The Challenges of Working as an Operating Room Nurse

The Challenges of Working as an OR Nurse

All careers come with a set of challenges, and working in the operating room (OR) is no exception. From its fast-paced environment to the rewarding experience of seeing the immediate outcomes of surgery, there are many reasons that nurses choose to work in the OR. However, it’s also important to consider the challenges that accompany the role.

Physically Demanding

OR nursing is a physically demanding job that involves lifting heavy instrument trays, pushing patient beds, moving large equipment, and standing for long periods of time.

Orthopedic and spine surgeries require an extensive amount of heavy instruments. Therefore, hefty instrument trays must be lifted in and out of procedure carts to be used for surgery and cleaned once complete. While trays are not supposed to weigh more than 25 pounds, some vendor trays overlook this requirement and may weigh up to 50 pounds.

Surgical procedures vary in duration and standing for long periods of time is a common requirement. Nurses who scrub into surgery for assistance will stand for their entire shifts with the exception of a lunch break. For surgeries that use radiation to take x-rays, the surgical team members are expected to wear heavy lead aprons. These aprons can be physically draining to wear and cause strains to the neck, back, and shoulders.

Different types of equipment are used for each surgery. Equipment must be rolled in and out of the OR, depending on what is needed. This includes weighty patient beds and positioning equipment. It’s critical for OR nurses to use proper body mechanics when moving patients and equipment, as there are no patient lifts in the OR. If the patient is larger in size, more staff are required to place the individual in the appropriate positions for surgery.

The Preferences of Surgeons

OR nurses work closely with surgeons to ensure a smooth procedure that delivers the best possible outcome for the patient. OR nurses must know a surgeon’s preferences for each surgery, down to precise details such as the specific sutures for each component of the procedure. While preference cards list some of the surgeon’s basic details, nurses should be knowledgeable about additional priorities that may not be included. It’s important for nurses to remain detail-oriented and dedicated to learning the procedural steps for each surgeon they work with.

Surgeon temperament can vary, but there are always high expectations for teams in the OR. When faced with the stress of performing successful surgeries, tempers can run hot. Since a surgery could mean life or death for the patient, polite communication may be put aside. It can become an extremely intense situation when a patient is not doing well and the surgeon is working their hardest to save a life. Nurses are often required to know which emergency instruments, supplies, or equipment are needed to assist in the best way.

Some surgeons can be more particular about their preferences for each item used in surgery. Just like any work situation, there are people who are easy to get along with and those who make life a bit more challenging. Making an effort to understand what each surgeon wants is the best way to reduce the risk of tension in the OR.

Surgeons want to be confident that their team fully comprehends the importance of having the appropriate materials to ensure a smooth procedure. This can be compared to sitting down to start a project and relying on somebody else to provide all of the necessary items. It would be aggravating if the person assisting you consistently failed to provide the right instruments or supplies. The key difference between a project and surgery is that surgery affects a patient’s life.

Detailed Technical Knowledge

Depending on the facility, OR nurses can work on a specialty team or within a variety of surgical specialties. When only working in one specialty, it can be easier to hone in on details and critical information for success. Working in one or two similar specialties also limits the number of surgeons and procedures to become familiar with.

For nurses who work in multiple specialties, the daily surgical variety can result in stressful situations. When working with a new surgeon, unfamiliarity exists around preferences for patient positioning, equipment, instruments, and supplies. Maintaining a working knowledge of specialty basics allows nurses to make the best possible choices until more specific questions can be asked. Gaining competency in multiple specialties helps nurses feel more confident when floated to a specialty that they are less familiar with.

Scrub technologists or scrub nurses are tasked with managing the sterile field during surgical procedures. A circulator and scrub personnel are assigned to each OR and expected to work together as a team. If either person is unfamiliar with the surgery or surgeon, trouble can arise. That’s why effective team communication is crucial throughout the procedure.

This interdependent team relies on each other for different steps of the planning process. The scrub determines which supplies and instruments are needed to perform the surgery and sets up the sterile field. The nurse is responsible for bringing in equipment, gathering missing supplies, managing medications, and reviewing the patient’s chart in advance. Collaborating as a team is one of the most critical yet challenging components of ensuring a successful surgery, reduced tension, and productive communication.

As surgical techniques expand, new equipment is introduced to the OR. Nurses must become familiar with safety functions, what they are used for, which supplies are required, and how to troubleshoot issues. Many ORs offer weekly education to review the basics of new equipment with the vendors from the company that produced it.


While the OR is an exciting place to work, it still comes with several challenges that can make the role feel physically draining. It’s critical for nurses to be open to learning new skills and specialties and stay up-to-date with surgeon preferences. The detail-oriented aspect of the job never truly goes away with additional surgeons onboarding, certain surgeons retiring, and new procedures developing over time. Although the OR has its fair share of difficulties, those who love working in surgery will continue to enjoy this nursing specialty.

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