperative Registered Nurses, usually relied upon due to their critical thinking skills and professional judgment. They usually work closely with healthcare professionals, surgical patients, as well as family members. They help in planning, implementing, and evaluating treatment of the client/patient.
- What Is a Scrub Nurse?
- Roles of a Scrub Nurse
- Scrub Nurse Tasks Before Surgery
- Scrub Nurse Tasks During Surgery
- Scrub Nurse Tasks After Surgery
- Scrub Nurse Specialties
- Scrub Nurse Practice Setting
- Scrub Nurse Work Environment
- How to Become a Scrub Nurse? Requirements
- Scrub Nurse Education
- Scrub Nurse Training
- Scrub Nurse Licensing and Certification
- Necessary Scrub Nurse Skills & Qualities
- Scrub Nurse Opportunities for Advancement
- Scrub Nurse Job Outlook
- Scrub Nurse Salary
Scrub Nurses, one part of registered nurses commonly called Operating Room (OR) or Perioperative Nurses, take care of clients/patients in the fast-paced and fascinating surgical environment. In this setting, every second counts, therefore a Scrub Nurse serves to prepare the operating/surgical room and works closely with other members of the healthcare team to make sure each procedure is safe and successful. A Scrub Nurse gets the operating area ready by laying out necessary equipment and instruments. Before each procedure, O.R. Nurses thoroughly disinfect their hands & arms and then put on sterile/protective clothing. Under the surgeon’s direction, scrub nurses help with procedures, check the patient, and handle instruments throughout the operation.
For a Scrub Nurse, each day at work is very busy & full of new experiences. Some nurses generally scrub in on several different types of surgical cases. Experienced nurses usually have greater options in their specialty and they focus on areas of interest, like cardiac surgery or orthopedics. Scrub nurses play an essential role in safe & successful surgical operations, plus taking great satisfaction in caring for & supporting patients through difficult experiences.
Perioperative Registered Nurses offer surgical care to patients by assessing, planning & implementing nursing care clients/patients receive before surgery, during surgery, and after surgery. The activities include:
- Patient assessment
- Creating & maintaining a safe and sterile surgical environment
- Pre & post-operative patient education
- Monitoring the patient’s emotional and physical well-being
- Integrating & coordinating client care throughout the continuing surgical care
During surgery, Perioperative Registered Nurse assumes the following responsibilities:
- Scrub Nurse – Works closely with the surgeon in a sterile field, passing sponges, instruments, and other items required during a surgical procedure.
- Circulating Nurse – Works outside sterile field and is responsible for managing proper nursing care in the operation room, by keenly observing surgical teams and assisting the surgical team in creating & maintaining a comfortable and safe environment.
- Registered Nurse First Assistant – After completing extensive continuing education & training to offer direct surgical care, Registered Nurse First Assistant may directly help the surgeon to control bleeding and offer wound exposure & suturing during a surgical procedure.
Scrub Nurses’ duties begin even before the operation starts. They make sure the surgical room is clean & ready to set-up, then prepare the equipment and instruments required for the surgery. They count all sponges, needles, instruments & other tools, and maintain/preserve the sterile environment by, scrubbing in, which requires washing their hands using special soaps & putting on sterile clothing, including gloves, face mask, and a gown. A Scrub Nurse also helps the surgeon with his gloves and gown before preparing the client/patient for surgery.
During the procedure, the scrub nurse’s main duty is selecting & passing instruments to surgeons. A Scrub nurse’s role is described as supporting surgeons while also maintaining patient’s safety. The nurses must know the instruments used for particular procedures & when they are required, so they can quickly pass them to surgeons. Scrub nurses must also look for hand signals in order to realize when the surgeon needs the next tool when he finishes using a tool & is ready to pass it back. The Scrub Nurse cleans the tools properly after use & places every tool in its specific place. The nurse also closely monitors the operation to make sure every item remains sterile.
After the operation, scrub nurses count all sponges, instruments & other tools, and tells the surgeon about the count. She removes equipment and tools from operating area, applies proper dressing to a surgical site & transports the client to the recovery area. Finally, the nurse completes any important documentation about surgery or the client’s transfer to recovery.
Perioperative Registered Nurse may also work as an Operating Room Director, staffing, managing budgets, plus other business forms of the O.R. Several Perioperative Registered Nurses can later opt for a promising career in business as a clinical educator, management consultant, medical sales professional or researcher.
Surgical sub-specialties for scrub nurses include:
- Cardiac surgery
- General surgery
- Otorhinolaryngology (nose, ear, and throat)
- Plastic and reconstructive
Scrub Nurses practice in all kinds of medical facilities providing surgical services, including:
- Hospital’s surgical departments
- Physician offices
- Ambulatory surgery centers (Day Surgery Units)
- Labor & delivery departments
Surgical nursing needs constant, high-quality interaction and communication with other healthcare professionals. Scrub Nurses form a part of the surgical team, therefore, they must effectively communicate with technicians, physicians, and other nurses to respond to emergencies and to offer high-quality care. Surgeons who practice privately usually employ their own O.R. Nurses who accompany them & help throughout their surgical procedures.
