The modern operating room (OR) is a highly specialized environment requiring professionals with distinct, advanced training. The question of whether nurses perform surgery is common and speaks to the complexity of surgical care, which extends far beyond the moment of incision. While Registered Nurses (RNs) do not execute the central, primary act of surgery—the cutting and repairing of tissue—they are indispensable members of the perioperative team. Nurses fulfill highly specialized roles that ensure patient safety and procedural success, providing expertise in logistics, instrument management, and direct, hands-on assistance. They are integral to every surgical procedure.
The Definitive Answer: Nurses Do Not Perform Primary Surgery
The act of “performing surgery” is defined legally and medically as structurally altering the human body for therapeutic or diagnostic purposes. This typically involves the incision or destruction of tissue, such as making the initial cut, excising diseased tissue, or performing primary wound closure. By law, these procedures are confined to licensed physicians, including Doctors of Medicine (MDs) or Doctors of Osteopathy (DOs). In some jurisdictions, specialized professionals like Physician Assistants (PAs) may also perform these acts within their specific scope of practice.
A Registered Nurse is licensed for the practice of nursing, which involves direct patient care, administering medication, and coordinating care, not the independent practice of medicine. A nurse who attempts to perform the primary surgical act outside of their specific, highly supervised roles could be charged with practicing medicine without a license. Nurses manage the patient’s care and the environment surrounding the operation, while the surgeon is accountable for the actual procedure on the patient’s anatomy.
The Circulating Nurse
The Circulating Nurse, typically a Registered Nurse, serves as the primary coordinator and patient advocate in the operating room. This role operates outside the sterile field, acting as the air traffic controller for the entire environment. Their focus is on logistics, safety, and communication, connecting the sterile surgical team with the rest of the hospital.
Before the procedure, the Circulating Nurse ensures all necessary equipment is functioning and confirms the patient’s identity and surgical site during the mandated “time-out.” They also verify patient consent forms. During the operation, they monitor the environment, manage supplies, troubleshoot equipment, and document every detail of the procedure in real-time. A crucial duty is coordinating the surgical counts of sponges, sharps, and instruments with the scrub person to prevent retained foreign objects.
The Scrub Nurse and Instrument Management
The Scrub Nurse works directly within the sterile field, maintaining the integrity of the operating area. This role is often filled by a specialized Registered Nurse or a Certified Surgical Technologist. Their primary function is managing all instruments and supplies that come into contact with the patient’s surgical site.
The Scrub Nurse meticulously sets up the sterile table, organizing hundreds of specialized instruments according to the anticipated sequence of the procedure. During surgery, they anticipate the surgeon’s needs, passing instruments, sutures, and supplies with precision and speed to maintain a continuous workflow. The Scrub Nurse also participates in the surgical counts and focuses intensely on maintaining the sterile field to prevent infection.
The Nurse Who Provides Direct Surgical Assistance
The most hands-on nursing role in the operating room belongs to the Registered Nurse First Assistant (RNFA). This expanded role is for highly trained RNs who work under the direct supervision of the operating surgeon. The RNFA’s duties are considered delegated medical functions and require extensive post-licensure education and clinical experience.
The RNFA performs specific manual tasks to assist the surgeon in making the procedure smoother and faster. These duties include providing surgical site exposure by holding retractors and assisting with hemostasis (controlling bleeding), often by applying electrocautery. They also handle and manipulate tissue. The RNFA may perform precise tasks such as suturing incisions, applying surgical dressings, and managing wound closure. These hands-on tasks are performed only under the surgeon’s constant supervision and are not independent surgical acts.
Education and Certification for Surgical Nursing
Specialized surgical nursing requires significant education and experiential milestones beyond the initial Registered Nurse licensure. Nurses must first obtain an Associate Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN) and pass the NCLEX-RN examination. Specialization requires gaining experience in perioperative nursing, which is the foundational field for all surgical nursing roles.
Many surgical nurses pursue the Certified Perioperative Nurse (CNOR) credential. This requires an unrestricted RN license and a minimum of two years and 2,400 hours of experience in perioperative nursing, with at least half of those hours in the intraoperative setting.
Achieving the RNFA role demands a higher commitment, requiring CNOR certification and completion of a formal, accredited RNFA program. These programs generally require a baccalaureate degree for entry. RNFA coursework focuses on surgical anatomy and advanced techniques, followed by a clinical component that includes at least 120 hours of first assisting experience under a board-certified surgeon.
The Importance of Surgical Nursing
The specialized roles of the surgical nurse ensure the patient receives coordinated, safe, and expert care throughout the surgical experience. The Circulating Nurse’s focus on documentation and logistics maintains procedural accountability and prevents errors. The Scrub Nurse’s management of instruments and the sterile field is foundational to preventing surgical site infections.
The Registered Nurse First Assistant contributes to optimal patient outcomes by directly supporting the surgeon, allowing for a more focused and streamlined operation. Without these specialized, technical nursing positions, modern surgery could not proceed safely or efficiently. Surgical nurses are the specialized workforce that translates the surgeon’s plan into a safely executed reality.