Job Overview

The Operating Room Nurse (OR Nurse), also called a perioperative nurse, works within the surgical department and reports directly to the Perioperative Services Manager or Charge Nurse. This role carries one of the highest responsibility profiles in clinical nursing: you are the patient's primary advocate when they are at their most vulnerable and cannot speak for themselves. Success in this position means maintaining a sterile field without exception, facilitating seamless surgical team communication, and reducing surgical site infection rates to at or below the facility's benchmark target. OR nurses function across three phases: preoperative preparation, intraoperative circulating or scrubbing, and postoperative handoff. Facilities that invest in highly skilled perioperative nurses consistently see fewer surgical complications and shorter procedure times.

Key Responsibilities

• Conduct thorough preoperative patient assessments, verify surgical consent, allergies, and NPO status before every case.

• Perform and document the WHO Surgical Safety Checklist in full, including time-out procedures with the surgical team prior to every incision.

• Serve as circulating nurse to manage the sterile field, coordinate instrument counts, and communicate between the sterile and non-sterile teams throughout surgery.

• Scrub into procedures when required, passing instruments and anticipating surgeon needs to keep procedures on schedule.

• Monitor and document patient vital signs, positioning, fluid intake and output, and electrocautery settings intraoperatively.

• Manage surgical specimen handling, labeling, and chain-of-custody documentation per pathology protocols.

• Coordinate efficient room turnovers, targeting turnover times within facility-established benchmarks.

• Maintain accurate medication reconciliation including controlled substances and surgical implants per regulatory requirements.

• Provide structured SBAR handoff to PACU staff, including pertinent intraoperative events and patient-specific concerns.

• Mentor new graduate nurses through perioperative orientation programs, evaluating competency against established timelines.

• Identify and report near-miss events, equipment failures, and sterility breaks through the facility's incident reporting system.

• Maintain competency with specialty surgical equipment across at least three service lines (e.g., orthopedic, laparoscopic, cardiovascular).

Required Qualifications

• Associate Degree in Nursing (ADN) required; Bachelor of Science in Nursing (BSN) strongly preferred.

• Active, unrestricted Registered Nurse (RN) license in the state of employment.

• Current BLS (Basic Life Support) certification; ACLS preferred for facilities performing cardiac procedures.

• 2-5 years of perioperative nursing experience in an acute care surgical setting.

• Demonstrated proficiency in both circulating and scrub roles across general and specialty surgical cases.

• Experience managing surgical counts and documenting retained surgical item (RSI) prevention protocols.

• Working knowledge of sterilization standards, aseptic technique, and AORN (Association of periOperative Registered Nurses) guidelines.

• Proficiency with electronic health records (EHR) systems; experience with Epic, Cerner, or Meditech preferred.

• Demonstrated ability to remain calm and perform high-stakes clinical tasks in emergent intraoperative situations.

Preferred Qualifications

• CNOR (Certified Nurse Operating Room) certification, or willingness to sit for exam within 18 months of hire.

• Experience in robotic-assisted surgery platforms (e.g., da Vinci Surgical System).

• Specialty certification or training in cardiovascular, neurosurgical, or orthopedic surgical nursing.

• Trauma surgery experience in Level I or Level II trauma center environments.

• Prior charge nurse or team lead experience in a perioperative setting.

Essential Skills and Competencies

Technical Skills

• Sterile field management and aseptic technique

• Surgical instrumentation identification and sterilization protocols

• Intraoperative patient monitoring and hemodynamic assessment

• Electronic health record documentation (Epic, Cerner, Meditech)

• Surgical count procedures and RSI prevention protocols

• Electrosurgical unit and specialty equipment operation

• Medication management and controlled substance handling

Soft Skills

• High-pressure decision-making and rapid clinical judgment

• Precise verbal communication within multidisciplinary surgical teams

• Attention to detail that doesn't waver after eight-hour cases

• Professional assertiveness to call time-out and halt a procedure when safety is in question

• Empathy in brief but meaningful preoperative patient interactions

• Conflict resolution within high-stakes, high-ego surgical team dynamics

Salary Range and Benefits

Salary Overview

OR nurses earn a national median salary of approximately $86,070 annually for registered nurses broadly, with perioperative specialists typically commanding $88,000 to $112,000 based on BLS Occupational Employment and Wage Statistics (May 2023) and supplemental data from PayScale (2025). Compensation rises with CNOR certification (typically adding 8-12% to base pay), years of specialty experience, and facility type. Trauma centers and large academic medical centers pay at the higher end of this range. Source: U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics, May 2023; PayScale, 2025.

