How To Become a Surgical Nurse in 2024

Responsibilities of a surgical nurse

The majority of operating room nurses have achieved the status of registered nurse and go on to obtain a specialized education in the field of surgical nursing. This means many have studied an ADN or BSN program to get RN licensure, followed by a master’s degree in surgical nursing or a specialty certification.

According to the Bureau for Labor Statistics, registered nurses can expect to enjoy excellent job growth over the next decade, with the role predicted to grow 7% between 2019 and 2029. This is already 3% faster than average — but for those individuals who zero in on a specific field of nursing, the rate is likely to even higher.

The mean annual wage for nurses is $80,010, which is more than $30,000 higher than the national average wage. The top paying states for registered nurses are California, Hawaii, Massachusetts, Oregon, and Alaska. When it comes to states with the highest demand for qualified RNs, South Dakota, West Virginia, Rhode Island, Delaware, and Mississippi come out on top. 

What is surgical nursing? 

A surgical nurse, also sometimes called a scrub nurse, is a highly motivated medical professional who works in surgical settings, assisting medical doctors and surgeons in complex and routine procedures. Perioperative nursing professionals usually work in intensive care units, recovery rooms, trauma and emergency care centers, surgical wards, and operating rooms. Every day, they work with people who are going through life-saving operations, in addition to elective procedures.

Operating room nurses often work side-by-side with a team that includes surgeons, anesthesiologist, nurse anesthetists, operating room practitioners, and porters. They have a crucial role assisting surgeons as they carry out hugely challenging, delicate work and ensure the patient is well looked-after. The surgeon wouldn’t be able to do their job without the support they get from the team around them.

Due to the extreme nature of working in a surgical setting, the role of OR nurse is one of the most demanding nursing specializations. You’ll need a broad range of skills to excel in the role, which includes pre-operative, intra-operative, and post-operative duties. As such, it’s also one of the most in-demand nursing jobs, which means surgical nurses are well-rewarded and highly-respected within the field.

Duties of a medical surgical nurse

There are four main phases of an operating room nurse’s daily duties: pre-operative care, anesthesia, perioperative care, and recovery supervision. While most of an OR nurse’s most pressing duties take place during surgical procedures, there’s much more to the role. This is because the surgical nurse also acts as an advocate for the patient, as well as liaising between the patient, their family, and the surgical team.

Let’s take a look at the duties a surgical nurse might turn their hand to each day.

Pre-operative nursing

First off, there’s the pre-operative phase of care, which involves making sure each patient is sufficiently prepared for the operation. You’ll let them know about the benefits of surgery, as well as any potential risks and check vital signs to ensure they’re healthy enough to go through with the procedure.

It’s important that patients feel secure and confident before going into an operating room, and a major part of a surgical nurse’s role is answering questions and putting the patient’s mind at ease. At this stage, you might need to make use of technical skills, such as administering medication, starting IV lines, and marking and sterilizing incision sites.  

Anesthesia

While an anesthesiologist and nurse anesthetist are in charge of this aspect of the operation, the surgical nurse is crucial to the process. You might assist them by preparing medications and operational equipment — but you’ll also usually be responsible for making sure the patient is responding to the medication as they should be.  

During surgery

Perioperative nursing isn’t just the time the patient in in the operating room, but it is the most intensive aspect of a med/surgery nurse’s role. There’s no time to stop and catch your breath or take a quick break, and you’re required to be fully aware of everything that’s going on with the surgical patient at all times. 

In small, rural hospitals, you might manage and monitor vital signs as well as providing assistance to the medical team. In large hospitals and medical settings, there are several types of operating room nurse:

• Pre-operative nurse: This professional gets the patient ready for surgery
• Scrub nurse: A scrub nurse is responsible for the instruments used during surgery
• Circulating nurse: The circulating nurse works outside of the sterile environment, making sure all supplies, personnel, and equipment are in the correct place
• RN first assistant nurses: Directly work with surgeons to control bleeding and provide help with suturing and wound exposure
• Post-operative nurse: Sometimes called post-anesthesia care unit nurses, they take care of the patient immediately following on from anesthesia

Recovery

Once the operation is complete, a medical/surgical nurse is required to carry out any necessary post-operative care until the patient is recovered. Depending on the specific procedure, the surgeon will provide a set of instructions, directing the surgical nurse to administer medication and change dressings.

