The practice of perioperative nursing requires specialized knowledge, skills, and attitudes that contribute to optimal patient outcomes.
AORN Position Statement on Perioperative Nursing Certification
A surgical nurse is the backbone of surgical teams. They collaborate with surgeons, anesthesiologists, and other specialists to ensure that every procedure is conducted safely and efficiently. From prepping patients for surgery to assisting in the operating room and helping with postoperative recovery, surgical nurses are key to every operation. To become one, you'll need education, clinical experience, and composure under pressure. Here's precisely what they do and how you can become one.
A surgical nurse plays a vital role in patient care before, during, and after surgery. These are highly trained type of specialist nurses who must ensure that every operation proceeds smoothly and safely. They prepare the operating room, support the surgical team, and care for patients recovering from anesthesia. They do everything from assisting during life-saving operations to helping patients understand post-op recovery systems. They tend to work in the three primary phases of surgery:
Preoperative (before surgery): Preparing patients physically and emotionally for their procedures, checking vital signs, and ensuring that all necessary equipment and documentation are ready.
Intraoperative (during surgery): Acting as either a scrub nurse, who handles instruments directly, or a circulating nurse, who manages supplies, monitors conditions, and maintains a sterile, organized environment.
Postoperative (after surgery): Monitoring patients in recovery rooms (PACU), managing pain, preventing complications, and providing discharge education for continued care at home.
Surgical nurses are key in every surgery. | Photo by National Cancer Institute
Key Responsibilities of a Surgical Nurse
Surgical nurses, like most nurses, have a wide range of duties. Just like L&D nurses, they need to be precise, able to work in teams, and have strong clinical judgment. Their responsibilities will vary according to their specific role, the procedure, and the setting; however, their overall responsibility is to ensure patient safety and care. Here are the primary duties of a surgical nurse:
Preoperative preparation: Assess patients, verify consent forms, and ensure readiness for surgery (including fasting instructions and IV placement).
Operating room setup: Sterilize instruments, arrange surgical equipment, and ensure all necessary supplies are available.
Scrub nurse duties: Hand instruments, sponges, and sutures to surgeons while maintaining strict sterile technique throughout the procedure.
Circulating nurse duties: Monitor the overall environment of the operating room, track equipment, and provide supplies or assistance as needed.
Intraoperative monitoring: Observe the patient's vital signs, blood loss, and anesthesia levels to help anticipate surgical needs or potential emergencies.
Postoperative care: Monitor recovery, manage pain, check for complications (like bleeding or infection), and educate patients on wound care and recovery protocols.
Communication: Serve as the link between the patient, surgical team, and family, ensuring accurate information is shared throughout every phase of care.
Surgical nurses have a lot of responsibilities. | Photo by Olga Kononenko
Educational and Certification Requirements
To become a surgical nurse, you need a solid nursing education, as well as specialized perioperative training. These professionals work in some of the most high-pressure areas of healthcare, which is why they have additional steps and educational requirements compared to other nurses.
Most surgical nurses will start their career as a Registered Nurse (RN). They need to complete either an Associate Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN) from an accredited nursing program. After that, they need to complete the NCLEX-RN exam and register as a nurse. Most employers prefer the BSN as it's a more extensive and advanced program, but the ADN is also accepted, and bridging programs are available.
Once a nurse is licensed, aspiring surgical nurses should aim to spend one to two years gaining clinical experience in hospital settings, particularly in medical-surgical or intensive care units. From there, the transition to the operating room is more effortless. Many hospitals offer perioperative nurse residency or fellowship programs, which train nurses for pre-, intra-, and postoperative care.
Educational Pathways
Your education will largely dictate what you end up doing as a nurse, and it's no different for surgical nurses. Your pathway could vary. However, these are the most common pathways:
Associate Degree in Nursing (ADN): A two-year degree that qualifies graduates to sit for the NCLEX-RN exam and begin working as registered nurses.
Bachelor of Science in Nursing (BSN): A four-year program offering a more comprehensive education, including courses in surgical nursing, anatomy, and healthcare management.
RN-to-BSN and Accelerated BSN programs: Designed for working RNs or those with a previous degree who want to complete a BSN more quickly.
Master of Science in Nursing (MSN): Ideal for those pursuing roles as nurse educators, operating room directors, or clinical specialists in perioperative care.
