10 Essential Skills for Operating Room Nurses

Updated on February 11, 2018
k@ri profile image

Kari has been an operating room nurse for 25 years. She has been everything from staff nurse to DON.


OR Nurses

OR nurses all have a standard skill set. These skills help them make decisions regarding care of the patient. Skills that help guide the nurses when dealing with doctors and other staff members. Communication skills, organizational skills, and a strong ego are all indispensable in the OR. These skills are necessary to maintain good outcomes for the patients.

I do not mention patient advocate in the list. I do feel that patient advocacy is the most important role of the operating room nurse. Patients are asleep, unable to speak for themselves. It is up to the nurse to speak for them. The nurse will use all of the skills listed as part of being a patient advocate.

I did not list the skills in any order, for example, most important to least important. I feel these skills are all equally important. The importance of skills changes depending on the situation.

1. Excellent Communication Skills

OR nurses are required to have excellent communication skills to help them communicate effectively with doctors, patients, and other staff members. Tension runs high in the operating room at times. Nurses need to speak calmly and professionally while others are angry or upset.

Patients may be fearful. OR nurses know how to communicate in ways to ease that fear. They must get the patient to trust them in less than 5 minutes. I always find it amazing that we accomplish this, but we do.

Never forget that body language is included in communication. Nurses must give the patient their full attention. S/he cannot look at his/her watch repeatedly. Sometimes, when I have been running around to get a case started, I need to remember to not seem rushed or frustrated to the patient. Taking a minute to ensure s/he is ready to see his/her patient calmly is crucial. If the patient sees the nurse frustrated it will increase his/her anxiety.

Part of communication is being a team player. This is quite an important skill in the OR. Nurses must be able to lead (ie: being the circulator) and follow (ie: being the scrub). As a team player, the nurse needs to make allowances when people are having an off day because we all have them.

This Does Happen

2. Physical and Mental Fortitude

OR nurses need to be physically strong. Good range of motion is a must. OR nurse are on their feet all day. They are kneeling, bending, reaching and lifting throughout the day. Fine motor skills are required for all the opening and pulling up medication.

The operating room is a physically challenging area. Patients need to be moved and positioned. Extremities need to be prepped. Instrument sets need to be lifted and carried. Carts need to be positioned. OR nurses go home physically exhausted each day. A love of hard work helps in the operating room.

Mental fortitude is necessary for dealing with frustrated, upset staff and doctors. Nurses may be yelled at in a derogatory manner during surgery. The ability to brush off the insults is a needed skill. OR nurses must have a strong ego.

Nurses need mental flexibility to deal with stuff such as, sudden changes in the schedule and changes to your assignment. You mind will be set about what you need to do, when suddenly everything changes. You will not be doing the procedure you are ready for, you will be doing the emergency that just came in.

3. Organizational Skills

OR nurses need to be organized. They need to organize supplies, actions and charting to allow the best outcome in surgery. Nurses need to be able to find items and medication in less than a minute. Often it is preferable to be less than 30 seconds. Only by being extremely organized is this possible.

Arranging case carts, room furniture and extras carts all rely on exceptional organizing skills. Certain items may need to be grouped together, while others do not.

OR nurses orchestrate the operating room. They make sure doctors, anesthesia providers, and staff are available and ready.

Most nurses have routines in the operating room. The routine may be: open the case, tie up the scrub, see the patient, go back to the room, count and go get the patient. Nurses have routines they follow interviewing the patient. They have routines in starting a case. Routines are made from good organizational skills.

Answering the Pager Is Considered a Circulating Nurse Duty by Most Surgeons

4. Dedication

OR nurses are dedicated to their jobs. They come in on-call weekends, holidays and any other time they are needed. Depending on the facility nurses work in they may have to cover a lot of calls, or just one shift a week.

It is vital for the new nurse to be dedicated. The first year in an operating room it seems like everything s/he does is wrong, or at the least, not quite right. Staff and doctors are particularly picky when the nurse is new. Anyone who has been in an OR less than a year is considered new.

Nurses are also considered new if they travel. When first starting in each new facility, it is like his/her first year in the OR. Everyone is watching him/her and judging his/her skill level. It is dedication that gets a nurse out of bed and into work in times like these.

