Perioperative (Surgical) Nurse Career Guide

    Nurse performing surgery on patient

    Perioperative (surgical) nursing is a dynamic and challenging field that offers many opportunities for learning and professional growth. Perioperative nursing spans nursing care before, during, and right after surgical and diagnostic procedures.

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    Part One What Is A Perioperative Nurse?

    Perioperative nurses are also known as Surgical or Operating Room (OR) nurses. They provide pre- and post-op teaching, perform various roles in the operating room, care for patients in the recovery room (post-anesthesia care unit (PACU)), and provide post-surgical care on medical-surgical units. 

    Perioperative nurses must be detail oriented, flexible, able to juggle multiple priorities without missing a beat, adept with technical skills, and team players, and must have excellent communication skills. They must also be able to think critically in a fast-paced, challenging environment. Emotional stamina is essential as the roles require facing human distress and life-threatening situations, and dealing with anxious family members.

    There are many surgical sub-specialties for learning, including neurosurgery, cardiac surgery, trauma, pediatrics, oncology, general surgery, urology, ophthalmology, ear/nose/throat, dental, orthopedics, plastic and reconstructive, and transplant surgery. 

    Regardless of your chosen area of perioperative nursing, you’ll be on a path of career-long learning that offers challenges, financial rewards, and opportunities for professional growth.

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    Part Two What Is The Salary Range For Perioperative Nurses?

    Nursing salaries depend on your level of education, years of experience, size of employer, and where you live and work. In May 2019 the Bureau of Labor Statistics reported the median annual income for nurses as $73,300, with a range from $52,080 to $111,220 per year, though conditions vary by area.

    Pay differentials can significantly increase your nursing salary. They are added to your base hourly rate for evening or night shifts, charge duties, or for mentoring new nurses.

    Higher salaries are possible with a BSN or MSN, or for obtaining certification in the field. Sign-on bonuses may be available depending on the demand for nurses. In many work settings, such as hospitals, nurses are eligible for overtime pay. 

    Be sure to look at the big picture when you consider total compensation. You should factor in the level of continuing education or tuition support, health insurance coverage, and the number of paid days off. Travel nursing can boost salary for adventurous nurses with flexibility in location and lifestyle. 

    Many employers offer additional compensation for achieving certification in your nursing specialty. For surgical nursing, these certifications include CNOR, CRNFA (Certified Registered Nurse First Assistant), and Certified Medical-Surgical Registered Nurse (CMSRN). More information about these certifications is included in Part Four: How Do I Become a Surgical Nurse? 

    Advanced practice nurses earn higher salaries, and this is true for surgical nursing. Some surgical nurses decide to pursue a master’s degree to become a nurse anesthetist, which is the highest-paid advanced practice nursing specialty. According to the U.S. Department of Labor Bureau of Labor Statistics, the median annual wage for nurse anesthetists in May 2019 was $174,790. 

    According to, graduate programs are not widely available for surgical nurses (with the exception of some perioperative clinical nurse specialist roles in the military). Nurses who wish to become a surgical nurse practitioner obtain a master’s degree or higher in a nurse practitioner program and then a certification in a perioperative subspecialty. 

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    Advanced practice salaries are affected by the same factors that shape RN salaries nationwide. In May 2018, the BLS reported that the highest paying states for nursing were as follows:

    State Annual Median Wage
    California $106,950
    Hawaii $98,080
    District of Columbia $92,350
    Massachusetts $92,140
    Oregon $91,080

    In the same year, the BLS ranked the highest mean annual salaries for nurses by area, and the top 10 were in California. The top three were:

    Metropolitan Area Mean Annual Salary
    Salinas, CA $131,710
    San Francisco-Oakland-Hayward, CA $128,990
    San Jose-Sunnyvale-Santa Clara, CA $128,610

    Part ThreeWhat Is The Career Outlook For Surgical Nurses?

    The Bureau of Labor Statistics predicts that nursing employment will grow at a rate of 12 percent through 2028 – much faster than the average for all jobs. There is a shortage of nurses, with baby boomer nurses nearing retirement and the growing health demands of our aging population.  

    Health care is undergoing tremendous change, with a focus on reducing the inpatient care provided in hospitals, even though tens of millions of inpatient surgeries are performed each year. Many surgeries and diagnostic procedures are now performed in ambulatory surgery facilities, also known as “day surgery.”  

    The CDC reported that in 2006, an estimated 53.3 million surgical and nonsurgical procedures were conducted in 34.7 million ambulatory surgery visits. Of the total visits, 43% took place in freestanding ambulatory surgery centers, and another 57% were performed in the same type of areas in hospitals. The demand for perioperative nurses will continue, as their care is essential regardless of the physical setting. 

    Part Four How do I become a perioperative nurse?

    To become a perioperative nurse you must first complete an entry-level nursing program. Medical-surgical (“med-surg”) nursing is a foundation course offered in nursing programs and provides an overview of care for many diseases and procedures. 

    To become a registered nurse you must:

    Graduate from a two- year program for an associate’s degree in nursing, a three-year program for a diploma in nursing (usually hospital-based), or a four-year college or university program leading to a bachelor’s degree in nursing.

    Take the RN licensing exam after graduation, also known as the NCLEX (National Council Licensure Examination). The NCLEX is a nationwide examination for the licensing of nurses in the United States and Canada.

    Once you pass this exam, you may apply for your first nursing job.

