How to Become an Operating Room Nurse

An Inside Look at the Education, Training, and Certification You Need to Become an Operating Room Nurse

operating room nurse hands surgeon tools during procedure
surgical team in operating room

Operating room (OR) nurses work as part of a team to care for patients before, during, and after surgery. Are you calm under pressure? Can you think fast?  If so, OR nursing might be right for you. These professionals are also often called “perioperative” nurses because they are involved in all patient care surrounding surgery. You’ll need at least an RN degree to get started.

“We have a workforce that’s looking for jobs that really make a difference in people’s lives, where they can have an impact, where it’s exciting, where they can be a hero, if you will,” says Judy Pins, an RN and president of Pfiedler Enterprises, a subsidiary of the Association of Operating Room Nurses, which offers highly specialized continuing education for surgeons and nurses. “They’re looking for jobs they can really bring the best part of themselves to it, and I think the OR offers that.”

Of the top 25 nursing specialties in 2019, OR nurses were the sixth highest in demand.

This field also offers an opportunity for non-stop problem solving. In the aftermath of worldwide pandemic health issues, for example, hospitals and operating teams are taking extra precautions and facing new challenges, and OR nurses are a vital part of this effort.

If you’re thinking about a career in this field, learn more about the job, how to pursue the education you need, and what sort of salary to expect.

What Does an OR Nurse Do?

OR nurses spend most of their time caring directly for patients who undergo surgery, so surgical and medical skills are crucial. But perioperative nurses also have other responsibilities that require attention to detail, extensive knowledge of medical technology, the ability to stay cool under pressure, and compassion for patients and their families during what can be a stressful time.

“Perioperative nursing is rewarding in that most patients undergo a procedure that prolongs or improves the quality of their life,” says Thereza Ayad, DNP and assistant professor at the University of Massachusetts Medical School. And this specialty is focused. “Only in perioperative nursing is the nurse able to care for one patient at a time,” says Ayad.

 As an OR nurse, you’ll typically be called on to:

  • Make sure medical equipment is working properly
  • Coordinate medical supplies for the OR and the patient
  • Manage patients throughout surgery
  • Monitor patient conditions, vital signs, and safety
  • Educate patients and family members about the procedure
  • Communicate patient needs to the rest of your team

The title “OR nurse” might be an umbrella for several jobs, depending on where you work and the size of your team. That means an OR nurse might have one or all of these roles:

Pre-op nurses prepare a patient for surgery. In this role, you’ll:

  • Take your patient’s health history
  • Record and monitor their vital signs
  • Ensure the patient is stable for surgery
  • Start any needed IVs
  • Complete any needed paperwork
  • Provide support and education to the patient and their family

Intra-op nurses are part of the surgical team in the operating room. In this role, you’ll:

  • Prepare the operating room and supplies for surgery
  • Assist the surgeon and keep instruments sterile
  • Ensure the room is sterile and controlled
  • Complete any needed paperwork

A post-op nurse provides patient care immediately following surgery. They’re are also sometimes called post-anesthesia care unit (PACU) nurses. As a PACU nurse, you’ll:

  • Monitor the patient as they wake from anesthesia
  • Watch the patient for any complications
  • Educate the patient about their recovery
  • Discharge the patient or transfer them to another unit

What’s the difference between an OR nurse and a trauma nurse?

OR nurses help patients before, during, and after surgery.

Trauma nurses help patients with a severe injury or other emergency.

OR Nurse Education Requirements

You’ll need to complete an RN program before you can become a perioperative nurse. It can take anywhere from two to four years to earn your degree. You have three options for earning an RN license. There are advantages to each educational path:

Hospital-Based Diploma Program

Hospital-based programs offer hands-on training alongside classes and allow you to start working quickly. However, you’ll likely need to start your nursing career at that hospital and work there for a predetermined amount of time. Plus, credits from a hospital program might not be transferable to an ADN or BSN program.

Two-Year Associate’s Degree in Nursing (ADN)

Earning your ADN is another fast-track option, and you can build a base for earning your BSN later.

Four-Year Bachelor’s Degree in Nursing (BSN)

Going for your BSN from the start will take longer but can help you stand out to employers and possibly advance your career more quickly.

 With all three, you’ll build a foundation in nursing by studying the basics:

  • Biology
  • Anatomy
  • Nursing theory
  • Nursing practice
  • Microbiology
  • Psychology

Can You Take Classes Online?

You can take some nursing classes online but not all. Most nursing degrees require hands-on, clinical training in a medical setting. This means you might be able to take a theory class online, but you’ll need to receive clinical instruction at a hospital or other medical facility.