Time Management Skills Are Vital

You will need good time management to become an OR nurse.
You will need good time management to become an OR nurse. | Source

5. Time Management

Time is everything in an operating room. Circulating nurses and scrub nurses are paid by the hour, but the doctors are paid by the case. Doctors say that anytime they are not operating they are losing money. Nurses need to be aware of time and manage it wisely to keep turnover times down.

Nurses also need to know if something requested is needed immediately or if it can wait a minute. One minute is actually a long time in the operating room. Nurses must be aware of time every second. In the OR time is measured in seconds and minutes, not hours or half hours.

6. Critical Thinking

OR nurses have the ability to judge, analyze and respond appropriately to changing situations quickly. Everything will change in a second in the operating room. Every "routine" procedure has the ability to turn into a nightmare case.

When the situation changes, the OR nurse needs to change with it. S/he has the ability to immediately judge what will be needed due to the change. I once saw a doctor cut into the vena cava accidentally. It was my job to collect the supplies this change necessitated. I also had to judge which ones were needed first.

Critical thinking is necessary when interviewing a patient and learning s/he has a shellfish allergy. The nurse uses critical thinking to know not to prep the patient with iodophor solution. She also uses her/his critical thinking skills to decide on a replacement prep agent.


You need to have a clear picture of right and wrong to maintain integrity.
You need to have a clear picture of right and wrong to maintain integrity. | Source

7. Integrity

Integrity is such an important skill in the operating room. Nurses need to ask for help when needed. They need to admit when they do not understand something. They also need to admit their mistakes, and not try to push them off on others.

At times the circulating nurse may forget to open something the scrub nurse asked for. If s/he does not have integrity, s/he may be tempted to let the scrub get yelled at. Your scrub nurse will soon become annoyed with you if you let this happen. And believe me, your scrub nurse can make you or break you.

So much of what the OR nurse does is done from standing orders. The nurse needs to know which orders to fulfill because the doctor is not present in the department to ask. S/he operates alone for the most part. It is imperative to admit mistakes as soon as possible.

8. Detail Oriented

Although OR nurses pay attention to the big picture, they must also pay attention to the littlest detail. Missing one small item may be disastrous to the patient. There are several factors to pay attention to in each operation.

Positioning, prepping and draping all have little details the nurse needs to know and pay attention to. One small detail is positioning the patient with their palms facing upward. If the nurse misses this and the palms remain facing down, damage to the ulnar nerve will occur. There are millions of small details the OR nurse pays attention to.

Alert and Observant

You need to remain alert and observant as an OR nurse.
You need to remain alert and observant as an OR nurse. | Source

9. Alert and Observant

Nurses in the operating room must stay alert at all times. They observe the sterile field throughout the surgery. By observing the sterile field, they can have supplies ready when needed. If the scrub nurse is down to two lap sponges, a good OR nurse has a pack in hand waiting for the scrub to ask for it. Being proactive is accomplished by observing and being alert for any change or break in sterile technique.

10. Stress Management

All OR nurses have days when it seems nothing they do pleases the doctors. Days when they are yelled at continuously. Days they are called names, and not nice ones. On these days the nurse needs to have good stress management techniques. OR nurses are required to remain calm and collected while the doctors yell and carry on. Without good stress management, this is impossible.

Of course, there are certain lines that must not be crossed. Doctors cannot touch the nurse or throw things at her/him. When they start throwing items, it is safest to sit right in front of them and do not move until they stop. This way they cannot say they did not see the nurse if s/he is hit.

Become an Operating Room Nurse

If you have these 10 qualities you should consider being an operating room nurse. OR nursing is an extremely satisfying job. As a nurse in the OR you only have one patient to care for at a time. Patients are taken back who have problems and the team operates and cures those problems. It is a field of instant gratification.

Everything is always changing in an OR. New equipment, supplies and procedures will guarantee the nurse will never get bored.

Operating room nurses have the opportunity to make extra money by taking call. This is one reason OR nurses make more than floor nurses.