You’ll also give the patient care and support as they come around from anesthesia and keep track of their vitals until they’re moved back to a general ward or discharged. You might work in an inpatient or outpatient setting, and on either ward, you’re responsible for deciding if a patient is fit for discharge.  

Benefits of being a perioperative nurse

For individuals who are passionate about their fellow human beings, have an iron-clad work ethic, and are highly motivated — a job as a surgical nurse can be highly-rewarding. Surgery is one of the most impressive feats in society, and you get to take part in life-saving procedures on a regular basis. This means you get instant, direct feedback after every successful surgery.

There are also plenty of ways to progress and climb up the career ladder as an OR nurse. The role of RN first assistant provides more responsibility and independence, and sees you take part in surgical procedures. After several years in the field, those who excel in their role will be eligible to apply to become a nurse educator, nurse manager, or nurse administrator, specializing in the field of operating room nursing. 

Educational requirements for surgical nurses

Getting into a role as a perioperative nurse requires extensive education, but not as much as you’d need to go through to become an advanced practice registered nurse, nurse practitioner, or nurse anesthetist. Below are the five steps you need to take to get into medical/surgical nursing.

Step one: understand the role

Before applying to nursing school, we’d strongly recommend that you do thorough research into what the role involves. While there are many benefits to entering this role for those who have the mental strength, bedside manner, and technical skills — it’s an extremely emotionally and physically demanding job. That said, if you’re the sort of person who’s considering this role, there’s a good chance you have what it takes.

Some nurses decide to further specialize so they work with patients in specific departments, such as: General surgery, trauma, pediatrics, oncology, plastic surgery, transplant surgery, cardiac surgery, and neurosurgery. The earlier you decide on your specialization, the more you can focus on boosting your CV by getting relevant experience in your clinical rotations.

Step two: qualification

Most surgical nurses start off by becoming an RN, which means they pursue an ADN or BSN, and then get an RN license. However, there are several pathways you can take, particularly if you already have some experience within the field. A bachelor’s degree is the most well-respected and sought-after qualification because it provides a full four-year education. We’ll discuss the various nursing degrees in detail in the final section of this article.  

Step three: RN licensure

Once you’ve graduated from an accredited nursing program, you’re ready to sit the National Council Licensure Examination for Registered Nurses, which qualify you for practice. When you’ve passed the exam and met the criteria for the board of licensure in your state, you can start working as a certified RN. 

Step four: experience

In many states, you’ll need to demonstrate at least one year of work experience to get into perioperative nursing. You’ll be able to do this during a master’s degree program, but you can also pursue a vocational program in the hospital or surgical center where you work. 

Step five: certification

As soon as you’re armed with relevant experience in medical surgical nursing, you can seek additional certification to make you stand out in the job market. There are three relevant certifications — certified medical surgical registered nurse, certified nurse first assistant, and CNOR certification:

• CMSRN certification: The medical surgical nursing certification board oversees this qualification. Eligibility requirements for the exam include: An RN license, two years of practice in a medical surgical setting, and at least 2,000 hours of practice in the past three years.
• CNFA certification: Administered by the competency and credentialing institute, this exam qualifies surgical nurses to practice as first assistants in surgical procedures. Some examples of requirements are: RN licensure, bachelor’s degree, 2,000 hours as an RNFA, and at least 500 of those hours accrued in the two-years leading up to the application.
• CNOR certification: This exam demonstrates that you’ve gone over and above in your studies as a perioperative nurse. Requirements include an RN license, current employment as a surgical nurse, and a minimum of 1,200 hours working in the operating theater. 

How long does it take to become a surgical nurse practitioner?

Depending on the route you select, and whether you elect to take part in an accelerated course, or study part time, becoming a surgical nursing professional can take between three and five years. 

Skills that successful surgical nurses need 

While all RNs require the following traits, there are additional pressures placed on surgical nurses that mean certain skills must be at the forefront on everything they do. 

Communication

As someone working in a large team within a situation that’s potentially life or death, tension can run extremely high. If you’re particularly sensitive to the way people speak to you, you’ll have to leave it at the door before going into theater. No matter what’s going on, you must be able to communicate clearly and calmly. What’s more, when patient safety is at risk, you’ll need to be confident and outspoken enough to alert the rest of the team to any concerning signs you see in the OR.

Being able to speak to patients before and after surgery to answer questions and offer reassurance means you’ll need to be able to switch effortlessly between being professional and straight to the point with colleagues, while demonstrating an exceptional bedside manner to patients.  