The work of Scrub Nurses needs both mental and physical strength. Some surgical procedures last many hours, and it isn’t unusual for them to spend a whole shift standing. They keep the operating area sterile, by putting on gloves, masks, gowns, and other protective garments. Before surgeries, they wash their hands and arms thoroughly using surgical soap. The nurses must adhere keenly to safety procedures/precautions when handling bodily fluids, chemicals and sharp instruments in the operating room.
Scrub Nurses are so significant to surgical procedures, at times they work for long hours, for an operation. A Scrub Nurse typically works 8- to 10-hour shifts. Most surgical procedures happen during daytime hours, but scrub nurses are usually called in on weekends, holidays and at night to help in emergency operations or surgeries. Scrub Nurses are employed to work part-time, or work full-time hours in certain locations, this depends on the number of available surgical cases. About 80% of Registered Nurses (RNs) (including Scrub Nurses) worked part-time in 2010.
To cope with this complex work environment, scrub nurses must have great knowledge of all operating room procedures, like the tools used for specific surgeries. In addition, they should be able to manage stress, stay calm & clear-headed even under pressure. Plus, they must also have great communication skills, for one of their main duties is working closely with the surgeon & assisting him with anything he wants during the procedure or operation.
Generally, registered nurses (RNs) obtain basic nursing experience before joining the specialty area or setting of Perioperative Nursing. There are 2 areas that can offer applicable experience, including emergency room care and critical care. They are sometimes stressful and fast-paced work environments where critical life-saving decisions making a great difference in the patient’s life are regularly made.
Perioperative registered nurses or scrub nurse must interact well with every person or patient in difficult situations. A scrub nurse needs emotional and physical stability to cope effectively with frequent emergencies and human suffering. In addition, they must be able to provide direction & guidance to others, accept responsibility, coordinate a client’s health care plan, and collaborate professionally with other healthcare professionals.
Many Scrub Nurses are approved as Registered Nurses (RNs). This requires at least an Associate Degree in Nursing (ASN). However, the Association of Peri-Operative Registered Nurses (AORN) highly recommends scrub nurses to have a Bachelors Degree in Nursing (BSN). This nursing degree guide offers a lot of useful info about the main differences between RN degree paths, and industry trends favoring the BSN.
Associate degree programs take 2 years to complete. They are available through community colleges, hospital-based nursing schools, and career centers. Completing a Bachelor’s degree needs at least 4 years of full-time study at a university or college. Many registered nurses enter the specialty or workforce with an Associate degree (ASN) & take advantage of employee tuition assistance programs to boost their studies.
Nursing education generally covers background courses or programs in subjects like biology, growth and development, pharmacology, and leadership. Every nursing program also includes extensive training to offer patient care & to practice in hospital settings as well as other clinical settings.
Nurses’ educational programs vary hugely in quality. Nursing candidates should be very cautious of for-profit schools, that are under the federal government’s scrutiny for offering low-quality education at very high fees or charges. The best choices available for nursing schools include those programs accredited by ACEN, Accreditation Commission For Education in Nursing, and authorized by the individual state’s Board of Nursing.
In addition, a scrub nurse with a registered nurse license and a hospital diploma from an approved hospital-based nursing school is eligible to practice as a perioperative registered nurse. The diploma equips the nurse with necessary skill and knowledge to practice in any operating room setting.
A Registered Nurse (RN) may transition or change into the role of a scrub nurse after some years of working or practicing in acute-care settings. AORN offers a program called Periop101, to prepare experienced registered nurses for practice in the operating room (OR). The course provides a detailed introduction to surgical care or surgical nursing & has been adopted and integrated by many hospitals.
To best ensure safety within the surgical environment or setting, AORN also recommends all scrub nurses to maintain a certification in the program, Basic Life Support (BLS). Generally, training takes 4.5 hours to cover and complete automated cardiopulmonary resuscitation and external defibrillation in a wide range of situations and settings.
Scrub nurses who monitor clients under local anesthesia and who administer/give moderate sedation must be certified in ACLS, Advanced Cardiovascular Life Support. This 10 to 12-hour course is designed for resuscitation teams & covers the management of cardiac arrests & related emergencies.
Training in ACLS and BLS is usually provided through outside agencies like The American Heart Association or through the nurse’s employer.
Upon graduation from a certified training course, RN candidates may apply to the state’s Board of Nursing. Once considered eligible for licensure, candidates must then complete the National Council Licensure Examination (NCLEX-RN), a complex, computer-based assessment that covers health promotion, physical & psychological care, and safety for patients.
