How to Become a Scrub Nurse

By: Meg Brannagan, RN, BSN

Last Updated: Dec 19, 2018

Scrub nurses are often called operating room (OR) or perioperative nurses, and they care for patients in the fascinating and fast-paced surgical environment. In a setting where every second counts, scrub nurses serve to prepare the operating suite and they work closely with other team members to make each procedure safe and successful. Scrub nurses play a vital role in the success of surgical operations and take great satisfaction in supporting people through difficult experiences.

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A scrub nurse prepares the operating area by laying out the necessary instruments and equipment. Before each procedure, nurses “scrub in” by thoroughly disinfecting their hands and arms and then putting on sterile clothing. Under the direction of the surgeon, scrub nurses handle instruments, assist with procedures, and monitor the patient throughout the operation.

For a scrub nurse, every day at work is busy and full of new experiences. Some nurses are generalists who scrub in on many different kinds of surgical cases. Experienced nurses often have greater choices in their cases and they focus on an area of interest, such as orthopedics or cardiac surgery.

Workplace Details

Scrub nurses practice in all types of medical facilities that provide surgical services, including hospitals, physician offices, and ambulatory surgery centers. Additionally, a growing number of scrub nurses work in labor and delivery departments. Surgeons in private practice often employ their own nurses who accompany them and assist throughout their procedures.

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 handling sharp instruments, bodily fluids, and chemicals in the operating room.

Scrub nurses typically work eight- to ten-hour shifts. Though most surgical procedures occur during daytime hours, scrub nurses are often called in at night and on weekends and holidays to assist with emergency surgeries. Scrub nurses may work full-time hours in some locations, or they may be employed to work part time, depending on the number of surgical cases available. About 80 percent of registered nurses (including scrub nurses) worked part time in 2010.

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According to the U.S. Bureau of Labor Statistics, the annual median salary for registered nurses (including scrub nurses) is $67,490. Eighty percent of RNs make between $46,360 and $101,630. Hospital nurses generally earn the highest salaries, along with nurses who work in outpatient care facilities. Wages typically increase with education level and experience.

According to the U.S. Bureau of Labor Statistics, employment of registered nurses (including scrub nurses) is expected to increase by 16% between 2014 and 2024, 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 the coming years. Another cause is the shift in healthcare toward outpatient surgical care, which is creating new positions in ambulatory surgery centers. Additionally, the growing popularity of elective surgery, including cosmetic surgery, is creating many opportunities for scrub nurses.

Job prospects will be greatest for licensed, experienced professionals. The Association of periOperative Registered Nurses (AORN) maintains a job board for surgical nurses on its website. There are many other options for scrub nurses to find jobs caring for patients in the perioperative setting.

Most scrub nurses are certified as registered nurses (RNs). At a minimum, this requires an associate’s degree in nursing (ASN); however, AORN highly recommends that scrub nurses hold a bachelor’s degree (BSN). Our nursing degree guide provides lots of useful information about the major differences between these RN degree paths, as well as industry trends that favor the BSN.

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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 background courses in subjects such as biology, pharmacology, growth and development, and leadership. All nursing programs also include extensive hands-on training to provide patient care and to practice 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 for nursing schools are those programs approved by each state’s Board of Nursing and accredited by the Accreditation Commission for Education in Nursing (ACEN).

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 Exam (NCLEX-RN), a rigorous, computer-based assessment covering safety, health promotion, and physical and psychological care for patients.

Usually, working in the operating room environment requires a history of critical care experience – for instance, ICU/CCU and emergency department experience. You will probably want to focus on building your critical care experience after you’re licensed as an RN, if you’re planning to qualify for work as a scrub nurse. A registered nurse may transition into the scrub nurse role after several years of working 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.

To best uphold safety in the surgical environment, AORN also 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 who monitor patients under local anesthesia must be certified in Advanced Cardiovascular 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 usually provided through the nurse’s employer or through outside agencies such as the American Heart Association.

Experienced nurses are able to pursue voluntary CNOR certification through the Competency & Credentialing Institute (CCI). This certification isn’t required for OR practice, but it can help if you decide to move or change jobs. Candidates must hold an RN license and have at least two years and 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.

