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Perioperative Nurse: Nursing Specialties Breakdown

Written by Mariya Rizwan, PharmD

A perioperative nurse, also known as a surgical nurse, scrub nurse, or operating room nurse, is a registered nurse (RN) with training to assist in the operating room during surgeries. They take care of the patients before and after surgeries and perform many tasks, from elective to life-saving.

As a perioperative nurse, you can work in hospitals, clinics, and surgery centers. For that, you need to be an RN and have an accreditation to practice as a surgical nurse.

Here, we will discuss how you can become a perioperative nurse, the required skills and traits, and other important details.

How to Become a Perioperative Nurse

Becoming a perioperative nurse can take three to five years, depending on your chosen route.

The following steps are required to become a perioperative nurse:

  1. Attend an accredited nursing program: To become an RN, you can opt for a two-year associate nursing program or a four-year university program for a bachelor’s in nursing.
  2. Pass the NCLEX-RN: To practice as a nurse in the United States, you need to have a license. To get that, take an NCLEX-RN or National Council Licensure Examination test. When you pass the test, you become an RN.
  3. Get additional experience and training: After you pass the NCLEX-RN, you can apply for nursing jobs. If you want to become a perioperative nurse, gain experience in the surgical unit where you will look after patients before and after surgery. Critical care or emergency nursing experience can help you prepare to become a surgical nurse.

Become Certified in Your Field

Once you have one to two years of experience in the surgical unit, you can advance your salary and career by becoming a certified perioperative nurse. To become one, the Competency and Credentialing Institute (CCI) offers three certifications: Certified Perioperative Nurse (CNOR), Certified Foundational Perioperative Nurse (CFPN), and Certified Ambulatory Surgery Nurse (CNAMB).

The Medical-Surgical Nursing Certification Board offers another Certified Medical-Surgical Registered Nurse (CMSRN) certification for medical-surgical nursing.

CNOR Certification

To qualify for CNOR certification, you should have:

  • A current license to practice in the United States as an RN
  • Have a full-time or part-time job as a perioperative nurse in clinical practice, nursing education, administration, or research.
  • Have a minimum of two years of working experience as a surgical nurse and 2,400 hours of experience in perioperative nursing, with a minimum of 1,200 hours in the operating room.

The exam comprises 200 multiple-choice questions, for which you have three hours and 45 minutes to complete.

Once you get the CNOR certification, you must renew it every five years. The first-time cost to take the CNOR test is $395 United States Dollars (USD), and the retake costs $445 USD.

CFPN Certification

Another certification that you can get to get yourself certified as a perioperative nurse is CFPN- a two-year credential with no recertification mechanism. To get it, you should have:

  • Current license to practice as an RN in the United States
  • Certification of completion from a perioperative orientation program
  • Have a full-time or part-time job as a perioperative nurse working in clinical practice, nursing education, administration, or research or up to 23 months of working experience as a surgical nurse from the initial hire date.
  • The cost for this certification is $195 USD.

CNAMB Certification

The CNAMB certification is for surgical nurses seeking to validate and improve their professional competencies in ambulatory surgery care.

The exam comprises 200 multiple-choice questions, for which you have three hours and 45 minutes to complete.

The fee for the exam for the CNAMB certification is $350 USD.

CMSRN Certification

Perioperative nurses with a flair for post-operative teaching can get this certification to validate their expertise. To take this exam, you should have the following:

  • A current license to practice as an RN in the United States
  • At least two years of working experience as a nurse in a medical-surgical setting
  • A total of 2,000 hours of clinical practice within the past three years

Skills and Traits Required to Become a Perioperative Nurse

Skills and traits required to become a perioperative nurse are:


Generally, all nurses need to be empathetic. Still, for perioperative nurses, that is required even more, so that you can have an exact idea of how the patient is feeling and how they can be comforted. For example, if a patient feels uncomfortable during a procedure and is too shy to voice out, you can gauge it and inform the surgeon.


Being a good administrator as a perioperative nurse can help make things smooth, especially when you take care of the patient from admission to discharge. You can ensure the patient has all the documentation done before and after the procedure. After the procedure is done, you can make sure with your administrative abilities that the patient attends their follow-up visits and that the discharge process is smooth.


As a perioperative nurse, you must communicate with the surgeons, other nurses, and patients. Efficient communication can ensure the patient's safety. Therefore, one should quickly communicate their doubts and queries about the patient. Moreover, you can teach the patient about pre-and post-operative care with good communication skills.


Perioperative nursing is challenging and demanding, both mentally and physically. You have to stand for long hours in the operating rooms. Some surgeries last many hours, and often, you have to attend more than one surgery. Therefore, you need good physical stamina that helps you keep working even at the end of the shift when you feel tired from standing and running the whole shift.

However, with physical stamina, you should have emotional stamina, too, because you have to deal with critical patients, grieving and anxious family members, and deaths at various times in your career.


Many healthcare professionals take care of the patient pre- and postoperatively, and you must work in a team. Therefore, as a surgical nurse, you should have good teamwork abilities to work well with others.

Attention to Detail

Attention to detail is a valuable tool that can help you serve better patient care. When you are attentive, you can pinpoint errors harmful to the patient. For example, you can spot if the prepared dose for the patient is incorrect, which could have life-threatening consequences.

Where Do Perioperative Nurses Typically Work?

Perioperative nurses work in the operation theaters, where they assist in surgeries. In hospitals, they work in inpatient and ambulatory operating rooms, recovery rooms, and medical-surgical care units, taking care of the patients.

As a perioperative nurse, you can work in hospitals, doctor's offices, or surgery centers.

