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10 Essential Skills Operating Room Nurses Must Have

Kari is a retired operating room registered nurse. Although she is retired, the interest never waned. She loves all things OR-related.

Operating room nurse skills

Operating room nurse skills

OR Nurses Are Something Special

You always hear that it takes something special to be an OR nurse. A certain temperament is required. But what is that temperament? How do I know if I will fit in?

Operating room nurses have so many different duties. Ensuring the room is clean, opening the supplies and instruments, interviewing the patient, counting the instruments with a tech, and ensuring all needed equipment is present and working are just a few things the nurse needs to get done before the patient can enter the room.

The OR is a constant balancing act. You must perform duties in a timely manner while upholding all rules of sterile technique. Turn-over times are judged by minutes and should not take longer than 15. (Turn-over is defined as the time between one patient leaving the operating room to the time that another patient enters it.)

OR Nurses

OR nurses all have a standard skill set. These skills help them make decisions regarding the 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 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, from most important to least important. I feel these skills are all equally important. The importance of skills changes depending on the situation.

Here are 10 skills essential to operating room nurses.

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. Tensions run 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 (e.g., being the circulator) and follow (e.g., being the scrub). As a team player, the nurse needs to make allowances when people are having an off day, realizing we all have them.

2. Confrontation Skills

I was not sure if confrontation skills came before communication skills. I decided to put confrontation skills at spot 1.5 because good communication may result in less conflict. But, confrontation skills are necessary for an O.R. nurse and the second most used technique required for problem-solving an OR problem.

If you cannot confront others, you will not become an operating room nurse. Every day holds small confrontation issues, such as getting the "right" bovie. You will need to confront both peers, surgeons and unlicensed personnel.

I had some confrontation skills in the beginning of my operating room career. As the years went past, my confrontation skills became honed. I attribute this entirely to being an OR nurse.

You most often start a case by tying up the surgeon and anyone else with her/him. After surgeons are "gloved and gowned," you immediately walk quickly to the other side of the patient to plug in the suction and bovie, then all the other equipment. You wait to start the insufflation so that the surgeon does not wait. Then you rush into the next task.

The surgeon quickly reviews the table. If you have forgotten anything s/he will ask for it. They may not need it to right now, but they want to prove you are stupid and untrained.

S/he will tell everyone in the room what an awful nurse you are. They will say thing like, "Just take your time" in a condescending voice. "Where did you train, the stupidity academy?" These are considered mild insults in an OR.

You will feel that it is hopeless after you complain to your manager many times. You feel horrible and know more abuse is coming tomorrow. Your ego will be shattered. And, there is nothing you can do but quit.

However, there is one thing you can do. That is to confront the surgeon alone and tell them you do not deserve to be treated like that. In my experience, the surgeon will not remember the incident and will apologize. They always seem surprised to know they acted in the described manner.

3. Physical and Mental Fortitude

OR nurses need to be strong. Good range of motion is a must. OR nurses are on their feet all day. They are kneeling, bending, reaching and lifting anytime they are not standing. Fine motor skills are required for opening supplies.

The operating room is a physically challenging area. Patients need to be moved and positioned. Extremities need to be held up while prepping. Instrument sets weighing up to fifty pounds need to be lifted and carried. Carts larger than the nurse need to be positioned. OR nurses go home physically exhausted each day. A love of hard work helps you cope 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 sudden changes in the schedule, your assignment and surgery. Your mind will be set on what you need to do when suddenly everything changes. You will not be helping in the procedure you are ready for, you will be helping with the emergency that just came in.

4. Organizational Skills

OR nurses must be organized. They need to organize supplies, actions and charting to allow the best outcome for the patient 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 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 for starting a case. Routines are made from good organizational skills.

5. Dedication

OR nurses are dedicated to their jobs. They come to work for emergencies when on-call during weekends, holidays and any other time they are needed. Depending on the facility nurses work in, they may have to cover a lot of call, 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.

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

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

6. 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.

7. 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 a very large vein in the stomach area accidentally. It was my job to collect the supplies this change necessitated. I also had to judge which ones needed to be opened first.

Critical thinking is necessary when interviewing a patient and learning s/he has a shellfish allergy. Shellfish allergies are usually an allergy to iodine. The nurse uses critical thinking to know not to prep the patient with an iodine solution. S/he 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.

7. Integrity

Integrity is a vital 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.

Many actions OR nurses do 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.

9. 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 may occur. There are millions of small details the OR nurse pays attention to.

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

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

10. 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.

11. 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 surgeons start throwing items, it is safest to sit right in front of their faces and not move until they stop their tantrums. 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 11 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 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.

All Operating Room Nurses Need This Book

This article is accurate and true to the best of the author’s knowledge. Content is for informational or entertainment purposes only and does not substitute for personal counsel or professional advice in business, financial, legal, or technical matters.

© 2018 Kari Poulsen


Kari Poulsen (author) from Ohio on July 06, 2020:

Thank you!!

clebia dias das xagas knoedt on June 29, 2020:

I love that!

Kari Poulsen (author) from Ohio on February 14, 2018:

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

Kari Poulsen (author) from Ohio on February 14, 2018:

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

CaribTales on February 14, 2018:

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 from England on February 12, 2018:

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

Kari Poulsen (author) from Ohio on February 12, 2018:

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

Nell Rose from England on February 11, 2018:

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!

Kari Poulsen (author) from Ohio on February 11, 2018:

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

Linda Crampton from British Columbia, Canada on February 10, 2018:

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.

Kari Poulsen (author) from Ohio on February 10, 2018:

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.

Kari Poulsen (author) from Ohio on February 10, 2018:

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.

Kari Poulsen (author) from Ohio on February 10, 2018:

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!

Kari Poulsen (author) from Ohio on February 10, 2018:

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

Bill Holland from Olympia, WA on February 10, 2018:

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.

Linda Lum from Washington State, USA on February 10, 2018:

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 from USA on February 09, 2018:

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.

Eric Dierker from Spring Valley, CA. U.S.A. on February 09, 2018:

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.