How to Become a Scrub Nurse
Scrub nurses (also called operating room, OR or perioperative nurses) care for patients in the fascinating, fast-paced surgical environment. In a setting where every second counts, they serve as the surgeon’s primary assistant and work closely with their team members to make each procedure safe and successful. They also provide much-appreciated comfort and reassurance to patients before and after the operation.
A scrub nurse begins each case by welcoming the patient to the OR, performing a preoperative assessment and helping the person understand what to expect. In some cases, the nurse will have already prepared the operating area by laying out instruments and equipment. Before each procedure, nurses “scrub in” by thoroughly disinfecting their hands and arms and putting on sterile clothing. Under the direction of the surgeon, they handle instruments, assist with procedures and monitor the patient throughout the operation.
For an OR nurse, every day at work is busy and full of new experiences. Some are generalists who scrub in on many different kinds of cases. Experienced nurses often have greater choice in their cases and focus on an area of interest such as orthopedics or labor and delivery.
Scrub nurses take great satisfaction in supporting people through difficult experiences. Though they see each person for only a few hours, they often form close, caring bonds with their patients. Because most people are understandably anxious about surgery, the reassurance provided by these professionals can be a great help and comfort, and make a significant difference in a patient's overall experience.
Scrub nurses practice in all medical facilities that provide surgical services, including hospitals and ambulatory surgery centers. In addition, a growing number work in labor and delivery departments. Surgeons in private practice often employ their own nurses who accompany them to procedures.
Surgical nursing requires constant, high-quality interaction with others. These professionals spend much of each shift working with people who are anxious, upset and in pain. As members of the surgical team, they must communicate effectively with physicians, technicians and other nurses to provide high quality care and respond to emergencies.
The work of a scrub nurse requires physical and mental stamina. Operations may last many hours, and it’s not unusual for these professionals to spend an entire shift on their feet. To keep the operating area sterile, they wear gowns, masks, gloves and other protective clothing. Before surgeries, nurses wash their arms and hands thoroughly with surgical soap. They must adhere closely to safety procedures when dealing with sharp instruments, bodily fluids and chemicals.
Scrub nurses typically work eight- to ten-hour shifts. Though most operations occur during daytime hours, they are often called in for nights, weekends and holidays to assist with emergency surgeries. About 80 percent of registered nurses (including scrub nurses) worked part time in 2010.
Most scrub nurses are certified as registered nurses (RNs). At minimum, this requires an associate’s degree in nursing (ASN). However, the Association of periOperative Registered Nurses (AORN) highly recommends that these professionals hold a bachelor’s degree (BSN).
Associate’s degree programs take two years to complete and are available through career centers, community colleges and hospital-based nursing schools. Completion of a bachelor’s degree requires at least four years of full-time study at a college or university. Many nurses enter the workforce with an ASN and take advantage of employee tuition assistance programs to further their studies.
Nursing education covers patient care, biology, pharmacology and leadership. All programs include extensive hands-on training in hospitals and other clinical settings.
Educational programs for nurses vary greatly in quality. Candidates should be especially wary of for-profit schools, which have come under the scrutiny of the federal government for delivering low-quality education at high cost. The best choices are those programs approved by the state board of nursing and accredited by the National League for Nursing.
RNs often transition into the scrub nurse role after several years in acute care settings. To prepare experienced nurses for work in the operating room, AORN offers a course called Periop101. The program provides a thorough introduction to surgical nursing and has been adopted by many hospitals.
AORN recommends that all scrub nurses maintain certification in Basic Life Support (BLS). Training takes 4.5 hours to complete and covers automated external defibrillation and cardiopulmonary resuscitation in a wide variety of settings and situations.
Scrub nurses who administer moderate sedation or monitor patients under local anesthetic must be certified in Advanced Cardiac Life Support (ACLS). This 10-12 hour course is geared toward resuscitation teams and covers management of cardiac arrest and related emergencies.
Training in BLS and ACLS is provided in-house or through outside agencies such as the American Heart Association.
Licensing and/or Certification
Upon graduation from an approved training program, RN candidates can apply to the state board of nursing. Once deemed eligible for licensure, they must next pass the National Council Licensure Examination (NCLEX-RN), a rigorous, computer-based assessment covering safety, health promotion and physical and psychological care for patients.
Experienced scrub nurses are able to pursue voluntary CNOR certification through the Competency & Credentialing Institute. Candidates must hold an RN license and have at least 2,400 hours of documented perioperative nursing experience. They must also pass an exam covering intraoperative activities, preoperative assessment and diagnosis, instrument care and handling, communication, emergencies and other relevant topics.
Necessary Skills and Qualities
Above all, scrub nurses need excellent interpersonal and communication skills to work effectively with patients and other professionals. A compassionate, empathetic nature will help them to put anxious and suffering patients at ease. Nurses also need energy, stamina and emotional stability to thrive in the intense, fast-paced operating room environment. Because the job requires strict adherence to safety and sanitary procedures, they should be excellent decision makers with a keen eye for detail.
Opportunities for Advancement
Experienced scrub nurses may advance to become perioperative care managers. In this role, they supervise the daily activities of OR nurses, technicians and non-licensed staff. Typical duties include scheduling, mentoring, recruitment and collaboration with other department leaders.
Some scrub nurses go on to become directors of perioperative care at the organizational level. These professionals are responsible for delivering safe, high-quality surgical services to all patients. In addition to their training in nursing, many directors hold graduate degrees in health care administration.
Scrub nurses at larger facilities or health systems have the opportunity to become in-house nurse educators. This involves creating and directing orientation programs for new operating room nurses. Educators also oversee the staff development and continuing education of the surgical nursing team.
Nurses who desire greater autonomy in their work should consider studying to become nurse practitioners or nurse anesthetists, roles which integrate areas of medicine and nursing. A master’s degree is required for certification.
According to the U.S. Bureau of Labor Statistics, the annual median salary for registered nurses (including scrub nurses) was $64,690 in May 2010. Eighty percent of RNs made between $44,190 and $95,130. Hospital nurses generally earned the highest salaries. Wages typically increased with education level and experience.
According to the U.S. Bureau of Labor and Statistics, employment of registered nurses (including scrub nurses) is expected to increase by 26% between 2010 and 2020, which is considered much faster than the average for all occupations.
One reason for this growth is the aging of the U.S. population, which is expected to increase the demand for all types of health care services in coming years. Another is the shift toward outpatient surgical care, which is creating new positions in ambulatory surgery centers. In addition, the growing popularity of elective surgery, including plastic surgery, is creating many opportunities for scrub nurses.
Job prospects will be greatest for licensed, experienced professionals. AORN maintains a job board for surgical nurses on its website.