The doctors learn to trust OR nurses more than other nurses. Working together for eight or more hours straight means they learn to trust the nurse quickly. The team learns about the people behind the masks.

Nurses either love the operating room or hate it. There is very little in-between. I love it and would put up with any amount of bad days just to be there.

I would advise you to try being an OR nurse. Most people know within a couple of months if they love it or hate it. Once you are an OR nurse you will never lack a job. Operating room nurses are always in high demand. So, if you have the above mentioned qualities, you have what it takes to make it in the OR.

One Nurse's View of What is Needed to Be an OR Nurse

© 2018 Kari Poulsen


    0 of 8192 characters used
    Post Comment

    • k@ri profile image

      Kari Poulsen 8 days ago from Ohio

      Dora, To me patient advocacy is what OR nursing is all about. It is the number one job. Thanks for reading and commenting.

    • k@ri profile image

      Kari Poulsen 8 days ago from Ohio

      Thanks anyway, Nell. I always want to know if I've missed something in my proof reading. :)

    • CaribTales profile image

      Dora Weithers 8 days ago from The Caribbean

      Happy that someone has patient advocacy as a priority. These skills are all very important, and there are many nurses who deserve our admiration for maximizing them.

    • Nell Rose profile image

      Nell Rose 10 days ago from England

      It was the title, stress management? But it looks like ya done it, lol! sorry.

    • k@ri profile image

      Kari Poulsen 10 days ago from Ohio

      Nell, Thank you for your comment. I cannot find the typo, could you be more specific? I appreciate you letting me know!

    • Nell Rose profile image

      Nell Rose 11 days ago from England

      Hiya Kari, sorry but just to let you know you got a typo on number 10 up there. I always love reading about your nursing, you all rock!

    • k@ri profile image

      Kari Poulsen 11 days ago from Ohio

      Thank you so much, Linda! I forgot one skill I ususally recommend, some psych nursing, lol. It comes in handy dealing with the docs. Most of us moms just treat them like toddlers. Luckily, schools seem to be putting out some respectful doctors these days. :D

    • AliciaC profile image

      Linda Crampton 12 days ago from British Columbia, Canada

      I always enjoy reading your articles about nursing and operating rooms. OR nurses do such an important job. I think it's a great shame that they're sometimes treated badly by doctors.

    • k@ri profile image

      Kari Poulsen 12 days ago from Ohio

      Bill, Thank you! I'm glad you are enjoying the tour. I have never watched Grey's Anatomy. I usually stay away from medical shows, no one wants to watch them with me. I'm always pointing out what is not correct, lol.

    • k@ri profile image

      Kari Poulsen 12 days ago from Ohio

      Thank you, Linda! In the OR we do have to read minds and predict the future, but it is all part of the job, lol. You become better and better with this through experience.

    • k@ri profile image

      Kari Poulsen 12 days ago from Ohio

      FlourishAnyway, You gave me a good laugh! I could not have imagined this until I worked in an OR. I have worked with more than one doctor who liked to throw stuff. Thanks!

    • k@ri profile image

      Kari Poulsen 12 days ago from Ohio

      Eric, You know how important these traits are having done triage of any type. Thanks for reading and commenting!

    • billybuc profile image

      Bill Holland 12 days ago from Olympia, WA

      Why watch Grey's Anatomy when I've got you to explain it all to me? :)

      Thanks for another fascinating trip into a room most of us, hopefully, will never visit.

    • Carb Diva profile image

      Linda Lum 12 days ago from Washington State, USA

      Kari, you make it sound so reasonable, but goodness, I am totally in awe of what nurses are required to do. Bottom line is you need to be able to read minds and see the future (predicting what will happen before it does). You have earned your angel wings.

    • FlourishAnyway profile image

      FlourishAnyway 13 days ago from USA

      You have my admiration. I can’t imagine a grown man or woman throwing something at a coworker. Spoiled baby needs to be sent to time out for acting like that.

    • Ericdierker profile image

      Eric Dierker 13 days ago from Spring Valley, CA. U.S.A.

      This reminds me that I have done Triage. Not the medical kind but need of service kind - well some medical kind. Like when the say "hang up and dial 911".

      These folks you talk of are my heroes.