You don’t need to earn an advanced nursing degree or additional nursing credentials if you want to work as a scrub nurse, but after you’ve worked in perioperative roles for some time, you may decide that you want to extend your nursing practice and take on a different surgical role. There are lots of options you might consider at that point. A seasoned surgical nurse (2+ years of perioperative practice, plus a specified number of working hours) can study to become an RNFA, or RN First Assistant to the surgeon. The RNFA takes a direct part in surgery, acting at the surgeon’s direction; this is distinct from the role of a scrub (instrument) nurse, who works within the sterile field but does not operate in concert with the surgeon. This role is suited to OR nurses who want greater responsibility and a high level of challenge.

You can also consider attending graduate school in nursing to study for your APRN (advanced practice registered nurse) licensure. In the perioperative setting, APRNs work as First Assistants, nurse anesthetists, and perioperative clinical nurse specialists (CNS-CP). Visit CCI for more information about clinical nurse specialists; the “task and knowledge statements” link is particularly useful for understanding the scope of the perioperative CNS role.

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. The typical duties of these nurses include scheduling shifts for nurses in the perioperative team, mentoring other staff members, recruiting new nurses to work in the surgical field, and collaborating with other department leaders.

Some scrub nurses also 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, which makes them excellent leaders because of their experience in acute surgical caregiving as well as their background in health management and supervision.

At larger facilities or health systems, scrub nurses have the opportunity to become in-house nurse educators. This involves creating and directing orientation programs for new operating room nurses. Nurse educators also oversee the staff development efforts and continuing education activities of the members of the surgical nursing team.

You need to be a licensed RN to work in surgery and you need a BSN degree if you want to enroll in a graduate nursing program down the road. There are several roads to the BSN-RN. The most direct involves attending a four-year college, graduating with a BSN, and taking the RN-NCLEX to get your RN license. If you decide to enter nursing as an AD-RN, LPN, or CNA, you can find an appropriate nursing “bridge” program at a two- or four-year college when you are ready to complete curriculum requirements for the BSN-RN.

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Many students who are considering nursing studies don’t understand that nursing programs can operate with or without national accreditation. A program has to seek out accreditation from national boards – the CCNE (Collegiate Council of Nursing Education) or ACEN (Accreditation Commission for Education in Nursing) – and there are programs that go on admitting and graduating students without maintaining national accreditation. Sometimes there might be gaps in a program’s accreditation status, but you should find a program that has a mostly continuous history of maintaining accreditation. Graduating from a non-accredited program can make it very hard to find work and further your education, not to mention seeking employment in a different state. Look for one of those two acronyms when you are considering different programs.

An associate degree in nursing is one of the two main degree paths that prepare students for the RN-NCLEX. Because ADN/ASN programs don’t take as much time to complete as BSN programs, and classes may be scheduled on a flexible or part-time basis, these programs enroll students with diverse backgrounds, including professionals starting new careers. Associate degree programs are not all created equal, and there are excellent programs out there waiting for you to find them; do yourself a favor and consider several options, not just the program that happens to be nearest you. If you’re interested in a career in surgical nursing, find out where the programs you’re thinking about send their students for clinical training. Busy, stressful critical care settings let you test the seriousness of your interest in surgical practice: large regional or city hospitals are more likely to have the kind of busy ICU/CCU and emergency departments that help you measure your interests.

Some of the courses you can expect to take include:

A bachelor’s degree in nursing prepares you for hospital practice, and also graduate study in nursing. Careers in nursing leadership, research, and education start with the BSN. Bachelor’s-prepared nurses are eligible to take the RN-NCLEX and qualify as RNs. The BSN is structured like a traditional four-year degree, with pre-professional work and humanities courses occupying much of the first three or four semesters. The major coursework in nursing takes up most of the junior and senior years. BSN students have a thorough grounding in science, including organic chemistry, microbiology, and physiology courses.

Your major nursing curriculum will include courses such as:

Bachelor’s-prepared students who graduated in a non-nursing field can consider enrolling in an accelerated BSN (ABSN) degree program, as opposed to the traditional four-year BSN. Your eligibility for an ABSN will depend on prior preparation in science and math, and your undergraduate (or graduate) GPA.

• In addition to the scrub nurse and RNFA roles, other career options in surgical nursing include working as a nurse anesthetist or a perioperative clinical nurse specialist (CNS-CP). Clinical nurse specialists must become licensed ARNPs – usually nurse practitioners with acute care specialty.
• The Association of periOperative Registered Nurses website includes listings for webinars, exam preparation information, conferences and continuing education opportunities for nurses working in surgery