Top-Paying Areas

• San Francisco Bay Area, CA ($115,000 - $138,000)

• Seattle, WA ($105,000 - $128,000)

• New York Metro Area, NY/NJ ($102,000 - $125,000)

• Boston, MA ($100,000 - $122,000)

• Honolulu, HI ($98,000 - $120,000)

Benefits Package

Competitive OR nurse packages typically include medical, dental, and vision insurance, 401(k) with employer matching (3-6%), three to four weeks of PTO in year one, and shift differentials for evenings, nights, and weekends. Most acute care hospitals cover CNOR exam fees and continuing education costs. Tuition reimbursement for BSN-to-MSN programs is increasingly standard at Magnet-designated facilities.

Warning Signs When Evaluating OR Nurse Candidates

• Cannot clearly explain the surgical count process: Retained surgical items remain one of the most preventable never events. A candidate who stumbles on count procedures represents immediate patient safety risk.

• Describes themselves as "always deferring to the surgeon": OR nurses must advocate for patients even when it creates team tension. Excessive deference is a liability, not a virtue.

• No demonstrated experience across multiple service lines: Candidates who have only worked one type of surgery will require longer orientation and may struggle with staff scheduling flexibility.

• Vague about their role in a past adverse event or near-miss: Strong OR nurses learn from errors and speak plainly about their part in them. Avoidance suggests they may repeat the mistake.

• Cannot describe their experience with the WHO Surgical Safety Checklist: This is table stakes in any accredited surgical facility. Unfamiliarity with it signals a significant gap.

Frequently Asked Questions

Q What does an OR nurse do?
A An OR nurse (operating room nurse) manages patient care throughout the surgical experience. They conduct preoperative assessments, maintain the sterile surgical field, serve as circulating or scrub nurse during procedures, and hand off patients to post-anesthesia care following surgery. Patient advocacy and surgical safety are their core functions.

Q What qualifications do you need to be an OR nurse?
A You need an active RN license, at least an ADN (BSN preferred), and current BLS certification. Most facilities require 2-5 years of perioperative experience. The CNOR certification from CCI (Competency and Credentialing Institute) is the gold standard specialty credential and is increasingly required or preferred for senior positions.

Q How much does an OR nurse make?
A OR nurses typically earn $88,000 to $112,000 annually, with the national RN median at $86,070 (BLS, May 2023). CNOR-certified nurses and those in high-cost metro areas or trauma centers earn toward the upper end. Shift differentials for nights and weekends can add $5,000 to $15,000 annually.

Q What skills are required for an OR nurse?
A OR nurses need mastery of sterile technique, surgical instrumentation, intraoperative monitoring, and EHR documentation. On the interpersonal side, they need precise team communication, rapid decision-making under pressure, and the assertiveness to halt a procedure when safety is at risk. Both skill sets are non-negotiable.

Q What is the career path for an OR nurse?
A Most OR nurses begin as staff nurses and advance to charge nurse or team lead roles. From there, paths include perioperative educator, OR manager, clinical nurse specialist (with MSN), or perioperative director. CNOR certification accelerates advancement at nearly every stage of this trajectory.

Q What are the biggest challenges facing OR nurses today?
A Staffing shortages in perioperative services have reached critical levels, with many facilities relying heavily on travelers to fill gaps. Burnout rates are high due to long shift lengths, physical demands, and high-stakes decision-making. Rapid adoption of robotic surgery platforms is also requiring constant retraining for existing staff.