You can take some nursing classes online, but all nursing degrees require hands-on, clinical training in a medical setting.

What Licensing Do You Need?

When you finish your coursework, the next step will be to pass the National Council Licensure Examination (NCLEX-RN). The NCLEX-RN consists of a maximum of 265 questions. You’ll need to get at least 75 correct to pass. After that, you’ll be ready to apply for an RN license. Licensing regulations can vary by state, but they’ll generally require:

  • A criminal background check
  • A reference letter

You don’t need any additional certification for an entry-level OR nursing position—and many hospitals and clinics accept applications from recent graduates.

In many cases, however, earning a certification may position you to earn a higher salary and advance in your career. If you hold an active registered nurse (RN) license and meet other requirements, you can earn a Certified Perioperative Nurse (CNOR) certification through the Competency and Credentialing Institute.

After at least two years of perioperative experience, you’ll be eligible to become a certified perioperative nurse (CNOR). This specialized credential could help you advance your career.

What’s the Career and Salary Outlook for OR Nurses?

Nursing is growing quickly, and hospitals will be looking to fill OR positions. In fact, the U.S. Bureau of Labor Statistics (BLS) predicts much faster-than-average growth in registered nursing jobs—12%—by 2028. OR nursing is unlikely to be replaced by automation or technology, making it a secure field now and in the future.

In fact, according to the Association of Perioperative Registered Nurses (AORN), the U.S. will need more than 1 million new RNs by 2022, especially in areas like perioperative nursing. Of the top 25 nursing specialties in 2019, OR nurses were the sixth highest in demand, and PACU nurses ranked ninth.

What’s the Salary Range for an OR Nurse?

According to the most recent (2018) figures from the BLS, the mean (average) salary for RNs is $77,460. A 2018 AORN survey of perioperative nurses found they made $73,100 to $73,400. While this is slightly below the BLS the average, you can move up in the field. The AORN survey found that OR nurses who are also charge nurses—meaning they’re in charge of their unit—made, on average, between $78,200 to $82,000.

Your salary will depend on your OR experience, location, and education. For example, you might earn a higher starting wage if you have a BSN, or if you work in a hospital with a large surgical unit.

How Does an OR Nurse Salary Compare to a Surgical Technologist Salary?

Surgical technologists also work in the operating room, assisting with surgery and providing patient care. However, OR nurses generally have more education and responsibility and earn significantly more. In 2018, surgical technologists earned a mean salary of $49,040, according to the BLS.

OR nurses looking to advance their careers might want to consider earning a license to be a nurse anesthetist. You’ll need at least an MSN, so more school and training are required. But the earning potential is more than twice that of a nurse. Nurse anesthetists earned a mean salary of $174,790 in 2018, according to BLS data.

How to Stay Informed in This Field

To learn of opportunities to build your nursing career, you’ll need to stay connected and informed about trends in your profession. Some important resources for OR nurses include:

Association of PeriOperative Registered Nurses (AORN)

AORN is a national organization dedicated to perioperative nurses. It provides continuing education, advocacy, networking opportunities, and more.

The International Federation of Perioperative Nurses (IFPN)

IFPN is an international organization dedicated to OR nursing and provides resources for OR nurses around the world.

American Pediatric Surgical Nurses Association Inc. (APSNA)

APSNA is dedicated to pediatric surgery and provides support, resources, and education opportunities for OR nurses specializing in pediatrics.

AORN also publishes the AORN Journal, a monthly peer-reviewed publication dedicated to the latest news in OR nursing. The journal’s articles contain enough educational content that AORN members can get over 200 free continuing education credits a year just by reading them.

Discover more professional nursing resources

There’s a lot to consider when you’re choosing a nursing specialty. You’ll want to think about the environment you work in, the tasks you’ll do and the pace you’ll be working at, among other things. You might be highly successful in this type of work if you’re:

  • Good at teamwork
  • Able to stay calm under stress
  • A fast problem solver
  • An excellent communicator
  • Highly organized
  • Highly knowledgeable about anatomy and biology

“If you are interested in working in a fast-paced environment where you are continuously learning,” says Ayad, “becoming a perioperative nurse sounds like the right career path for you.”

Written and reported by:

Stephanie Behring

Contributing Writer

With professional insight from:

Judy Pins, RN, MBA, MHRD

President, Pfiedler Enterprises (a subsidiary of the Association of Operating Room Nurses)

thereza ayad

Thereza Ayad, DNP

Assistant Professor, University of Massachusetts Medical School