Experienced scrub nurses can pursue a voluntary CNOR certification via the Institute of Competency & Credentialing. Candidates must have a Registered Nurse License & at least 2400 hours of documented or evidenced perioperative nursing experience. Plus, they must pass an exam that covers preoperative assessment & diagnosis, communication, instrument care & handling, emergencies, intraoperative activities, as well as other relevant topics.
Scrub Nurse Certificate
Generally, coursework is designed to teach perioperative nursing techniques & skills to students who have minimal knowledge and skills of operating room settings and procedures. This program offers students ability to develop effective capabilities to manage resources and people within the operating room setting. This program covers topics like:
- RN first assistant
- Perioperative nursing theory
- Health care management
- Principles in peri-operative nursing
- Fundamental of surgical procedures or care
Overall, scrub nurses need great communication & interpersonal skills to work well with patients & a team of healthcare professionals. The job needs strict adherence to sanitary and safety procedures, therefore, scrub nurses should be great decision makers with a key emphasis on detail. Additionally, these nurses need stamina, emotional stability, and energy to thrive and cope with the fast-paced & intense operating room environment/setting. An empathic, compassionate nature will aid them to put suffering and anxious patients at ease.
Experienced scrub nurses can advance to become peri-operative care managers. This role requires them to supervise the daily activities of technicians, operating room nurses, and non-licensed staff. Typical duties of these scrub nurses include:
- Scheduling nurse shifts within the perioperative team
- Mentoring other healthcare professionals and staff members
- Recruiting new nurses who will work within the surgical field
- Collaborating with other health care professionals and department leaders
Some scrub nurses, advance to become perioperative care directors at the organizational level. These professionals have a responsibility to deliver high-quality and safe services to every patient. Adding to their nurse training, many directors have graduate degrees in healthcare administration, which make them excellent leaders due to their background in supervision and health management, as well as experience in offering acute surgical care.
Scrub nurses working at larger health care systems or facilities have an opportunity to become In-House Nurse Educators. This commonly involves creating & directing orientation programs or courses for new O.R. Nurses. Nurse educators also monitor staff development efforts & oversee continuing education activities of surgical nursing team members.
Nurses who desire for greater work autonomy in their practice should consider more studying to become certified nurse anesthetists (CRNAs) or nurse practitioners (NPs). These roles incorporate different areas of medicine with nursing care. A surgical nurse needs a Doctorate or Master’s degree in Nursing practice to be certified in these fields.
According to U.S. Bureau Of Labor Statistics, registered nurse employment, including scrub nurses, is expected to grow by 19% between 2012 & 2022. This increase is considered to be much faster than the average growth for all other occupations.
Some of the reasons that facilitate this growth include:
- The aging of the American population — This leads to an increase in the demand for all kinds of healthcare services in the years to come.
- The progressive shift in health care to outpatient surgical care — This creates new positions in various ambulatory surgery centers.
- The increasing popularity of elective surgery, like cosmetic surgery — This creates many job opportunities for experienced scrub nurses.
- Shortage of nurses — Half of the currently employed registered nurses are nearing their retirement age, while the number of patients continues to increase, hence need for more nurses including scrub nurses.
Job prospects are likely to be great for experienced and licensed professionals. Currently, AORN maintains a surgical nurses job board on its website. Many more job options are available for aspiring scrub nurses. Career options for students interested in practicing as experienced scrub nurses include:
- Circulating nurse
- PACU nurse
- Pre-operation holding nurse
All of these career prospects are based on offering care to patients within the perioperative setting.
According to U.S. Bureau Of Labor Statistics, the annual average salary for RNs, including scrub nurses, is $66,640. 80% of RNs make around $45,880 to $98,880. Generally, hospital nurses and nurses working in out-patient care facilities, earn the highest salaries. Wages specifically increase with experience and education level. In other instances, salaries for surgical nurses, including scrub nurses, increase with:
- Type of facility
Pay by Position
The AORN salary survey indicates that staff nurses who work in emergency rooms earn an annual average salary of between $65,400 & $67,100. RN first assistants reported an annual average salary of between $70,900 & $76,300. Clinical nurse specialists who work in emergency departments reported an annual average annual salary of $85,600.
Pay by Type of Facility
According to AORN reports; surgical nurses working for a general hospital earn an annual average salary of $64,700, those working for a specialty hospital averaged $69,000 per year, and those working for a university & academic hospital earned roughly $72,400 annually.
Surgical nurses employed by a general ambulatory surgery center reported an annual average salary of about $60,100, while those employed by an academic & university ambulatory surgery center averaged $70,500 annually.
Pay by Location
AORN found out that some states showed notable differences in average salary. For example, surgical nurses in (eastern) South Central states earned $2,500 below the annual national average. Surgical nurses in mountain states earned $5,000 above the annual national average, those in Mid-Atlantic states averaged about $7,700 more, while those in New England reported the highest pay of $15,100 above average.