Perioperative Nurse Fellowships: Offered by large healthcare systems (like Mayo Clinic and Chamberlain University), these structured programs include hands-on training in surgical environments.
Pathway
Typical Duration
Prerequisites
Outcome / Role
Certification Readiness
Typical Settings
Notes
ADN (Associate Degree in Nursing)
2 years
High school diploma; bio/chem recommended
Eligible for NCLEX-RN; entry-level RN
Foundation only; CNOR requires periop hours later
Med-surg, community hospitals
Lower cost; RN-to-BSN bridges available
BSN (Bachelor of Science in Nursing)
4 years (12–18 mo ABSN)
College admission; science & general ed
Eligible for NCLEX-RN; preferred for OR roles
Education meets CNOR once periop hours met
Hospitals, OR residencies, PACU
Preferred by employers; leadership & research content
MSN (Master of Science in Nursing)
2–3 years
BSN + RN; experience preferred
Advanced clinical/education/leadership roles
Supports CNOR/CSSM prep; pathway to CNS/NP
OR leadership, education, periop specialty teams
Higher salary potential; may include teaching practicum
RNFA (Registered Nurse First Assistant) Program
6–12 months
Active RN; periop experience; CNOR often required/preferred
First-assist in surgery (suturing, exposure)
Meets criteria toward CRNFA after required cases
ORs, surgical practices, specialty centers
Program + case log required; greater autonomy & pay
Licensure
Licensure is a crucial step in becoming a nurse. Since it's required for becoming a nurse, it's a key step in specializing as any other type of nurse from nurse educator to medical specializations. Licensure exists to guarantee that nurses meet national and state standards for safety and patient care. To obtain RN licensure in the United States, candidates must:
Graduate from an accredited nursing program, either an ADN or BSN.
Pass the NCLEX-RN (National Council Licensure Examination), a standardized exam that assesses knowledge across key areas of nursing practice such as health promotion, infection control, and physiological integrity.
Apply for state licensure through their state's Board of Nursing. This process typically involves submitting transcripts, undergoing background checks, and paying application fees.
Before you can start assisting in surgeries, you need to qualify as a nurse and then specialize as a surgical nurse. | Photo by National Cancer Institute
While your licensure is typically issued by the state whose board provided it, some states participate in the Nurse Licensure Compact (NLC). This allows nurses to hold a multistate license and practice across participating states.
Licensure renewal typically occurs every two to three years, although this timeframe can vary by state. You usually have to provide proof of continuing education or professional development hours. Surgical nurses must maintain an active RN license, not just to keep working, but to ensure they have up-to-date knowledge of best practices, technologies, and safety standards.
There are currently over
1,800,000
surgical procedures performed weekly across U.S. hospitals, and every single one requires skilled perioperative nurses to make it possible.
Certifications
Specialized certifications help RNs improve their professional standing and employability. These certifications validate advanced skills in surgical care, cardiac or respiratory emergencies, demonstrate commitment to professional growth, and often come with higher salaries and leadership opportunities. Here are the most recognized certifications for surgical nurses:
CNOR (Certified Perioperative Nurse): Offered by the Competency & Credentialing Institute (CCI), this is the gold standard for surgical nurses. To qualify, candidates must have an active RN license, at least 2,400 hours of perioperative experience, and pass a rigorous exam covering surgical procedures, infection control, and patient safety.
CSSM (Certified Surgical Services Manager): Also provided by CCI, this certification is ideal for experienced perioperative nurses moving into leadership or management roles. It focuses on budgeting, staffing, and strategic operations in surgical departments.
CRNFA (Certified Registered Nurse First Assistant): This advanced credential is designed for surgical nurses who directly assist surgeons during procedures. Offered through the National Assistant at Surgery Certification (NASC), it requires both experience and completion of an accredited RNFA program.
CAPA and CPAN Certifications: Offered by the American Board of Perianesthesia Nursing Certification (ABPANC), these credentials focus on postoperative recovery and anesthesia-related care, which is particularly relevant for nurses working in PACUs (Post-Anesthesia Care Units).
Advanced Cardiac Life Support (ACLS) & Basic Life Support (BLS): Mandatory for all surgical nurses, these certifications from the American Heart Association (AHA) ensure that nurses can handle cardiac or respiratory emergencies in the OR or recovery room.
