Perioperative Nurse: The Journey Behind the “Authorized Personnel Only” Doors

• A medical-surgical nurse describes the journey of becoming a perioperative nurse and what truly takes place in the operating room.
• One must fully understand the requirements of a perioperative nurse and the extra training that is required.
• A perioperative nurse can work in several different environments, but overall, these nurses have fewer options regarding various facilities.

Despite living in the technology age, where just about everything can be looked up with computer clicks, social media, drones, Alexa, and more, Intra-Operative Nursing remains a fascinating enigma. Not only to the common-folk world, but also to the nursing specialty world.

What actually happens behind those “authorized personnel only” doors when a team of people roll or walk your loved one to the operating room? Your loved one comes out to the recovery room with their consented procedure completed and yet another team of perioperative nurses makes sure they wake up and are good to go to their respective places. But what actually happens in between? Is it some exclusive, secret club where only the best and brightest are allowed to perform their executive craft?

I can assure you we are all mere mortals, but many levels of knowledge and expertise, both seen and unseen, are behind those doors.

I have been a perioperative nurse since March 2012. At the time, I was a med-surg nurse working three days per week with every other weekend. I had an array of colorful scrubs with multiple themes. I rolled my medication carts from room to room and did the patient documentation while sipping my morning coffee out of a green-and-white mug. I read, followed orders, questioned doctors, hung IVs, and gave blood transfusions with relative ease.

However, I was bored. I wanted to expand my horizons, try something different, and be better qualified for more job opportunities. The operating room always fascinated me, but not much information was available about it. Not even in nursing school, where the one day I was in there, I was told to stand to the side, not touch anything blue, and watch a hip replacement.

So I took the chance, applied for a transfer, and got accepted into my employer’s “Periop 101” program. The road was long and arduous, but it was worth the investment.

Requirements of a Perioperative Nurse

A registered nurse license in the appropriate jurisdiction is the minimal qualification needed to be a perioperative nurse. A Periop 101 program is essential to prepare for success in the operating room journey, but every surgery environment varies in its orientation requirements. As for certifications, I received my CNOR in March 2018, which is a proud moment!

This is where I temporarily pause on the cheerleader optimism and begin to get purely objective on what being an Intra-Operative Nurse is about. Remember my prior med-surg life that I spoke about a few lines back?

 After beginning in the OR, there were no more colorful scrubs, only the blue ones provided by the hospital. No nail polish. Earrings under your surgical cap or jewelry are hidden for sterility reasons. This surgical mask I have to wear all of the time is stifling (this was pre-COVID). I’m so thirsty, but I can’t have food or drink in the surgical room, and my break or lunch is hopefully coming soon to let me out for a bit. Why is this machine not working? The surgeon asked what the issue was. I don’t know, doctor; I’m trying to figure it out as everyone stares at me. I could go on and on. It was, and is, a very different environment than I was in before, and a significant adjustment — a different type of stress for other reasons than outside the intraoperative environment.

One of the many unique things regarding the operating room is that you are a significant patient advocate. Still, the patients themselves don’t know about the extent of the problem because they are asleep. It would be best to advocate for your patient by communicating with your OR team. Be comfortable with being assertive and speaking up if a concern arises or something needs to be clarified. It would be best if you also were prepared for the unexpected. The patients are human; the OR team is human. Things happen that are beyond our control. It is up to all of the team in the room to assist the surgeon and each other to get the patient through critical events.

Work Environments of a Perioperative Nurse 

Perioperative Nurses work at hospitals and outpatient surgery centers. Both places have the same basis of what is done in their ORs, but with different outside tasks that I will not get into in this article.

The nurse can be a circulator or a scrub in a particular case. The circulating nurse assists the room in being correctly set up, giving medications, making sure the consents are correct and valid, documenting surgical counts, and ensuring the sterile field is maintained. The scrub nurse (who could also be a surgical tech) prepares the sterile field, gowns, and gloves, and the surgeon hands back and forth what is needed for the procedure to be done correctly.

The Bottom Line

I genuinely enjoy what I do for my career in perioperative nursing. It has opened a new world and many doors to my nursing expertise. Practicing my craft by traveling to different environments in different locations is incredibly fulfilling. If whoever reads this feels up to the challenge, check out what it is like behind those “authorized personnel only” doors. You won’t be disappointed.

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