There are further sub-specializations in perioperative nursing, such as:

  • Neurosurgery
  • Cardiac surgery
  • Ear/nose/throat
  • Dental
  • Orthopedics
  • Plastic and Reconstructive
  • Transplant surgery
  • Trauma
  • Pediatrics
  • Oncology
  • General surgery
  • Urology
  • Ophthalmology

The responsibilities of a perioperative nurse differ with its type, which can be discussed as follows:

Scrub Nurses

As a scrub nurse, you stand with the surgeon, assisting them with the surgical equipment during the surgery. The everyday responsibilities of a scrub nurse include:

  • Scrubbing before surgery
  • Setup the operating room
  • Make sure all the surgical types of equipment are sterilized and accounted for
  • Hand over the surgical equipment to the surgeon during the procedure
  • Counting all surgical equipment, including sponges, before and after the procedure
  • Efficiently communicating with the surgical team

Scrub nurses are essential in maintaining the efficient flow of the procedure and ensuring that the surgical equipment and the field remain sterile.

Circulating Nurses

Circulating nurses work outside the sterile field. They manage the activities of the operating room and perform other duties, such as:

  • Inspection of surgical equipment
  • Make sure that consent forms are signed
  • Reviewing pre-op assessments with the patient

Registered Nurse First Assistants

Registered first nurse assistants, or RNFAs, require additional training and education, and assist the surgeon in:

  • Controlling bleeding and suturing
  • Watching for signs of complications
  • Applying dressings and bandages

Post-Anesthesia Care Unit Nurse

Post-anesthesia care unit nurses, or PACU nurses, care for patients soon after anesthesia and surgery while they are stabilized and in the recovery room. They prepare the patient to get shifted to the ICU or medical-surgical unit.

Operating Room Directors

Operating room directors manage the business functions of an operating room. They order equipment and products, perform staffing, and manage the operating room budget. Operating room directors ensure all equipment is available and all patient needs are met on time. They play an essential role in the smooth functioning of the operating room.

Medical-Surgical Nurses

Medical-surgical nurses care for the patient while recovering from surgery. They perform duties such as fluid and electrolyte management, medication administration, checking the wound for any infection, managing the wound and taking care, checking the surgery site for bleeding, and many other jobs.

Medical-surgical nurses also teach the patient and caregivers about post-operative care.

What Are the Benefits of Working as a Perioperative Nurse?

Some advantages of working as a perioperative nurse are:

Flexible Schedule

Operating rooms can work 24 hours, seven days a week, with full staff all the time. Therefore, you can choose the shift that suits you the best and adjust your job with other engagements.

Opportunities To Develop New Skills

As a perioperative nurse, you encounter various surgeries for different diseases, physical health, injuries, and ages. You will have broad exposure and opportunities to grow as you learn new things with new cases.

High-Paying Career

Perioperative nursing is a lucrative career. According to online sites, the average hourly wage for perioperative nurses is $32.14 USD, and the yearly salary is $60,831 USD. However, experience plays a major role in gauging the salary, such as:

  • With less than one year of experience, a perioperative nurse earns an average salary of $28.83 per hour
  • With 1-4 years of experience, a perioperative nurse earns an average salary of $29.92 per hour
  • With 5-9 years of experience, a perioperative nurse earns an average salary of $30.68 per hour
  • With 10-19 years of experience, a perioperative nurse earns an average salary of $35.59 per hour
  • With over 20 years of experience, a perioperative nurse earns an average salary of $40.77 per hour

The highest paying states for perioperative nurses, with annual salaries, are:

  • New York- $84,248
  • California- $81,644
  • Idaho- $81,239
  • New Hampshire- $79,465
  • Vermont- $78,208

As a perioperative nurse, you can earn a handsome salary. However, to increase the salary:

  • Keep advancing your education- consider completing a master’s degree after a bachelor’s
  • Get certifications
  • Keep your continuing education hours up to date

Salary depends on experience, education, certifications, and continuing education hours. Make sure to keep them advanced and up to date to be well paid.

The Bottom Line

Nurses pursuing their career as perioperative nurses should:

  • Find a mentor: A nursing mentor can help you through tricky times when everything seems complicated. They can help you in career growth and planning. Therefore, connect with other surgical nurses and find mentors who can guide you at every step of your career.
  • Focus on mental toughness: As a surgical nurse, you must have strong nerves. It is not just a physically challenging job but mentally and emotionally demanding.
  • Develop your social skills: Strong social skills are crucial for effective daily communication with patients and team members. Therefore, developing social skills can help in efficient and flawless communication.
  • Invest time in self-care: Take time out of your busy schedule to sit, hydrate, eat, and then return to work. You can only serve others when you take care of yourself.
  • Invest in suitable clothing: As a surgical nurse, you must stand all day. So you should have comfortable shoes that don’t leave your feet sore and breathable scrubs that are comfy and make you feel at ease throughout the day. You can’t perform well if you are uncomfortable in your clothing.

Being a perioperative nurse can be challenging and rewarding at the same time. You may witness deaths, but people are recovering at the same time. Moreover, it is a highly paying job with other benefits such as paid time off, child care, medical insurance, vision and dental coverage, tuition reimbursement, and certification reimbursement.

Working as a perioperative nurse is all about patient safety. Therefore, work with your team to best serve patients.

About the Author:

Mariya Rizwan is an experienced pharmacist who has been working as a medical writer for four years. Her passion lies in crafting articles on topics ranging from Pharmacology, General Medicine, Pathology to Pharmacognosy.

Mariya is an independent contributor to CEUfast’s Nursing Blog Program.

Please note that the views, thoughts, and opinions expressed in this blog post are solely of the independent contributor and do not necessarily represent those of CEUfast. This blog post is not medical advice. Always consult with your personal healthcare provider for any health-related questions or concerns.

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