CNOR (Certified Perioperative Nurse)
Gold standard in surgical nursing
Focus on safety, asepsis, and technique
Increases job prospects and salary
CSSM (Certified Surgical Services Manager)
Designed for surgical leaders
Emphasizes staffing, budgeting, and quality
Ideal for OR management positions
CRNFA (Certified Registered Nurse First Assistant)
For nurses assisting surgeons directly
Involves tissue handling and suturing
Requires completion of RNFA program
Thinking about becoming a surgical nurse? There are a number of qualifications you could do. | Photo by National Cancer Institute
school
Why are surgical nurse certifications important?
Earning certifications not only strengthens clinical expertise but also opens doors to promotions and specialized roles within the healthcare industry. Hospitals prefer certified nurses for their proven competence and commitment to high standards of care and many even offer salary incentives for holding CNOR or similar credentials.
Skills and Qualities of an Effective Surgical Nurse
Working in surgery takes precision, focus, and teamwork. Surgical nurses play a vital role before, during, and after procedures. They must combine technical skills with calmness, compassion, and effective communication. They must be resolute professionals who anticipate the surgeon's needs, protect patient safety, and ensure a smooth operating environment. Surgical nurses need a combination of clinical, interpersonal, and, like research nurses, critical-thinking skills:
Technical expertise: Mastery of surgical instruments, aseptic technique, and operating room protocols. Surgical nurses must have a thorough understanding of anatomy, surgical procedures, and sterile field management.
Attention to detail: Even a small oversight in the operating room can have serious consequences. Precision and vigilance are crucial throughout the preparation, surgery, and postoperative care process.
Calm under pressure: Surgery can be unpredictable. Nurses must remain composed during emergencies and adapt quickly to changing conditions.
Strong communication: Clear communication with surgeons, anesthesiologists, and fellow nurses ensures efficiency and safety during each procedure.
Empathy and patient advocacy: Surgical nurses are often the last people patients see before anesthesia and the first they see upon waking. Compassion and reassurance are key to easing patient anxiety.
Physical endurance: Long procedures require stamina, as nurses may spend hours standing in one place while maintaining concentration and precision.
Team collaboration: The best surgical nurses work seamlessly within multidisciplinary teams, ensuring coordination and trust among all OR staff.
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The Human Side of the Operating Room
While surgical nursing is highly technical, emotional intelligence and empathy are just as critical. Nurses must balance compassion with clinical accuracy, creating an environment of trust where patients, and surgeons, feel supported.
Career Options and Advancement Opportunities
So, where exactly can surgical nurses work and in what roles? Surgical nursing is a diverse and rewarding career path. Thanks to their wide range of technical and leadership skills, there are actually several roles they can fill. Here are some of the most common and promising career paths for surgical nurses:
Staff Surgical Nurse (Perioperative Nurse): Provides direct patient care before, during, and after surgery. This is the entry point for most surgical nurses and the foundation for future specialization.
Scrub Nurse: Works directly alongside surgeons in the sterile field, passing instruments, maintaining aseptic conditions, and anticipating surgical needs throughout the procedure.
Circulating Nurse: Manages the overall care environment in the operating room, ensuring equipment readiness, coordinating communication, and maintaining patient safety documentation.
Registered Nurse First Assistant (RNFA): An advanced perioperative role that allows nurses to assist surgeons during operations, including tissue handling, suturing, and exposure management. Requires additional education and certification.
Surgical Nurse Educator: Trains new nurses or staff members in surgical techniques, safety protocols, and perioperative best practices. Often requires a Master of Science in Nursing (MSN) with a focus on education.
Operating Room Manager or Director: Oversees staffing, budgeting, and compliance in surgical departments. These leadership positions require both experience and management training, often supported by certifications like CSSM.
Travel or Agency Surgical Nurse: Works on temporary contracts across hospitals or regions. Travel nurses can earn significantly higher pay while gaining experience in different surgical specialties.
Advanced Practice or Surgical Nurse Practitioner: With a Doctor of Nursing Practice (DNP) or MSN, nurses can transition into advanced practice roles focusing on perioperative or acute care management.
Over
90,000
Surgical nurses are currently employed in U.S. hospitals, with demand projected to grow 6% by 2032.
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Joseph
Joseph is a French and Spanish to English translator, copywriter, and all-round language enthusiast.