    An additional year of education and training is generally required to become a perioperative nurse who works in the pre-op, intra-op, and post-op areas. This is available in on-the-job programs in hospitals or surgery centers, or from a post-bachelor’s perioperative certificate program. Critical care or emergency nursing experience can prepare you well for this training.

    The Association of peri-Operative Registered Nurses (AORN) also offers an online program, “Periop101: A Core Curriculum.” This course provides content coupled with lab and clinical experience and includes coursework in anesthesia, surgical draping, patient and equipment safety, and many other topics. 

    Once you have experience in perioperative nursing, you can advance your knowledge and salary potential by becoming certified. Two certifications are offered for perioperative nurses: CNOR and CNFA. Both are provided by the Competency and Credentialing Institute (CCI).

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    CNOR Certification

    According to CCI, CNOR is a definition, not an acronym. It means meeting identified standards of practice for providing nursing care to patients before, during, and after surgery. 

    To qualify for the CNOR exam you must:

    • Have a current unrestricted RN license
    • Be currently working full- or part-time as a perioperative nurse in clinical practice, nursing education, administration, or research
    • Have completed a minimum of two years and 2,400 hours of experience in perioperative nursing, with a minimum of 1,200 hours in the operating room 

    CNOR certification must be renewed every five years. There are a number of options for renewing your certification. Visit for details.

    CNFA Certification

    CCI also offers the Certified Nurse First Assistant (CNFA) credential for registered nurses first assistants. To apply to take this exam, you must:

    • Have a current, unrestricted RN license
    • Have CNOR certification or be an ARNP with a specialty certification
    • Have a bachelor’s degree in any field
    • Have completed an RNFA program that’s accepted by CCI
    • Be able to document 2,000 practice hours as an RNFA, including pre-op, intra-op, and post-op care
    • (At least 500 of these hours must be accrued in the two years immediately preceding application)

    Other details, including recertification requirements, are on the website.

    CMSRN Certification (Medical-surgical Nursing) 

    Nurses with a passion for post-op care and teaching may wish to confirm their expertise with certification as a Certified Medical-Surgical Registered Nurse (CMSRN). Available through the Medical-Surgical Nursing Certification Board, requirements for taking the exam include:

    • Having a current RN license in the U.S.
    • At least two years of practice as an RN in a medical-surgical setting
    • Accrual of at least 2,000 hours of practice hours within the past three years

    The Association for Critical Care Nurses (ACCN) also offers certification (CSC) for nurses providing care to adult cardiac surgery patients. CNFAs may also wish to pursue certification as a Certified Surgical First Assistant (CSFA) through the National Board of Surgical Technology and Surgical Assisting (NBSTSA)

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    Part Five What does a perioperative (surgical) nurse do?

    Perioperative nursing roles offer variety and challenge:

    1. Scrub nurses work within the sterile field in the operating room. Their role is to set up the operating room for the patient, choose and handle instruments and supplies, hand surgical instruments to the surgeon, and many other duties. 
    2. Circulating nurses work outside the sterile field, and manage activities in the operating room. They inspect surgical equipment, ensure that consent forms are signed, review pre-op assessments with the patient, and perform many other tasks. 
    3. RN first assistants (RNFAs) work with the surgeon to help with controlling bleeding, suturing,  watching for signs of complications, applying dressings and bandages, and carrying out many other functions. Additional education and training are required before becoming an RNFA. 
    4. PACU (post-anesthesia care unit) nurses care for patients immediately after surgery and anesthesia to monitor them closely as they stabilize, preparing them to be transferred to the medical-surgical or intensive care unit as appropriate. 
    5. Operating room directors: In this role, nurses assume the business functions of running an OR. This includes managing budgets, staffing, and ordering equipment and supplies. This position can also prepare you for roles in management consulting, clinical nurse education, or work in medical technology and supply companies.
    6. Medical-surgical nurses provide care to patients recovering from surgery. They provide close monitoring immediately post-PACU and –critical care, and apply a range of technical and assessment skills to ensure patient safety and recovery (fluid and medication administration, monitoring for signs of bleeding and infection, wound care, and many others). They also provide post-op teaching for patients and caregivers.

    Perioperative nurses work in:

    • Hospitals (inpatient and ambulatory operating rooms, recovery rooms, medical-surgical care units)
    • Ambulatory surgery centers or day surgery centers
    • Clinics
    • Physician offices

    Part Six What are the continuing education requirements for perioperative nurses?

    Clinical practice and continuing education requirements for renewing a nursing license, certification, and advanced practice certification vary by state and credentialing agency. Check with your state board and professional organization for the rules on keeping your RN license and certification up to date. 

    You can also visit our CNE Guide for details. The organization that oversees your certification will have specific guidelines on when to recertify. 

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    Part Seven Where Can I Learn More About Surgical Nursing?

    Learn more about perioperative/surgical nursing by searching the web, and networking to find and talk with nurses currently working in the field. The following organizations can provide more information about perioperative/surgical nursing:

    PartEight Where can I find the best perioperative nursing jobs?

    Many sources can get you started in your search for perioperative nursing positions. First, check the “Careers” pages of websites for hospitals and agencies that interest you, as well as career centers on websites of professional organizations. 

    Many online resources are available these days, including social media sites, career sites, and dedicated nursing career sites such as our job board

    Perioperative nursing provides you with many opportunities to make a difference – improving patient outcomes, reassuring patients and family members, supporting surgical teams and taking part in life-saving work every day.

    As a perioperative nurse you’ll know that opportunities for learning, new challenges, and professional growth will be ongoing as medical science evolves.

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