Teamwork 

A surgical room has unique dynamics and you’ll need to be able to navigate them unflinchingly at all times. Every person in the room plays a pivotal role, and needs a particular skillset. However, for these skills to come together and make for a successful team, there are common traits nurses, surgeons, surgical tech, and anesthesia providers all must share.

Anticipation, organization, and respect are key team working tools you’ll need to master before going into work as a perioperative nurse.

Attention to detail

All surgical nurses demonstrate exceptional detail orientation and the ability to multitask. You’re expected to know where everything is, as well as monitoring surgical technology and the patient’s vital signs. Even the slightest change in their condition could have major implications. As such, you’ll need a knack for paying attention to the finest details for team, patient, and technology. 

Problem solving

Operating room nursing requires that you think on your feet and apply critical thinking skills on a regular basis. There’s often no time for speculation, you need to trust your instincts and move straight into action when required. Being self-assured comes from being well-prepared, but a propensity for problem-solving puts you at an advantage in this role. 

Being able to swiftly and confidently find solutions in the blink of an eye and implement them with minimal fuss supports patient safety and ensures the best possible outcomes.  

Organization

Organization skills are non-negotiable in this role, which requires professionals to find medications and surgical items quickly and understand the most practical way to conduct themselves under any amount of pressure. 

Top programs for surgical nursing

There are several routes you can take to become a surgical nurse, with plenty of options for those who want to advance into an advanced position such as RNFA or CNFA.

Let’s take a look at the available nursing degree programs, types of nursing specialty, how to choose a nursing school is best for you — and the top schools for perioperative nurses in the United States.

Popular nursing degrees

To become an operating room nurse, you’ll need to become a registered nurse, and then advance your studies to specialize in medical surgical nursing. You can do this by pursuing a vocational qualification with a medical center or study a master’s degree to get the skills necessary. Certification is separate, and not a requirement, but it can help you stand out above other applicants when you’re seeking employment.  

Associate degree in nursing 

An ADN takes two years to complete, and provides nursing students with all the information and skills they need to become an RN. A mixture of classroom time and on-the-job learning prepares you for a role in nursing, with some prerequisite classes and some electives. Prerequisites might include:

• Communications
• Physiology 
• Psychology
• Anatomy
• English
• Statistics
• Chemistry

Some of the coursework topics you’ll study on an ADN course include:

• Maternal and child care
• Behavioral health
• Foundations in nursing
• Pharmacology
• Nursing care in adults

Bachelor of Science in Nursing Degree

Many nurses prefer to get a BSN because of the additional opportunities it opens up to them. It usually takes four years to complete, which means more time to learn about the hard and soft skills nurses must possess. Many large medical settings prefer a BSN education and some offer to pay for those with an ADN qualification to advance to a BSN. This is usually faster than four years due to the additional credits obtained in your associate degree. 

During the first two years, you usually focus solely on prerequisite courses, which might include general education studies, nursing-specific prerequisites, and coursework. Topics you might cover include:

• English
• Math
• Computer literacy
• Anatomy and physiology
• Chemistry
• Biology
• Nursing care for geriatric adults
• Pathophysiology
• Nursing ethics
• Wellness promotion

Master of Science in Nursing Degree

An MSN is an excellent qualification for BSN graduates who wish to get into a more specialized field of nursing when they graduate. It’s also a great way for those who have been working as nurses to step up and move forward in their career. Many require a nursing bachelor’s degree, but accelerated programs accept individuals who have an unrelated bachelor’s degree. 

Many nursing students have the ambition of becoming an advanced practice registered nurse, which you can do with a master’s degree. Other nursing programs let learners zero in on a specialization such as oncology, cardiology, mental health, or pediatrics. MSN students can expect to study the following topics:

• Advanced practice geriatric, pediatric, adult, and new-born nursing
• Research
• Evidence-based practice
• Public health
• Health care policy

Types of nursing specialty

If you have a burning ambition to gain advanced certification and work within a specific field of nursing, there are plenty options to choose from. Here are some of the most in-demand:

• Nurse leader: A nurse leader or administrator work as managers and coordinators in large health care settings. They work alongside other consultants, managers, and decision-makers to ensure the policies, procedures, and structures in place are up-to-date, compliant, and meeting patient’s needs. In addition to knowing the job role inside out, you’ll need to understand modern health care systems and the legal and governmental factors that affect practice.
• Nurse anesthetist: Nurse anesthetists work as part of the surgical team to manage pain and ensure patients remain unconscious while undergoing surgical procedures. This is the highest-paying nursing specialty, and practically every state in the nation is calling out for more of these highly-trained specialists.
• Cardiac nurse: The leading cause of death in the United States is heart disease, so you can understand why this role is in such high-demand. You’ll need to understand what’s normal and abnormal with regards to how the heart functions as well as having excellent attention to detail and the relevant patient care skills. 
• Clinical nurse specialist: RNs who excel in their roles often go on to become clinical nurse specialists. The highly-skilled medical professionals are advanced nurses who are qualified to work within practically any specialized field of nursing. At the top of this career, you can expect to work as an educator; offering guidance and support to junior nurses as well as helping administrators govern hospitals and other health care settings.
• Critical care nurse: A critical care nurse works with individuals who are in a critical condition. Patients may have chronic or terminal illnesses or just come out of a life-threatening accident or surgery. In this role, you’ll need to have the mental strength necessary to work with people who are very sick or injured. Not only do they help patients who are in units such as the ICU, but they also speak with families to offer education, support and guidance. It’s possible to enter this career at entry-level, but you’ll need to have honed some impressive skills already.
• Geriatric nurse: The population in the U.S. is aging, which means there are more older people than ever before. Older people require specific care, and training in this field puts you in an excellent position with regards to future job growth. Many entry-level gerontological nurses work in hospitals, although hospices, private clinics and home care are other options for these professionals. If you’ve got a passion for helping the elderly, this is the perfect role for you.
• Nurse midwife: A nurse midwife has a very special role because they’re delivering the people of the future into the world. However, their job starts long before the delivery room. They usually meet parents quite early in the pregnancy and get to know them throughout the entire process. As such, you need to have exceptional people skills and enjoy building long-term bonds with your patients. 
• Neonatal nurse: New-born babies have such a complicated set of needs, there’s a specialized area of nursing you can study to prepare for this role. The work you do depends upon how healthy the baby is at the time of birth, but neonatal practice covers every milestone from the first day of their life up until around day 30. 
• Nurse practitioner: A nurse practitioner is at the top of the nursing career ladder of those who work on the ward. They have graduate degrees and study advanced practices extensively so they can specialize in fields such as acute care, family health, psychiatric, gerontology, pediatric, and women’s health.
• Psychiatric nurse: Psychiatric nurses often work helping individuals who have been admitted into a psychiatric care facility. This can involve administering medication, providing support and advice, educating family members, and helping people who are inform manage day-to-day duties. One of the major responsibilities you’ll hold is patient advocacy, communicating the needs of your patients do psychiatrists and medical assistants.

How to choose a nursing school 

There are several metrics to look at when choosing which school to study as a surgical nurse. We’d recommend placing equal importance on four factors: Academic quality, price, reputation, and NCLEX-RN pass rate. You can look into acceptance rate, graduation rate, tuition fees, online reviews, and ranking lists from sites such as U.S. News & World Report and QS Universities.

Best schools to study a surgical nursing program

If you’re looking to study a program that’s specific to the field of surgical nursing, the following schools offer relevant medical surgical programs:

• University of Pennsylvania: This private Ivy League university offers two courses for medical surgical nursing students. The average cost of tuition is around $77,000 per year, and the school’s acceptance and graduation rates are 8% and 95%, respectively. It’s made number 12 on the Times Higher Education list of the best colleges in the United States, and number six in Forbes’ list of America’s top colleges.
• University of Michigan: The University of Michigan is ideal if affordability is a top priority for you, but you still want to go to one of the best schools in the country for nursing. Tuition isn’t much more than $30,000 per year for out-of-state students, and the graduation rate is 95%, while the acceptance rate is 8%
• Southern Illinois University: With an acceptance rate of 66% and a graduation rate of 63%, nursing students are well-placed to get into this school and graduate. As a public university, it costs less than $30,000 to get into, but still boasts an excellent reputation.  
• University of Pittsburgh: You can study surgical nursing as a specialty at this college, where a year of tuition costs around $33,000 per year. It has impressive academic statistics, with an acceptance rate (57%) much lower than the graduation rate of 81%. 
• Quinnipiac University: This Connecticut institution costs around $67,000 per year and has an excellent graduate program for surgical nursing students. The acceptance rate is 70% and the graduation rate is 78%, making this a low-risk option for aspiring nurses.